Identifying non-value added waste that delay emergency CT brain workflow using lean management principles

Introduction: The Department of Radiology at Groote Schuur Hospital receives numerous emergency CT brain requests especially from the Emergency and Trauma departments. Improvement in emergency CT brain workflow should reduce waiting times for CT scans resulting in earlier diagnosis and treatment of these patients. Identification of the nonvalue-added waste (NVAW) (steps regarded as wasteful to the customer) in the CT brain workflow can be determined by use of a lean management tool namely a value stream map (VSM - a flow analysis of information required to provide service to the customer). AIM: The study aims to identify non-value-added waste in the CT brain workflow value stream map which may result in delay in emergency CT brain reporting. Method: This study investigated NVAW in emergency CT brain workflow for 5 working days between 08h00 to 22h00 from Monday to Friday. Nineteen patients booked for an emergency CT brain scan by the Emergency Department (ED) only between 08h00 and 22h00 over the specific 5 day working period were randomly selected using convenience sampling. The indications for emergency CT brain scans in the sample were similar to the wider group of patients undergoing emergency CT brain scans. A VSM identifying all the relevant steps in the emergency CT brain workflow was constructed. The investigator accompanied each of the nineteen patients from the ED to the CT scanner and back and manually recorded the time elapsed in minutes for each separate step on the data collection sheet. The outstanding information required was obtained from the Xiris system on the Phillips PACS (Picture Archiving and Communicating System). The average time interval for each of the steps as indicated on the VSM was calculated, and the rate limiting step(s) which resulted in a delay in emergency CT brain reporting was identified. Results: Overall, the longest step was the time interval from the time of completion of the scan to the generation of the report (turnaround time (TAT)) with an average time of 72.21 minutes (p value of < 0,01). Conversely, the time interval from placing the request by the clinician on the PACS to the time of annotation by the radiologist was the shortest with an average time of 5.84 minutes. Discussion: The lean management system was used to identify the rate limiting step(s) which resulted in delay in emergency CT brain reporting. Possible reasons identified for the delay caused by the rate limiting step include the backlog in reporting of the large number of already scanned cases which may be due to staff constraints as only one radiologist was on duty during most of the study period. Additional contributory factors include clinician telephonic query interruptions to radiology registrars during reporting sessions and delay in the emergency doctor authorising and facilitating transport of the patient from the emergency unit to the CT scanner. Conclusion: The value stream map tool in lean management can be utilised to identify non value added waste in emergency CT brain workflow

The bile duct ligated rat : a relevant model to study muscle mass loss in cirrhosis

Muscle mass loss and hepatic encephalopathy (complex neuropsychiatric disorder) are serious complications of chronic liver disease (cirrhosis) which impact negatively on clinical outcome and quality of life and increase mortality. Liver disease leads to hyperammonemia and ammonia toxicity is believed to play a major role in the pathogenesis of hepatic encephalopathy. However, the effects of ammonia are not brain-specific and therefore may also affect other organs and tissues including muscle. The precise pathophysiological mechanisms underlying muscle wasting in chronic liver disease remains to be elucidated. In the present study, we characterized body composition as well as muscle protein synthesis in cirrhotic rats with hepatic encephalopathy using the 6-week bile duct ligation (BDL) model which recapitulates the main features of cirrhosis. Compared to sham-operated control animals, BDL rats display significant decreased gain in body weight, altered body composition, decreased gastrocnemius muscle mass and circumference as well as altered muscle morphology. Muscle protein synthesis was also significantly reduced in BDL rats compared to control animals. These findings demonstrate that the 6-week BDL experimental rat is a relevant model to study liver disease-induced muscle mass loss

Project Retrosight. Understanding the returns from cardiovascular and stroke research: Case Studies

Copyright @ 2011 RAND Europe. All rights reserved. The full text article is available via the link below.This project explores the impacts arising from cardiovascular and stroke research funded 15-20 years ago and attempts to draw out aspects of the research, researcher or environment that are associated with high or low impact. The project is a case study-based review of 29 cardiovascular and stroke research grants, funded in Australia, Canada and UK between 1989 and 1993. The case studies focused on the individual grants but considered the development of the investigators and ideas involved in the research projects from initiation to the present day. Grants were selected through a stratified random selection approach that aimed to include both high- and low-impact grants. The key messages are as follows: 1) The cases reveal that a large and diverse range of impacts arose from the 29 grants studied. 2) There are variations between the impacts derived from basic biomedical and clinical research. 3) There is no correlation between knowledge production and wider impacts 4) The majority of economic impacts identified come from a minority of projects. 5) We identified factors that appear to be associated with high and low impact. This report presents the key observations of the study and an overview of the methods involved. It has been written for funders of biomedical and health research and health services, health researchers, and policy makers in those fields. It will also be of interest to those involved in research and impact evaluation.This study was initiated with internal funding from RAND Europe and HERG, with continuing funding from the UK National Institute for Health Research, the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and the National Heart Foundation of Australia. The UK Stroke Association and the British Heart Foundation provided support in kind through access to their archives

Research Opportunities in Nutrition and Metabolism in Space

The objectives of the Life Sciences Research Office (LSRO) study on nutrient requirements for meeting metabolic needs in manned space flights are as follows: review extant knowledge on the subject; identify significant gaps in knowledge; formulate suggestions for possible research; and produce a documented report of the foregoing items that can be used for program planning. In accordance with NASA's request for this study, the report focuses on issues of nutrition and metabolism that relate primarily to the contemplated United States Space Station, secondarily to the Shuttle Program as an orbital test bed for operational studies, and incidentally to scenarios for future long-term space flights. Members of the LSRO ad hoc Working Group on Nutrition and Metabolism were provided with pertinent articles and summaries on the subject. At the meeting of the Working Group, presentations were made by NASA Headquarters program staff on past experiences relative to space-flight nutrition and metabolism, as well as scenarios for future flights. The discussions of the ad hoc Working Group focused on the following: (1) metabolic needs related to work and exercise; (2) nutrients required to meet such needs; (3) food types, management, and records; and (4) nutritional amelioration or prevention of space-related physiological and behavioral changes

Application of six sigma methodology to reduce defects of a grinding process

Six Sigma is a data-driven leadership approach using specific tools and methodologies that lead to fact-based decision making. This paper deals with the application of the Six Sigma methodology in reducing defects in a fine grinding process of an automotive company in India. The DMAIC (Define–Measure–Analyse–Improve–Control) approach has been followed here to solve the underlying problem of reducing process variation and improving the process yield. This paper explores how a manufacturing process can use a systematic methodology to move towards world-class quality level. The application of the Six Sigma methodology resulted in reduction of defects in the fine grinding process from 16.6 to 1.19%. The DMAIC methodology has had a significant financial impact on the profitability of the company in terms of reduction in scrap cost, man-hour saving on rework and increased output. A saving of approximately US$2.4 million per annum was reported from this project

Health considerations for transgender women and remaining unknowns : a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address

Obesity-induced changes in lipid mediators persist after weight loss.

BackgroundObesity induces significant changes in lipid mediators, however, the extent to which these changes persist after weight loss has not been investigated.Subjects/methodsWe fed C57BL6 mice a high-fat diet to generate obesity and then switched the diet to a lower-fat diet to induce weight loss. We performed a comprehensive metabolic profiling of lipid mediators including oxylipins, endocannabinoids, sphingosines and ceramides in key metabolic tissues (including adipose, liver, muscle and hypothalamus) and plasma.ResultsWe found that changes induced by obesity were largely reversible in most metabolic tissues but the adipose tissue retained a persistent obese metabolic signature. Prostaglandin signaling was perturbed in the obese state and lasting increases in PGD2, and downstream metabolites 15-deoxy PGJ2 and delta-12-PGJ2 were observed after weight loss. Furthermore expression of the enzyme responsible for PGD2 synthesis (hematopoietic prostaglandin D synthase, HPGDS) was increased in obese adipose tissues and remained high after weight loss. We found that inhibition of HPGDS over the course of 5 days resulted in decreased food intake in mice. Increased HPGDS expression was also observed in human adipose tissues obtained from obese compared with lean individuals. We then measured circulating levels of PGD2 in obese patients before and after weight loss and found that while elevated relative to lean subjects, levels of this metabolite did not decrease after significant weight loss.ConclusionsThese results suggest that lasting changes in lipid mediators induced by obesity, still present after weight loss, may play a role in the biological drive to regain weight