A framework for health care planning and control

Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address various important planning and control problems. We conclude that they only focus on hospitals, and are too narrow, focusing on a single managerial area, such as resource capacity planning, or ignoring hierarchical levels. We propose a modern framework for health care planning and control. Our framework integrates all managerial areas involved in health care delivery operations and all hierarchical levels of control, to ensure completeness and coherence of responsibilities for every managerial area. The framework can be used to structure the various planning and control functions, and their interaction. It is applicable broadly, to an individual department, an entire health care organization, and to a complete supply chain of cure and care providers. The framework can be used to identify and position various types of managerial problems, to demarcate the scope of organization interventions, and to facilitate a dialogue between clinical staff and managers. We illustrate the application of the framework with examples

Toxicity of cancer therapy: what the cardiologist needs to know about angiogenesis inhibitors

Clinical outcomes for patients with a wide range of malignancies have improved substantially over the last two decades. Tyrosine kinase inhibitors (TKIs) are potent signalling cascade inhibitors and have been responsible for significant advances in cancer therapy. By inhibiting vascular endothelial growth factor receptor (VEGFR)-mediated tumour blood vessel growth, VEGFR-TKIs have become a mainstay of treatment for a number of solid malignancies. However, the incidence of VEGFR-TKI-associated cardiovascular toxicity is substantial and previously under-recognised. Almost all patients have an acute rise in blood pressure, and the majority develop hypertension. They are associated with the development of left ventricular systolic dysfunction (LVSD), heart failure and myocardial ischaemia and can have effects on myocardial repolarisation. Attention should be given to rigorous baseline assessment of patients prior to commencing VEGFR-TKIs, with careful consideration of baseline cardiovascular risk factors. Baseline blood pressure measurement, ECG and cardiac imaging should be performed routinely. Hypertension management currently follows national guidelines, but there may be a future role forendothelin-1 antagonism in the prevention or treatment of VEGFR-TKI-associated hypertension. VEGFR-TKI-associated LVSD appears to be independent of dose and is reversible. Patients who develop LVSD and heart failure should be managed with conventional heart failure therapies, but the role of prophylactic therapy is yet to be defined. Serial monitoring of left ventricular function and QT interval require better standardisation and coordinated care. Management of these complex patients requires collaborative, cardio-oncology care to allow the true therapeutic potential from cancer treatment while minimising competing cardiovascular effects

De reikwijdte van het beslag

Mr. J.H. van Dam-Lely en mr. M.L. Tuil doen verslag van de voorjaarsvergadering van de Nederlandse Vereniging voor Procesrecht op 6 juni 2008 over de ‘reikwijdte van het beslag’. De inleidingen van mr. A.J. van der Meer (beslagverlof en opheffingskortgeding), mr. J.G.A. Linssen (bewijsbeslag) en mr. J.C. van Oven (beslag op verhulde beslagobjecten) worden in het verslag beknopt samengevat; van de discussie wordt uitgebreid verslag gedaan

De prijs van het gelijk

Het verslag van de discussie die is gevoerd tijdens de vergadering van de Nederlandse Vereniging voor Procesrecht van 1 jnui 2007 naar aanleiding van de inleidingen van mr. J.L.R.A. Huydecoper, mr. G.A. van der Veen en mr. F.B. Falkena met als centraal thema de kritische bespreking van het systeem van vergoeding van gerechtelijke en buitengerechtelijke kosten

Brain adaptation and alternative developmental trajectories

Resilience and adaptation in the face of early genetic or environmental risk has become a major interest in child psychiatry over recent years. However, we still remain far from an understanding of how developing human brains as a whole adapt to the diffuse and widespread atypical synaptic function that may be characteristic of some common developmental disorders. The first part of this paper discusses four types of whole-brain adaptation in the face of early risk: redundancy, reorganization, niche construction, and adjustment of developmental rate. The second part of the paper applies these adaptation processes specifically to autism. We speculate that key features of autism may be the end result of processes of early brain adaptation, rather than the direct consequences of ongoing neural pathology

Dissolution profile of theophylline modified release tablets, using a biorelevant Dynamic Colon Model (DCM)

AbstractThe human proximal colon has been considered a favourable site to deliver drugs for local and systemic treatments. However, modified dosage forms face a complex and dynamically changing colonic environment. Therefore, it has been realized that in addition to the use of biorelevant media, the hydrodynamics also need to be reproduced to create a powerful in vitro dissolution model to enable in vivo performance of the dosage forms to be predicted.A novel biorelevant Dynamic Colon Model (DCM) has been developed which provides a realistic environment in terms of the architecture of the smooth muscle, the physical pressures and the motility patterns occurring in the proximal human colon. Measurements of pressure inside the DCM tube confirmed a direct association between the magnitude of the pressure signal with the occlusion rate of the membrane and the viscosity of the fluid.The dissolution profile and the distribution of the highly soluble drug, theophylline, were assessed by collecting samples at different locations along the DCM tube. Differences in the release rates of the drug were observed which were affected by the sampling point location, the viscosity of the fluid and the mixing within the DCM tube. Images of the overall convective motion of the fluid inside the DCM tube obtained using Positron Emission Tomography enabled relation of the distribution of the tracer to likely areas of high and low concentrations of the theophylline drug.This information provides improved understanding of how extensive phenomena such as supersaturation and precipitation of the drug may be during the passage of the dosage form through the proximal colon

An analytical comparison of the patient-to-doctor policy and the doctor-to-patient policy in the outpatient clinic

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room, while patients visit for consultation, we call this the Patient-to-Doctor policy. A different approach is the Doctor-to-Patient policy, whereby the doctor travels between multiple consultation rooms, in which patients prepare for their consultation. In the latter approach, the doctor saves time by consulting fully prepared patients. We compare the two policies via a queueing theoretic and a discrete-event simulation approach. We analytically show that the Doctor-to-Patient policy is superior to the Patient-to-Doctor policy under the condition that the doctor’s travel time between rooms is lower than the patient’s preparation time. Simulation results indicate that the same applies when the average travel time is lower than the average preparation time. In addition, to calculate the required number of consultation rooms in the Doctor-to-Patient policy, we provide an expression for the fraction of consultations that are in immediate succession; or, in other words, the fraction of time the next patient is prepared and ready, immediately after a doctor finishes a consultation.We apply our methods for a range of distributions and parameters and to a case study in a medium-sized general hospital that inspired this research

Annual research review: Infant development, autism, and ADHD – early pathways to emerging disorders

- Background: Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders, with a high degree of co-occurrence. - Methods: Prospective longitudinal studies of infants who later meet criteria for ASD or ADHD offer the opportunity to determine whether the two disorders share developmental pathways. - Results: Prospective studies of younger siblings of children with autism have revealed a range of infant behavioral and neural markers associated with later diagnosis of ASD. Research on infants with later ADHD is less developed, but emerging evidence reveals a number of relations between infant measures and later symptoms of inattention and hyperactivity. - Conclusions: We review this literature, highlighting points of convergence and divergence in the early pathways to ASD and ADHD