Are we operating effectively? A lean analysis of operating theatre changeovers

Hospital operating theatres are a critical but costly resource in healthcare processes. Their efficiency and utilisation impact upon hospital finances, clinical effectiveness and patient outcomes. Operations management techniques have now been applied widely to optimise flow. An important challenge is to balance the needs of process flexibility, efficiency and work standardisation with clinical requirements. This paper applies operations management methods to analyse elective orthopaedic surgery at five international hospitals to describe the issues that affect operating theatre productivity. It utilises an innovative method of video analysis to observe patient changeovers over 29 days of surgery and data is analysed to understand the causes of variability and waste. The findings suggest that processes which are standardised via operations management methodologies can improve productivity in a process that exhibits wide variation in practice. There are apparent trade-offs associated with efficiency and clinical concerns such infection control, that lead to different standard process archetypes being utilised. Recommendations for standardising patient changeovers are provided.     

卫生技术评估：澳大利亚的反映

本文分为三部分。第一部分主要是描述性的,列出了在澳大利亚应用卫生技术评估（HTA）的主要机构。首先,讨论了医疗用品管理局（Therapeutic Goods Administration,TGA）对HTA的应用。     

An economic evaluation attached to a single-centre,parallel group,unmasked, randomized controlled trial of a 3-day intensive social cognitive treatment (can do treatment) in patients with relapsing remitting multiple sclerosis and low disability

Abstract

Aims: This trial-based economic evaluation (EE) assesses from a societal perspective the cost-effectiveness of an intensive 3-day cognitive theory-based intervention (CDT), compared to care-as-usual, in patients with relapsing remitting multiple sclerosis (RRMS) and low disability (Expanded Disability Status Scale [EDDS] score < 4.0).

Materials and methods: The trial of the EE was registered in the Dutch Trial Register: Trial NL5158 (NTR5298). The incremental cost-effectiveness ratio (ICER) was expressed in cost on the Control sub-scale of the Multiple Sclerosis Self-Efficacy Scale (MSSES) and the incremental cost-utility ratio (ICUR) in the cost per Quality Adjusted Life Years (QALY) using the EQ-5D-5L. Bootstrap, sensitivity, and sub-group analyses were performed to determine the robustness of the findings.

Results: The two groups of 79 patients were similar in baseline characteristics. The base case ICER is situated in the northeast quadrant (€72 (40.74/€2,948)) due to a higher MSSES Control score and higher societal costs in the CDT group. The ICUR is situated in the northwest (inferior) quadrant due to losses in QALY and higher societal costs for the CDT group (?0.02/€2,948). Overall, bootstrap, sensitivity, and sub-group analyses confirm the base case findings. However, when the SF-6D is used as a study outcome, there is a high probability that the ICUR is situated in the northeast quadrant.

Limitations: The relative short follow-up time (6?months) and the unexpected increase in MSSES Control in the control group.

Conclusions: When using the EQ-5D-5L to calculate a QALY, CDT is not a cost-effective alternative in comparison to care as usual. However, when using self-efficacy or SF-6D as outcomes, there is a probability that CDT is cost-effective. Based on the current results, CDT for patients with RRMS clearly show its potential. However, an extended follow-up for the economic evaluation is warranted before a final decision on implementation can be made.     

Crude oil price forecasting based on internet concern using an extreme learning machine

The growing internet concern (IC) over the crude oil market and related events influences market trading, thus creating further instability within the oil market itself. We propose a modeling framework for analyzing the effects of IC on the oil market and for predicting the price volatility of crude oil’s futures market. This novel approach decomposes the original time series into intrinsic modes at different time scales using bivariate empirical mode decomposition (BEMD). The relationship between the oil price volatility and IC at an individual frequency is investigated. By utilizing decomposed intrinsic modes as specified characteristics, we also construct extreme learning machine (ELM) models with variant forecasting schemes. The experimental results illustrate that ELM models that incorporate intrinsic modes and IC outperform the baseline ELM and other benchmarks at distinct horizons. Having the power to improve the accuracy of baseline models, internet searching is a practical way of quantifying investor attention, which can help to predict short-run price fluctuations in the oil market.     

Bayesian model averaging and identification of structural breaks in time series

Bayesian Model Averaging (BMA) is used for testing for multiple break points in univariate series using conjugate normal-gamma priors. This approach can test for the number of structural breaks and produce posterior probabilities for a break at each point in time. Results are averaged over specifications including: stationary; stationary around trend and unit root models, each containing different types and number of breaks and different lag lengths. The procedures are used to test for structural breaks on 14 annual macroeconomic series and 11 natural resource price series. The results indicate that there are structural breaks in all of the natural resource series and most of the macroeconomic series. Many of the series had multiple breaks. Our findings regarding the existence of unit roots, having allowed for structural breaks in the data, are largely consistent with previous work.     

Saving Accounts versus Stocks and Bonds in Household Portfolio Allocation

We study the structure of household portfolios of financial wealth by analyzing both the determinants of total financial wealth and the choice between risky (stocks and bonds) and riskfree assets (saving accounts). The econometric specification is a generalized trivariate Tobit model, estimated on a cross section of 3,077 households in the Netherlands in 1988. We account for endogeneity of financial wealth and for selectivity due to nonreporting. Results show that the level of financial wealth and the marginal tax rate are major determinants of the allocation between riskfree and risky assets.     

Explaining The <Emphasis Type="Italic">Hump</Emphasis> In Life Cycle Consumption profiles

Summary  This paper documents life cycle (or age) profiles of (log) household income, durable and non-durable consumption for Dutch households after explicitly controlling for time (or business cycle) effects and birth cohort effects. We find that both measures of consumption as well as income is clearly hump shaped over the life cycle. Hence, real consumption per household seems to track income over the life cycle. This empirical regularity is hard to reconcile with basic specifications of the life cycle model. We further document life cycle profiles of demographic and labor supply variables. We argue that part, but not all, of the hump in consumption may be explained by household composition variables. Durable consumption per adult equivalent stays approximately flat until age 60 after which it drops dramatically. This phenomenon may be partly explained by a decrease in work related durable expenditures after retirement. Non-durable consumption per equivalent adult increases steadily until age 55 and stays approximately flat after that.      

Case Studies of Farmers' Use of Information Systems

Exploratory case study research was initiated to study the evolution of management information systems and their use in operational and strategic decisions. The unit of analysis was the management team on farms with innovative or successful information systems. Human factors, such as an analytical nature and commitment to lifelong learning, were perceived to be the most important common elements. Production variables often were critical success factors. Managers annually developed financial statements; enterprise and "what if" analyses were conducted regularly. Learning about questions that innovative producers have difficulty addressing was time-consuming but instructive with respect to research and educational needs.