Digital Transformation of Health Services Value Streams

This research proposes the use of value stream mapping to guide the choice of Healthcare 4.0 (H4.0) digital applications that are more prone to support the enhancement of value flows in health services. A three-step approach is developed, beginning with mapping the current and future state of the value streams, identifying improvement kaizen bursts, and finally evaluating H4.0 digital applications that best underpin improvements and comply with attributes that characterize well-succeeded technological innovations. This method is illustrated through a case study in the sterilization unit of a large university hospital. With the advent of Industry 4.0, the accelerated pace at which digital transformation has been conducted challenges healthcare organisations to prioritise the digital applications with the largest positive impact in their operations assertively. Our propositions provide means to integrate H4.0 into healthcare towards more effective health services values streams

Reporte de formación complementaria en área de concentración en sistemas embebidos y telecomunicaciones

El objetivo principal del presente documento es dar a conocer los proyectos más sobresalientes que se desarrollaron en la Maestría de Diseño Electrónico en el área de Sistemas Embebidos y Telecomunicaciones. En el Taller de Diseño de Tarjetas de Circuito Impreso se desarrolló el proyecto de Diseño de un circuito impreso para reproductor de audio portátil. En la asignatura de Ingeniería de Software en Ambientes Embebidos se trabajó en el desarrollo de la documentación de las especificaciones de requisitos de software para un protocolo de comunicación automotriz. Y en el curso de Diseño de Sistemas Operativos en Ambientes Embebidos se trabajó en el diseño e implementación de un módulo de control automotriz.ITESO, A. C.Freescale Semiconductor Mexico, S de R

Microorganismos más frecuentes en urocultivo de pacientes con ruptura prematura de membranas en embarazo pretérmino

"La infección del tracto urinario se define como la existencia de gérmenes capaces de producir alteraciones funcionales y morfológicas en la vejiga, sistemas colectores o riñones. Se asocia predominantemente al sexo femenino debido a la anatomía del tracto genitourinario, los hábitos miccionales y situaciones fisiológicas como son el embarazo. En mujeres embarazadas, se considera de gran importancia dado que corresponde a una de las complicaciones obstétricas más frecuentes, superada únicamente por la anemia y la cervicovaginitis. Durante la gestación, los cambios anatómicos y fisiológicos en el sistema urinario propician a hidronefrosis, reflujo vesico-ureteral y cambios fisicoquímicos en la orina. Esto, aunado a alteraciones hormonales como el aumento en la progesterona y consecuente disminución del tono muscular uretral y vesical y reducción en la peristalsis ureteral conllevan a estasis urinaria; generando así, un entorno facilitador para sobrecrecimiento bacteriano y potencial desarrollo de un foco séptico. Las ITU durante el embarazo aumentan la morbilidad tanto de la madre como del feto. La implementación de medidas preventivas como la corrección de hábitos miccionales y el manejo de comorbilidades que predisponen a su desarrollo se consideran importantes"

SIMULACIÓN “HARDWARE IN THE LOOP” DE UN INVERSOR TRIFÁSICO CONECTADO A LA RED ELÉCTRICA

ResumenEn este artículo se presenta la simulación “Hardware In the Loop” de un inversor trifásico conectado a la red eléctrica. El inversor permite la inyección controlada de flujo de potencia activa o reactiva a la red eléctrica, el inversor se alimenta con una fuente que simula el voltaje de salida de un sistema de generación de energía renovable. Se propone el uso de la técnica de control por corriente para el inversor y para la etapa de sincronización a la red eléctrica se utiliza la técnica de marco de referencia síncrono SRF-PLL, posteriormente se analiza el comportamiento del inversor ante perturbaciones generadas en la red eléctrica. La propuesta de este trabajo aprovecha la simulación en tiempo real de sistemas de potencia para validar de manera más confiable la eficiencia de una de las técnicas de control y sincronización aplicadas a inversores conectados a la red eléctrica.Palabras Claves: Hardware in the Loop, inversor sincronizado a la red, PLL. SIMULATION "HARDWARE IN THE LOOP" OF A THREE-PHASE INVERSOR CONNECTED TO THE ELECTRICAL NETWORKAbstractThis paper addresses a grid-tied power inverter simulation based on a Hardware in the Loop system. A voltage source inverter is simulated. Current control strategy is used to control the inverter. Synchronization to the grid is accomplished by means of a synchronous reference frame PLL. Afterwards the behavior of the inverter is analyzed with disturbances generated in the grid. The present work takes advantage of the real-time simulation of power systems to validate in the most reliable way the effectiveness of one of the control and synchronization techniques applied to inverters connected to electrical grid.Keywords: Hardware in the loop, PLL, synchronized power-inverter

Hospital Investment Decisions in Healthcare 4.0 Technologies: Scoping Review and Framework for Exploring Challenges, Trends, and Research Directions

BACKGROUND: Alternative approaches to analyzing and evaluating health care investments in state-of-the-art technologies are being increasingly discussed in the literature, especially with the advent of Healthcare 4.0 (H4.0) technologies or eHealth. Such investments generally involve computer hardware and software that deal with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. Besides, the use of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach to analyzing investments in H4.0 technologies is not available in the literature. OBJECTIVE: This study aims to analyze previous research related to the evaluation of H4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with hospitals’ H4.0 technology investment decisions and suggest five main research directions on the topic. METHODS: To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords investment, health, industry 4.0, investment, health technology assessment, healthcare 4.0, and smart in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all the databases. After removing papers published before 2011 as well as duplicates and performing further screening, we were left with 244 articles, from which 33 were selected after in-depth analysis to compose the final publication portfolio. RESULTS: Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0 technologies. We found that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominate bundle analysis, H4.0 technology value considerations, and multiple decision-maker involvement. CONCLUSIONS: Some of our findings were unexpected, given the interrelated nature of H4.0 technologies and their multidimensional impact. Owing to the absence of a more holistic approach to H4.0 technology investment decisions, we identified five promising research directions for the topic: development of economic valuation methodologies tailored for H4.0 technologies; accounting for technology interrelations in the form of bundles; accounting for uncertainties in the process of evaluating such technologies; integration of administrative, medical, and patient perspectives into the evaluation process; and balancing and handling complexity in the decision-making process

Effects of lean interventions supported by digital technologies on healthcare services: a systematic review

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean−Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications

CALIDAD DE LA ATENCIÓN A NIÑOS Y ADOLESCENTES CON LEUCEMIA LINFOBLÁSTICA AGUDA EN UN CENTRO ONCOLÓGICO

Introducción: La Leucemia Linfoblástica Aguda (LLA) es el cáncer más frecuente en niños y adolescentes, tiene altas tasas de mortalidad que la convierten en un problema de salud pública en México y en el mundo. Mediante el Modelo de calidad de Donabedian con sus tres enfoques de evaluación: estructura, proceso y resultado, valorándolos a través de los calificativos de excelente, suficiente e insuficiente se pueden identificar los valores porcentuales del comportamiento de calidad de la atención de este tipo de pacientes, favoreciendo identificar de manera más fácil áreas de oportunidad.    Objetivo: Identificar la calidad de la atención que se ofrece a pacientes menores de 18 años con LLA en un centro oncológico del estado de Veracruz según los enfoques del Modelo de calidad de Donabedian (estructura, proceso y resultado). Material y métodos: estudio observacional, descriptivo y transversal analítico. Población de estudio menores de 18 años con LLA, sus acompañantes, prestadores de servicio del área de Oncopediatría y servicios relacionados. Se emplearon cinco instrumentos de recolección de datos, validados previo a su aplicación. Resultados: Estructura 67% de excelencia, 20% de suficiencia y 13% de insuficiencia; Proceso 88% de excelencia, 11% de suficiencia y 1% de insuficiencia; de Resultado se obtuvo 76% de excelencia, 17% de suficiencia y 7 de insuficiencia. La calidad de la atención global presentó 77% de excelencia, 16% de suficiencia y 7% de insuficiencia. Discusión: La calidad de la atención fue mayoritariamente excelente, sin embargo, se detectaron áreas de oportunidad, que deben ser consideradas en las intervenciones sanitarias para mejorar la calidad de la atención prestada y la sobrevida de estos pacientes

Effects of contingencies on healthcare 4.0 technologies adoption and barriers in emerging economies

Studies on the influence of contingency factors on the introduction of novel digital technologies into high- complexity systems, such as hospitals, are still incipient. As the introduction of Healthcare 4.0 (H4.0) usually implies in high capital expenditures and requires a more skilled labor force, such understanding gains relevance when considering hospitals in emerging economies, more likely to be resource-constrained. This study examines the effect of five contingency factors on the adoption of H4.0 technologies and associated barriers to H4.0 adoption in emerging economies; they are: hospital´s ownership and age, number of employees, number of inpatient beds, and functionality (teaching hospital or not). The analysis is based on a transnational survey with 159 middle and senior managers from 16 hospitals, located in Brazil, India, Mexico and Argentina. Results indicate that contingencies do affect both H4.0 technologies adoption and associated barriers although not homogeneously in terms of effect, being more prominent on technologies? adoption than on barriers to H4.0 implementation. Our study sheds light on these relationships, providing hospitals? managers a means to an- ticipate potential issues and handle eventual difficulties inherent to the context in which they are inserted.Fil: Tortorella, Guilherme Luz. Universidade Federal de Santa Catarina; BrasilFil: Fogliatto, Flávio Sanson. Universidade Federal do Rio Grande do Sul; BrasilFil: Espôsto, Kleber Francisco. Universidade de Sao Paulo; BrasilFil: Vergara, Alejandro Mac Cawley. Pontificia Universidad Catolica de Chile. Escuela de Ingeniería; ChileFil: Vassolo, Roberto Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Austral. Instituto de Altos Estudios; ArgentinaFil: Mendoza, Diego Tlapa. Universidad Autónoma de Baja California Sur; MéxicoFil: Narayanamurthy, Gopalakrishnan. University of Liverpool; Reino Unid

The impact of Industry 4.0 on the relationship between TPM and maintenance performance

Purpose In this paper, the authors examine the impact of Industry 4.0 (I4.0) technologies on the relationship between total productive maintenance (TPM) practices and maintenance performance. Design/methodology/approach Data collection was carried out through a multinational survey with 318 respondents from different manufacturing companies located in 15 countries. Multivariate data techniques were applied to analyze the collected data. Diffusion of innovations theory (DIT) was the adopted theoretical lens for our research. Findings The authors’ findings indicate that I4.0 technologies that aim to process information to support decision-making and action-taking directly affect maintenance performance. Technologies oriented to sensing and communicating data among machines, people, and products seem to moderate the relationship between TPM practices and maintenance performance. However, the extent of such moderation varies according to the practices involved, sometimes leading to negative effects. Originality/value With the advances of I4.0, there is an expectation that several maintenance practices and performance may be affected. Our study provides empirical evidence of these relationships, unveiling the role of I4.0 for maintenance performance improvement