This document outlines an investment business plan for establishing a robotic surgery program at Athens Medical Center. It discusses evaluating the costs of robotic surgery compared to alternative procedures. A key part of the plan is developing an activity-based costing model to accurately assess the true costs. The plan also covers initiating the program, including dedicating an OR room, assembling the robotic surgery team of a leading surgeon, nurses, and assistants. Training programs for staff and residents are also important. Monitoring outcomes and the economic feasibility is essential for the long-term success of the robotic surgery program.
How prepared is your lab? Can it handle infectious diseases like Ebola? MD Buyline recommends certain instruments and pricing for point of care systems for bedside testing.
View the full article at http://www.mdbuyline.com/blog/contained-laboratory-ebola-infectious-disease-preparedness/.
Orthopaedic Care Shifts to Outpatient and Urgent Care ClinicsApril Bright
The Shift in Care Delivery - As the healthcare delivery system evolves, hospitals may no longer be the first stop for patients seeking orthopaedic care. This is evidenced by the growing trend of surgeons moving to the outpatient setting, as patients seek less invasive procedures. Orthopaedic urgent care centers have also emerged as a viable alternative, due to their ability to address price concerns in the industry by reducing time and overhead costs for both providers and patients.
Attendees gain more insight into this shift, and learn how it will affect demands on manufacturers from a product design and delivery standpoint.
How prepared is your lab? Can it handle infectious diseases like Ebola? MD Buyline recommends certain instruments and pricing for point of care systems for bedside testing.
View the full article at http://www.mdbuyline.com/blog/contained-laboratory-ebola-infectious-disease-preparedness/.
Orthopaedic Care Shifts to Outpatient and Urgent Care ClinicsApril Bright
The Shift in Care Delivery - As the healthcare delivery system evolves, hospitals may no longer be the first stop for patients seeking orthopaedic care. This is evidenced by the growing trend of surgeons moving to the outpatient setting, as patients seek less invasive procedures. Orthopaedic urgent care centers have also emerged as a viable alternative, due to their ability to address price concerns in the industry by reducing time and overhead costs for both providers and patients.
Attendees gain more insight into this shift, and learn how it will affect demands on manufacturers from a product design and delivery standpoint.
Illustration on how the CPGs Adaptation Program has helped in quality improvement through compliance with national and international accreditation standards.
Cost accounting project report - CT & MRI Scan Analysis at a Superspeciality ...Aditya Kumar Varshney
Economic constraints are one of the major limitations on the quality of health care even in India’s urbanized cities. Quality improvement demands optimizing the existing facilities within available resources. In addition, the cost of medical services has risen dramatically in the past decade. This has laid a lot of importance to understand the actual cost of providing medical services.
Radiology, which is an integral component of diagnostic modalities in a tertiary setting. With more patients availing these services at tertiary care hospitals, thus with this study, we strive to assess the cost analysis of MRI and CT scan radiology services at a tertiary care hospital.
What is the difference between development and adaptation of clinical practice guidelines? This was presented by Dr. Yasser Amer during the 2nd Regional Workshop for CPG adaptation, Tunis, Tunisia May 24-26 2016
Link:
https://www.facebook.com/media/set/?set=a.481589005298936.1073741852.215244758600030&type=1&l=67dff997c7
Journal of applied clinical medical physics Vol 14, No 5 (2013)oncoportal.net
Journal of applied clinical medical physics Vol 14, No 5 (2013)
--
Журнал прикладной клинической медицинской физики (JACMP) публикует статьи, которые помогут клиническим медицинским физиков выполнять свои обязанности более эффективно и результативно, с большей полезностью для пациента. Журнал был основан в 2000 году, является журналом открытого доступа и публикуется дважды в месяц.
Design for reimbursement in medical device developmentAmber Hol Horeman
In medical device development it is essential to start with reimbursement strategy from day one to enhance the chance to successful implementation in the healthcare system. This presentation shows the outcomes of a 5 month graduation project to the role of reimbursement in medical device development. The design for reimbursement framework proposed provides an overview for starting entrepreneurs in the complex field of medical devices.
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
Prioritising Pharmacy Patient Care WebinarColin Thomson
Gordon Thomson, Principal Clinical Pharmacist, NHS Tayside discusses how they implemented PharmacyView, reducing their time spent on administrative tasks, enabling the more efficient deployment of staff resource and how they can now more easily identify priority patients on high risk drugs.
The Wennberg International Collaborative Policy Conference. E.bernal-delgado ...Atlas VPM
TRACKING REGIONAL VARIATION IN HEALTH CARE
A Key to Understanding and Improving Our Health Care Systems? Berlin, 4-5. June 2015
'Conclusions to draw from the analysis of variation in times of saving targets– experiences from member countries of the ECHO Project' E.Bernal.-Delgado
Quality Assurance in Radiotherapy. Web-based quality assurance; using medical web instrument to facilitate the education, collaboration and peer review, providing an environment in which clinical investigators can receive, share and analyse treatment planning digital data.
How to Make Postmarket Surveillance More Cost EffectiveApril Bright
When it comes to postmarket surveillance (PMS), it’s common for the costs to outweigh the value. But, by working with the right team, you’ll be able to execute a study that maximizes return on investment and minimizes the financial impact of conducting further observational research. Postmarket study challenges that must be addressed include enrollment delays, patient attrition, long-term follow-up, resourcing demands and global payor requirements. This session will provide a case study of one orthopaedic company’s seamless transition between postmarket approval and post-approval studies.
High-cost, innovative pharmaceuticals are one serious challenge for health care systems today. At a panel that explored how this might be addressed in Asia, Adrian identified the issues and discussed the potential role of managed entry agreements (MEAs) and performance-based risk-sharing arrangements (PBRSAs). In essence, these measures allow a new medicine to be marketed while additional data about its use in actual clinical practice are being collected. Implementing MEAs or PBSRAs can be difficult, he notes. Crucial to success are assessing local value and ensuring that measures are based on formal written agreements that clealry set out expectations and responsibilities for all stakeholders.
Integrate RWE into clinical developmentIMSHealthRWES
With greater application of RWE throughout the pharmaceutical
lifecycle, learnings are emerging that offer guidance for
approaches to derive the maximum value. This article captures
the author’s experience at a leading international biotech, with
insights for smoothing RWE assimilation into clinical
development and realizing the benefits it brings.
Is your All-Inclusive Resort part of a “complex” or has nearby properties under the same brand, do you have exchange privileges so that you may “dine-around” at the other resorts?
Illustration on how the CPGs Adaptation Program has helped in quality improvement through compliance with national and international accreditation standards.
Cost accounting project report - CT & MRI Scan Analysis at a Superspeciality ...Aditya Kumar Varshney
Economic constraints are one of the major limitations on the quality of health care even in India’s urbanized cities. Quality improvement demands optimizing the existing facilities within available resources. In addition, the cost of medical services has risen dramatically in the past decade. This has laid a lot of importance to understand the actual cost of providing medical services.
Radiology, which is an integral component of diagnostic modalities in a tertiary setting. With more patients availing these services at tertiary care hospitals, thus with this study, we strive to assess the cost analysis of MRI and CT scan radiology services at a tertiary care hospital.
What is the difference between development and adaptation of clinical practice guidelines? This was presented by Dr. Yasser Amer during the 2nd Regional Workshop for CPG adaptation, Tunis, Tunisia May 24-26 2016
Link:
https://www.facebook.com/media/set/?set=a.481589005298936.1073741852.215244758600030&type=1&l=67dff997c7
Journal of applied clinical medical physics Vol 14, No 5 (2013)oncoportal.net
Journal of applied clinical medical physics Vol 14, No 5 (2013)
--
Журнал прикладной клинической медицинской физики (JACMP) публикует статьи, которые помогут клиническим медицинским физиков выполнять свои обязанности более эффективно и результативно, с большей полезностью для пациента. Журнал был основан в 2000 году, является журналом открытого доступа и публикуется дважды в месяц.
Design for reimbursement in medical device developmentAmber Hol Horeman
In medical device development it is essential to start with reimbursement strategy from day one to enhance the chance to successful implementation in the healthcare system. This presentation shows the outcomes of a 5 month graduation project to the role of reimbursement in medical device development. The design for reimbursement framework proposed provides an overview for starting entrepreneurs in the complex field of medical devices.
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
Prioritising Pharmacy Patient Care WebinarColin Thomson
Gordon Thomson, Principal Clinical Pharmacist, NHS Tayside discusses how they implemented PharmacyView, reducing their time spent on administrative tasks, enabling the more efficient deployment of staff resource and how they can now more easily identify priority patients on high risk drugs.
The Wennberg International Collaborative Policy Conference. E.bernal-delgado ...Atlas VPM
TRACKING REGIONAL VARIATION IN HEALTH CARE
A Key to Understanding and Improving Our Health Care Systems? Berlin, 4-5. June 2015
'Conclusions to draw from the analysis of variation in times of saving targets– experiences from member countries of the ECHO Project' E.Bernal.-Delgado
Quality Assurance in Radiotherapy. Web-based quality assurance; using medical web instrument to facilitate the education, collaboration and peer review, providing an environment in which clinical investigators can receive, share and analyse treatment planning digital data.
How to Make Postmarket Surveillance More Cost EffectiveApril Bright
When it comes to postmarket surveillance (PMS), it’s common for the costs to outweigh the value. But, by working with the right team, you’ll be able to execute a study that maximizes return on investment and minimizes the financial impact of conducting further observational research. Postmarket study challenges that must be addressed include enrollment delays, patient attrition, long-term follow-up, resourcing demands and global payor requirements. This session will provide a case study of one orthopaedic company’s seamless transition between postmarket approval and post-approval studies.
High-cost, innovative pharmaceuticals are one serious challenge for health care systems today. At a panel that explored how this might be addressed in Asia, Adrian identified the issues and discussed the potential role of managed entry agreements (MEAs) and performance-based risk-sharing arrangements (PBRSAs). In essence, these measures allow a new medicine to be marketed while additional data about its use in actual clinical practice are being collected. Implementing MEAs or PBSRAs can be difficult, he notes. Crucial to success are assessing local value and ensuring that measures are based on formal written agreements that clealry set out expectations and responsibilities for all stakeholders.
Integrate RWE into clinical developmentIMSHealthRWES
With greater application of RWE throughout the pharmaceutical
lifecycle, learnings are emerging that offer guidance for
approaches to derive the maximum value. This article captures
the author’s experience at a leading international biotech, with
insights for smoothing RWE assimilation into clinical
development and realizing the benefits it brings.
Is your All-Inclusive Resort part of a “complex” or has nearby properties under the same brand, do you have exchange privileges so that you may “dine-around” at the other resorts?
Making Value-Based Healthcare in Cataract a Reality Insights from VBHCAT Pr...Alexandre Lourenço
Alexandre Lourenço's keynote on "Making Value-Based Healthcare in Cataract a Reality - Insights from VBHCAT Project in Portugal", at the 44th World Hospital Congress organized by the International Hospital Federation, in November 8th 2021.
HOSPITALMBA-9617Angela DiazAutomation of Hospital.docxpooleavelina
HOSPITALMBA-9617Angela Diaz
Automation of Hospital Emergency Department
Angela Diaz
Barry University
MBA-617
Industry Focus
An emergency department is a medical treatment institution or facility that focuses on the emergence of medicine acute care whereby the patient comes to the hospital by them or through the use of the ambulance. The emergency department is located in the hospital at times in the primary care center. Which is usually is operated 24 hours a day, seven days a week. The hospital emergency department had been facing a lot of challenges due to the sharp rise in the number of patients with emergencies. In most cases, many of the condition are life-threatening and as such, require immediate hospital intervention or attendance. Overcrowding and critical shortages in the Emergency Department (ED) limits access to timely emergency care in the hospital. Another common issue that arises with overcrowding is long patient wait times (Manyika, 2017). The emergency department in the country has about 80 to 85% walk in and the similar number of the patients that are sent home after treatment with medical prescriptions, the remaining 15% are usually admitted to the hospital-based on the type of ailment that they are diagnosed with (Gutherz & Baron, 2001). There is always the unintended nature of patient appearance; therefore, the hospital must deliver the primary treatment for a wide range of diseases or injuries (Manyika, 2017). That can be missed due to lack of efficiency and quality care provided by overwhelmed staff. Such challenges can only be solved by technical factors or automation. The automation process gives the physician ample time to concentrate on the quality outcome instead of receiving distractions from a disorganized emergency department system. Therefore, automation is a solution because it increases the level of productivity because machines assume roles such as registrations, dispensing of the prescription, and checkout.
Debates in differences for solutions in implementing technology to enhance efficiency within the emergency department have been discussed between organizations such as the Society for Academic Emergency Medicine as well as the American College of Emergency Physician have held several annual conferences to meet the technical solution for the ED challenge. In many ED in the country, many hospitals are overcrowded, and the leading cause is based on the hospital itself. It has been found, that safety and liability are one of the primary challenges in the emergency department sector (Manyika, 2017). It was found within the United States of America that $3.6 billion was lost due the lack of efficiency within emergency department due to multiple lawsuits. In such like state, intelligent companies might find themselves in the receiving end.
Problems Faced by the Industry
Therefore, there is critical need for increase and quality care provided to patients that can be resolved through the means of tec ...
: Intralign’s Rep-less Program empowers providers to successfully navigate healthcare reform through better control of the episode of care – which includes reducing the influence of the sales rep.
The Top 5 Ancillary Services For Urology PracticesClark Love
Reduction in Medicare contract payments and decreased physician reimbursement from insurers are causing decreased physician salaries, medical profits and general revenue. This is driving the desire for urology practices to add ancillary services - and this is a good thing for patients.
Costing for Hospitals - How to arrive at service level cost ?Manivannan S
Costing hospital Services poses serious challenges in identifying the basis of allocation of costs and the allocation itself. This PPT gives you the entire methodology
Similar to Mira 2011 Athens Business Class Vassilis Bardis Athens Medical Center (20)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Mira 2011 Athens Business Class Vassilis Bardis Athens Medical Center
1. Investment Business Plan for aRobotic Surgery Program. Athens Medical Center VASSILIS BARDIS COO ATHENS MENTICAL CENTER DLSHTM , MSc HSM.
2. 1983 : foundation of Athens Medical Center Today, leading role in the field of health care in southeastern Europe. Listed in Super brands catalogue Forbes Magazine ranks us among the 200 most important companies in the world European Business Magazine : 100 most important Companies President of Athens Medical Group, Dr. G.Apostolopoulos
11. The successful strategic and business plan requires not only the evaluation of robotic costs, but the evaluation of relative costs such as lost labor cost e.t.c which have influence in patients decision making
12.
13. of the associated material, staff recruitment and/or staff trainingPossible operating room (OR) modifications necessary ->to support the console and other equipment. ->recruitment of a leading surgeon or his development.
14. Evaluation of the growth potential key element Use market analysis to estimate the impact of the new program on the institution. Additional aspects: study of the population and the competition, analysis of reimbursements payers
15. The Surgical Volume strictly connected to the learning curve and to the quality of outcomes three to five cases per week during the initiation of the program are necessary to obtain continuity in the learning curve (Ohio State Uni).
16. Establishment of an economic model Crucial With Activity-based costing and management (ABC) or alternative models
17. ABC Acosting model that identifies activities in an organization assigns the cost of each activity resource to all products and services it assigns more indirect costs (overhead) into direct costs.
18. Additional costs ( per case ) Personal costs (per day) Personal costs (per day) Preoperative Surgery Material costs (per day) Material costs (per day) Cost of capital (per day) Cost of capital (per day) Administration costs (per day) Personal costs (per day) Anesthesiology Personal costs (per day) Material costs (per day) Total cost Operative Material costs (per day) Cost of capital (per day) Cost of capital (per day) Consumables Robotic operation (per day) Administration costs (per day) Laparosc. operation (per day) Amortization Personal costs (per day) Robotic system (per day) Postoperative Material costs (per day) Laparosc. System (per day) Operating room Ward Cost of capital (per day) Administration costs (per day) Principle of the cost analysis
22. In current economic climate it is equally important for medical institutions and patients alike to consider the financial impact of treatment decisions.
23. ABC Establish the true cost of its individual products and services Able to eliminate those which are unprofitable Able to lower the prices of those which are overpriced.
24. Purchase of a robotic system a significant cost associated with da Vinci’s purchase $1.2–1.7 million USD per case disposable fee for the robotic instruments; $200 per instrument used maintenance contract of $100,000 USD yearly per system
25. Cost analysis - Economic feasibility check the cost of the surgery, 2) the reimbursement (according to the different health systems).
26. Cost of surgery analysis of the variable costs and the fixed costs
27. Variable Costs related to all those activities that are necessary to produce the surgical performance (such as disposable tools, medications etc.).
28. Fixed costs represented by the overall OR time dedicated to robotics and the purchase of the system. a high surgical volume center can have an impact in terms of variable costs reduction;
29. Reduction of cost hence, the best chance to increase surgical volume and therefore to reduce costs the use of the da Vinci system with our surgical teams, as gynecologists, general surgeons and other specialties.
35. Comparing Alternatives to a given health intervention (x) Costs more Robotic procedure’s point Alternative is worse in both respects More Effective X Less Effective Alternative is better in both respects Costs less Status quo
36.
37. Administrative Dedicated robotic program manager to Coordinate administrative staff Connect clinicians’ work and marketing plan Website management Patients’ information
38. Implementation Dedicated OR room The robotic team The leading surgeon The operating room nursing staff (SN) The surgical physician assistant (PA) Surgical fellows and residents
71. Acquiring the da Vinci® Surgical System a strategic initiative with a three-to-five year business plan Return on investment depends upon volume and complexity of surgical procedures routinely performed with robotic assistance.
72. Potential Procedural Cost-Shifts decreased intra-operative minutes decreased hospital length of stay decreased consumption of routine post-op surgical care needs, such as IVs, narcotics, blood transfusions, wound care management & nursing care surveillance avoidance of intra-operative conversions avoidance of post-operative wound infections
73. Business Development Metrics New direct referrals for elective surgical procedures New referrals to ancillary services in the hospital’s continuum of care pre- & post-robotic surgery, such as Radiology, Laboratory, Cancer Center, etc. Market share shifts beyond customary primary & secondary service catchment Shift in payer mix to a younger, insured patient population Change in private payer contract terms, in particular shift from per diem to case rates Change in open surgical volume to minimally invasive surgery volumes Change in adverse surgical events reported by Infection Control & Quality Assurance Reduction in surgical re-admission rates
75. Laparoscopic Radical Prostatectomy with robotic assistanceICD-9-CM Procedure Code 60.56ICD-9-CM Procedure Code 17.42 Total number of cases performed Length of stay (range & average) Age of patient (range & average) Name of payer Type of reimbursement (MS-DRG, Case Rate, Percent-of-Charges) Amount of reimbursement for each case Cost per case (not charge)
76. 3-D ValueBudgeting for Change Clinical: Conversion of complex open surgical procedures to minimally invasive procedures Financial: Operational direct patient care efficiencies Strategic: Change in business practices (new patient referrals, broader market share, shift in payer mix and contract term corrections)
77. Will Robotics become commonplace? depends on a number of factors in the private healthcare climate it can justify its high price tag through the added business a hospital can attract using a prestigious device such as the da Vinci
78. 1st factor: Hospital ‘s Investment Plan However the Health Insurance Plan usually pays the same amount to the hospital for a robotic surgery as it does for the same laparoscopic procedure in many countries. the difference in cost for each operation must be covered by the hospital, leaving only the largest centers with the potential for operating a system like the da Vinci
79. The $4.5 million investment covers the system training Support and five years worth of “disposables,” the one-time use items which are discarded after every operation
80. After five years, however, the hospital must cover the disposable costs on its own, which at approximately $2800, are $2000 more expensive than laparoscopic surgery per operation.
81. 2nd factor of acceptance: doctors A next step in surgery’s evolution, or just another gimmick ? 2006 poll of urology residents in Canada and the U.S. found that over half of the respondents believed that robotic surgery “looked promising but was not currently the gold standard,” with only 30% responding that “they would be performing robotic surgery after residency.”
82. Increased number of systems exposure of doctors to robotic surgery, and access to specialized training, it is becoming more common with over 1000 da Vinci systems in 36 countries worldwide
83. Realization on a larger scale depends on whether they are perceived as significant enough to warrant the sizable outlay of investment from the finite resources of the healthcare system.
84. Technology of tomorrow is already here but until it can be reconciled with today’s economic realities it will remain more a novelty than an effective means of improving the health of patient population on a significant scale
85. Conclusion robotic surgery as it exists today represents a powerful new tool in the modern surgeon’s armament improving on many of the shortcomings of laparoscopy with the addition of special features that can enhance a surgeon’s own natural abilities.
Scandinavian Journal of Surgery 98: 72–75, 2009BUILDING A ROBOTIC PROGRAMB. Rocco1,3, A. Lorusso2, R. F. Coelho3, K. J. Palmer3, V. R. Patel31 Division of Urology, European Institute of Oncology, Milan, Italy2 Senior Planning and Control Department, European Institute of Oncology, Milan, Italy3 Global Robotic Institute, Florida Hospital Celebration Health, Celebration Florida, University of Central Florida School of Medicine, U.S.AKey words: Prostate cancer; prostatectomy; robot; da Vinci; laparoscopically naïveBusiness plan developmentThe establishment of an economic model is crucial for a robotic program. An accurate due diligence is important to establish the economic boundaries that each institution has to deal with
; the development of the business plan requires an evaluation of the direct costs (such as buying the robotic system) and of the associated material, staff recruitment and/or staff training. Possible operating room (OR) modifications could be necessary to support the console and the other equipment; a further necessary action is the recruitment of a leading surgeon or his development.
A further key element is the evaluation of the growth potential; for this particular purpose, a thorough market analysis will help to estimate the impact of the new program on the institution. A study of the population and the competition, the analysis of reimbursements and payers are additional aspects that conclude the evaluation.
One of the key steps to pursue a successful robotic program is the surgical volume. It is strictly connected to the learning curve and to the quality of outcomes. According to the experience of the Ohio state university, three to five cases per week during the initiation of the program are necessary to Authors report a significant increase in surgical volume since the introduction of the robotic program, from 40 to 350 cases per year within five years (12). obtain continuity in the learning curve.
Furthermore, the establishment of an economic model is crucial for a robotic program. Activity-based costing and management (ABC) or alternative models seem appropriate approaches to develop a business plan related to robotic surgery.
ABC is a costing model that identifies activities in an organization and assigns the cost of each activity resource to all products and services according to the actual consumption by each: it assigns more indirect costs (overhead) into direct costs. In this way an organization can establish the true cost of its individual products and services for the purposes of identifying and eliminating those which are unprofitable and lowering the prices of those which are overpriced.
Purchase of robotic systemThe da Vinci robotic system has a significant cost associated with its purchase. The cost of the robot is approximatel $1.2–1.7 million USD depending upon the type of system purchased. In addition there is a per case disposable fee for the robotic instruments of approximately $200 per instrument used. There is also a maintenance contract of $100,000 USD yearly per system (11).
In order to make a cost analysis and therefore to check the economic feasibility of the purchase of a da Vinci system, we need to evaluate the following items:1) the cost of the surgery, 2) the reimbursement (according to the different health systems).
The cost of surgery can be evaluated with an analysis of the variable costs and the fixed costs.
Variable costs are related to all those activities that are necessary to produce the surgical performance (such as disposable tools, medications etc.).
Fixed costs are represented by the overall OR time dedicated to robotics and the purchase of the system. It is clear that a high surgical volume center can have an impact in terms of variable costs reduction; hence, the best chance to increase surgical volume and therefore to reduce costs is to share the use of the da Vinci system with our surgical teams, as gynecologists, general surgeons and other specialties.
Initiation of the programThe beginning of any robotic program can be challenging as multiple members of the team are learning the technology and their own personal roles on the team. Not with standing the robotic learning curve could be considered less challenging than laparoscopic one in terms of surgical procedure, there are many aspects that beyond the surgical act need to be developed at the beginning of the experience. Robotic docking and undocking, use of disposable instruments, assisting at the bedside far from the console: all the different people involved in the robotic program have their own learning curve; therefore it is of major importance to define which robotic procedures need to be performed at the beginning, since the main goal of a robotic team is to standardize the procedure as soon as possible.
Administrative staffBeside the clinical team, a dedicated robotic program manager is necessary to coordinate administrative staff, connect the work of clinicians with the marketing plan of the institution, make sure that the website is up-to-date, patients’ information of the robotic system and other crucial applications.This way, the clinician can be more concentrated on surgical works and the program manager could accurately monitor the growth and all the other collateral activities.
MaintenanceData collectionStarting a new surgical program should suggest a frequent update and audit regarding efficiency, outcomes and patient satisfaction. In addition, it is advisable to present and share a new experience with colleagues during meetings and scientific events or reporting it as peer reviewed papers in order to improve quality and to share knowledge and findings. An appropriate and prospective data collection is mandatory. A simple, easy to read database should include all the information; validated self administered questionnaires should be used as evaluation methods and strict follow up should be carried out particularly for oncological diseases. Outcomes should be monitored regularly, in order to constantly monitor the outcome of the new surgical approach. A comparison with the previous adopted technique will be useful to evaluate possible advantages due to the advent of the new technique (16). Clinically it is also helpful to record each of the early cases and review them with the team to evaluate progress and plan a common approach to the procedure. A complete collection of video recorded surgical procedures is mandatory for surgical audits and for training of fellows and residents.Monitoring the economic feasibilityA previously reported econominc feasibility study at an academic institution (12) concluded that the cost of medical and surgical supplies, including the cost of instruments accounted for 45% of total average direct cost and approximately one-third of average total cost. Operating room services and therefore, duration of OR utilization accounted for almost 30% of total average direct cost and 35% of the total cost per procedure, respectively. Projecting an increase in the number of procedures performed per year from 100 to 500 reduced costs by around 18%, based on the cost of the robot, and maximal change in costs was seen in increasing volumes from 20 to 100 cases per year.Training and educationOnce the program is launched, maintenance implies the enlargement of the surgical staff. Residents and fellows are involved in surgical activities with the supervision of a PA and primary clinician, beginning their surgical activity as bedside assistants, after an initial experience watching at least 20 cases.It is noteworthy that surgical procedures performed using a camera have many advantages in terms of training. The video monitors and recorders allow the trainee to watch the procedure with the same field of vision as the operator and it is easier to create a complete video data base that can be used for further and future training. Growth All the aspects involved in the robotic program need to be checked periodically. Together with the program manager, the leading surgeon needs to assess the economic sustainability of the program; a breakdown of all parameters allows for an accurate check of materials and waste assessment. Considering the elevated costs, a reduction in OR time is one of the most important items to be checked to increase the economic feasibility of the project. Obviously, the most important thing is the clinical evaluation. Matching databases and literature to compare the results of the new technique with the gold standard procedures and with other groups performing robotic programs can help monitor surgical quality. Only if the auto-assessment reveals satisfactory outcomes, a further increase of the activity with new investments in terms of materials (another robot) and / or HR (surgeons, PA etc.) can be considered.Nevertheless, an accurate market analysis needs to be renewed before the investment occurs, to match the chance of offering much more surgical volume and the real necessity of this increase.
According to the literature, robotic surgery has a less steep learning curve when compared to laparoscopy; particularly for a procedure such as radical prostatectomy. Building a successful robotic program means taking into account many details such as economics, organization and teaching. The keys for success are directly related to the infrastructure supporting the program, coordination of team work and careful review of outcomes.To create, maintain and grow a robotic program, it is of utmost importance to build a complete and accurate strategy from the beginning. The risk-benefits analysis, the business plan and the leading surgeon are key factors for success.
The keys for success are directly related to the infrastructure supporting the program, coordination of team work and careful review of outcomes.To create, maintain and grow a robotic program, it is of outmost importance to build a complete and accurate strategy from the beginning. The risk-benefits analysis, the business plan and the leading surgeon are key factors for success.
Magazine: Physician Oct 2006ConsumerdemandSome national experts saythe drive toward wider useof robotic surgery will notcome from doctors, many ofwhom are used to doing surgerythe traditional way. However,consumers increasingly aredemanding the latest innovations.Advanced technology also may helphospitals recruit young surgeons to theirmedical staffs. “The younger generation ofsurgeons look for institutions that have thelatest in robots,”Kwart notes.“Some of our competitors already haverobotic surgery,” Kwart concludes. “Patientsare demanding the latest innovations. Let’sget started and remain competitive.”
Kathryn Barry, MPH, MSN, RNHealth Policy Specialist for Intuitive® SurgicalRe: Planning for Long-Term Success with a Robotic Surgery Program2009
Acquiring the da Vinci® Surgical System is a strategic initiative that should be associated with a three-tofive-year business plan. Return on this investment depends upon both the volume and complexity oflaparoscopic surgical procedures routinely performed with robotic assistance.
the operating room mayfocus on procedural line-item cost-analyses, but the Finance Department should maintain a focus onstrategic business development metrics
During the due diligence process, the hospital’s coding department should review Intuitive Surgical’s“Laparoscopic Robotic Surgery Coding and Reimbursement” document (PN 871971). Its purpose is tobriefly share education and information consistent with decisions made by the American MedicalAssociation (AMA), Centers for Medicare and Medicaid Services (CMS) and leading payers, assummarized in Table 6.
Before delving into a comprehensive financial analysis, a baseline query of the hospital’s most prevalentrobotic-assisted laparoscopic procedure — such as laparoscopic radical prostatectomy — helps to identifyany programmatic issues that require correction
In conclusion, a paradigm shift in healthcare financing will inevitably cause a shift in healthcare deliverydecisions. Shifts from cost-accounting to new financial metrics that reward quality and efficiency are onthe horizon. Hospitals that pursue a multi-specialty robotic surgery program should be guided by thedynamic interaction of cost-accounting, strategic planning and business development principles.Oversight requires a multi-disciplinary team, chaired by a Financial Director experienced in monitoring astrategic investment. As a new service line for the Department of Surgery, three strategic shifts are desiredmanagement outcomes
On the Cutting Edge: Robotic Surgery's Renaissance Toronto 2009Whether robotic surgery in its current incarnation becomescommonplace in Canada depends on a number of factors.Robotic surgery in the private healthcare climate of the UnitedStates can justify its high price tag through the added business ahospital can attract using a prestigious device such as the daVinci.
However, the Ontario Health Insurance Plan pays thesame amount to the hospital for a robotic surgery as it does forthe same laparoscopic procedure.26 This means the differencein cost for each operation must be covered by the hospital, leavingonly the largest centres in Canada with the potential foroperating a system like the da Vinci. Exacerbating this expensebeyond the initial sale price is the actual operating cost of the daVinci.
The $4.5 million investment covers the system, training,support, and five years worth of “disposables,” the one-time useitems which are discarded after every operation.
After five years,however, the hospital must cover the disposable costs on its own,which at approximately $2800, are $2000 more expensive thanlaparoscopic surgery per operation.26
Another factor important to widespread acceptance iswhether doctors consider robotic surgery as the next step insurgery’s evolution, or just another gimmick. A 2006 poll ofurology residents across Canada and the U.S. found that overhalf of the respondents believed that robotic surgery “lookedpromising but was not currently the gold standard,” with only30% responding that “they would be performing robotic surgeryafter residency.”5
Still, with the increased number of systems exposure of doctors to robotic surgery, and access to specializedtraining, it is becoming more common with over 1000 da Vincisystems in 36 countries worldwide.9 For example, the number ofurological procedures performed worldwide with the da Vincisystem has continued to increase from 1500 to 20 000 to 36 000in the year 2000, 2005, and 2006 respectively.28 In 2003, LondonHealth Sciences Centre was the first hospital in Canada to usethe system.29 Other cities in Canada that have the systeminclude: London, Montreal, Toronto, Edmonton, andVancouver.
Whether theseimprovements can ever be realized on a larger scale depends onwhether they are perceived as significant enough to warrant thesizable outlay of investment from the finite resources of ourhealthcare system.
The technology of tomorrow is already here,but until it can be reconciled with today’s economic realities itwill remain more a novelty than an effective means of improvingthe health of Canadians on a significant scale. Leonardi daVinci’s designs ranged from the revolutionary, in the moderntank, to the ultimately unrealized in the ornithopter, an ill-fatedflying machine. Where on this spectrum the da Vinci surgicalsystem falls, only time will tell.
ConclusionThere is no question that robotic surgery as it exists inCanadian hospitals represents a powerful new tool in the modernsurgeon’s armament, improving on many of the shortcomingsof laparoscopy, with the addition of special features that canenhance a surgeon’s own natural abilities.