Optimizing sterilized logistics in hospitals

This paper deals with the optimization of the flow of sterile instruments in hospital which takes place between the sterilization department and the operating theatre. This topic is especially of interest in view of the current attempts of hospitals to cut costs by outsourcing sterilization tasks. Oftentimes, outsourcing implies placing the sterilization unit at a larger distance, hence introducing a longer logistic loop, which may result in lower instrument availability, and higher cost. This paper discusses the optimization problems that have to besolved when redesigning processes so as to improve material availability and reduce cost. We consider changing the logistic management principles, use of visibility information, and optimizing the composition of the nets of sterile materials.Economics (Jel: A)

Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units:A Systematic Review

Abstract Objective: The goal of this review was to assess the relationships among aims, designs, and outcomes of integrated inpatient medical and psychiatric care units (IMPUs) and gather the evidence base on the effectiveness of these units. Methods: Using online searches of Embase, Medline, Web of Science, PsycINFO, Scopus, CINAHL, Cochrane, and Google Scholar, the authors identified and reviewed literature describing the aims and outcomes of specific IMPU designs. Results: The search yielded 55 studies, in which the authors identified 39 IMPUs that focused on patients with mood, psychotic, somatic symptom, substance use, organic, and personality disorders and a broad array of medical diagnoses. Most units were psychiatric-medical units and had medium medical and psychiatric acuity capabilities. The studies reviewed provided little information on the cost-effectiveness of various IMPU designs. Although some comparative studies indicated reductions in hospital length of stay (LOS), these studies were generally of low quality and rarely reported other intended outcomes. Conclusions: IMPUs may help shorten LOS. IMPUs should focus care on patients with complex conditions and high acuity to maximize health system value. Implementing compulsory admission facilities; qualified psychiatric, medical, and nursing staff involvement; and cross-disciplinary training may improve IMPUs’ capacity to treat high-acuity patients. Future research should relate IMPU designs to intended outcomes

Selecting Telecommunication Carriers to Obtain Volume Discounts

During 2001 many European markets for mobile phones reached saturation. Hence, mobile phone operators have shifted their focus from growth and market share to cutting costs. One way of doing so is to reduce spending on international calls, which are routed via network operating companies (carriers). These carriers charge per call-minute for each destination and may use a discount on total business volume to price their services. We developed a software system that supports decisions on allocating destinations to carriers. The core of this system is a min-cost flow routine that is embedded in a branch-and-bound framework. Our system solves the operational problem to optimality and performs what-if analyses and sensitivity analyses. A major telecommunication services provider implemented the system, realizing two benefits: it has structured the business process of allocating carriers to destinations and cut the costs of routing international calls

Many Ways to Communicate—Crosstalk between the HBV-Infected Cell and Its Environment

Chronic infection with the hepatitis B virus (HBV) affects an estimated 257 million people worldwide and can lead to liver diseases such as cirrhosis and liver cancer. Viral replication is generally considered not to be cytopathic, and although some HBV proteins may have direct carcinogenic effects, the majority of HBV infection-related disease is related to chronic inflammation resulting from disrupted antiviral responses and aberrant innate immune reactions. Like all cells, healthy and HBV-infected cells communicate with each other, as well as with other cell types, such as innate and adaptive immune cells. They do so by both interacting directly and by secreting factors into their environment. Such factors may be small molecules, such as metabolites, single viral proteins or host proteins, but can also be more complex, such as virions, protein complexes, and extracellular vesicles. The latter are small, membrane-enclosed vesicles that are exchanged between cells, and have recently gained a lot of attention for their potential to mediate complex communication and their potential for therapeutic repurposing. Here, we review how HBV infection affects the communication between HBV-infected cells and cells in their environment. We discuss the impact of these interactions on viral persistence in chronic infection, as well as their relation to HBV infection-related pathology