Planning and Managing of Diagnostic Imaging Technologies in Healthcare: The Introduction of Managed Equipment Service (MES) for the System’s Sustainability

The lack of resources has driven healthcare management studies to recognise Private and Public Partnerships (PPP) as the solution in managing efficiency, effectiveness and profitability of technological innovation. Recent researchers have identified the buying model called Managed Equipment Service (MES), in which purchaser and seller share the risks of technology’s management and use, as an optimal problem-solving method. The aim of this research is to analyse the potential economic-financial and organizational benefits of MES introduction in healthcare, in particular for the acquisition of the diagnostic imaging technologies. The research applies the case study method. We have examined a representative Italian Local Health Authority for its dimensions, managerial characteristics and case-mix offered but, especially, for its high health standards. In the study we have involved the strategic figure of radiographer in diagnostic imaging. The data has been elaborated through statistical analysis to observe the correlations. Evidence demonstrates that MES costs are lower than all the other planning and purchasing methods analysed (between 11% - 239%). When correlations between age of facilities and effectiveness of provided services is strong, MES grants the maintenance of a lower average age of technologies and a more efficient use of resources and significant margins of profitability. The emerging model of PPP is a possible solution to the current issues surrounding economic and financial sustainability of healthcare systems, considered the fewer resources and the technological progress. MES in healthcare appears to be a highly efficient way of managing innovation, in particular for diagnostic imaging technologies. Keywords: Public Private Partnership (PPP), Managed Equipment Service (MES), middle-high technologies, diagnostic imaging

The impact of outsourcing operating theatre support services on hospital performances: the case of the largest university hospital of the Albania

Hospitals in most of the countries in transition face the challenge to raise efficiency in a rapidly evolving health sector. In this framework, the Albanian Ministry of Health has outsourced the sterilization and operating theatre support(SOTS) services of all the public hospitals. The aim of this article is to evaluate the impact of the outsourcing of SOTS services on the productivity of the surgical services. A case study analysis was conducted in the Country’s largest hospital. Surgical activity data of all the surgical services were analyzed. Furthermore, interviews with key stakeholders were conducted in order to enable a more detailed exploration of the results. Compared with the previous twelve months, a relevant increase in the total number of surgical interventions performed by the hospital was registered in the twelve months after the introduction of the new organizational model (þ14%); this significant increase occurred in almost all the surgical services. Results of the interviews highlighted several organizational-, supply capacity-, and confidencerelated determinants behind the productivity gains. These findings have significant implications for poorly performant—but increasingly competitive and evolving—hospital sectors of countries in transition, in which the outsourcing of SOTS services may represent a key tool for enhancing the productivity

Governance models for historical hospitals: evidence from Italy

Abstract Many hospitals and health care organizations over the centuries have inherited handcrafts of artistic value, objects of worships, donations from pilgrims, votive offerings, legates as a result of their centuries-old activity in the social and health care of their community. The value of these artistic assets and the role in the territory of these hospitals have transformed them into cultural heritage over time, introducing the issue of the coexistence of cultural and care management. Therefore, the aim of this paper is to identify governance models of what we will call historical hospitals, that is, hospitals that because of their history, their assets, and their artistic heritage, far from being places only dedicated to provision of health care services represent cultural heritage. To pursue this research objective, five Italian historical hospitals were selected and identified as significant case studies for their historic and artistic relevance. Through the analysis of these case studies the paper identifies models of governance of historical hospitals and the reasons of their adoption

Scolosis secondary to ganglioneuroma: Case report and up to date literature review

Idiopathic scoliosis is the most common form of spinal deformity in children. However, secondary causes of scoliosis, such as ganglioneuroma, should be always considered to avoid wrong diagnosis, and further investigations are required when there are atypical signs. We report a case of ganglioneuroma misdiagnosed as idiopathic scoliosis and review the literature to identify the red flags useful for physicians during the evaluation of a child with scoliosis. On the basis of both clinical and radiographic criteria that emerged from this study, we propose an algorithm that could help in the differential diagnosis, suggesting when to perform an MRI.Idiopathic scoliosis is the most common form of spinal deformity in children. However, secondary causes of scoliosis, such as ganglioneuroma, should be always considered to avoid wrong diagnosis, and further investigations are required when there are atypical signs. We report a case of ganglioneuroma misdiagnosed as idiopathic scoliosis and review the literature to identify the red flags useful for physicians during the evaluation of a child with scoliosis. On the basis of both clinical and radiographic criteria that emerged from this study, we propose an algorithm that could help in the differential diagnosis, suggesting when to perform an MRI

High levels of serum prostaglandin E2 in children with osteogenesis imperfecta are reduced by neridronate treatment.

Prostaglandin E2 (PGE2) is an activator of bone remodeling, and increase levels of PGE2 are found in several disorders characterized by chronic inflammation. Bisphosphonates are used in the treatment of osteogenesis imperfecta (OI), an inherited disorder characterized by bone fragility and low bone mass. We evaluated the serum PGE2 (ng/mL) level in 16 children affected by OI (11 with mild and 5 with severe forms) at basal time and during treatment with neridronate. The levels of PGE2 in mild and severe forms were increased at basal time compared with controls (13.14 ± 4.2 versus 0.72 ± 0.05, p < 0.01; 15.1 ± 1.5 versus 0.72 ± 0.05, p < 0.01, respectively) and showed a significant decrease after the second (T1) cycle of treatment (mild: 4.97 ± 5.0 versus 13.14 ± 4.2, p < 0.01; severe: 5.32 ± 4.5 versus 15.1 ± 1.5, p < 0.01) with a further significant decrease after the fourth (T2) cycle. The high basal PGE2 levels in OI, a noninflammatory disorder, could be explained by stress-induced release mediated by inducible cyclooxygenase-2-catalyzed pathway. The reduction obtained by treatment with bisphosphonates could be attributed to a direct pharmacological effect since these drugs has been reported to modulate the release of proinflammatory mediators

Echo state networks for the recognition of type 1 Brugada syndrome from conventional 12-LEAD ECG

Artificial Intelligence (AI) applications and Machine Learning (ML) methods have gained much attention in recent years for their ability to automatically detect patterns in data without being explicitly taught rules. Specific features characterise the ECGs of patients with Brugada Syndrome (BrS); however, there is still ambiguity regarding the correct diagnosis of BrS and its differentiation from other pathologies.This work presents an application of Echo State Networks (ESN) in the Recurrent Neural Networks (RNN) class for diagnosing BrS from the ECG time series.12-lead ECGs were obtained from patients with a definite clinical diagnosis of spontaneous BrS Type 1 pattern (Group A), patients who underwent provocative pharmacological testing to induce BrS type 1 pattern, which resulted in positive (Group B) or negative (Group C), and control subjects (Group D). One extracted beat in the V2 lead was used as input, and the dataset was used to train and evaluate the ESN model using a double cross-validation approach. ESN performance was compared with that of 4 cardiologists trained in electrophysiology.The model performance was assessed in the dataset, with a correct global diagnosis observed in 91.5 % of cases compared to clinicians (88.0 %). High specificity (94.5 %), sensitivity (87.0 %) and AUC (94.7 %) for BrS recognition by ESN were observed in Groups A + B vs. C + D.Our results show that this ML model can discriminate Type 1 BrS ECGs with high accuracy comparable to expert clinicians. Future availability of larger datasets may improve the model performance and increase the potential of the ESN as a clinical support system tool for daily clinical practice