Value Flow Map: application and results in the disinfection center / Mapa de la Cadena de Valor: aplicación y resultados en el centro de desinfección / Mapa de Fluxo de Valor: aplicação e resultados na central de desinfecção

ABSTRACT Objective: To identify and eliminate steps that do not add value for customers in the disinfection center. Method: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. Result: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. Conclusion: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.

RESUMEN Objetivo: identificar y eliminar los pasos que no agregan valor para los clientes en el centro de desinfección. Método: aplicamos la herramienta Lean: mapa de la cadena de valor, conceptos de gemba y kaizen, en el proceso de trabajo de la unidad de desinfección para materiales de asistencia ventilatoria con el objetivo de mejorar el proceso. Después de realizar una capacitación con el equipo sobre los conceptos Lean descritos anteriormente, aplicamos el Mapa de la cadena de valor en el gemba, analizamos las oportunidades de mejora y aprobamos los cambios; se diseñó el Mapa de la cadena de valor del estado futuro y se implementaron los cambios. Resultado: el tiempo del proceso de desinfección se redujo en dos horas y treinta y siete minutos, y los recursos financieros requeridos también disminuyeron en R$ 809,08/mes. Conclusión: la aplicación de los conceptos Lean presentó resultados positivos para la eliminación de desperdicios en el centro de desinfección.

RESUMO Objetivo: identificar e eliminar as etapas que não agregam valor ao cliente na central de desinfecção. Método: foi aplicada a ferramenta Lean: Mapa de Fluxo de Valor, utilizando os conceitos Gemba e Kaizen no processo de trabalho da unidade de desinfecção de materiais para uso na assistência ventilatória com o intuito de melhorar o processo de trabalho. Foi realizada a capacitação da equipe em relação aos conceitos Lean descritos acima, foi aplicado o Mapa de Fluxo de Valor no Gemba, foram analisadas as oportunidades de melhoria e, após, aprovação das alterações, foi desenhado o Mapa de Fluxo de Valor do estado futuro e implementadas as mudanças. Resultado: obteve-se redução de tempo em 2h37 no processo de desinfecção e redução de recursos financeiros em R$ 809,08 reais/mês. Conclusão: a aplicação de conceitos Lean apresentou resultados positivos na eliminação de desperdícios na central de desinfecção.

Enteral diet therapy: use of the Lean Healthcare philosophy in process improvement / Dietoterapia enteral: la utilización de la filosofía Lean Healthcare en la mejora del proceso / Dietoterapia enteral: utilização da filosofia Lean Healthcare na melhoria do processo

ABSTRACT Objective: To identify the nonconformities of the enteral diet therapy process. Method: Exploratory case study, using as a theoretical framework the philosophy of Lean Healthcare in an inpatient unit of a large hospital in Minas Gerais State. The sample consisted of 19 professionals from the multidisciplinary team involved in the enteral nutritional therapy process and the unit's documentary sample. For the data collection, we used a semi-structured script, participant observation and documentary analysis. Results: There were eight nonconformities related to enteral diet therapy. During the participant observation, there was a lack of a management model that seeks the continuous improvement of the process, as well as resistance to change. Conclusion: Although enteral diet therapy is important in the patient's evolution, there are adverse events that could be prevented and the Lean philosophy assists in the identification of process nonconformities.

RESUMEN Objetivo: Identificar las no conformidades del proceso de dietoterapia enteral. Método: Estudio de caso exploratorio, utilizando como referencial teórico la filosofía Lean Healthcare en una unidad de internación de un hospital de gran porte del estado de Minas Gerais. La muestra fue compuesta por 19 profesionales del equipo multidisciplinario involucrado en el proceso de terapia nutricional enteral y la muestra documental de la unidad. Para la recolección de datos, se utilizó un itinerario semiestructurado, la observación participante y el análisis documental. Resultados: Se constataron ocho no conformidades relacionadas a la dietoterapia enteral. Durante la observación participante, se evidenció la falta de un modelo de gestión que busca la mejora continua del proceso, así como la resistencia al cambio. Conclusión: Aunque la dietoterapia enteral sea importante en la evolución del paciente, existen eventos adversos que podrían prevenirse y la filosofía Lean ayuda a identificar las no conformidades de los procesos.

RESUMO Objetivo: Identificar as não conformidades do processo de dietoterapia enteral. Método: Estudo de caso exploratório, utilizando como referencial teórico a filosofia Lean Healthcare em uma unidade de internação de um hospital de grande porte de Minas Gerais. A amostra foi composta por 19 profissionais da equipe multidisciplinar envolvida no processo de terapia nutricional enteral e a amostra documental da unidade. Para a coleta de dados, utilizou-se roteiro semiestruturado, observação participante e análise documental. Resultados: Constataram-se oito não conformidades relacionadas à dietoterapia enteral. Durante a observação participante, evidenciou-se a falta de um modelo de gestão que busca a melhoria contínua do processo, bem como resistência à mudança. Conclusão: Embora a dietoterapia enteral seja importante na evolução do paciente, existem eventos adversos que poderiam ser prevenidos e a filosofia Lean auxilia na identificação das não conformidades dos processos.

Budget Impact of the Accreditation Program for Clinical Laboratories on Colorectal Cancer Screening via Fecal Immunochemical Testing: Results from the National Cancer Screening Program in Korea

BACKGROUND: False-positive fecal immunochemical test (FIT) results in the National Cancer Screening Program (NCSP) for colorectal cancer may lead to unnecessary procedures, such as colonoscopies, increasing the medical costs. We estimated reductions in the cost of National Health Insurance according to the accreditation status of screening facilities participating in the NCSP for colorectal cancer. METHODS: We used data collected between 2007 and 2010 from NCSP and the Korea Central Cancer Registry to identify patients with colorectal cancer. We also ascertained the history of the accreditation of each facility by the Korean Laboratory Accreditation Program (KLAP). Budget impact was defined as a reduction in medical costs achieved when the false-positive rate of the non-accredited facilities decreased relative to that of the accredited facilities. RESULTS: A total of 3,285 screening facilities participated in the NCSP. Of these, 196 were accredited by the KLAP. The false-positive rate of the accredited facilities was 2.47%, and that of the non-accredited facilities was 6.83%. Medical costs were estimated to be reduced by approximately 19 million US dollars (USD), and the cost of detecting one case of colorectal cancer was estimated to decrease from 9,212 USD to 7,332 USD if the false-positive rate of non-accredited facilities were decreased to that of the accredited facilities. Clinics were estimated to have the largest associated cost reduction. CONCLUSIONS: Quality assurance in clinical laboratories could lower false-positive rates and prevent the use of unnecessary procedures, ensuring patient safety and increasing the cost-effectiveness of FIT screening in the NCSP for colorectal cancer.

Exploration of science management mode for high-value medical consumables / 中国医学装备

Objective:To investigate and explore the science management mode for high- value medical consumables in order to solve the problem of management deficiency in purchase and using of high-value medical consumables.Methods: To strengthen the management for high value consumables on 5 aspects: systematized institution, normalized processes, standardized operation, scientific evaluation and informationalized management.Results:The normalized, standardized and programmed management mode for high-value medical consumables has been established and improved throughout the whole process monitoring and management of total life cycle for the consumables. This research normalized the management for these consumables and formed a new science management mode.Conclusion: The exploration and implementation of new management method and path for medical high-value consumables can effectively improve the level of hospital material management, reduce management loopholes, decrease the cost of high-value consumables and increase work efficiency.

Aproximación metodológica a la planificación y a la programación de las salas de cirugía: una revisión de la literatura / Methodological approach to the planning and scheduling of operating rooms: a literature review / Aproximação metodológica à planificação e programação das salas de cirurgia: revisão de literatura

El sector hospitalario en diferentes partes del mundo se ha visto obligado a incursionar en lareducción de costos. Las salas de cirugía son uno de los departamentos más costosos de loshospitales debido a los problemas que presenta la planeación y programación de las operaciones.El presente trabajo proporciona una revisión de las diferentes investigaciones enfocadas asolucionar los problemas de la planeación de las salas de cirugía. Se realizó una clasificaciónde las técnicas de solución más utilizadas y los resultados que se consiguieron. De los ochentaartículos más recientes se encuentra que un 62 % de los trabajos abordan el problema de la reduccióndel tiempo de espera de los pacientes por ser atendidos, y que la optimización multiobjetivoestocástica es la metodología que en un 33 % de los casos se plantea como la aproximación quede manera más completa aborda todos los aspectos involucrados en el proceso de planeación,reduciendo los costos hasta en un 15 %...

The hospital sector in different parts of the world has been forced to move into cost reduction.The operating rooms are one of the most expensive departments of hospitals due to the problemspresented by planning and scheduling the operations. This paper provides an overview of thedifferent research focused on solving the problems of planning the operating rooms. We performeda classification of the solution techniques used and the results that were achieved. Of theeighty latest articles, 62% of the works deal with the problem of reducing the waiting time forpatients to be treated, and the optimization of the multiobjective stochastic is the methodologywhich in 33% of the cases arises as the approach that more fully addresses all aspects involvedin the planning process, reducing costs by up to 15%...

O setor hospitalar em diferentes partes do globo tem se visto obligado a incursionar na reduçãode custos. As salas de cirurgia são um dos departamentos mais custosos dos hospitais devidoaos problemas que apresenta o planejamento e programação das operações. O presente trabalhoproporciona revisão das diferentes pesquisas focadas a solucionar os problemas do planejamentodas salas de cirurgia. Realizou-se uma classificação das técnicas de solução mais utilizadase os resultados que se conseguiram. Dos oitenta artigos mais recentes encontra-se que um62 % dos trabalhos abordam o problema da redução do tempo de espera dos pacientes por seratendidos, e que a otimização multiobjetivo estocástica é a metodologia que, em um 33 % doscasos, esboça-se como a aproximação que de maneira mais completa aborda todos os aspectosenvolvidos no processo de planejamento, reduzindo os custos até um 15 %...

Comparative Study of Medical Cost about Generic Drugs Use Promotion of Eye Drops / 医薬品情報学

<b>Objective: </b>From the viewpoint of drug cost reduction, many generic drugs have appeared in the eye drops market.  Although the price of eye drops is defined on a per bottle (or per mL) basis, the difference in the total number of drops per bottle between the original drug and its generic drug may alter the drug cost reduction effect greatly.  Moreover, the difference in the total number of drops per bottle may also affect the number of pharmacy visits made by a patient in one year.<br><b>Methods: </b>The total number of drops per bottle of an original drug and a generic drug was computed, and the influence of the number of drops on the drug cost reduction effect, including drug cost, was evaluated.<br><b>Results: </b>Distinct differences in the volume per drop and the total number of drops per bottle were observed between the original drug and its generic drug, and those differences were found to clearly influence the drug cost reduction effect.  Moreover, in a survey of patients who shifted to generic eye drops, there were some patients who returned to the original eye drops because they could not apply the generic eye drops with ease or their eyes started to smart after using the generic eye drops.<br><b>Conclusion: </b>This study revealed the need to take into consideration patient’s ease of use and the drug cost reduction effect, in the selection of eye drops.

Estímulo do comportamento fotoautotrófico durante o enraizamento in vitro de Annona glabra L., II. Aspectos da anatomia da folha antes da aclimatização / Stimulus of the photoautotrophic behavior during the in vitro rooting of Annona glabra L., II. Aspects of leaf anatomy before acclimatization

A baixa sobrevivência durante a aclimatização de plantas regeneradas através da micropropagação tem sido atribuída, entre vários fatores, à baixa capacidade fotossintética. O desenvolvimento de protocolos que utilizem sistemas de cultivo in vitro fotoautotróficos surgem como possibilidades potenciais para aumentar a eficiência da micropropagação. Objetivou-se, neste trabalho comparar as medições dos tecidos foliares de plantas de Annona glabra L. cultivadas in vitro, sob condições de estímulo ao fotoautotrofismo e heterotróficas, durante a fase de enraizamento, com plantas ex vitro (mantidas sob radiação fotossintética ativa de 130-170µmol.m-2.s-1, sem controle de temperatura). As brotações foram enraizadas em condições de estímulo ao fotoautotrofismo (meio sem sacarose e com aeração) e em condições heterotróficas (meio com sacarose e sem aeração). O meio de cultivo utilizado foi o WPM adicionado de 164,4mM de carvão ativado e 4,9µM AIB. Após 30 dias de cultivo realizaram-se medições das espessuras das epidermes abaxial, adaxial, parênquima esponjoso, paliçadico e do limbo. Verificaram-se variações na anatomia das folhas, que foram caracterizadas por um aumento na espessura foliar de acordo com a aeração estabelecida. O enraizamento de plantas de A. glabra em condições de estímulo ao fotoautotrofismo permitiu desenvolvimento anátomo-fisiológico semelhante àquele observado em condições ex vitro, o que pode minimizar as perdas no processo de micropropagação.

The low survival during the acclimatization of plants regenerated through the micropropagation has been attributed, among several factors, to low the photosynthetic capacity. The development of photoautotrophic in vitro culture systems appears as potential possibilities of increasing the efficiency of the micropropagation. The aim of this work was to compare the leaf anatomy of plants of Annona glabra L. cultivated in vitro, under photoautotrophic and heterotrophic conditions, during the phase of rooting, with ex vitro (maintained in greenhouse under photosynthetic acitve radiation of 130-170µmol.m-2.s-1, without control of room temperature). Shoots were rooted in photoautotrophic conditions (sucrose-free medium with aeration) heterotrophic conditions (medium with sucrose without ventilation). The medium of culture was the WPM supplied of 164.4mM of activated charcoal and 4.9µM AIB. After 30 days of culture measurements of the foliar thickness of the epidermises abaxial, adaxial, parenchyma spongy, palisade and limb one. Verified variations in the anatomy of the leaves, that had been characterized by an increase in the leaf thickness in accordance with the established aeration. In vitro photoautotrophic rooting of plants Annona glabra L stimulated an anatomical and physiological development similar to the one observed in an ex vitro condition, which may minimize the losses at the acclimatization process.

Estímulo do comportamento fotoautotrófico durante o enraizamento in vitro de Annona glabra L., I. desenvolvimento do sistema radicular e da parte aérea / Stimulus of the photoautotrophic behavior during the in vitro rooting of Annona glabra L., I. development of root system and shoot

Conduziu-se este trabalho, com o objetivo de induzir a estímulo do comportamento fotoautotrófico durante o enraizamento in vitro em brotações de Annona glabra L. Brotações oriundas de cultivo em tubos fechados com tampa e película de PVC (cultivo sem aeração), com tampa sem a película de PVC e tampão de algodão (cultivo com aeração) foram inoculadas em meio WPM suplementado com 4,9 µ M de AIB e 164,4mM de carvão ativado na presença (58,42mM) ou ausência de sacarose. Durante o enraizamento, foram mantidas as mesmas condições de vedação dos tubos de ensaio em que as brotações foram induzidas. Após a inoculação, os tubos contendo os explantes foram mantidos em sala de crescimento sob radiação fotossintética ativa de 45-56 µ mol.m-2.s-1 a 25±3ºC. Os resultados mostraram que o enraizamento das brotações de A. glabra não dependeu do suprimento de sacarose no meio de cultura, em tubos fechados com o tampão de algodão ou tampa plástica sem PVC. A aeração dos tubos de ensaio trouxe incrementos de significativos (até 250 por cento) na matéria seca radicular. A indução de raízes secundárias (laterais) em A. glabra só ocorreu em culturas com aeração, independentemente da presença ou ausência de sacarose no meio de cultura. Com os resultado desse experimento, conclui-se que o estímulo do comportamento fotoautotrófico em A.glabra pode ser obtido com sucesso durante a fase de enraizamento in vitro.

The objective of the present work was to evaluate whether Annona glabra L. shoots are able to acquire the photoautotrophic behavior during the in vitro rooting. In vitro A. glabra shoots originated from cultures in vessels sealed with cap and PVC film (culture without aeration), cap without PVC film or cotton tampon (cultures with aeration), were inoculated in WPM medium supplemented with 4.9 µ M IBA and 164,4mM activated charcoal in the presence (58.42mM) or absence of sucrose. During rooting, the same conditions in which shoots were induced were maintained. After inoculation, the tubes with explants were maintained in growth room under photosynthetic active radiation of 45-56 µ mol.m-2.s-1 and of temperature 25±3ºC. The results showed that the rooting of A. glabra shoots do not depend on the supply of sucrose into culture medium, in vessel with aeration. Aeration of cultures brought expressive increments of dry weight of roots (up to 250 percent). The induction of secondary (side) roots was found only in cultures with aeration, independently of sucrose presence. One concluded that the acquisition of the photoautotrophic behavior in A. glabra may be obtained with success during the in vitro rooting phase.

Development of six sigma concurrent parameter and tolerance design method based on response surface methodology / 药物分析学报

Using Response Surface Methodology (RSM), an optimizing model of concurrent parameter and tolerance design is proposed where response mean equals its target in the target being best. The optimizing function of the model is the sum of quality loss and tolerance cost subjecting to the variance confidence region of which six sigma capability can be assured. An example is illustrated in order to compare the differences between the developed model and the parameter design with minimum variance. The results show that the proposed method not only achieves robustness, but also greatly reduces cast. The objectives of high quality and low cost of product and process can be achieved simultaneously by the application of six sigma concurrent parameter and tolerance design.