Improving access to health services – Challenges in Lean application

Purpose: Healthcare organisations face significant productivity pressures and are undergoing major service transformation. This paper serves to disseminate findings from a Lean healthcare project using a NHS Single Point of Access environment as the case study. It demonstrates the relevance and extent that Lean can be applied to this type of healthcare service setting. Design/methodology/approach: Action research was applied and Lean tools used to establish current state processes, identify wastes and develop service improvement opportunities based upon defined customer values. Findings: The quality of referral information was found to be the root cause of a number of process wastes and causes of failure for the service. Understanding the relationship and the nature of interaction between the service‟s customer/supplier led to more effective and sustainable service improvement opportunities and the co-creation of value. It was also recognised that not all the Lean principles could be applied to this type of healthcare setting. Practical implications: The study is useful to organisations using Lean to undertake service improvement activities. The paper outlines how extending the value stream beyond the organisation to include suppliers can lead to improved co-production and generation of service value. Originality/value: The study contributes to service productivity research by demonstrating the relevance and limitations of Lean application in a new healthcare service setting. The case study demonstrates the practical challenges of implementing Lean in reciprocal service design models and adds validity to existing contextual models

Lean Thinking: Theory, Application and Dissemination

This book was written and compiled by the University of Huddersfield to share the learnings and experiences of seven years of Knowledge Transfer Partnership (KTP) and Economic and Social Research Council (ESRC) funded projects with the National Health Service (NHS). The focus of these projects was the implementation of Lean thinking and optimising strategic decision making processes. Each of these projects led to major local improvements and this book explains how they were achieved and compiles the lessons learnt. The book is split into three chapters; Lean Thinking Theory, Lean Thinking Applied and Lean Thinking Dissemination

Maternal and Fetal Responses to Long-Term Hypoxemia in Sheep

The effect of acute or short term hypoxia on fetal and maternal cardiovascular hemodynamics has been well known, however, little is known about the effect of long term hypoxemia. To determine the animals hemodynamic responses to this stress we studied 3 groups of animals 1) pregnant ewes (n=20) 110 to 115 days of gestation, subjected to hypoxia for up to 28 days, 2) pregnant ewes (n=4) which served as normoxic controls, and 3) non pregnant ewes (n=6) subjected to hypoxemia for up to 28 days. We measured maternal and fetal mean arterial pressure (Bp), heart rate (HR), arterial PO2, O2 saturation (HbO2), hemoglobin (Hb), Hematocrit (Hct), blood volume (BV), and erythropoeitin (Ep) for at least 17 days. In addition we also measured maternal arteriovenous O2 difference (ΔA-V), uterine blood flow (Qut) uterine vascular resistance (VRut) and uterine O2 uptake (VO2ut). Fetal cortisol, epinephrine (Epi) and norepinephrine levels were also measured. In the pregnant hypoxic group arterial PO2 decreased from a control value of 101.5 ± 5.1 Torr to 59.2 ± 5.1 Torr within a few minutes, where it remained throughout the study. The concentration of hemoglobin increased from 8.9 ± 0.5 g/dl to 10.0 ± 0.5 g/dl within 24 h where it remained, while erythropoietin concentration increased from 16.6 ± 2.1 mU/ml to 39.1 ± 7.8 mU/ml at 24 h, but then returned to control levels. Arterial O2 content, glucose concentration, mean arterial pressure, and cardiac output decreased slightly. m contrast, body weight, heart rate, blood volume, uterine blood flow, uterine O2 flow, uteroplaoental O2 uptake and the concentrations of catecholamines and cortisol remained relatively constant. For the fetuses, within a few minutes of hypoxia, arterial Po2, decreased from control value of 29.7 ± 2.1 Torr to 19.1 + 2.1 Torr, where it remained. Hemoglobin increased from 10.0 ± 1.0 g/dl to 12.9 ± 1.0 g/dl by day 7 where it remained. This was associated with an increase of [Ep] from 22.8+2.2 mn/ml to 144 ± 37 mu/ml within 24 h, but by day 7 it had returned to levels slightly above normal. Epinephrine also increased moderately and remained elevated throughout the study. However, value of mean arterial pressure and heart rate did not differ from controls. Thus in response to long term hypoxemia of moderate severity both pregnant and nonpregnant sheep experience relatively minor cardiovascular and hematologic responses. Perhaps surprisingly, these fetuses were able to compensate, so that at term their body weights were normal, 3.77 ± 0.2 kg

Modulation of SIRT1-foxo1 signaling axis by resveratrol: Implications in skeletal muscle aging and insulin resistance

© 2015 S. Karger AG, Basel. Aging individuals and diabetic patients often exhibit concomitant reductions of skeletal muscle mass/strength and insulin sensitivity, suggesting an intimate link between muscle aging and insulin resistance. Foxo1, a member of the FOXO transcription factor family, is an important player in insulin signaling due to its inhibitory role in glucose uptake and utilization in skeletal muscle. Phosphorylation of Foxo1 is thought to mitigate the transactivation of pyruvate dehydrogenase lipoamide kinase 4 (PDK4), which is a negative regulator of the glycolytic enzyme pyruvate dehydrogenase (PDH). In contrast, how aging would regulate acetylation/deacetylation machineries and glucose utilization in skeletal muscle through the Foxo1/PDH axis remains largely undetermined. Accumulating body of evidence have shown that resveratrol, a natural polyphenol in grapes and red wine, activates the longevity-related protein sirtuin 1 (SIRT1) and augments insulin sensitivity in addition to its well-documented effects on mitochondrial energetics. The present review summarizes the role of Foxo1/SIRT1 in insulin signaling in skeletal muscle and proposes the insight that activation of SIRT1 deacetylase activity to deacetylate and suppress the Foxo1-induced transactivation of PDK4 may represent an anti-hyperglycemic mechanism of resveratrol in aging skeletal muscle.Link_to_subscribed_fulltex

Predicting the need for intubation in the first 24 h after critical care admission using machine learning approaches

Early and accurate prediction of the need for intubation may provide more time for preparation and increase safety margins by avoiding high risk late intubation. This study evaluates whether machine learning can predict the need for intubation within 24 h using commonly available bedside and laboratory parameters taken at critical care admission. We extracted data from 2 large critical care databases (MIMIC-III and eICU-CRD). Missing variables were imputed using autoencoder. Machine learning classifiers using logistic regression and random forest were trained using 60% of the data and tested using the remaining 40% of the data. We compared the performance of logistic regression and random forest models to predict intubation in critically ill patients. After excluding patients with limitations of therapy and missing data, we included 17,616 critically ill patients in this retrospective cohort. Within 24 h of admission, 2,292 patients required intubation, whilst 15,324 patients were not intubated. Blood gas parameters (PaO2, PaCO2, HCO3-), Glasgow Coma Score, respiratory variables (respiratory rate, SpO2), temperature, age, and oxygen therapy were used to predict intubation. Random forest had AUC 0.86 (95% CI 0.85-0.87) and logistic regression had AUC 0.77 (95% CI 0.76-0.78) for intubation prediction performance. Random forest model had sensitivity of 0.88 (95% CI 0.86-0.90) and specificity of 0.66 (95% CI 0.63-0.69), with good calibration throughout the range of intubation risks. The results showed that machine learning could predict the need for intubation in critically ill patients using commonly collected bedside clinical parameters and laboratory results. It may be used in real-time to help clinicians predict the need for intubation within 24 h of intensive care unit admission.Peer reviewe

Transcriptional Profiling of Endocrine Cerebro-Osteodysplasia Using Microarray and Next-Generation Sequencing

BACKGROUND: Transcriptome profiling of patterns of RNA expression is a powerful approach to identify networks of genes that play a role in disease. To date, most mRNA profiling of tissues has been accomplished using microarrays, but next-generation sequencing can offer a richer and more comprehensive picture. METHODOLOGY/PRINCIPAL FINDINGS: ECO is a rare multi-system developmental disorder caused by a homozygous mutation in ICK encoding intestinal cell kinase. We performed gene expression profiling using both cDNA microarrays and next-generation mRNA sequencing (mRNA-seq) of skin fibroblasts from ECO-affected subjects. We then validated a subset of differentially expressed transcripts identified by each method using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Finally, we used gene ontology (GO) to identify critical pathways and processes that were abnormal according to each technical platform. Methodologically, mRNA-seq identifies a much larger number of differentially expressed genes with much better correlation to qRT-PCR results than the microarray (r² = 0.794 and 0.137, respectively). Biologically, cDNA microarray identified functional pathways focused on anatomical structure and development, while the mRNA-seq platform identified a higher proportion of genes involved in cell division and DNA replication pathways. CONCLUSIONS/SIGNIFICANCE: Transcriptome profiling with mRNA-seq had greater sensitivity, range and accuracy than the microarray. The two platforms generated different but complementary hypotheses for further evaluation

Thermally Driven Analog of the Barkhausen Effect at the Metal-Insulator Transition in Vanadium Dioxide

The physics of the metal-insulator transition (MIT) in vanadium dioxide remains a subject of intense interest. Because of the complicating effects of elastic strain on the phase transition, there is interest in comparatively strain-free means of examining VO2 material properties. We report contact-free, low-strain studies of the MIT through an inductive bridge approach sensitive to the magnetic response of VO2 powder. Rather than observing the expected step-like change in susceptibility at the transition, we argue that the measured response is dominated by an analog of the Barkhausen effect, due to the extremely sharp jump in the magnetic response of each grain as a function of time as the material is cycled across the phase boundary. This effect suggests that future measurements could access the dynamics of this and similar phase transitions.Comment: 16 pages, 4 figures. Accepted for publication in Appl. Phys. Let

SIRT1-dependent myoprotective effects of resveratrol on muscle injury induced by compression

© 2015 Sin, Yung, Yip, Chan, Wong, Tam and Siu. Our current understanding on the molecular mechanisms by which sustained compression induces skeletal muscle injury is very limited. This study aimed to test the hypothesis that activation of SIRT1 by the natural antioxidant resveratrol could deactivate apoptotic and catabolic signaling in skeletal muscle exposed to moderate compression. Two cycles of 6-h constant pressure at 100 mmHg was applied to the tibialis region of right, but not left hindlimbs of Sprague Dawley rats pre-treated with DMSO (vehicle control) or resveratrol with/without sirtinol. Skeletal muscle tissues lying underneath and spatially corresponding to the compressed sites were collected for analyses. Resveratrol prevented the compression-induced manifestations of pathohistological damages including elevations of the number of interstitial nuclei and area of interstitial space and ameliorated oxidative damages measured as 4-hydroxy-2-nonenal (4HNE) and nitrotyrosine in skeletal muscle. In parallel, resveratrol augmented the expression level and activity of SIRT1 and phosphorylation levels of Foxo3a and Akt while suppressed the increases in protein abundances of p53, Bax, MAFbx, and ubiquitin, enzymatic activities of caspase 3 and 20S proteasome, and apoptotic DNA fragmentation in the compressed muscle. These favorable myoprotective effects of resveratrol were diminished upon pharmacological blockade of SIRT1 by using sirtinol. These novel data support the hypothesis that the anti-apoptotic and anti-catabolic effects of resveratrol on compression injury in skeletal muscle required the action of SIRT1.Link_to_subscribed_fulltex

Implications of MicroRNAs in the treatment of gefitinib-resistant non-small cell lung cancer

2015-2016 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe