Total abrogation of facial seborrhoeic dermatitis with extremely low-frequency (1–1.1 Hz) ‘imprinted’ water is not allergen or hapten dependent: a new visible model for homoeopathy

Extremely low frequencies, from 1 to 1.1 Hz, imprinted in water (imprinting was done by succussing a glass containing the water) led to a total abrogation of a facial seborrhoeic dermatitis, previously proposed as a visible model for the theory of ‘memory of water’. This technique provides a new perspective on the enigma of homoeopathy and the treatment of allergic diseases and possibly all other inflammatory reactions.     

Stochastic programming for outpatient scheduling with flexible inpatient exam accommodation

This study is concerned with the determination of an optimal appointment schedule in an outpatient-inpatient hospital system where the inpatient exams can be cancelled based on certain rules while the outpatient exams cannot be cancelled. Stochastic programming models were formulated and solved to tackle the stochasticity in the procedure durations and patient arrival patterns. The first model, a two-stage stochastic programming model, is formulated to optimize the slot size. The second model further optimizes the inpatient block (IPB) placement and slot size simultaneously. A computational method is developed to solve the second optimization problem. A case study is conducted using the data from Magnetic Resonance Imaging (MRI) centers of Lahey Hospital and Medical Center (LHMC). The current schedule and the schedules obtained from the optimization models are evaluated and compared using simulation based on FlexSim Healthcare. Results indicate that the overall weighted cost can be reduced by 11.6% by optimizing the slot size and can be further reduced by an additional 12.6% by optimizing slot size and IPB placement simultaneously. Three commonly used sequencing rules (IPBEG, OPBEG, and a variant of ALTER rule) were also evaluated. The results showed that when optimization tools are not available, ALTER variant which evenly distributes the IPBs across the day has the best performance. Sensitivity analysis of weights for patient waiting time, machine idle time and exam cancellations further supports the superiority of ALTER variant sequencing rules compared to the other sequencing methods. A Pareto frontier was also developed and presented between patient waiting time and machine idle time to enable medical centers with different priorities to obtain solutions that accurately reflect their respective optimal tradeoffs. An extended optimization model was also developed to incorporate the emergency patient arrivals. The optimal schedules from the extended model show only minor differences compared to those from the original model, thus proving the robustness of the scheduling solutions obtained from our optimal models against the impacts of emergency patient arrivals.

     

Value Driven Outcomes (VDO): a pragmatic,modular, and extensible software framework for understanding and improving health care costs and outcomes

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.     

Coronary stent thrombosis: time course and clinical outcome

The current clinical practice of stent implantation has changed over the last few years. We analysed the incidence and time course of stent thrombosis in patients undergoing successful coronary angioplasty and stenting over the last three years. All the patients were treated with aspirin and ticlopidine. A total of 13 patients experienced stent thrombosis. The mean age was 52+/-12 years; 12 were smokers and 10 had a recent history of myocardial infarction. None of these patients had received abciximab. The median time from stent implantation to stent thrombosis was 10 hours, with all the stent occlusions occurring within 18 hours of stent implantation procedure. All the patients underwent a repeat intervention at a median time of 30 minutes after the clinical suspicion of stent occlusion. On follow-up of 1 to 24 months, three patients developed reocclusion. In the present era of coronary angioplasty and stenting, when interventional procedures are not pre-planned and patients are treated with aspirin and ticlopidine or clopidogrel at the time of stent implantation, the incidence of stent thrombosis is low; it is seen mainly in patients with recent myocardial infarction, majority of them being smokers, and occurs within 18 hours in all the patients.