Utilization of Failure Mode and Effects Analysis (FMEA) Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (p<0.001). 111.0% increase in the ED revenue after solving of first priority problems reveals that they were extremely indispensable in decreasing the revenue (p<0.0001). Conclusion: The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by nursing unit and lack of specific identifying code for the patients' files, moving from ED to any other department, were the two first priority problems in decreasing our ED revenue.

A Mixed Integer Programming Formulation for the Heterogeneous Fixed Fleet Open Vehicle Routing Problem

The heterogeneous fixed fleet open vehicle routing problem (HFFOVRP) is one of the most significant extension problems of the open vehicle routing problem (OVRP). The HFFOVRP is the problem of designing collection routes to a number of predefined nodes by a fixed fleet number of vehicles with various capacities and related costs. In this problem, the vehicle doesn’t return to the depot after serving the last customer. Because of its numerous applications in industrial and service problems, a new model of the HFFOVRP based on mixed integer programming is proposed in this paper. Furthermore, due to its NP-hard nature, an ant colony system (ACS) algorithm was proposed. Since there were no existing benchmarks, this study generated some test problems. From the comparison with the results of exact algorithm, the proposed algorithm showed that it can provide better solutions within a comparatively shorter period of time

An Efficient Solution for the VRP by Using a Hybrid Elite Ant System

The vehicle routing problem (VRP) is a well-known NP-Hard problemin operation research which has drawn enormous interest from many researchers duringthe last decades because of its vital role in planning of distribution systems andlogistics. This article presents a modified version of the elite ant system (EAS) algorithmcalled HEAS for solving the VRP. The new version mixed with insert and swapalgorithms utilizes an effective criterion for escaping from the local optimum points.In contrast to the classical EAS, the proposed algorithm uses only a global updatingwhich will increase pheromone on the edges of the best (i.e. the shortest) route andwill at the same time decrease the amount of pheromone on the edges of the worst(i.e. the longest) route. The proposed algorithm was tested using fourteen instancesavailable from the literature and their results were compared with other well-knownmeta-heuristic algorithms. Results show that the suggested approach is quite effectiveas it provides solutions which are competitive with the best known algorithms in theliterature

Association Between Objectively Sleep Pattern and Obesity in the Elderly

Background: Previous studies on the relationship between sleep patterns and obesity in the elderly are limited and have conflicting results. Moreover, few studies have measured sleep patterns objectively. In this study, we investigated objective sleep patterns and their relationship with obesity in the elderly in Tehran, Iran.Methods: In this cross-sectional study, 88 elderly (≥60 years old) who were members of health homes of zone 5 in Tehran, Iran, were included by simple random sampling method in 2014. Sleep patterns were objectively assessed using waist actigraphy for a mean of 4.3 ± 1.7 days). Height, weight, and waist circumference (WC) were measured by standard methods and body mass index (BMI) was calculated. Data entry and statistical analyses were performed using SPSS version 21.Results: Mean actigraphy-assessed sleep duration, sleep efficiency (percentage of time in bed spent sleeping), and sleep latency (time required to fall asleep) were 427 ± 62 min, 71.3 ± 18%, and 14.2 ± 3.8 min, respectively. A negative relationship was found between BMI and sleep duration (r = −0.2, p = 0.03), BMI and sleep efficiency (r = −0.3, p=0.01), and WC and sleep efficiency (r = −0.2, p = 0.04). Also, a positive association was observed between BMI and sleep latency (r = 0.4, p = 0.006).Conclusions: In the elderly, actigraphy-assessed sleep duration was associated with obesity and the sleep efficiency was poor in obese participants. It seems that sleep patterns and BMI are correlated with each other. However, there is a need for prospective studies to affirm causal relationships between these constructs

Association Between Objectively Sleep Pattern and Obesity in the Elderly

Background: Previous studies on the relationship between sleep patterns and obesity in the elderly are limited and have conflicting results. Moreover, few studies have measured sleep patterns objectively. In this study, we investigated objective sleep patterns and their relationship with obesity in the elderly in Tehran, Iran.Methods: In this cross-sectional study, 88 elderly (≥60 years old) who were members of health homes of zone 5 in Tehran, Iran, were included by simple random sampling method in 2014. Sleep patterns were objectively assessed using waist actigraphy for a mean of 4.3 ± 1.7 days). Height, weight, and waist circumference (WC) were measured by standard methods and body mass index (BMI) was calculated. Data entry and statistical analyses were performed using SPSS version 21.Results: Mean actigraphy-assessed sleep duration, sleep efficiency (percentage of time in bed spent sleeping), and sleep latency (time required to fall asleep) were 427 ± 62 min, 71.3 ± 18%, and 14.2 ± 3.8 min, respectively. A negative relationship was found between BMI and sleep duration (r = −0.2, p = 0.03), BMI and sleep efficiency (r = −0.3, p=0.01), and WC and sleep efficiency (r = −0.2, p = 0.04). Also, a positive association was observed between BMI and sleep latency (r = 0.4, p = 0.006).Conclusions: In the elderly, actigraphy-assessed sleep duration was associated with obesity and the sleep efficiency was poor in obese participants. It seems that sleep patterns and BMI are correlated with each other. However, there is a need for prospective studies to affirm causal relationships between these constructs

The study of fibroblast proteome changes in the presence of Ethanol

    Ethanol known as ethyl alcohol is being widely used around the world. Many serious diseases are related with its consumption.  Alcohol posses many divers effects on human body including risk of cirrhosis and/or hepatocellular carcinoma. Therefore, analysis of this component is prominent. Fibroblast cells were cultured in various dosages of ethanol. The effective dosage was then investigated by proteomic methods.  Separated proteins of fibroblast cells by Two-Dimensional Gel (2DG) Electrophoresis method based on pI and MW were analyzed based on spots alteration by Same Spot Software. Furthered analysis was carried out with vigorous statistical analysis based on significant folding changes and one-way ANOVA. About 372 protein spots were identified and among them 65 of them were having significant expression profile, which is evaluated as p <0.05. Therefore, ethanol can induce a great impact on protein profile of fibroblast. It is concluded that altering morphologic features and viability, as well as protein expression changes, confirm toxic properties of ethanol in human body.

A Review of Non-pharmacological Oral Supplements Containing Nutrients and Micronutrients in the Treatment of Osteoarthritis

Since osteoarthritis is the most common musculoskeletal inflammation that causes people to be unable to move with age, a proper diet can be effective in treating it. Therefore, understanding the impact of non-pharmacological nutritional supplements may provide guidelines for the prevention of this disease thereby reducing the costs of medical care. The purpose of this study was to review the effect of various non-pharmacological dietary supplements containing nutrients and micronutrients in the prevention and treatment of osteoarthritis. Taking these non-pharmacological nutritional supplements over a short to medium term reduced pain and inflammation, and improved patients' quality of life. However, their impact was low to moderate. To achieve the best treatment results in patients with osteoarthritis, it is recommended that these dietary supplements be taken along with medication and adopt a healthier lifestyle

The Association between Obesity and Quality of Life among the Elderly

Background: The prevalence of obesity in the elderly is increasing worldwide. Obesity greatly impacts quality of life(QoL). The present study aimed to investigate the association between obesity and QoL among the elderly, in Tehran, Iran.Methods: This cross-sectional study (observational) was conducted in 2014 in Tehran, Iran. A total of 421 elderly people aged ≥ 60 years old were recruited using simple random sampling methods. Height, weight, and waist circumference were measured by standard methods; body mass index (BMI) was calculated from height and weight. QoL was evaluated by the Persian language version of the SF-36 questionnaire.The alpha value was set at 0.05 to indicate the statistical significant level. Independent samples t-tests and Chi-square tests were used for comparing the quantitative and categorical variables, respectively. One-way ANOVA, followed by Tukeys’ post-hoc test, was used to compare mean scores of SF-36 scales between BMI groups. Pearson correlation coefficients were used for investigating the relationship between SF-36 scores and anthropometric parameters.Results: The mean age of participants was 77.6 ± 8.6 years. The frequency of obesity and overweight (BMI ≥ 25 kg/m2) was 59.4% (57.2% in males and 60.6% in females). Except for the mental health scale, for all other SF-36 scale mean scores, participants with overweight or obesity had lower scores compared to their normal weight counterparts (p < 0.05). Additionally, subjects with underweight had significantly lower scores for the vitality scale (p < 0.05).Conclusions: The results of present study persist on importance of preserving normal weight on improving quality of life in elderly. Although the observed association in this study was bidirectional and prospective studies are needed to investigate the cause and effect relationship.