Technic and Collaboration Breakdown Structures: Drivers of collaborative problem solving approaches in a supply chain context

Problem Solving Methodologies have been par excellence a cornerstone element of the firms’ strategy on achieving effective continuous improvement. But the enterprise evolution towards an extended environment characterized by network-based organization has radically changed the problem solving paradigms. This paper aims to propose a generic and collaborative methodology addressing more complex and distributed problems, dealing with Supply Chain issues and having a key role as a driver for building global competitive advantages and create superior performances at a Supply Chain level

Collaborative methodology for supply chain quality management: framework and integration with strategic decision processes in product development

The new generation of network-based organizations has triggered the emergence of distributed and more complex contexts for the analysis of firms’ strategies. This gradual change in the way we understand enterprises has induced radical evolutions on the Quality Management domain. As a consequence, the Problem Solving Methodologies (PSM)widely used in industry and positioned up to now as one of the key elements for achieving continuous improvement efforts within local scopes are now insufficient to deal with major and distributed problems and requirements in this new environment. The definition of a generic and collaborative PSM well-adapted to supply chain contexts is one of the purposes of this paper. Additional requirements linked to specificities carried out by the introduction of a networked context within the methodology scope, the relational aspects of the supply chains, complexity and distribution of information, distributed decision-making processes and knowledge management challenges are some of the aspects being addressed by the proposed methodology. A special focus is made on benefits obtained through the integration of those elements across all problem-solving phases and particularly a proposal for multi-level root-cause analysis articulating both horizontal and vertical decision processes of supply chains is presented. In addition to laying out the expected benefits of such a methodology in the Quality Management area, the article studies the reuse of all the quality-related evidence capitalized in series phase as a driver for improving upstream phases of product development projects. This paper addresses this link between series and development activities in light of the proposed PSM and intends to encourage discussion on the definition of new approaches for Quality Management throughout the whole product life cycle. Some enabling elements in the decision-making processes linked to both the problem-solving in series phase and the roll-out of new products are introduced

Case-based reasoning and system design: An integrated approach based on ontology and preference modeling

This paper addresses the fulfillment of requirements related to case-based reasoning (CBR) processes for system design. Considering that CBR processes are well suited for problem solving, the proposed method concerns the definition of an integrated CBR process in line with system engineering principles. After the definition of the requirements that the approach has to fulfill, an ontology is defined to capitalize knowledge about the design within concepts. Based on the ontology, models are provided for requirements and solutions representation. Next, a recursive CBR process, suitable for system design, is provided. Uncertainty and designer preferences as well as ontological guidelines are considered during the requirements definition, the compatible cases retrieval, and the solution definition steps. This approach is designed to give flexibility within the CBR process as well as to provide guidelines to the designer. Such questions as the following are conjointly treated: how to guide the designer to be sure that the requirements are correctly defined and suitable for the retrieval step, how to retrieve cases when there are no available similarity measures, and how to enlarge the research scope during the retrieval step to obtain a sufficient panel of solutions. Finally, an example of system engineering in the aeronautic domain illustrates the proposed method. A testbed has been developed and carried out to evaluate the performance of the retrieval algorithm and a software prototype has been developed in order to test the approach. The outcome of this work is a recursive CBR process suitable to engineering design and compatible with standards. Requirements are modeled by means of flexible constraints, where the designer preferences are used to express the flexibility. Similar solutions can be retrieved even if similarity measures between features are not available. Simultaneously, ontological guidelines are used to guide the process and to aid the designer to express her/his preferences

Résolution collaborative de problèmes au sein des chaînes logistiques (cadre conceptuel, processus et méthodologie)

La Résolution de problèmes est l'un des piliers des stratégies d'amélioration continue des entreprises. Dans ce cadre, un certain nombre des méthodes ont réussi à démontrer son efficacité pour adresser des problèmes particulièrement complexes. Parmi ces méthodes, on peut distinguer le PDCA, le DMAICS, le 7Steps et le 8D/9S. Pourtant, l'apparition des réseaux distribuées de partenaires, ainsi que le positionnement du concept d'entreprise étendue, ont obligé les entreprises à aller au-delà de ses frontières pour travailler en synergie avec tous les partenaires en amont et en aval de sa chaîne. Dans ce contexte, l'efficacité de ces méthodes de résolution des problèmes a été fortement impactée. Ceci car non seulement les problèmes, mais aussi les produits, les partenaires, les ressources et l'information nécessaires pour sa résolution sont extrêmement fragmentés et décentralisés. Cette thèse s'intéresse donc à la résolution collaborative de problèmes au sein des chaînes distribuées de partenaires et son objectif est de proposer un processus et une méthodologie adaptés à ces contextes. Les propositions faites prennent en compte les aspects techniques (e.g. la modélisation des flux et la configuration de la chaîne) ainsi que les aspects collaboratifs (e.g. le niveau de confiance et/ou le rapport de pouvoir entre les partenaires) que conditionnent l'opération et l'efficacité du réseau. Finalement, cette thèse s'intéresse à l'articulation d'un système de retour d'expérience dans la résolution de problèmes distribués afin d'améliorer son efficacité.The Problem Solving Process is a central element of the firms' continuous improvement strategies. In this framework, a number of approaches have succeeded to demonstrate their effectiveness to tackle industrial problems. The list includes, but is not limited to PDCA, DMAICS, 7Steps and 8D/9S. However, the emergence and increasing emphasis in the supply chains have impacted the effectiveness of those methods to solve problems that go beyond the boundaries of a single firm and, in consequence, their ability to provide solutions when the contexts on which firms operate are distributed. This can be explained because not only the problems, but also the products, partners, skills, resources and pieces of evidence required to solve those problems are distributed, fragmented and decentralized across the network. This PhD thesis deals with the solving of industrial problems in supply chains based in collaboration. It develops a general framework for studying this paradigm, as well as both a generic process and a collaborative methodology able to deal with the process in practice. The proposal considers all the technical aspects (e.g. products modeling and network structure) and the collaborative aspects (e.g. the trust decisions and/or the power gaps between partners) that simultaneously impact the supply chain operation and the jointly solving of problems. Finally, this research work positions the experiential knowledge as a central lever of the problem solving process to contribute to the continuous improvement strategies at a more global level.TOULOUSE-INP (315552154) / SudocSudocFranceF

Antibiotic use and associated factors in a large sample of hospitalised older people.

OBJECTIVES: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance

Prognostic relevance of glomerular filtration rate estimation obtained through different equations in hospitalized elderly patients

The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from \u201cRegistro Politerapia Societ\ue0 Italiana di Medicina Interna (REPOSI)\u201d. Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR > 60 ml/min/1.73 m2 at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR < 60 ml/min/1.73 m2 was associated with unfavorable outcomes, although with a poor level of accuracy (AUC 0.60\u20130.66). No difference in predictive power between different equations was found. Physicians should be aware of the prognostic role of eGFR in a comprehensive assessment of elderly in-patients

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards

Background: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. Objective: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. Methods: Taking advantage of the “REgistro POliterapie Società Italiana Medicina Interna” (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. Results: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p <.0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p <.0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p =.172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p <.0001). Conclusions: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged 6565 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5\u201345.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3\u201334.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention