Potenciando la contribución de la logística hospitalaria: tres casos, tres trayectorias

La logística tiene un gran potencial de contribución a la búsqueda de los objetivos de calidad, cobertura y eficiencia de las instituciones hospitalarias. Desafortunadamente, ésta área es a menudo relegada a un segundo o tercer plano y sólo es visible a los ojos de la alta dirección cuando aparecen problemas. Este artículo analiza tres casos en los que se logra incrementar la contribución de la logística al desempeño de tres hospitales en Francia, Canadá y Colombia. Este análisis permite identificar algunos elementos comunes que pueden guiar a quienes busquen una transformación similar en sus instituciones.La logistique peut contribuer significativement à la recherche des objectifs de qualité, d’accessibilité et d’efficacité des établissements de santé. Toutefois, l’importance de la logistique est souvent ignorée par les dirigeants. Cette recherche analyse trois cas où la logistique a su augmenter l’importance de son rôle auprès de la direction. Les hôpitaux étudiés sont situés en France, au Canada et en Colombie. Cette analyse permet d’identifier quelques éléments communs aux trois centres pouvant guider une semblable transformation dans d’autres organisations.Logistics can contribute to the pursuit of quality, accessibility and efficiency of healthcare institutions. However, the full potential of logistics is often unknown and top managers are sometimes unaware of its importance. This study analyses three cases where it has been possible to increase the contribution of logistics to the performance of three hospitals located in France, Canada and Colombia. We identify some common elements that may guide managers seeking a similar transformation in their organizations

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Non-invasive in vivo hyperspectral imaging of the retina for potential biomarker use in Alzheimer's disease

Studies of rodent models of Alzheimer's disease (AD) and of human tissues suggest that the retinal changes that occur in AD, including the accumulation of amyloid beta (Abeta), may serve as surrogate markers of brain Abeta levels. As Abeta has a wavelength-dependent effect on light scatter, we investigate the potential for in vivo retinal hyperspectral imaging to serve as a biomarker of brain Abeta. Significant differences in the retinal reflectance spectra are found between individuals with high Abeta burden on brain PET imaging and mild cognitive impairment (n = 15), and age-matched PET-negative controls (n = 20). Retinal imaging scores are correlated with brain Abeta loads. The findings are validated in an independent cohort, using a second hyperspectral camera. A similar spectral difference is found between control and 5xFAD transgenic mice that accumulate Abeta in the brain and retina. These findings indicate that retinal hyperspectral imaging may predict brain Abeta load

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

L’implantation de l’approche Lean : le cas de la pharmacie de l’Hôpital Fleurimont au Centre hospitalier universitaire de Sherbrooke

Résumé Introduction : Depuis une dizaine d’années, on constate un intérêt grandissant de la part des établissements de santé pour l’approche Lean. Cet article décrit un projet d’amélioration du temps de préparation des ordonnances au département de pharmacie de l’Hôpital Fleurimont du Centre hospitalier universitaire de Sherbrooke. Description de la problématique : Alors que le personnel de la pharmacie traitait plus de 448 280 ordonnances dans le courant de l’année 2003-2004, ce chiffre s’élevait à environ 598 135 en 2008-2009, soit une augmentation de près de 34 % contre seulement 5 % d’effectifs supplémentaires. Résolution de la problématique : Au cours de l’année 2008, un comité de travail a été formé à l’initiative de la direction de la pharmacie pour discuter des recommandations déposées par un consultant, dont l’une d’entre elles proposait la révision du processus de traitement des ordonnances à la pharmacie. Le projet a démarré en septembre 2008 pour se terminer officiellement en mai 2009. Le comité de travail s’est réuni à 19 occasions pour un total de 45 heures en ayant recours aux méthodes et aux outils Lean (p. ex. cartographie des processus, diagrammes à ficelles, loi de Pareto et contrôles visuels, standardisation, cellule de travail, etc.). Des exemples et des mesures de résultats ont servi à la vérification des retombées de l’usage de ces outils sur le traitement des ordonnances de médicaments. Conclusion : Dans un réseau de la santé où les ressources se font rares, le Lean permet des gains significatifs et durables tout en réduisant les investissements. Ainsi, avec des investissements d’environ huit mille dollars, le Centre hospitalier universitaire de Sherbrooke a pu réduire de 35 % le délai de traitement des ordonnances par le personnel du département de pharmacie de l’Hôpital Fleurimont tout en améliorant significativement le climat de travail. Abstract Introduction: Over the past 10 years, healthcare establishments have shown an increasing interest in the Lean method. This article describes a project in which prescription preparation time was improved at the Fleurimont Hospital site of the Centre hospitalier universitaire de Sherbrooke. Problem description: Although pharmacy personnel evaluated more than 448 280 prescriptions during 2003–2004, this was increased by nearly 34% to 598 135 in 2008–2009 with an increase in additional staff of only 5%. Problem resolution: In 2008, under the initiative of pharmacy management, a task force was formed to discuss the recommendations made by a consultant, one recommendation being the revision of the prescription management process at the pharmacy. The project started in September of 2008 and was officially finished in May of 2009. Using the Lean method and associated tools (process maps, flow charts, Pareto’s law and visual aids, standardization, workgroups, etc), the taskforce met 19 times for a total of 45 hours. Examples and outcome measures were used to evaluate the impact on prescription management of using these tools. Conclusion: In a healthcare system with limited resources, the Lean method allowed significant and sustainable gains while reducing investments. Also, with an investment of approximately $8000, the Centre hospitalier universitaire de Sherbrooke reduced by 35% the delay in prescription evaluation by personnel of the pharmacy department of the Fleurimont Hospital, this while significantly improving working conditions. Key words: medication circuit, distribution, Lea

Vers une politique du département SHS en matière de bases de données documentaires. Propos de Sylvain Auroux

Auroux Sylvain, Bourlet Caroline, Polo de Beaulieu Marie-Anne. Vers une politique du département SHS en matière de bases de données documentaires. Propos de Sylvain Auroux. In: Le médiéviste et l'ordinateur, N°31-32, Printemps - automne 1995. Les médiévistes et la politique de l'informatique. pp. 8-9