SFA vs. DEA for measuring healthcare efficiency: A systematic review

Frontier techniques have been used to measure healthcare provider efficiency in hundreds of published studies. Although these methods have the potential to be useful to decision makers, their utility is limited by both methodological questions concerning their application. The aim of this paper is to search articles applying combined data envelopment analysis (DEA) and stochastic frontier analysis (SFA) in order to facilitate a common understanding about the adequacy of these methods, defining any differences in healthcare efficiency estimation and the reasons that are behind this. A systematic review of 21 such studies published the last decade was conducted. Only studies written in English were considered. Results are summarized in a form of meta-analysis in order to synthesize results and draw out further implications. Overall, DEA and SFA were found to yield divergent efficiency estimates due to many factors such as statistical noise, how inputs and outputs were defined, as well as data availability. Researchers, besides the combination of models to measure efficiency, lately have introduced environmental variables in their analyses, aiming at better understanding the relationship of these factors to efficiency and thus achieving a better decision making process. In any case the analysis concludes that there is a need for careful attention by stakeholders since the nature of the data and its availability influence the measurement of efficiency and thus it is necessary to model the behavior which generates the data by choosing the appropriate mathematical form

An empirical study of comparing DEA and SFA methods to measure hospital units’ efficiency

Frontier techniques have been used to measure healthcare provider efficiency in hundreds of published studies. Although these methods have the potential to be useful to decision makers, their utility is limited by both methodological questions concerning their application. The aim of this paper is to examine the data envelopment analysis (DEA) and stochastic frontier analysis (SFA) results in order to facilitate a common understanding about the adequacy of these methods, defining any differences in healthcare efficiency estimation. A two-stage bootstrap DEA method and the Translog formula of the SFA were performed. Multi-inputs and multi-outputs were used in both of the approaches assuming two scenarios either including environmental variables or not. The introduced environmental variables were regressed with the bias corrected estimations derived from the first step of the two-stage bootstrap DEA model. In the Translog SFA functional form, these variables were introduced as shifted. Thirty-two Greek public hospital units constitute the sample. The main output of the analysis was that the efficiency scores increased with the incorporation of environmental variables in the SFA model, with the average efficiency score to become from 0.85 to 0.89. However, DEA and SFA were found to yield divergent efficiency estimates due to many factors such as the nature of the environmental variables, the measurement error and other random factors. Environmental variables being hospital status and geographical position were found significantly correlating with inefficiency, while patient mobility was not found strongly correlating. The analysis concludes that there is a need for careful attention by stakeholders since the nature of the data and its availability influence the measurement of the efficiency and thus it is necessary to be specific when choosing the appropriate mathematical form in order to test the behavior which generates the data

Arrhythmogenic Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common condition present in 1–3% of the population. There has been evidence that a subset of MVP patients is at higher risk of sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in the papillary muscles caused by the prolapsing valve. ECG features include ST-segment depression, T wave inversion or biphasic T waves in inferior leads, and premature ventricular contractions arising from the papillary muscles and the fascicular system. Echocardiography can identify MVP and mitral annular disjunction, a feature that has significant negative prognostic value in MVP. Cardiac MRI is indicated for identifying fibrosis. Patients with high-risk features should be referred for further evaluation. Catheter ablation and mitral valve repair might reduce the risk of malignant arrhythmia. MVP patients with high-risk features and clinically documented ventricular arrhythmia may also be considered for an ICD

Širenje područja rasprostranjenja britke jedroglavke, Lophotus lacepede Giorna 1809 u vodama sjevernog Egejskog mora, Grčka

On September 20th 2011, a rather large specimen of 134 cm total length (mature, female), weighing 6974 g, of the rare crested oarfish Lophotus lacepede Giorna 1809, was obtained from a fisherman fishing off Halkidiki Peninsula, north Aegean Sea (Greece). This capture represents the northernmost record in the Aegean Sea for one of the scarcest species in Eastern Mediterranean.Dana 20. rujna 2011. godine, prilično velika jedinka 134 cm ukupne dužine (zrela ženka), mase 6974 g, rijetke vrste britka jedroglavka Lophotus lacepede Giorna 1809, je ulovljena pokraj poluotoka Halkidiki, sjeverno egejsko more (Grčka). Ovaj ulov predstavlja najsjeverniji nalaz u egejskom moru jedne od najrjeđih vrsta u istočnom Mediteranu

Difficult intubation provokes bacteremia

Abstract Purpose: To evaluate the prevalence of bacteremia after mask ventilation, laryngoscopy, and endotracheal intubation before induction of general anesthesia and to discover any correlation between traumatic manipulations and bacteremia. The specific bacteria responsible, knowledge of which may guide the prophylactic use of antibiotics, also were investigated. Methods: Fifty patients were enrolled. Three 10-mL blood samples were collected from a peripheral vein 10 min before induction of anesthesia, 10 min after mask ventilation, and 10 min after intubation. All samples were placed in aerobic and anaerobic bottles for culture and bacterial identification. Results: Cultures received 10 min after intubation were positive in 12% of patients. The following strains were isolated: Escherichia coli in two cases, Staphylococcus aureus in three cases, and Peptostreptococcus anaerobius in one case. A strong positive correlation was found between difficult intubation and bacteremia. No correlation between bacteremia and easy intubation or between bacteremia and face mask ventilation was identified. Conclusion: Traumatic manipulations during difficult laryngoscopy and endotracheal intubation could cause bacteremia. This finding may justify and guide prophylactic use of antibiotics. 52

Nitrogen replenishment using variable rate application technique in a small hand-harvested pear orchard

Precision agriculture is a management approach for sustainable agriculture. It can be applied even in small fields. It aims to optimize inputs, improve profits, and reduce adverse environmental impacts. In this study, a series of measurements were conducted over three growing seasons to assess variability in a 0.55 ha pear orchard located in central Greece. Soil ECa was measured using EM38 sensor, while soil samples were taken from a grid 17 × 8 m and analysed for texture, pH, P, K, Mg, CaCO3, and organic matter content. Data analysis indicated that most of the nutrients were at sufficient levels. Soil and yield maps showed considerable variability while fruit quality presented small variations across the orchard. Yield fluctuations were observed, possibly due to climatic conditions. Prescription maps were developed for nitrogen variable rate application (VRA) for two years based on the replacement of the nutrients removed by the crop. VRA application resulted in 56% and 50% reduction of N fertiliser compared to uniform application

Evaluation of the effectiveness of internal audit in Greek Hotel Business.

Abstrac

Toll/Interleukin-1 receptor member ST2 exhibits higher soluble levels in type 2 diabetes, especially when accompanied with left ventricular diastolic dysfunction

<p>Abstract</p> <p>Background</p> <p>Soluble ST2, a member of the of the Toll/IL-1 superfamily, is a novel biomarker with exceptional predictive value in heart failure and myocardial infarction- related mortality as well as in acute dyspneic states. Soluble ST2 is considered a decoy receptor of IL 33 that blocks the protective effects of the cytokine in atherosclerosis and cardiac remodeling. In the present study we investigated the differences in the levels of soluble ST2, BNP and hs-CRP between healthy controls and patients with type 2 diabetes with and without left ventricular diastolic dysfunction. A secondary aim was to investigate correlations between sST2 and other biomarkers of type 2 diabetes, such as HbA1c.</p> <p>Methods</p> <p>158 volunteers were recruited and underwent a complete Doppler-echocardiographic evaluation of both systolic & diastolic cardiac function. All subjects with ejection fraction < 50% were excluded. The study population was divided in 4 groups as follows: A: 42 healthy controls, B: 18 subjects without diabetes with LVDD, C: 48 patients with type 2 diabetes without LVDD & D: 50 patients with type 2 diabetes & LVDD. ELISA technique was performed to measure sST2 levels. Statistical analysis was performed with Kruskal-Wallis & Mann-Whitney test (continuous variables), chi squared & Fischer exact test (discrete variables), Spearman coefficient (univariate analysis) and step-wise backward method (multivariate analysis).</p> <p>Results</p> <p>Patients with type 2 diabetes with (p < 0.001) or without LVDD (p = 0.007) had higher serum ST2 levels compared to healthy controls, state found also for hs-CRP levels but not for the corresponding BNP levels (p = 0.213 & p = 0.207 respectively). Patients with type 2 diabetes & LVDD had higher serum ST2 in relation to diabetic patients without LVDD (p = 0.001). In multivariate analysis HbA1c positively and independently correlated with sST2 levels in both groups of patients with type 2 diabetes.</p> <p>Conclusions</p> <p>Patients with type 2 diabetes exhibit higher sST2 levels compared to healthy controls. The presence of LVDD in patients with type 2 diabetes is associated with even higher sST2 levels. A significant correlation between glycemic control and sST2 levels was also revealed.</p

Littoral cell angioma of the spleen accompanied by haemophagocytic syndrome in a dialysis patient suffering from aa amyloidosis

Littoral cell angioma (LCA) is a rare form of vascular tumor unique to the spleen that arises from the specialized endothelial cells that line the splenic sinuses (littoral cells). Haemophagocytic syndrome (HS) is also a rare hematologic disorder that some times accompanies LCA. The authors describe a young dialysis patient with a history of familiar mediteranean fever and secondary amyloidosis who was found to have this rare association of AA amyloidosis with LCA and haemophagocytic syndrome