Average Start Time Research Articles

Implementing Six Sigma in The Netherlands

Six Sigma, a process-focused strategy and methodology for business improvement, can be used to improve care processes, eliminate waste, reduce costs, and enhance patient satisfaction. Six Sigma was introduced in 2001 at the 384-bed Red Cross Hospital (Beverwijk). During the Green Belt training, every participant was required to participate in at least one Six Sigma project. The hospital's total savings in 2004 amounted to 1.4 million dollars, for an average savings of 67,000 dollars for each of the completed 21 projects. In one project, the team designed a new admission process for the operating rooms, resulting in an average starting time nine minutes earlier. This relatively minor improvement made it possible to operate on an additional 400 patients a year and to achieve a net savings of >273,000 dollars. A second project reduced the number of patients receiving intravenous (IV) antibiotics by switching to oral administration, yielding annual savings, based on medication costs alone, of >75,000 dollars. A third project reduced the length of stay in the delivery room from 11.9 to 3.4 hours, yielding an annual savings of 68,000 dollars. The "Ultimate Cure?": Six Sigma, which entails involvement of health care workers; use of improvement tools (from industry); creation of trained project teams to tackle complex, often cross-departmental processes; data analyses; and investment in quality improvement may prove the "ultimate cure" to the current cost, quality, and safety issues that challenge health care.

Dawn singing reflects past territorial challenges in the winter wren

Territory defence can be seen as a dynamic long-term process that involves some learning. For example, a resident may adjust its territory proclamation behaviour depending on its prior experience with territorial intruders. We investigated whether short territorial challenges could have long-lasting effects on the singing behaviour of male birds. We used song playbacks to simulate intrusions into autumn territories of male winter wrens, Troglodytes troglodytes, shortly after dawn and compared male singing behaviour immediately before and 1 day after the simulated intrusion. As in many other bird species, unchallenged male wrens tended to sing more songs before than after sunrise. One day after a simulated intrusion, however, this pattern was much more pronounced. Males significantly increased their song output before sunrise, but maintained or even reduced song output after sunrise. This result suggests that dawn singing before sunrise is particularly important for territory defence. On the day after the intrusion, the start of dawn singing varied less between males, although the average starting time remained the same. Our findings suggest that a territorial challenge can influence singing behaviour almost 24 h after the intrusion. The amount and timing of birdsong, as a preventive territorial proclamation, can thus be adjusted to past territorial challenges.

A Study on Back Pain, Pain Disability, and Labour Pain of Postpartum Women

【Purpose: The purpose of this study was to look into back pain, pain disability, labour pain, and related areas of pain experienced by postpartum women. Method: A survey about pain including a Visual Analogue Scale (VAS), Oswestry pain disability, and pain drawing was used in a descriptive research method on 98 women 2-3 days after delivery. Result: 57.1% of those surveyed reported experiencing back pain before pregnancy. 75.5% reported experiencing back pain during pregnancy. The average starting time of back pain for pregnant women was 2.9 months into pregnancy. 48.8% reported the most severe back pain in the last trimester of pregnancy, while most women complained of left and right pubic pain and lumbar area pain during pregnancy. Statistical relations were calculated and menstrual symptoms (F=5.938, p=0.004), back pain prior to pregnancy (F=4.714, p=0.000), back pain during pregnancy (F=-3.429, p=0.001), and back pain disability prior to pregnancy (F=-1.994). Conclusion: There is a relation in postpartum women's back pain between back pain prior to pregnancy and back pain during pregnancy. Pelvic examinations early in pregnancy can determine if back pain will change for the worse or relapse. Therefore, the application of a pain relieving nursing intervention is needed.】

Smart Prep法を用いた造影三次元MR angiography : Smart Prep法の動作不良の対策について

We have pointed out a number of problems with the Smart Prep technique as used in initial clinical practice. A number of measures to solve these problems were evaluated and applied to clinical practice to determine their effectiveness, (1) In cases in which scan start timing was too early, the cause was assumed to be the monitoring of a signal other than the target vessel. The tracking volume was set for the ascending aorta to counter the problem. In addition, two to three continuous scans were performed during one breath hold. Good MRA images were obtained in all cases as a result of this modification. (2) In cases in which scan start timing was too late, the cause was assumed to be deviation of the tracking volume from the target vessel. In order to solve this problem, the average scan start time of the target vessel was calculated, and this value was used to set the fail-limit time. Good quality MRA images were obtained in cases for which the scan time was started at the fail-limit time when operation was not triggered by the Smart Prep technique.

Bright Light Treatment of Winter Depression

Bright light therapy is the recommended treatment for winter seasonal affective disorder (SAD). However, the studies with the best placebo controls have not been able to demonstrate that light treatment has a benefit beyond its placebo effect. Ninety-six patients with SAD completed the study. Patients were randomly assigned to 1 of 3 treatments for 4 weeks, each 1.5 hours per day: morning light (average start time about 6 AM), evening light (average start about 9 PM), or morning placebo (average start about 6 AM). The bright light (approximately 6000 lux) was produced by light boxes, and the placebos were sham negative-ion generators. Depression ratings using the Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) were performed weekly. There were no differences among the 3 groups in expectation ratings or mean depression scores after 4 weeks of treatment. However, strict response criteria revealed statistically significant differences; after 3 weeks of treatment morning light produced more of the complete or almost complete remissions than placebo. By 1 criterion (24-item SIGH-SAD score <50% of baseline and < or =8), 61% of the patients responded to morning light, 50% to evening light, and 32% to placebo after 4 weeks of treatment. Bright light therapy had a specific antidepressant effect beyond its placebo effect, but it took at least 3 weeks for a significant effect to develop. The benefit of light over placebo was in producing more of the full remissions.