Lean Six Sigma Approach to Implement a Femur Fracture Care Pathway at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

Timeliness in the treatment of fracture of the femur, through surgery, is crucial in the elderly patient as it reduces the risk of mortality and disability. Here we propose a Lean Six Sigma (LSS) approach to reduce the preoperative length of stay for patients with femur fracture. Through the LSS, a tailored Diagnostic Therapeutic Assistance Path (DTAP) for these has been implemented and monitored over time. In particular, through the analysis, based on the application of the DMAIC cycle conducted on data extrapolated from the information system of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, the new DTAP was designed and implemented. After the introduction of the DTAP, a significant reduction in the average length of hospital stay was observed, with a preoperative length of stay within 48 h in 65% cases (compared to the previous 9%). In particular, the most significant reduction (over 55%) is obtained for patients aged over 65 years old. Such a result reflects not only the improvement in the care process but it is also compliant with the guidelines of the Italian Ministry of Health, as reported in the New Guarantee System for monitoring the quality of care. © 2021, Springer Nature Switzerland AG

DMAIC Approach for the Reduction of Healthcare-Associated Infections in the Neonatal Intensive Care Unit of the University Hospital of Naples ‘Federico II’

Improvements in the obstetrical and neonatal management have allowed children to survive. These enhancements have showed, anyway, a general increased incidence of healthcare-associated infections, one of the most influent causes of morbidity and mortality in neonatal intensive care units. The aim of this paper is to suggest corrective measures to reduce sentinel germs colonization and identify the relationships between bacteria colonization with the number of procedures and the length of hospital stay. The Lean Six Sigma methodology was used to tackle this issue using a tailored Define, Measure, Analyze, Improve, and Control problem-solving strategy. An increased number of procedures and an extended length of hospital stay demonstrated a statistically significant influence on newborns’ possibility to be infected by sentinel germs. These findings could guide the clinical staff to improve the management of neonates in neonatal intensive care units reducing the number of infected patients, their length of hospital stay and the costs for the hospital. © 2021, Springer Nature Switzerland AG

High‐Resolution Seismic Imaging of Fault‐Controlled Basins: A Case Study From the 2009 Mw 6.1 Central Italy Earthquake

We present the first seismic reflection images of the Paganica and Bazzano basins, two tectonic basins developed in the hanging wall of the Paganica-San Demetrio Fault System, the causative fault of the 2009 Mw 6.1 L'Aquila earthquake, Italy. Five high-resolution seismic profiles were acquired along a main, 7 km long transect cutting across the strands of an active fault system in urbanized areas with widespread sources of seismic noise. Three processing approaches were chosen to tackle a variable and site-dependent data quality . To aid interpretation of this complex setting, we complemented seismic amplitude images with energy and similarity attributes as well with post-stack acoustic impedance inversion. The final seismic sections expose, with unprecedented resolution, the basins' structure and the uppermost splays of the 2009 earthquake. The seismic data show fine details of the subsurface stratigraphic setting, revealing continental depocenters carved in the marine Meso-Cenozoic substratum and displaced by a series of conjugate normal faults, mostly unknown before this study. Several of the imaged fault strands connect to the 2009 coseismic surface ruptures. Matching the seismic interpretation with constraints from surface geology and shallow boreholes, published data from field surveys and scientific drilling, we present a structural map of the Bazzano and Paganica basins with an estimation of the depth of the Meso-Cenozoic substratum. This map highlights a different structure, evolution, and age of the two basins, with the older Bazzano basin that likely began to form in late Pliocene

Risk Factors Analysis of Surgical Infection Using Artificial Intelligence: A Single Center Study

Background: Surgical site infections (SSIs) have a major role in the evolution of medical care. Despite centuries of medical progress, the management of surgical infection remains a pressing concern. Nowadays, the SSIs continue to be an important factor able to increase the hospitalization duration, cost, and risk of death, in fact, the SSIs are a leading cause of morbidity and mortality in modern health care. Methods: A study based on statistical test and logistic regression for unveiling the association between SSIs and different risk factors was carried out. Successively, a predictive analysis of SSIs on the basis of risk factors was performed. Results: The obtained data demonstrated that the level of surgery contamination impacts significantly on the infection rate. In addition, data also reveals that the length of postoperative hospital stay increases the rate of surgical infections. Finally, the postoperative length of stay, surgery department and the antibiotic prophylaxis with 2 or more antibiotics are a significant predictor for the development of infection. Conclusions: The data report that the type of surgery department and antibiotic prophylaxis there are a statistically significant predictor of SSIs. Moreover, KNN model better handle the imbalanced dataset (48 infected and 3983 healthy), observing highest accuracy value

Digital Innovation in Healthcare: A Device with A Method for Monitoring, Managing and Preventing the Risk of Chronic Polypathological Patients

New digital technologies can have a huge impact on the traditional healthcare sector, both from a clinical and economic perspective. Doctors and health specialists will increasingly need technology to improve the services they provide to their patients. Here a novel patented device for automatic processing of clinical data of chronic poly-pathological patients is presented. The invention consists of a reconfigurable equipment that allows the assessment of clinical risk severity indexes that can be customized for polypathological patients and which acts both as a decision support system for specialist doctors in the diagnosis and treatment phases, and as a monitoring system in the clinical environment

Air quality biomonitoring through Olea europaea L.: The study case of “Land of pyres”

The “Land of pyres”, namely “La Terra dei Fuochi”, is an area of Campania region (South-Italy), highly inhabited and comprises between the Provinces of Naples and Caserta, sadly known worldwide for the criminal activities related to the illegal waste disposal and burning. These fires, concomitantly with traffic emissions, might be the source of potential toxic element (PTE) dangerous for the human health and causing pathologies. In the framework of Correlation Health–Environment project, funded by the Campania region, eight municipalities (of area “Land of pyres”) and three remote sites have been bio-monitored using the olive (Olea europaea L.) plants as biomonitors. Leaves of olive plants were collected in each assayed municipality and the concentration of 11 metal(loid)s was evaluated by means of ICP-OES. Our findings revealed that the air of these municipalities was limitedly contaminated by PTE; in fact, only Sb, Al and Mn were detected in the olive leaves collected in some of the assayed municipalities and showed a high enrichment factors (EC) manly due, probably, to the vehicular traffic emissions. Furthermore, the concentrations of the other assayed PTEs were lower than those of Sb, Al and Mn. For these reasons we suppose that their emissions in the troposphere have been and are limited, and they mainly have a crustal origin. Even if our data are very comforting for those urban area, regarded by many as one of the most contaminated one in Italy, a great environment care, in any case, is always needed

The Use of Six Sigma to Assess Two Prostheses for Immediate Breast Reconstruction

Breast reconstruction is fundamental and urgent for patients in order to avoid future psychological and physical issues. That’s why immediate breast reconstruction has been requested increasingly in the last years. In this study two prosthesis with different structures and properties were compared according the aesthetic appearance (BREAST-Q© was employed) and five complications (seroma, hematoma, infections, dehiscence and red breast syndrome). The overall population was composed by 56 patients: 24 received a Tutomesh prosthesis and 32 received a Surgimend prosthesis. The DMAIC (define, measure, analyse, improve and control) cycle was implemented as a problem-solving strategy of the Six Sigma to compare the prostheses. While statistically significant difference between the two groups wasn’t found according to the overall BREAST-Q© (p-value = 0.674), the number of complications of the two groups resulted statistically different (p-value of chi-square test less than 0.001). Although it is not possible to understand from this study the reasons of the differences between the complications, this research proved that Surgimend and Tutomesh prostheses can be both implanted safely for immediate breast reconstruction since the higher costs of Surgimend could be neutralized with its lower hospitalization compared to Tutomesh. © 2021, Springer Nature Switzerland AG

Implementation and validation of a new method to model voluntary departures from emergency departments

In the literature, several organizational solutions have been proposed for determining the probability of voluntary patient discharge from the emergency department. Here, the issue of self-discharge is analyzed by Markov theory-based modeling, an innovative approach diffusely applied in the healthcare field in recent years. The aim of this work is to propose a new method for calculating the rate of voluntary discharge by defining a generic model to describe the process of first aid using a “behavioral” Markov chain model, a new approach that takes into account the satisfaction of the patient. The proposed model is then implemented in MATLAB and validated with a real case study from the hospital “A. Cardarelli” of Naples. It is found that most of the risk of self-discharge occurs during the wait time before the patient is seen and during the wait time for the final report; usually, once the analysis is requested, the patient, although not very satisfied, is willing to wait longer for the results. The model allows the description of the first aid process from the perspective of the patient. The presented model is generic and can be adapted to each hospital facility by changing only the transition probabilities between states

A Hybrid Analytic Hierarchy Process and Likert Scale Approach for the Quality Assessment of Medical Education Programs

The quality assessment of training courses is of utmost importance in the medical education field to improve the quality of the training. This work proposes a hybrid multicriteria decision-making approach based on two methodologies, a Likert scale (LS) and the analytic hierarchy process (AHP), for the quality assessment of medical education programs. On one hand, the qualitative LS method was adopted to estimate the degree of consensus on specific topics; on the other hand, the quantitative AHP technique was employed to prioritize parameters involved in complex decision-making problems. The approach was validated in a real scenario for evaluating healthcare training activities carried out at the Centre of Biotechnology of the National Hospital A.O.R.N. “A. Cardarelli” of Naples (Italy). The rational combination of the two methodologies proved to be a promising decision-making tool for decision makers to identify those aspects of a medical education program characterized by a lower user satisfaction degree (revealed by the LS) and a higher priority degree (revealed by the AHP), potentially suggesting strategies to increase the quality of the service provided and to reduce the waste of resources. The results show how this hybrid approach can provide decision makers with helpful information to select the most important characteristics of the delivered education program and to possibly improve the weakest ones, thus enhancing the whole quality of the training courses

An Augmented Reality-Based Solution for Monitoring Patients Vitals in Surgical Procedures

In this work, an augmented reality (AR) system is proposed to monitor in real time the patient's vital parameters during surgical procedures. This system is characterised metrologically in terms of transmission error rates and latency. These specifications are relevant for ensuring real-time response. The proposed system automatically collects data from the equipment in the operating room (OR), and displays them in AR. The system was designed, implemented and validated through experimental tests carried out using a set of Epson Moverio BT-350 AR glasses to monitor the output of a respiratory ventilator and a patient monitor in the OR