Capacity planning in Specialized Healthcare

The purpose of the thesis is to contribute to the knowledge of healthcare capacity planning for effective use of resources. Capacity planning concerns the balancing of the demand for capacity with the available capacity of the production system. Within the healthcare setting, various studies report on the difficulties of providing healthcare services according to patient demand. So, how can the balance between required and available capacity be achieved? How can we use our resources in accordance with what the patients need?The research presented in this thesis is based on five research questions which are answered by the results of five case studies made at Swedish hospital departments. The research questions concern how discrepancies between practice and capacity planning theory may affect production performance; what a tactical capacity planning framework in healthcare would comprise; on what conditions rough-cut capacity methods (RCCP) are applicable in healthcare; the importance of including the knowledge of the surgeons when estimating required capacity; and if a team-based workflow can be employed without compromising production performance. The five research questions are answered through five individual studies, all with a case study approach. The findings presented in this thesis provide knowledge regarding the structure of capacity planning processes; more specifically regarding the linkages between capacity planning processes and their effects on production performance. Furthermore, the research provides a step-by-step framework for tactical capacity planning to improve production performance by keeping a long-term perspective when planning. The tactical framework describes the structure of the capacity planning process and its included activities. Additionally, the framework gives an account of required information for the planning process and proposes possible adjustment to balance demand and supply. The output of the planning process is also described. To support the task of balancing required and available capacity two studies contribute to the interpretation of patient demand into required capacity. First, conditions under which rough-cut capacity planning methods are applicable in a healthcare setting are studied and discussed. Second, the research extends existing knowledge of the estimation of required surgery time, based on surgeons’ subjective knowledge of the patient condition and thereby decreasing the risk of exceeding the scheduled surgery time. As concerns assessing available capacity, the research studies the use of a team-based work method, which shows an increase of productivity compared with a functionally divided production system, while maintaining the same level of resources. In a capacity planning perspective, the use of teams simplifies the assessment of available capacity by reducing the number of planning points from individual workers to the number of teams

Infections and hyperbaric oxygen : new methods for highdose protocols and noninvasive measurements

The scientific evidence of Hyperbaric Oxygen Treatment is despite the fact that the hyperbaric method has been in use since 1662 still under debate. At Karolinska University Hospital the method has been under the supervision of the department of anesthesia and intensive care since 1990. The number of treatments increased slowly and reached a total of approximately 3000 /year in 2008 (fig 1) although evidence of the efficacy slowly developed. The facility develops towards HBO for intensive care patients, a real challenge because of the demand for high technology in high-pressure and fire hazard surroundings. Infectious disorders such as severe soft tissue infections or postoperative neurosurgical infections have slowly developed to make a large part of the patients (fig 1). In 2005 a committee from Karolinska Institutet inspected the facility and identified among other things the lack of clinical research projects. My thesis was therefore started first with a description of one of our large patient groups (paper I) and with the aim to perform clinical research projects for severe soft tissue and neurosurgical infectious patients using prospective randomized protocols. The lack of evidence for the correct dosage of HBOT and the lack of non-invasive methods to measure oxygen content in tissues during treatment soon became evident. These issues made the efforts to construct conclusive prospective protocols seem premature and the focus of the thesis changed to help providing a solid basis for future HBO studies. We tested 2 non-invasive methods to monitor oxygen content in target tissues, NIRS and PPG, and developed a new method (HOPAN) to make it possible to treat intensive care patients according to patients’ demands without risk of DCS for attendants. NIRS measurements provided focus on soft tissues and PPG on bone tissues. NIRS (paper II) and PPG (paper III) have been tested with healthy subjects during NBO and HBO. NIRS was found to follow the inhaled oxygen within minutes. Using PPG technique we found individual changes in blood flow following the inhaled oxygen also within minutes. NIRS is a commercially available method though not yet approved for use in hyperbaric chambers. PPG equipments for clinical use are not yet available. To make it possible to test HBO doses with the focus on patient need instead of the conventional compromise between the attendants safety and patient need we constructed a protocol with nitrox breathing for attendants (HOPAN, study IV). In our retrospective evaluation the method we found the method to be safe for both patients and attendants. Both the tested non-invasive oxygen monitoring methods and the new HBO method will hopefully make a contribution to the development of good clinical prospective randomized research protocols

Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface

AbstractObjectives: Heparin coating of the cardiopulmonary bypass circuit is shown to improve the biocompatibility of the surface. We have studied a new heparin surface, the Corline Heparin Surface, applied to a complete set of an extracorporeal device used during coronary artery bypass grafting in terms of activation of inflammation, coagulation, and fibrinolysis in patients and in shed mediastinal blood. Methods: Sixty patients scheduled for coronary artery bypass grafting were randomized to one of 3 groups with heparin-coated devices receiving either a standard, high, or low dose of systemic heparin or to an uncoated but otherwise identical circuit receiving a standard dose of systemic heparin. Samples were drawn before, during, and after the operation from the pericardial cavity and in shed mediastinal blood. No autotransfusion of shed mediastinal blood was performed. Results: The Corline Heparin Surface significantly reduced the activation of coagulation, fibrinolysis, platelets, and inflammation compared with that seen with the uncoated surface in combination with a standard dose of systemic heparin during cardiac surgery with cardiopulmonary bypass. Both a decrease and an increase of systemic heparin in combination with the coated heparin surface resulted in higher activation of these processes. A significantly higher expression of all studied parameters was found in the shed mediastinal blood compared with in systemic blood at the same time. Conclusions: The Corline Heparin Surface used in cardiopulmonary bypass proved to be more biocompatible than an uncoated surface when using a standard systemic heparin dose. The low dose of systemic heparin might not be sufficient to maintain the antithrombotic activity, and the high dose resulted in direct cell activation rather than a further anti-inflammatory and anticoagulatory effect.J Thorac Cardiovasc Surg 2002;124:321-3

Прямые и косвенные директивные речевые акты в речи учащихся

СТУДЕНТЫШКОЛЬНИКИРЕЧЬречевые акты директивныепрагмалингвистик

Predictors in the Swedish Counterterrorism Intervention Unit selection Process

This study examines the importance of physical and psychological predictors of work sample performance within the Swedish police Counterterrorism Intervention Assessment and Selection (CTIAS) process (N = 160). CTIAS consists of a 4-day prescreening (Phase 1) and a 10-day work sample test (Phase 2). Applicants may withdraw freely or be stopped by a CTIAS board (if they do not fulfill the CTIAS requirement criteria) at any moment throughout Phases 1 and 2. The dependent variable was applicants being approved at the end of CTIAS Phase 1. Biserial correlations were used to determine relationships between the predictors’ age, general mental ability, executive functions, personality, physical strength, coordination, running capacity and the dependent variable. Significant (p < 0.01) results in the biserial correlations were strength (r = 0.217), coordination (r = 0.223), and running capacity (r = 0.412). In conclusion, the logistic regression analysis with all predictors revealed that only running capacity (2800 meters) was significant for approval to CTIAS. Implications for the practical selection of CTIAS are discussed, and suggestions for future investigation are proposed. Public significance statement: The current study examined physical and psychological predictors in a selection process within a tactical unit in the Swedish Police Authority. Higher running capacity was the only predictor that increased the odds of approved applicants

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and≥10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results: The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08). Conclusions: Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to ofer support during pregnancy and childbirth

Ассоциация полиморфизма генов ферментов биотрансформации и детоксикации ксенобиотиков с риском развития заболеваний у детей, перенесших перинатальные гипоксические поражения ЦНС

ПОЛИМОРФИЗМ ГЕНЕТИЧЕСКИЙФЕРМЕНТЫБИОТРАНСФОРМАЦИЯЛЕКАРСТВ ДЕТОКСИКАЦИЯ МЕТАБОЛИЧЕСКАЯКСЕНОБИОТИКИФАКТОРЫ РИСКАПЕРИНАТОЛОГИЯНЕРВНАЯ СИСТЕМА ЦЕНТРАЛЬНАЯ /повреждПЛОДА ГИПОКСИ

Методика використання фізичних задач в курсі охорона праці

(uk) У статті розкривається важливість розв’язання фізичних задач в курсі охорона праці. Використання фізичних задач забезпечить повноцінне засвоєння навчального матеріалу з курсу.(en) In the article importance of of physicaltasks opens up in a course labour protection. The use of physical tasks will provide the valuable mastering of educational material from a course

Urinary phosphate is associated with cardiovascular disease incidence

Elevated phosphate (P) in urine may reflect a high intake of inorganic P salts from food additives. Elevated P in plasma is linked to vascular dysfunction and calcification. Objective, To explore associations between P in urine as well as in plasma and questionnaire-estimated P intake, and incidence of cardiovascular disease (CVD). Methods, We used the Swedish Mammography Cohort-Clinical, a population-based cohort study. At baseline (2004–2009), P was measured in urine and plasma in 1625 women. Dietary P was estimated via a food-frequency questionnaire. Incident CVD was ascertained via register-linkage. Associations were assessed using Cox proportional hazards regression. Results, After a median follow-up of 9.4 years, 164 composite CVD cases occurred (63 myocardial infarctions [MIs] and 101 strokes). Median P (percentiles 5–95) in urine and plasma were 2.4 (1.40–3.79) mmol/mmol creatinine and 1.13 (0.92–1.36) mmol/L, respectively, whereas dietary P intake was 1510 (1148–1918) mg/day. No correlations were observed between urinary and plasma P (r = −0.07) or dietary P (r = 0.10). Urinary P was associated with composite CVD and MI. The hazard ratio of CVD comparing extreme tertiles was 1.57 (95% confidence interval 1.05, 2.35; P trend 0.037)—independently of sodium excretion, the estimated glomerular filtration rate, both P and calcium in plasma, and diuretic use. Association with CVD for plasma P was 1.41 (0.96, 2.07; P trend 0.077). Conclusion, Higher level of urinary P, likely reflecting a high consumption of highly processed foods, was linked to CVD. Further investigation is needed to evaluate the potential cardiovascular toxicity associated with excessive intake of P beyond nutritional requirement