ESTIMATION OF THE EFFICIENCY OF JAPANESE HOSPITALS USING A DYNAMIC AND NETWORK DATA ENVELOPMENT ANALYSIS MODEL

This workshop is supported by JSPS KAKENHI Grant Number 22310092 under the title “Theory and Applications of Dynamic DEA with Network Structure.”This study evaluates the policy effect of the reformation of municipal hospitals in Japan. We focused on the efficiency improvement of not only the hospital itself but also separate internal organizations of a hospital. Hospitals have two heterogeneous internal organizations: the medical-examination section and administration section. The administration section carries out business management and the medical-examination section provides medical care services. We employed a dynamic and network data envelopment analysis model. The model makes it possible to estimate both the efficiencies of separate organizations and the dynamic changes of the efficiencies simultaneously. We found that there are positive policy effects. Additionally, we should focus on the administration section rather than the medical-examination section in reforming municipal hospitals in Japan.Workshop 2013 on Dynamic and Network DEA (January 29-30, 2013)conference pape

How successful was the policy of reformation of municipal hospitals in Japan? : Estimation of the efficiency of Japanese hospitals using a dynamic and network data envelopment analysis

Workshop 2015 -Advances in DEA Theory and Applications (December 1-2, 2015)The purpose of this study was to perform an evaluation of the policy effect of the current reform of Japan’s municipal hospitals. We focused on efficiency improvements both within hospitals and within two separate internal hospital organizations. Hospitals have two heterogeneous internal organizations: the medical examination division and administration division. We extend observation time from 3years to 6years to compare to previous version of this study. We also added new variable MRI as link variable. Results showed that the average overall efficiency obtained with the DN-DEA model was 0.829 for 2007. The change in efficiency scores from 2007 to 2012 was slightly lower. The average estimated efficiency of both the administration division and medical-examination division decreased. We were unable to find any significant improvement in efficiency despite the reform policy. Thus, there are no positive policy effects despite the increased financial support from the central government.The workshop is supported by JSPS (Japan Society for the Promotion of Science), Grant-in-Aid for Scientific Research (B), #25282090, titled “Studies in Theory and Applications of DEA for Forecasting Purpose.本研究はJSPS科研費 基盤研究(B) 25282090の助成を受けたものです

Micro- isis: uma ferramenta para o gerenciamento de bases de dados bibliográficas

O Micro-ISIS é uma ferramenta de apoio bastante acessível e flexível para gerir bases de dados bibliográficas. Este trabalho tem por objetivo, apresentar algumas sugestões para a criação e manutenção de sistemas de informações padronizados e  cooperativos no Micro-Isis, observadas suas características funcionais e recursos disponíveis, bem como suas principais limitações. Micro-Isis: a tool for bibliographic database management   Abstract   Micro-Isis is a very flexible and versatile support tool for bibliographic database management. This paper intends to present suggestions to create and maintain standardized and cooperative information systems using Micro-lsis. It is considered its functional caracteristics, resources available as well as its main limitations

Struma ovarii with massive ascites mimicking ovarian carcinoma treated with conservative laparoscopic surgery: a case report

Struma ovarii is a rare taratoma that accounts for 0.5-1% of all ovarian tumors. It is sometimes difficult to differentiate struma ovarii from ovarian carcinoma. We encountered a case of struma ovarii that was suspected to be malignant due to the accumulation of massive ascites and an elevated CA125 level. It was successfully treated with laparoscopic surgery.A 37-year-old nulliparous woman consulted a local physician with a chief complaint of abdominal distention. Computed tomography (CT) of the abdomen revealed a pelvic tumor with a large amount of ascites. She was referred to our department. Contrast-enhanced magnetic resonance imaging (MRI) and CT showed bilateral ovarian tumors with multicystic and solid components. CA125 level was markedly elevated. Two cytological examinations of ascites showed no malignant cells. Preoperatively, malignancy was strongly suspected, but considering the possibility of a benign ovarian tumor, laparoscopic surgery was scheduled. During laparoscopic surgery, 4,850 mL of ascites were aspirated, and the left adnexa was removed. Intraoperative rapid pathology suggested struma ovarii with no evidence of malignancy. Postoperative pathology showed mature teratoma and struma ovarii.Although struma ovarii is benign in 90-95% of cases, there have been scattered case reports in which suspected malignancy led to unnecessary or excessive surgery. We propose that appropriate preoperative imaging and accurate intraoperative rapid pathology can prevent excessive surgery, conservative or laparoscopic excisions should be considered

A case of polypoid endometriosis mimicking advanced ovarian carcinoma with rapid growth, invasion, and dissemination

Polypoid endometriosis is a rare form of endometriosis characterized by polypoid masses that histologically often resemble endometrial polyps. We report a case of rapidly progressing polypoid endometriosis that was preoperatively assumed to be advanced ovarian cancer. A 46-year-old woman, para 0, underwent laparoscopic myomectomy and left adnexectomy for uterine fibroids and a left ovarian endometrial cyst after administration of gonadotropin releasing hormone (GnRH) agonist for 4 months. Eleven months postoperatively, rapid right ovarian enlargement occurred. CT and MRI (both contrast-enhanced) showed masses in the right adnexa, cecum, sigmoid colon, and omentum, and PET-CT demonstrated increased uptake, suggesting ovarian cancer and peritoneal dissemination. The patient later developed intestinal obstruction, and colonoscopy revealed multiple polypoid lesions in the sigmoid colon. The omental tumor and right adnexa were biopsied during exploratory laparotomy, and diagnosed as polypoid endometriosis with no malignancy by permanent pathology. The right adnexal tumor shrunk markedly after 4 months of GnRH antagonist treatment. Second laparotomy was then performed for right adnexal tumor resection and ileocecectomy. Pathological examination revealed polypoid endometriosis extending from the ovary to the cecal mucosa. The patient has been asymptomatic for over 1 year postoperatively. The sigmoid colon tumor shrunk but is still present.Polypoid endometriosis predominantly affects the ovaries, colon, peritoneum, and omentum of patients in their 40s and 50s. It is a benign disease but is often difficult to distinguish from malignancy preoperatively because it rapidly forms numerous solid lesions. Although polypoid endometriosis is rare, with no specific imaging findings, including it in a differential diagnosis may facilitate preoperative identification