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The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.
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Abstract: Virus-based biopesticides are effective biocontrol agents of crop insect pests. Development of suitable formulations and production processes are necessary to obtain high-quality products easily adopted by farmers. A detailed unit operation study was carried out for the production process of a Phthorimaea operculella granulovirus-based biopesticide to control the tomato leafminer, Tuta absoluta, one of the most important pests affecting this crop. Physicochemical, microbiological, and insecticidal parameters were implemented in the process and applied to the finished product, and a scaling strategy was developed. A Quantitative Polymerase Chain Reaction (Q-PCR) technique was implemented to quantify viral concentrations in the active ingredient (5.34 ± 1.44 x109 Occlusion Bodies mL-1) and in the finished product (>1.6x109 OB mL-1), without contaminant interferences. The Q-PCR methodology was also useful to select the appropriate solid mixing time following Lacey´s mixing index (8 min). Factors and similarity principles influencing the liquid mixing process were identified in the scaling evaluation. Furthermore, the drying kinetics analysis enabled identifying a drying temperature of 35 °C, with an efficacy under controlled conditions higher than 97%. Contaminant concentration was lower than 1%, indicating controlled and aseptic formulation process conditions. A simple statistical method was used to estimate the reproducibility and repeatability of the parameters assessed in the finished product. These results enable to establish and extrapolate important parameters in the standardization, scale-up, and quality control for the granulovirus-based biopesticide.
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In this paper, the inline turbidity sensor technology was used to quantify the turbidity of the solution during the dissolution of Chinese medicine granules. The probe measurement position and the magnetic stirring speed were optimized. As a result, the stirring speed was 400 r·min~(-1), and the probe position was at 1/4 of the diameter of the beaker. The measurement results were accurate and reliable. Totally 105 batches of commercially available Chinese medicine granules were collected and dissolved according to the requirements of the Chinese Pharmacopoeia. At the time point of 5 min, 57 batches of granules were completely dissolved, and the corresponding turbidity values ranged between 0-70 FTU; 32 batches of granules showed a slight turbidity, and the corresponding turbidity values ranged between 70-350 FTU; 14 batches of granule solution were turbid, and the corresponding turbidity values ranged between 350-2 000 FTU; two batches of granule solution were heavily turbid, and the corresponding turbidity values were >2 000 FTU. Among the above results, the number of batches in line with the pharmacopoeia dissolution requirement was 84.76%, and the dissolution of some granules still needed to be improved. The turbidity sensor recorded the change curve of turbidity value over time(solubility behavior curve). The degree of important of disintegration and dissolution during the dissolution process showed disintegration > dissolution, disintegration≈dissolution, disintegration < dissolution. The dissolution behavior of the granules can be classified into three categories. The analysis of the mechanism in the process of granule solubility provides a basis for product process improvement.
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Medicine, Chinese Traditional , Pharmaceutical Preparations/chemistry , Solubility , Tablets , Technology, PharmaceuticalABSTRACT
Introducción: Los procesos sanitarios se producen, generalmente, en entornos cambiantes y lo conducen profesionales con formación y criterios diversos, cuyas decisiones son las que condicionan las prácticas. La variabilidad impacta negativamente sobre funciones gerenciales importantes como la planificación, la gestión, el control de los recursos y la calidad de los servicios. Objetivo: Diagnosticar el estado actual de la variabilidad en la ejecución de los procesos hospitalarios en Cuba. Métodos: El estudio se realizó en los meses de enero a mayo de 2016 y participaron instituciones de subordinación nacional. Se encuestaron a 49 especialistas en gestión hospitalaria y 29 analistas de procesos de negocio. Para el diagnóstico se utilizó como herramienta metodológica la investigación acción, se aplicarón las técnicas: entrevistas, encuestas, el análisis de campos de fuerzas, el grupo focal, la herramienta del diagrama causa-efecto y el método de estudio de casos. El análisis documental se empleó para identificar las principales causas que limitan la detección de variabilidad en la ejecución de procesos hospitalarios. Resultados: Los resultados más relevantes permiten asegurar que no es posible realizar la planificación, control y gestión de los recursos de forma eficiente, si no se detecta y reduce la variabilidad. Los métodos que se están empleando actualmente en Cuba, no son suficientes para analizar y comprender el comportamiento de la variabilidad hospitalaria. Conclusiones: Las técnicas de modelado y los métodos existentes para reducir la variabilidad no son efectivos en el entorno sanitario cubano, por la alta variabilidad en sus procesos y la complejidad que poseen estas técnicas hospitalarias para apoyar a la toma de decisiones, elementos a tener en cuenta para su aplicación en Cuba(AU)
Introduction: Health processes are frequently subject to changing environments and are governed by professionals with different backgrounds and criteria, whose decisions influence the practices. Variability negatively impacts on important managerial functions such as planning, management, control of resources and the quality of services. Objective: To perform a diagnosis on the current state of the variability in the implementation of hospital's processes in Cuba. Methods: A research was carried out from January to May, 2016 and institutions of national subordination also participated. There were interviewed 49 specialists with experience in hospital management and 29 business process analysts. As methodological tool for diagnosis, it was used research-action, and there were applied techniques as: interviews, surveys, analysis of force fields, focal group, the tool of cause-effect's diagram, and the method of cases study. Documentary analysis was used to identify the main causes that limit the detection of variability in the implementation of hospitals processes. Results: The most relevant results allow ensuring that it is not possible to effectively contribute to the planning, control and management of resources without detecting and reducing variability. The methods currently used in Cuba are not enough to analyze and understand the behavior of hospital variability. Conclusions: The modeling techniques and the existing methods to reduce variability are not effective in the Cuban health environments, due to the high variability in the processes and the complexity that these techniques present. In Cuba there is a need to detect the variability in hospital processes to support the decision making in this regard(AU)
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Humans , Process Assessment, Health Care/standards , Hospitals , CubaABSTRACT
Objective To analyze the process of clinical nursing operation assessment in a third-grade class-A hospital in China, and design the scoring system of clinical nursing operation examination (SSCNOE), and discuss its clinical application effect. Methods Through operation process analysis chart to analyze the flow of current clinical nursing operation assessment of shanxi provincial people's hospital to look for improvement priorities that can be optimized, and based on Microsoft Visual Basic technology and 15 commonly used clinical nursing operation, we developed SSCNOE. A total of 102 nurses were selected as subjects and were randomly divided into the experimental and control groups using random numbers. The experimental group accepted SSCNOE examination, while the control group received the traditional paper test. The differences in the examination time and examination cost between the two groups were compared. Results SSCNOE simplified the examination process of clinical nursing operation and saved a lot of manpower, material and financial resources. The time required to use SSCNOE was (202.13±24.69)min, shorter than the traditional assessment (347.67±6.51)min (t=12.99, P<0.01), and the overall cost was (948.13± 72.47)yuan, lower than the traditional test (1689.12 ± 126.72)yuan (t=13.56, P<0.01). Conclusion The research and application of SSCNOE can improve the efficiency of the assessment of nursing operation, save the cost of examination and improve the level of hospital nursing information construction.
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In this study, an analytical method based on ultraviolet spectroscopy was established for the rapid determination of nine components including isophorone, 4-methylene-isophorone, curcumenone, curcumenol, curdione, curzerenone, furanodienone, curcumol and germacrone in the first extraction process of Xingnaojing injection. 166 distillate samples of Gardeniae Fructus and Radix Curcumae were collected in the first extraction process of Xingnaojing injection. The ultraviolet spectra of these samples were collected, and the contents of the nine components in these samples were determined by high performance liquid chromatography. Least squares support vector machine and radial basis function artificial neural network were used to establish the multivariate calibration models between the ultraviolet spectra and the contents of the nine components. The results showed that the established ultraviolet spectrum analysis method can determine the contents of the nine components in the distillates accurately, with root mean square error of prediction of 0.068, 0.147, 0.215, 0.319, 1.01, 1.27, 0.764, 0.147, 0.610 mg•L⁻¹, respectively. This proposed method is a rapid, simple and low-cost tool for the monitoring and endpoint determination of the extraction process of Xingnaojing injection to reduce quality defects and variations.
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The manufacture of traditional Chinese medicine (TCM) products is always accompanied by processing complex raw materials and real-time monitoring of the manufacturing process. In this study, we investigated different modeling strategies for the extraction process of licorice. Near-infrared spectra associate with the extraction time was used to detemine the states of the extraction processes. Three modeling approaches, i.e., principal component analysis (PCA), partial least squares regression (PLSR) and parallel factor analysis-PLSR (PARAFAC-PLSR), were adopted for the prediction of the real-time status of the process. The overall results indicated that PCA, PLSR and PARAFAC-PLSR can effectively detect the errors in the extraction procedure and predict the process trajectories, which has important significance for the monitoring and controlling of the extraction processes.
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OBJECTIVES: This study presents the indicators and proxy variables for the quantitative assessment of green chemistry technologies and evaluates the relative importance of each assessment element by consulting experts from the fields of ecology, chemistry, safety, and public health. METHODS: The results collected were subjected to an analytic hierarchy process to obtain the weights of the indicators and the proxy variables. RESULTS: These weights may prove useful in avoiding having to resort to qualitative means in absence of weights between indicators when integrating the results of quantitative assessment by indicator. CONCLUSIONS: This study points to the limitations of current quantitative assessment techniques for green chemistry technologies and seeks to present the future direction for quantitative assessment of green chemistry technologies.
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Humans , Chemistry , Ecology , Green Chemistry Technology , Health Resorts , Proxy , Public Health , Weights and MeasuresABSTRACT
OBJECTIVES: This study presents the indicators and proxy variables for the quantitative assessment of green chemistry technologies and evaluates the relative importance of each assessment element by consulting experts from the fields of ecology, chemistry, safety, and public health. METHODS: The results collected were subjected to an analytic hierarchy process to obtain the weights of the indicators and the proxy variables. RESULTS: These weights may prove useful in avoiding having to resort to qualitative means in absence of weights between indicators when integrating the results of quantitative assessment by indicator. CONCLUSIONS: This study points to the limitations of current quantitative assessment techniques for green chemistry technologies and seeks to present the future direction for quantitative assessment of green chemistry technologies.
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Humans , Chemistry , Ecology , Green Chemistry Technology , Health Resorts , Proxy , Public Health , Weights and MeasuresABSTRACT
Objective:To develop a UV optical fiber in situ process monitoring method for the dissolution behavior of five cepha-lexin solid dosage forms and compare the drug dissolution behavior of different cephalexin preparations. Methods: The dissolution of five different cephalexin preparations was on-line monitored according to the dissolution method for cephalexin tablets in Chinese Phar-macopeia (2010 edition) combined with a six channel optical fiber chemical sensor in situ dissolution monitor. Results:The dissolu-tion curves could show the drug release characteristics of different cephalexin preparations, and the five different preparations exhibited various drug release features. Conclusion:An in-situ, real time, on-line and process analysis of dissolution can be obtained by optical fiber dissolution test system automatically. The release characteristics of different preparations can be presented through dissolution curves directly, which can provide reference for the overall assessment of drug internal quality and clinical medication.
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OBJECTIVE: To establish a nondestructive and rapid analysis method to measure the critical parameter, mixing uniformity, in the production of Ginkgo leaf dispersible tablets in order to control the quality of products. METHODS: The near-infrared diffuse reflectance spectroscopy (NIRDRS) spectra of the pre-mix and the total mixed Ginkgo leaf dispersible tablets (Wuhan Jianmin Suizhou Pharmaceutical Co., Ltd.) were obtained. The mixing uniformity of samples was monitored by quantitative analysis model and standard deviation method combined with the Mahalanobis distance method, respectively. Meanwhile, lab-made mixing samples and dynamic simulation mixing process were used to validate the feasibility of Mahalanobis distance method. RESULTS: The results obtained from quantitative analysis model and standard deviation method were consistent with each other, and the Mahalanobis distance method was feasible for monitoring the mixing process. CONCLUSION: The method is rapid, simple, and can be used for online and sideline analysis in drug production process.
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Near infrared chemical imaging (NIR-CI) is an emerging technology for rapidly analyzing the critical quality attribute of Chinese materia medica (CMM). It integrates NIR spectroscopy with chemical imaging. In this paper, it provided a systematic introduction to NIR-CI, such as the core part of instrument, the reliability, transformation, analysis and application of high-dimensional data acquisition. In addition, current studies of NIR-CI application in pharmaceutical field were analyzed. Finally, future opportunities and challenges of NIR -CI applications in the quality control of CMM preparation were prospected.
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OBJECTIVE: To investigate the feasibility of using mid-infrared spectroscopy (MIRS) technology for rapid quantification of harpagoside contents in crude and processed Radix Scrophulariae by means of attenuated total reflectance. METHODS: HPLC was used as the reference method to determine the content of harpagoside, and multivariate calibration models based on PLS algorithm were developed to correlate the spectra and the corresponding values determined by the reference method. RESULTS: The determination coefficient of the calibration model for crude Radix Scrophulariae was r2 = 83.81, and the standard error of estimate (SEE) and the standard error of prediction (SEP) were 0.02155 and 0.05103, respectively. The determination coefficient of the calibration model for processed Radix Scrophulariae was r2 = 95.56, and the standard error of estimate (SEE) and the standard error of prediction (SEP) were 0.00730 and 0.03478, respectively. CONCLUSION: The proposed method is fast and nondestructive, and it provides a novel efficient and environmental friendly approach for the fast determination of the active components in crude and processed traditional Chinese medicine (TCM). Copyright 2012 by the Chinese Pharmaceutical Association.
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El análisis del microproceso terapéutico del dispositivo Grupo de Terapia Focalizada- GTF para adolescentes tempranos violentos se realizó en el marco de los Proyectos UBACYT 2004-2007 P069 y 2008-2010 P049. El instrumento utilizado fue el Modelo de Ciclo Terapéutico-TCM (Mergenthaler, 1996a, 1996b, 1998, 2008; Adaptación argentina para procesos grupales generales y específicos: Fontao y Mergenthaler, 2005 a, b; Toranzo, Taborda, Ross, Mergenthaler y Fontao, 2007; Quiroga y Cryan, 2007 d, 2008 a, 2009b). En este trabajo se presenta el análisis correspondiente al microproceso terapéutico considerando el texto completo (pacientes y terapeuta) para una única sesión (sesión 7) de los dos grupos seleccionados al azar (GTF 7 y GTF 9); esta sesión fue segmentada en fragmentos de 150 palabras. Este análisis del microproceso permitió observar que en todos los segmentos se registró actividad verbal de los pacientes así como también la presencia de los cuatro patrones (Connecting, Relaxing, Reflecting y Experiencing), con alternancia de Ciclos Terapéuticos abreviados y completos. Asimismo, fue posible identificar actividad textual terapéuticamente relevante, lo cual sugiere que el terapeuta juega un rol imprescindible en la expresión de emociones, en la formulación verbal de procesos reflexivos y en el logro de la conexión de los contenidos emocionales y abstractos.
The therapeutic microprocess analysis of the Focalised Therapy Group- FTG device for violent early adolescents was carried out in the framework of the 2004- 2007 P069 and 2008-2010 P049 UBACYT Projects. The instrument used was the Therapeutic Cycle Model- TCM (Mergenthaler, 1996a, 1996b, 1998, 2008; Argentine adaptation for general and specific group processes: Fontao and Mergenthaler, 2005 a, b; Toranzo, Taborda, Ross, Mergenthaler and Fontao, 2007; Quiroga and Cryan, 2007 d, 2008 a , 2009b). In this research the analysis corresponding to the therapeutic microprocess, taking into account the whole text (both patients and therapists) in only one session (session number 7) of two groups selected at random (FTG 7 and FTG 9), is shown. This session was segmented into 150-word fragments. With this microprocess analysis it was possible to observe in all the segments the verbal activity of the patients as well as the presence of four patterns (Connecting, Relaxing, Reflecting y Experiencing), with abridged and complete Therapeutic Cycles rotation. Furthermore, it was possible to identify therapeutically relevant textual activity, which implies that the therapist plays an indispensable role in the expression of emotions, in the verbal formulation of reflexive processes and in the achievement of the connection between emotional and abstract contents.
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En el marco de los Proyectos UBACYT 2004-2007 P069 y 2008-2010 P049, se realizaron 9 Grupos de Terapia Focalizada-GTF para adolescentes tempranos violentos con diagnóstico de Trastorno Negativista Desafiante y Trastorno Disocial en el período 2001-2005. Para el Análisis de Proceso Terapéutico, la muestra se conformó con dos grupos GTF, seleccionados al azar, compuestos por casi el 30% de los pacientes (N=11) de la muestra total del Análisis de Resultados (N=42). El instrumento utilizado fue el Modelo de Ciclo Terapéutico- TCM (Mergenthaler, E., 1996a, 1996b, 1998, 2008; Adaptación argentina para procesos grupales generales y específicos: Fontao y Mergenthaler, 2005 a, b; Toranzo, Taborda, Ross, Mergenthaler y Fontao, 2007; Quiroga y Cryan, 2007 d, 2008 a). En el análisis del macroproceso considerando el texto completo, se pudo apreciar en la primera mitad del dispositivo, la presencia de sesiones que indicaban una combinación de elevado tono emocional y elevada abstracción (patrón Connecting). En la segunda mitad del dispositivo, se detectó que el nivel del tono emocional y de la abstracción fue menor a la media del dispositivo (patrón Relaxing). Los patrones que implican un claro predominio del tono emocional o de la abstracción (patrones Experiencing y Reflecting), fueron escasos y poco marcados.
Within the framework provided by the UBACYT 2004-2007 P069 y 2008-2010 P049 Projects, 9 Focalised Therapeutic Groups (FTG) for early violent adolescents, diagnosed in the period 2001-2005 as having a Oppositional Defiant Disorder and a Conduct Disorder, were formed. For the Analysis of The Therapeutic Process, the sample was composed by two FTG groups, chosen at random, formed by almost 30% of the patients (N= 11) of the total sample of the Outcome Analysis (N= 42). The instrument used was the Therapeutic Cycle Model- TCM (Mergenthaler, E., 1996a, 1996b, 1998, 2008; the Argentine Adaptation for general and specific group processes: Fontao & Mergenthaler, 2005 a , b; Toranzo, Taborda, Ross, Mergenthaler y Fontao, 2007; Quiroga & Cryan, 2007 d, 2008 a). During the macroprocess analysis, taking into consideration the whole text, the presence of sessions with a combined high emotional tone and high abstraction could be observed (Connecting Pattern) in the first half of the device. In the second half, both the level of emotional tone and the abstraction were detected to be lower than the media of the device (Relaxing Pattern). There were only a few and little marked patterns which imply a clear predominance of either the emotional tone or the abstraction (Experiencing and Reflecting patterns).
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Este artigo tem como objetivo realizar um exercício analítico do modo de fazer da Política Nacional de Humanização (PNH) sobre a função apoio institucional, com base em diferentes dispositivos, diretrizes e princípios. O texto está dividido em três partes: na primeira, traz reflexões acerca da concepção de humano e humanismo que fundamenta as análises; a segunda busca ampliar o debate sobre a indissociabilidade entre atenção e gestão e o modo de fazer apoio institucional; a terceira aborda a indissociabilidade entre a produção de serviços e produção de sujeitos, e encaminha a discussão dessas três partes que se desdobram em outros planos de análise. Ressalta, em todo o texto, a aposta na inclusão dos diferentes sujeitos e na análise e gestão coletiva dos processos de trabalho como estratégia para criar desestabilizações produtivas e práticas de humanização dos serviços de Saúde.
This paper had the aim of conducting an analytical exercise about how the National Humanization Policy is undertaken, with regard to the institutional support function, based on different mechanisms, guidelines and principles. The text is divided into three parts. The first part provides reflections concerning the concepts of humaneness and humanism on which the analyses are based. The second seeks to expand the debate regarding the indissociability of healthcare and management and the way of providing institutional support. The third covers the indissociability between the production of services and the production of subjects and moves the discussion on these three parts forward for them to be developed in other planes of analysis. Throughout the text, emphasis is placed on banking on including different subjects and on analysis and collective management of labor processes as a strategy for creating productive destabilization and humanization practices within the healthcare services.
El presente artículo tiene como objetivo hacer un ejercicio analítico del modo de hacer de la Política Nacional de Humanización, sobre la función apoyo institucional, con base en diferentes dispositivos, directrices y principios. El texto está dividido en tres partes. En la primera, trae reflexiones acerca de la concepción de humano y del humanismo que fundamenta los análisis. La segunda busca ampliar el debate sobre la inseparabilidad entre atención y gestión y el modo de hacer apoyo institucional. La tercera plantea la noción de inseparabilidad entre la producción de servicios y la producción de sujetos y encamina la discusión de estas tres partes que se desdoblan en otros planos de análisis. Resalta en todo el texto la apuesta en la inclusión de los diferentes sujetos y en el análisis y gestión colectiva de los procesos de trabajo como estrategia para crear desestabilizaciones productivas y prácticas de humanización de los servicios de salud.
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Health Management , Health Policy , Humanization of Assistance , Public PolicyABSTRACT
AIM:To study the feasibility of online monitoring and controlling of the key process of column chromatographic separation in the production of Salvianolate by combining near-infrared(NIR) spectrum and HPLC fingerprinting. METHODS: Partial Least Square(PLS) regression was used to model the correlation of NIR spectra with the concentrations of salvianolic acid B,and the influences of light path,wavelength selection,and preprocessing method on the PLS model were investigated systematically. RESULTS: A 2 mm light path was better than 1 mm one,and with 2 mm light path,the optimal wave-number was in the range of 6 102.1-5 446.3 cm~(-1) and the optimal preprocessing method was the vector normalization.The root mean-square error of PLS model on test samples was 0.234 mg/mL,and R~2 was 0.995 2. CONCLUSION: This method is proved to be fast,convenient,and precise.It can be used to online monitoring and quality control of the manufacturing of Salvianolate.