Could Value-Based Purchasing Approach Be Used in Assessment of Healthcare Delivery Outputs?

In spite of increasing expenditures for health services, the lack of improvement in the quality and patient safety at the desired level brought about the search for reform of the reimbursement mechanisms. The main purpose of the present review is a search for a comprehensive answer for the question of "Can Value-based Purchasing (VPB) approach emerged as such kind of quest and applications developed in this context be used to evaluate the outputs of health service delivery?". According to the studies, the VBP approach and especially Hospital Value-based Purchasing Program and Hospital-Acquired Conditions Program which are the two applications developed under this approach can provide effective results in evaluating the outputs in health services and improving quality and patient safety. The data show that the VBP approach in health care has the potential to contribute significantly to improving the quality and patient safety level of the health care service and to keep costs under control. In this context, Hospital Value-based Purchasing and Hospital-Acquired Conditions Programs draw attention in terms of its potential to be implemented especially in the public sphere in our country. The realization of the research and applications in our country aimed at revealing the potential benefits of the mentioned programs will facilitate the evaluation

Wall-to-horizontal diaphragm connections in historical buildings: A state-of-the-art review

Wall-to-horizontal diaphragm connections play a crucial role in the global stability of historical buildings under seismic actions. When these links are ineffective or absent, engineered measures should be considered to enhance the earthquake-resistant box-type behavior. Besides the great variety on the construction systems and materials, common damages were observed in recent seismic events showing the high vulnerability of local mechanisms promoted by the lack of structural integrity. Although the acknowledged importance of connections, this topic has been practically neglected over time among the research community and practitioners and only few of them focused on the influence of diaphragm-to-wall connections on the dynamic behavior of the building as a whole.This paper presents a literature review of the traditional wall-to-floor or wall-to-roof connections in unreinforced masonry buildings and summarizes typical and innovative strengthening solutions, taking into account the indications provided by the few design codes addressing this topic. Experimental laboratory researches are investigated, including shaking table tests on global and local scale, and cyclic or monotonic tests to characterize anchoring systems. An overview of the typical vulnerability assessment approaches and modelling techniques is given, considering present standards that account for connections.This work was partly financed by FEDER funds through the Operational Programme Competitiveness Factors (COMPETE) and by national funds through the Foundation for Science and Technology (FCT) within the scope of project POCI-01-0145-FEDER-007633. The financial support of FCT to the first author, through the PhD grant SFRH/BD/131652/2017, is also acknowledged

Atypical glandular cells in conventional cervical smears: Incidence and follow-up

BACKGROUND: Atypical glandular cells on cervical smears are often associated with clinically significant uterine lesions. The frequency and accuracy of AGC-NOS (i.e. atypical glandular cells, not otherwise specified) diagnoses, regardless of the gland cell type or the degree of suspicion, and their outcome were investigated. METHODS: From January 1, 1990 to December 31, 1999 a total of 261 patients had an AGC-NOS diagnosis made by conventional cervical Papanicolaou smear interpretation representing 0.05% of all Pap-smears analyzed at the national level. 191 (73.2%) patients had a subsequent histological examination, 8 samples were not representative by origin and were excluded. RESULTS: Out of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis. CONCLUSION: Our findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required

In vitro and in vivo characterization of highly purified Human Mesothelioma derived cells

<p>Abstract</p> <p>Background</p> <p>Malignant pleural mesothelioma is a rare disease known to be resistant to conventional therapies. A better understanding of mesothelioma biology may provide the rationale for new therapeutic strategies. In this regard, tumor cell lines development has been an important tool to study the biological properties of many tumors. However all the cell lines established so far were grown in medium containing at least 10% serum, and it has been shown that primary cell lines cultured under these conditions lose their ability to differentiate, acquire gene expression profiles that differ from that of tissue specific stem cells or the primary tumor they derive from, and in some cases are neither clonogenic nor tumorigenic. Our work was aimed to establish from fresh human pleural mesothelioma samples cell cultures maintaining tumorigenic properties.</p> <p>Methods</p> <p>The primary cell cultures, obtained from four human pleural mesotheliomas, were expanded in vitro in a low serum proliferation-permissive medium and the expression of different markers as well as the tumorigenicity in immunodeficient mice was evaluated.</p> <p>Results</p> <p>The established mesothelioma cell cultures are able to engraft, after pseudo orthotopic intraperitoneal transplantation, in immunodeficient mouse and maintain this ability to after serial transplantation. Our cell cultures were strongly positive for CD46, CD47, CD56 and CD63 and were also strongly positive for some markers never described before in mesothelioma cell lines, including CD55, CD90 and CD99. By real time PCR we found that our cell lines expressed high mRNA levels of typical mesothelioma markers as mesothelin (MSLN) and calretinin (CALB2), and of BMI-1, a stemness marker, and DKK1, a potent Wingless [WNT] inhibitor.</p> <p>Conclusions</p> <p>These cell cultures may provide a valuable in vitro and in vivo model to investigate mesothelioma biology. The identification of new mesothelioma markers may be useful for diagnosis and/or prognosis of this neoplasia as well as for isolation of mesothelioma tumor initiating cells.</p

Bibliometric analysis of studies on HRM during Covid-19 pandemic

Purpose- The purpose of this research is to determine the course of HRM research studies conducted during the COVID 19 Pandemic period by focusing on the author, country, citation, subject, etc. Methodology- The research was carried out with the method of bibliometric analysis. The articles containing the subjects of COVID-19 Pandemic and HRM published in the Web of Science Core Collection database between 2020 and 2021 were examined within the scope of the research. Findings- As a result of the research conducted, it is observed that 206 publications covering the subjects of pandemic and HRM were made between 2020-2021. These publications were included in 139 sources (journals, books, etc.), written by 1004 authors. Citation rate per article was 6.019 and the collaboration index of authors was quite high (5.72). Moreover, it is found that the journal publishing the most articles on HRM during the pandemic period was BMJ Open. The most relevant institution on the subject was Shanghai Jiao Tong University with 14 articles. The countries publishing the most articles were China, the USA and India, respectively, and the countries that received the most citations per article were Brazil, Denmark and Kuwait. It is determined that the most cited article worldwide is Carnevale JB 2020 with 122 citations. In the keyword analysis of the author, it is revealed that the terms of COVID-19, human resource management, COVID-19 pandemic, pandemic, coronavirus, crisis management, health policy, public health, human resource development and mental health are mostly used. Conclusion- It is believed that the findings obtained as a result of the research will contribute to the literature. Carrying out the research using a single database (Web of Science) constitutes an important limitation for the research. Keywords: Human resources, human resources development, Covid-19, pandemic, bibliometric analysis. JEL Codes: M12, M15, M54 </jats:p

Evaluation of three different techniques for measuring wound area in diabetic foot ulcers: a reproducibility study

Objective: Wound surface area can be measured with several assessment tools, including a manual planimetric method, ImageJ software and three-dimensional wound measurement (3DWM) methods. This study aimed to determine the advantages of each method as well as the concordance between them. Method: This reproducibility study included adult patient volunteers with diabetic foot ulcers (DFUs). Wounds with ambiguous borders were excluded. All included wounds were sequentially assessed with each of the three measurement methods, and the time for each measurement was recorded with a chronometer. SPSS and MedCalc package software were used for all statistical analyses. Results: A total of 20 patients with 20 DFUs took part in the study. According to the measurement method, the average wound area was 6.41cm2 by the manual planimetric method, 6.53cm2 by ImageJ and 6.32cm2 by 3DWM. Correlation analyses revealed correlation coefficients of 0.997 between the manual planimetric method and ImageJ, 0.929 between the manual planimetric method and 3DWM, and 0.929 between ImageJ and 3DWM. Bland–Altman analysis was used to determine whether these three measurement methods could be used interchangeably. There was no significant difference between the three measurement methods and, therefore, it was concluded that they could be used interchangeably. Wound area measurement times were 173.35±19.38 seconds by the manual planimetric method, 61.60±9.21 seconds by ImageJ and 36.90±6.91 seconds by the 3DWM method. Conclusion: The three measurement methods studied can be used interchangeably, as each method is highly concordant with the other two. The fastest method was 3DWM and the manual planimetric method was the slowest. </jats:sec

Waste management approaches in hospital organizations and an example of practice

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Effect of an Educational Intervention Based on Bandura's Theory on Foot Care Self-Efficacy in Diabetes: A Prospective Quasi-Experimental Study

toygar, ismail/0000-0003-3065-5756; YILDIRIM SIMSIR, ILGIN/0000-0002-6801-8499WOS: 000560792300001PubMed: 32806981The purpose of this study is to evaluate the foot care self-efficacy of diabetic foot patients and the effect of an educational intervention for improving it. This study was of a semi-experimental design and was conducted between January and December 2019 in a diabetic foot council of a university hospital. After power analysis to determine sample size, 33 participants meeting the inclusion criteria were included in the study. A Patient Identification Form and Diabetic Foot Care Self-Efficacy Scale (DFCSES) were used to collect data. of the patients, 51.5% were male and the mean age was 54.91 +/- 16.61 years. the mean score of DFCSES was 50.18 +/- 20.88 before education and 72.67 +/- 20.74 after education. the educational intervention has large effects on self-efficacy (d= 1.233), perceived knowledge level on diabetic foot (d= 1.102), perceived health status (d= 0.859), and perceived quality of life (d= 0.807). Educational intervention was found to be an effective way to improve foot care self-efficacy, perceived knowledge level on diabetic foot, perceived health status, and perceived quality of life