Eine Methodik für Erdbebenrisikoentschärfung von Untersuchungssystemen

Aims: As it represents the final point of the whole rescue chain, hospital infrastructure is one of the most important elements of medical response to earthquakes. In order to correctly manage the emergency by providing the most efficient medical response, it is fundamental to carry out a simple, rapid and reliable risk assessment of seismic impact on hospitals. The purpose of this work was to develop a decision support system for helping the decision makers with the seismic risk mitigation of health structures. Main Findings: A new integrated methodology was designed to identify vulnerabilities in the hospital based on a combination of two main research approaches: the theory of complex systems (Leontief model and Fault Tree Analysis) and the rapid seismic vulnerability assessment (field evaluation forms). After a first risk assessment based on hospital safety and coping capacity at the OSMA Florence Hospital, the model was validated with a real past event (L’Aquila earthquake in 2009, Italy) and, finally took into consideration the risk mitigation phase at the Santa Clara Valley Medical Center in California, US. The model application found out that the Leontief model is less robust and reliable than FTA especially for high seismic intensity scenarios. The risk mitigation phase showed that the structural interventions did not add any further appreciable improvements to the non-structural actions. Conclusions: The results of the study serve as a support to decision makers for seismic risk mitigation of modern health structures by providing a software prototype able to simulate the effects and evaluate the cost of applying different retrofitting actions. Furthermore, the new approach took into account both the strategic and sheltering functions of health structures by using quantitative indices such as the Hospital Treatment and the new index Intrinsic Security.Zielsetzung: Krankenhausinfrastrukturen und deren Funktionalität stellen die letzte – und damit die wichtigste – Einheit der medizinischen Antwort nach einem Erdbeben dar. Um einen Notfall angemessen medizinisch koordinieren zu können, ist es nötig, eine einfache und zuverlässigen Risiko-Beurteilung auszuführen, die die Einstufung der seismischen Auswirkungen auf alle Akteure im Gesundheitswesen zum Ziel hat. Zweck meiner Arbeit ist es, ein Modell zu entwerfen, das die Entscheidungsträger dabei unterstützt, die Auswirkungen von Erdbeben auf das Gesundheitswesen durch die Anwendung von adäquaten Risiko-Reduktions-Strategien zu mindern. Grundlegende Resultate: Auf einer Kombination zweier Untersuchungsansätze aufbauend wurde eine neue Methode entwickelt: Die Theorie komplexer Analysesysteme vergleicht Leontiefs In-Out-Analyse mit der Fehlerbaumanalyse, sowie mit der Abschätzung seismischer Gefährdung mittels Verwendung von Evaluationsbögen zur Datengewinnung. Erstens beinhaltet das Arbeitsprogramm eine Risiko-Bewertung für Krankenhaussicherheit des OSMA- Krankenhauses in Florenz. Zweitens wurde das Modell anhand eines realen Vorfalls (L’Aquila, 2009) getestet. Drittens umfasst es die Risiko - Reduktions - Strukturen des Santa Clara Valley Medical Center in USA. Die Risiko- Reduktions- Phase zeigte, dass strukturelle Interventionen keine weitere positive Verbesserung im Vergleich zu nicht-strukturellen Interventionen bieten. Zusammenfassung und Ausblick: Die Studie liefert einen Software-Prototypen zur angemessenen Unterstützung der Entscheidungsträger moderner Gesundheitsinfrastruktur. Weiterhin beinhaltet der neue Ansatz sowohl Strategie- als auch Beherbergungsfunktionen des Gesundheitswesens, indem er quantitative Indizes nutzt, wie z.B. Krankenhaus-Behandlungs-Kapazität durch den “Hospital Treatment Capacity” HTC sowie den Index “Intrinsic Security” (IS)

Health Technology Management

Non

Case study: IBM Watson Analytics cloud platform as Analytics-as-a-Service system for heart failure early detection

In the recent years the progress in technology and the increasing availability of fast connections have produced a migration of functionalities in Information Technologies services, from static servers to distributed technologies. This article describes the main tools available on the market to perform Analytics as a Service (AaaS) using a cloud platform. It is also described a use case of IBM Watson Analytics, a cloud system for data analytics, applied to the following research scope: detecting the presence or absence of Heart Failure disease using nothing more than the electrocardiographic signal, in particular through the analysis of Heart Rate Variability. The obtained results are comparable with those coming from the literature, in terms of accuracy and predictive power. Advantages and drawbacks of cloud versus static approaches are discussed in the last sections

Careggi Smart Hospital: A mobile app for patients, citizens and healthcare staff

This paper presents a mobile app called “Careggi Smart Hospital” which has been developed for the Careggi Polyclinic in Florence. The application is designed for Android smartphones and tablets and it is freely downloadable from the Google Play Store. It provides various useful tools to the hospital's users such as personnel and structures finding, way-finding and the possibility to access personal medical records collected on regional electronic health record

Integrated HTA and FMECA methodology for the evaluation of robotic surgery

Robotic surgery has been strongly improved since the beginning of the twenty-first century and chased important level of technical and clinical performances. Within the robotic area, the most worldwide used surgical robot is the da Vinci® system made by Intuitive Surgical Inc. The aim of this study was to evaluate at the hospital scale the robotic surgery (Hospital –Based Health Technology Assessment) in comparison to the open and laparoscopic procedures yet combining a FMECA analysis to accurately assess all those aspects involving patient and staff safety. The total number of robotic procedures directly observed by the surgical department and reported in the following study was 44, including 28 urology interventions and 16 general surgeries. The study confirmed clinical benefits carried out with the robot but bigger complexity in managing the whole surgical system in terms of structural needs, staff and technology. For the future, further steps regard the necessity to dispose of a wider number of robotic procedures in order to strength the analysis reliability and complete the socio-economic assessment with medium and long terms observation. Finally a new FMECA application will be essential to monitor the real effects of the suggested actions on the evaluated risks according to the already known and new failure modes

The role of IREB2 and transforming growth factor beta-1 genetic variants in COPD: a replication case-control study

<p>Abstract</p> <p>Background</p> <p>Genetic factors are known to contribute to COPD susceptibility and these factors are not fully understood. Conflicting results have been reported for many genetic studies of candidate genes based on their role in the disease. Genome-wide association studies in combination with expression profiling have identified a number of new candidates including <it>IREB2</it>. A meta-analysis has implicated transforming growth factor beta-1 (<it>TGFbeta1</it>) as a contributor to disease susceptibility.</p> <p>Methods</p> <p>We have examined previously reported associations in both genes in a collection of 1017 white COPD patients and 912 non-diseased smoking controls. Genotype information was obtained for seven SNPs in the <it>IREB2 </it>gene, and for four SNPs in the <it>TGFbeta1 </it>gene. Allele and genotype frequencies were compared between COPD cases and controls, and odds ratios were calculated. The analysis was adjusted for age, sex, smoking and centre, including interactions of age, sex and smoking with centre.</p> <p>Results</p> <p>Our data replicate the association of <it>IREB2 </it>SNPs in association with COPD for SNP rs2568494, rs2656069 and rs12593229 with respective adjusted p-values of 0.0018, 0.0039 and 0.0053. No significant associations were identified for <it>TGFbeta1</it>.</p> <p>Conclusions</p> <p>These studies have therefore confirmed that the <it>IREB2 </it>locus is a contributor to COPD susceptibility and suggests a new pathway in COPD pathogenesis invoking iron homeostasis.</p

Association of MMP - 12 polymorphisms with severe and very severe COPD: A case control study of MMPs - 1, 9 and 12 in a European population

BACKGROUND: Genetic factors play a role in chronic obstructive pulmonary disease (COPD) but are poorly understood. A number of candidate genes have been proposed on the basis of the pathogenesis of COPD. These include the matrix metalloproteinase (MMP) genes which play a role in tissue remodelling and fit in with the protease--antiprotease imbalance theory for the cause of COPD. Previous genetic studies of MMPs in COPD have had inadequate coverage of the genes, and have reported conflicting associations of both single nucleotide polymorphisms (SNPs) and SNP haplotypes, plausibly due to under-powered studies. METHODS: To address these issues we genotyped 26 SNPs, providing comprehensive coverage of reported SNP variation, in MMPs- 1, 9 and 12 from 977 COPD patients and 876 non-diseased smokers of European descent and evaluated their association with disease singly and in haplotype combinations. We used logistic regression to adjust for age, gender, centre and smoking history. RESULTS: Haplotypes of two SNPs in MMP-12 (rs652438 and rs2276109), showed an association with severe/very severe disease, corresponding to GOLD Stages III and IV. CONCLUSIONS: Those with the common A-A haplotype for these two SNPs were at greater risk of developing severe/very severe disease (p = 0.0039) while possession of the minor G variants at either SNP locus had a protective effect (adjusted odds ratio of 0.76; 95% CI 0.61 - 0.94). The A-A haplotype was also associated with significantly lower predicted FEV1 (42.62% versus 44.79%; p = 0.0129). This implicates haplotypes of MMP-12 as modifiers of disease severity

Prediction of second neurological attack in patients with clinically isolated syndrome using support vector machines

The aim of this study is to predict the conversion from clinically isolated syndrome to clinically definite multiple sclerosis using support vector machines. The two groups of converters and non-converters are classified using features that were calculated from baseline data of 73 patients. The data consists of standard magnetic resonance images, binary lesion masks, and clinical and demographic information. 15 features were calculated and all combinations of them were iteratively tested for their predictive capacity using polynomial kernels and radial basis functions with leave-one-out cross-validation. The accuracy of this prediction is up to 86.4% with a sensitivity and specificity in the same range indicating that this is a feasible approach for the prediction of a second clinical attack in patients with clinically isolated syndromes, and that the chosen features are appropriate. The two features gender and location of onset lesions have been used in all feature combinations leading to a high accuracy suggesting that they are highly predictive. However, it is necessary to add supporting features to maximise the accuracy. © 2013 IEEE

Approach to the management of infusion systems in hospitals

Drugs administration is the distinguishing feature of the infusion systems. They represent fundamental instruments in controlling clinical risk and in the improvement of the heath care assistance. Using infusion systems allows the continuous drugs administration, resulting in the reduction of concentration fluctuation, and, keeping the appropriate speed infusion, is the way to guarantee the desired therapeutic effect. The study presented in this paper allowed us to analyze and describe some critical points in the management of infusion systems, volumetric and syringe pumps, inside a subarea of Azienda Unica Regionale Sanitaria delle Marche (ASUR Marche). Some management solutions have been suggested such as supplementary services, in order to keep the functional continuity of the medical units, ready-to-use extra devices and their traceability. These services would allow to have extra devices in case of breakdown or in emergency situations; extra devices would belong to the so called infusion library and their handling can be both free or with a penalty. In order to decide the proper quantity of infusion systems, from the one hand, and from the other assuring the full service of the available devices, a mathematical reasoning has been done using real data from medical units. In our view this would guarantee to the hospital to save money and to get the most from the devices. In the end we suggest for the introduction of the closedcircuits for increasing the safety of the operator during the infusion of cancer therapy