Efficiency Of Healthcare Services Research Articles

What characteristics of provider payment mechanisms influence health care providers' behaviour? A literature review.

SummaryBackgroundProvider payment mechanisms (PPMs) create incentives or signals that influence the behaviour of health care providers. Understanding the characteristics of PPMs that influence health care providers’ behaviour is essential for aligning PPM reforms for improving access, quality, and efficiency of health care services. We reviewed empirical literature that examined the characteristics of PPMs that influence the behaviour of health care providers.MethodsWe systematically searched for empirical literature in PubMed, Web of Science, and Google Scholar databases and complemented these with physical searching of the references of selected papers for further relevant studies. A total of 16 studies that met our inclusion and exclusion criteria were identified. We analysed data using thematic review.ResultsWe identified seven major characteristics of PPMs that influence health care providers’ behaviour. Of these characteristics, payment rate, the sufficiency of payment rate to cover the cost of services, timeliness of payment, payment schedule, performance requirements, and accountability mechanisms were the most important.ConclusionsOur review found that health care providers’ behaviour is influenced by the characteristics of PPMs.Provider payment mechanism reforms that optimally structure these characteristics can elicit required incentives for access, equity, quality, and efficiency in service delivery among health care providers towards achieving universal health coverage.

Evaluating the impact of optimization algorithms for patient transits dispatching using discrete event simulation

The on-time completion of patient transits can be identified as a bottleneck for the efficiency of health care services in major New Zealand hospitals. Delayed transits of patients between wards and treatment or diagnostic facilities lead to increasing waiting times at clinics and inefficient resource utilization (e.g. surgery teams) as appointment times are not met. Patient transits are carried out by orderlies, but in some cases require the assistance of a nurse. Ad-hoc dispatching of staff members, nurses and orderlies, to transits has been identified as one major source for delays currently observed in the system. To address this issue we present automated, optimized dispatching algorithms for staff members performing those transits. To develop these algorithms, a network formulation of the problem is introduced that is strongly related to classical vehicle routing problem with semi-soft time windows. However, the need to synchronize the routes of staff members of different types (nurses and orderlies) adds a whole new layer of complexity to the problem, as routes cannot be assessed independently. We present a set of algorithms with varying complexity, ranging from simple heuristics to the use of critical path methods to combine mixed integer formulations for the separated orderly and nurse problems. To address a transit service’s stochasticity, volatility and the resulting need for constant re-optimization, we embed the optimization algorithms in a discrete event simulation to evaluate their performance under realistic circumstances.

Care relationships at stake? Home healthcare professionals\u2019 experiences with digital medicine dispensers \u2013 a qualitative study

BackgroundAlthough digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships.MethodsThe multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. The constant comparative method was used for data analyses.ResultsAltogether, interviewed healthcare professionals reported three main technology-related impacts upon their patient-caregiver relationships. First, national and local pressure to increase efficiency had troubled their relationships with patients who suspected that municipalities have sought to lower costs by reducing and digitalising services. Participants reported having to consider such worries when introducing technologies into their services. Second, participants reported a shift towards empowering patients. Digital technology can empower patients who value their independence, whereas safety is more important for other patients. Healthcare professionals needed to ensure that replacing care tasks with technology implies safe and improved care. Third, the safety and quality of digital healthcare services continues to depend upon surveillance and control mechanisms that compensate for less face-to-face monitoring. Participants did not consider the possibility that surveillance exposes information about patients’ everyday lives to be problematic, but to constitute opportunities for adjusting services to meet patients’ needs.ConclusionsTechnologies such as digital medicine dispensers can improve the efficiency of healthcare services and enhance patients’ independence when introduced in a way that empowers patients as well as safeguards trust and service quality. Conversely, the patient-caregiver relationship can suffer if the technology does not meet patients’ needs and fails to offer safe and trustworthy services. Upon introducing technology, home healthcare professionals therefore need to carefully consider the benefits and possible disadvantages of the technology. Ethical implications for both individuals and societies need to be further discussed.

Regional efficiency of healthcare services in Saudi Arabia

ABSTRACTThis study aims to estimate the regional efficiency of healthcare services in Saudi Arabia. A non-parametric methodology, data envelopment analysis (DEA), is applied to evaluate the relative efficiency of 13 Saudi regions in 2014 by using multiple regional inputs and outputs to characterize healthcare provision. This study provides a unique measurement of Saudi regional efficiency since most of the previous studies that applied DEA in Saudi Arabia focused on public hospitals or primary medical services, which work under the supervision of the Ministry of Health. This is one of the first studies in developing and Arab countries in general, and in Saudi Arabia in particular, which focuses on an interregional level, as it divides each region into public and private sectors. The empirical results show that efficiency differs across the selected regions and between the private and public sectors. In general, less developed regions show a relatively high level of efficiency whereas others, such as Makkah and the Eastern regions, seem to be the least efficient regions in both sectors. The study revealed that the Riyadh region, which employs a disproportionately large amount of health resources in comparison with other regions, is efficient in both sectors. The empirical study also finds evidence of the potential to improve health outcomes by ensuring a sufficient level of healthcare resources in the inefficient regions that are lagging behind significantly. Finally, in some regions the public sector was efficient whereas the private sector was not, and vice versa.

Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry

ABSTRACTBackground: Major national primary healthcare reforms are seldom implemented, and few studies have explored the benefits of primary healthcare outreach teams to rural households, a knowledge gap we sought to address with this study.Objective: The objective of this study was to explore the community benefits in the context of PHC services delivered in rural households by outreach teams.Methods: The study was conducted in the iLembe District on the east coast of KwaZulu-Natal, South Africa between July 2015 and January 2017. In-depth, explorative and semi-structured qualitative interviews were conducted as part of a mixed-method study. A total of 21 in-depth interviews with key informants and four focus group discussions (n = 28) were conducted with purposefully sampled households and outreach team members. Content analysis was used to explore and understand the households’ experiences of primary healthcare services provided by outreach teams.Results: Household members benefited from outreach team services tailored to specific households and individuals, which improved the efficiency of healthcare services, access to appropriate health information and the overall experience of healthcare, particularly among those who are physically unwell, on chronic treatment, default treatment or immunisation, or who need referrals for clinical and social services. The benefits to household members included personalised care in the home, improved referral pathways, awareness of health events, improved adherence to treatment and reduction in opportunity costs of healthcare.Conclusion: It is perceived that participants have benefitted from the model of PHC service delivery by outreach teams through improved access to healthcare services, and by allowing community members to receive services that are responsive to their needs since the outreach team members’ advocate and negotiate to deliver services on behalf of community members. These stated benefits, as perceived by household members, have the potential to improve health outcomes and increase satisfaction levels amongst household members.

Performance Measurement of Healthcare Service and Association Discussion between Quality and Efficiency: Evidence from 31 Provinces of Mainland China

Performance of healthcare service includes quality and efficiency, so there is inevitably an association between them. In general, it is believed that there is a trade-off between quality and efficiency; however, we prove that it is not completely accurate. We take the quality as an additional output to measure the healthcare service efficiency creatively, and discuss the association between quality and efficiency based on the effect of quality on relative efficiency. Firstly, we use TOPSIS method to calculate relative quality index values of healthcare service of 31 provinces of mainland China. This practice ensures the consistent comparison of 31 provinces’ qualities. Subsequently, we measure the 31 provinces’ relative performances and efficiencies of healthcare service with consideration of quality or not, by constructing DEA models. Then, we analyze the association between quality and efficiency from each group of the national, east, central and west, and conclude that the association between them is different along with their advantage degrees of quality and efficiency. Finally, we use the Tobit regression method to test 12 environment variables’ net impacts on efficiency values both with consideration of quality or not. The results indicate that the main drivers of healthcare service efficiency are different when we take quality as an additional output or not. This article contributes to the field of performance measurement of healthcare service, puts forward a new method to integrate quality and efficiency and provides management guidelines.

Improving the quality and efficiency of healthcare services in Ghana through HTA

A case for further investment in health cannot be made unless systems are in place to ensure good value for money for every Cedi spent. Identifying in an evidence informed way, opportunities for releasing resources for reinvestment to expand coverage whilst ensuring health outcomes remain the same or improve, is a powerful argument for more and better spending on health in Ghana. This report goes some way towards making the case for an HTA mechanism for strengthening the handle of the Ghanaian authorities over its own budget through tackling a specific case of high spending and high burden area, namely hypertension management. Using Ghanaian data and making all assumptions explicit, this analysis points to areas for improved spending, quantifies potential savings and health gains from reallocation and makes a case for an institutionalised approach to HTA in Ghana, as an important tool for transitioning away from aid and move towards sustainable and affordable Universal Healthcare Coverage. A technical working group comprised of UK and Ghanaian members adapted an existing Excel model, initially developed for the 2006 update of the NICE clinical guidelines on hypertension. This model compared the cost-effectiveness of the four main classes of antihypertensive drugs (ACE inhibitors/ ARBs, beta-blockers (BB), calcium channel blockers (CCBs), thiazide-like diuretics (TZD), and no intervention). The model predicted that in the Ghanaian context, diuretics and CCBs would be more effective and less expensive than other drug classes. Compared with no treatment, diuretics cost an additional GH¢ 642 per DALY avoided, while the incremental cost per DALY avoided for CCBs compared with diuretics was much higher at GH¢ 32,482. Furthermore, in order to enhance the policy relevance and usefulness of the model to Ghanaian policy makers, the report goes through a number of policy scenarios. The extent to which there are policy levers for acting on them (e.g. drug price), and whether the model could offer credible analytics to back such policy actions were discussed. The results show substantial potential for cost savings, if such policy scenarios could be implemented. For instance, a 10% reduction in mean drug cost would yield the greatest savings, over GH¢ 25 million over the first five years. This was followed by 10% prescription shift from CCB to TZD, with five-year savings of over GH¢ 18 million, and 10% shift from ACEi/ARB/BB to TZD yielding 5-year savings of over GH¢ 5 million, not to mention the addition of health benefits following such shift. Finally, the findings of this report consider the reallocation of savings from these cost saving scenarios to improve health benefits and coverage in Ghana. For example, providing diuretic treatment to all patients with diagnosed but untreated hypertension would only cost an extra GH¢ 5.9 million over five years, only using a fraction of the savings of above scenarios, as well as yielding a net gain of avoiding over 46,000 extra DALYs.

Japanese healthcare: Fostering competition and controlling costs.

Japan's universal healthcare system is relatively inexpensive, provides accessible services, and was established nearly 10 years before Canada's. Two aspects of Japan's system are particularly interesting. The first is that there is active competition for patients between a variety of hospital providers, which can be privately or publicly owned. This competition is based on service quality because prices are set centrally. The second feature is that these prices are adjusted biannually by a National Council, the Chuikyo, that includes payers (employers), providers, and third-party experts in public negotiations. This process improves transparency, reduces political stakes, and allows for appropriate fee adjustments. Recent movements in Canada toward more activity-based funding and greater management accountability are developing the capabilities of healthcare executives to embrace these ideas, if introduced in Canada. The increased autonomy afforded to providers will empower their leaders to make strategic decisions to improve the quality and efficiency of healthcare services.

Evaluation of Respect for Patient's Rights from the Viewpoint of Hospitalized Surgical Patinents in Shohada Ashayer Hospital of Khorramabad City, Iran in 2015-2016

One of the most important branches of medical science, until past time, law and consequently to medical ethics. Patients' satisfaction of their rights, one of the most important indicators of effectiveness, efficiency, productivity and quality of healthcare services. The goal of this study was to Check the Observance of the rights of patients in surgical patients admitted to Shohaday Ashayer hospital in 2015-2016 from the perspective of patients. This cross-sectional study included 800 patients admitted to Shohada Ashayer Hospital in 2015 and 2016. Respecting patient’s bill of rights from their viewpoint was determined by a questionnaire using a Likert scale from one (strongly disagree) to five (strongly agree). The results obtained in this study showed that the rate of patients' rights in all aspects of the %15.8 patient's view was poor, from the %67.4 patient's perspective was middle, and from the %16.8 patient's view was good. Most patients' satisfaction with their rights in respect to the axis of the right to choose and decide freely and the lowest levels of satisfaction was at the core of respect for patient privacy and confidentiality principle. Level of satisfaction in all axes was significantly associated with age, type of substrate in the third axis, history of hospitalization in the fourth axis and duration of hospital stay in the second axis(P>0.O5). Between gender and place of residence and educational level found no significant relaion(P>O.O5). In total, based on the obtained results and comparing them with the results of other studies, it may be concluded that respecting patient’s bill of rights from the viewpoint of patients is considered as optimal and to enhance the implementation of the Charter as well as patient satisfaction is essential that solutions be identified barriers to implementation

Evaluating inappropriate patient stay and its reasons based on the appropriateness evaluation protocol

Background: Hospital beds are among valuable resources for care delivery. Therefore, optimum use of them is crucial for increasing the efficiency of health-care services and controlling health-care costs. Objective: This study intended to evaluate inappropriate patient stay (IPS) in hospital settings and its reasons based on the appropriateness evaluation protocol. Methods: This cross-sectional study was conducted on 335 patients hospitalized in a tertiary care university hospital. Data were gathered prospectively by 13 hospital nurses during a 6-month period. IPS rate was evaluated using a checklist, the 27 criteria of which were related to medical services, nursing/life support services, and patient's conditions. Moreover, a 12-item checklist was used to determine physician-, hospital-, and patient/family-related factors behind inappropriate hospital stay. Results: In total, 121 of 1925 (6.3%) hospitalization days of 335 patients were determined to be inappropriate. Neurosurgery and gynecology wards had the highest and the lowest inappropriate hospital stay rates (22.5% vs. 0%), respectively. The main reasons behind inappropriate hospital stay were hospital-related factors (33.1%), physician-related factors (29.1%), and patient-related factors (21.3%). Conclusion: A wide variety of physician-, hospital-, and patient/family-related factors contribute to IPS. Given the multifactorial causes of IPS, reducing its rate necessitates multidisciplinary approaches.

Saúde Móvel: desafios globais à proteção de dados pessoais sob a perspectiva do direito da União Europeia

A saúde móvel ou mHealth – as práticas médicas e de saúde pública apoiadas por dispositivos móveis (telefones celulares, smartphones e tablets) – tem claro potencial para aumentar significativamente a qualidade e a eficiência dos cuidados de saúde. Contudo, constatam-se várias fragilidades na proteção dos dados pessoais utilizados nesse contexto. Este artigo tem como objetivo analisar os aspectos jurídicos mais importantes para que uma proteção efetiva dos dados pessoais na mHealth seja alcançada. Tendo este objetivo e, partindo das regras da União Europeia e das melhores práticas internacionais sobre a matéria, apresentamos uma série de pressupostos condensados em três eixos: maior responsabilidade de todos os atores envolvidos no tratamento de dados mHealth; maior transparência na forma como os dados são tratados, compartilhados e reutilizados; e maior controle dos usuários das tecnologias e da utilização de seus dados. O artigo procura contribuir com um panorama global a fim de levantar as reflexões para a criação e a validação de políticas locais.

Features of application modules ARDUINO platforms in telemedicine

The creation of telemedicine systems for monitoring biomedical parameters of patients currently acquires a qualitatively new content, due to the rapid development of microprocessor technology and the growing needs of modern medicine in the form of services. The first can be explained by the improvement of the software and hardware microelectronics base and the creation of a number of commonality of microelectronics devices, united in the platform on the basis of complementarity with vozmozhkoy sharing. The second is determined to high demands for mobility and efficiency of health care services, what Telemedicine opens up new opportunities, creating preconditions dispersed medical process significantly uprotsayuschego the whole process of treatment and rehabilitation of the patient. The authors have set to investigate the possibility of establishing effective TMK based on the existing universal hardware and software platform. This research was chosen as a unified platform Arduino microprocessor in conjunction with the sensor platform e-Health Sensor Platform V2.0. Studies have shown good quality sex biometric measurements, thereby poddverdiv the possibility of practical application of the proposed solutions. Further work is aimed at minimization of volume of transferable hannyh through the use of a cryptographic algorithm, effective compression and filtering. As well as bringing the format of data transmitted from the standard digital transmission of medical information

Digital Revolution and Innovative Business Models in Healthcare: Global Trends and Russian Realities

Digital revolution is one of the major global trends resulting in the unprecedented scale and depth of penetration of information and communication technologies into all sectors of national economy, including healthcare. The development of this trend brought about high expectations related to the improvement of quality of medical assistance, accessibility and economic efficiency of healthcare services. However, euphoria of the first steps of digital revolution is passing now, opening doors to more realistic analysis of opportunities and conditions of realization of the true potential hidden in the digital transformation of healthcare. More balanced perception of the peculiarities of innovation processes in the sector is coming together with understanding of the serious barriers, hampering implementation of the new ideas and practices due to complicated interweaving of social, economic, ethical and psychological factors. When taking into account the industry specifics it becomes evident that digital revolution cannot be a quick turnaround but rather would pass a number of phases and is likely to last more than one decade. In this context the article focuses on the prospects of the new business models, capable of making significant changes in today’s economic landscape of the sector (including uber-medicine, retail clinics, retainer medicine, network models of medical services). The authors also provide assessment of the current situation and perspectives of digital healthcare development in Russia.

Lean Behavioral Health: the Kings County Hospital Story, Edited by Joseph P. Merlino, Joanna Omi and Jill Bowen, Oxford University Press USA, 2014, £35.00, pb, 288pp. ISBN 9780199989522

Lean Behavioral Health: the Kings County Hospital Story, Edited by Joseph P. Merlino, Joanna Omi and Jill Bowen, Oxford University Press USA, 2014, £35.00, pb, 288pp. ISBN 9780199989522 - Volume 40 Issue 1

Exploring health information technology implementation success factors: a comparative investigation in Nordic countries

The implementation of health information technology (HIT) can improve the quality and efficiency of healthcare services. There is a gap in terms of generalising and systematising the results of previous research and in understanding HIT implementation worldwide. The majority of studies on HIT implementation have been conducted in North America, most of which are case studies or other qualitative research. In this research, we surveyed IT managers in Nordic healthcare and used factor analysis to uncover success factor groups. Six groups emerged: culture conducive to change, quality of system and service, collaboration, alignment, end-user involvement, and management commitment. We found that IT managers in Nordic countries have different opinions regarding success factors (SFs) related to cultural issues. However, they strongly agree on the importance of most of the SFs. Therefore, an internationally applicable set of recommendations for HIT implementation could be within the realm of possibility.

The Cost-Effectiveness Analysis of Teleglaucoma Screening Device.

Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective than current in-person examination and can improve the quality of life in glaucoma patients.

Health Information Technology in the Knowledge Management of Health Care Organizations

Background: The complexity of clinical decisions in health care organizations (HCOs) increases the information-processing demands, and the benefits of a Health Information Technology (HIT)-based Knowledge Management (KM). Therefore, since 1995, the health sector of Iran has gradually introduced and utilized hospital information systems, the internet, and office automation in HCOs to increase the efficiency of health care services. Studies show that the status of information management and knowledge in HCOs of Iran is inappropriate. Objectives: The current study evaluated whether the current status of HIT and its application in the HCOs are in line with KM goals. Patients and Methods: The study was performed on 550 staff members of hospitals affiliated to Semnan university of medical sciences in 2014. A researcher made questionnaire was developed. All medical and non-medical staff members were included in this study. Results: According to the obtained results 15% of the subjects highly used clinical information systems for information exchange inside their institution, 35.5% somewhat used electronic reports, and in some subjects significant relationship was found between demographic background and attitude (P < 0.05). Conclusions: It was concluded that HCOs need an HIT clearly designed with KM and they have to recognize where knowledge is resided, when designing strategies to warrant that knowledge is being created and transferred in the best way and to the right persons. Otherwise, the HCOs do not use an efficiency-oriented HIT.

ЩОДО СТАНДАРТИЗАЦІЇ СУБСТАНЦІЇ ГІПЕРТРИЛУ

&lt;p align="center"&gt;&lt;strong&gt;ON THE STANDARDIZATION OF HYPERTRIL SUBSTANCE&lt;/strong&gt;&lt;/p&gt;&lt;p align="center"&gt;Kucherenko L.I.&lt;/p&gt;&lt;p align="center"&gt;Zaporozhye State Medical University&lt;/p&gt;&lt;p align="center"&gt;SPC «Pharmatron»&lt;/p&gt;&lt;p&gt;&lt;em&gt;Key words:&lt;/em&gt; substance, Hypertril, standardization, identification, nonaqueous titration&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction.&lt;/strong&gt; Increase of mortality and disability caused by cardiovascular diseases is the problem not only of health protection institutions, it is the social problem of our society. Efficiency of health care service in Ukraine depends on the presence of highly effective competitive drugs of domestic production. Especially it concerns drugs used for treating of cardiovascular diseases, notably coronary heart disease, arterial hypertension, myocardial infarction and acute heart failure. So the development of drugs for treatment of mentioned diseases is the urgent task of modern medicine and pharmacy. According to the recommendations of The European Society of Cardiology important components of complex therapy of heart failure especially after myocardial infarction are the following drugs: β-adrenoceptor antagonists, ACE inhibitors and diuretics. Thus primary task of pharmacy and medicine is the developing and improvement of new highly effective and safe drugs using of which would lead to the improvement of quality of life and its extension. All about mentioned urge to develop perfectly new antianginal and antihypertensive remedy of original structure which has minimum side effects.&lt;/p&gt;&lt;p&gt;At the Pharmaceutical Chemistry Department of Zaporizhzhia State Medical University in collaboration with the SPC "Pharmatron" new original compound – derivative of 4-amino-1,2,4-triazole (drug Hypertril) was synthesized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective. &lt;/strong&gt;The aim of this investigation is the development of Hypertril substance standardization methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; On the basis of structural formula of Hypertril and methods of its receiving we have worked out the draft of quality control methods (QCM) for the substance. While developing it we used latest modern methods of standardization which are ordered by State Pharmacopoeia of Ukraine (SPU) and the European Pharmacopoeia.&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results and discussion. &lt;/strong&gt;For identification of Hypertril substance we proposed to carry out characteristic reaction (C) for bromide ion notably with the solution of chloramine in the presence of dilute hydrochloric acid and chloroform (chloroform layer receives yellow-brown colour). Besides, taking into account modern standardization methods we proposed to determine correspondence of infrared spectrum of the substance with the infrared spectrum of pharmacopeia standard sample.&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;Next task was the development of methods of quantitation of Hypertril substance. First we studied the possibility of Hypertril substance titration with 0.1M solution of perchloric acid with the use of internal indicator and determination of point of equivalence potentiometrically. As solvent we used acetic acid nonaqueous. The investigation showed that the substance is soluble in acetic acid nonaqueous only under prolonged heating. Results received were satisfactory and were from 98.5% up to 101%. But taking into consideration the time one analysis takes we believe this method is not to be practical. To reduce the Hypertril substance analysis duration we proposed to dissolve weighed portion preliminarily in formic acid nonaqueous and then add acetic acid nonaqueous. During the analysis of Hypertril substance according to this method we received unsatisfactory results in the limits from 94% up to 98%. In further investigations we used as solvent the mixture of formic acid nonaqueous with acetic anhydride. As indicator we used crystal violet and defined point of equivalence potentiometrically. While using internal indicator there were some difficulties because the transition of coloring was not clear. Thus we proposed to define point of equivalence potentiometrically. During analysis we received satisfactory results and analysis duration shortened three times.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions.&lt;/strong&gt; According to the results of the investigations we can conclude that developed method of defining of quantitative content of Hypertril substance by nonaqueous titration is easy-to-use and simple, accurate, reproducible and corresponds to all demands of State Pharmacopoeia and international standards. Further worked out methods of qualitative and quantitative determination of Hypertril substance are planned to introduce into QCM for Hypertril substance.&lt;/p&gt;

Human Factors in the Design of Medical Simulation Tools

This paper describes the human factor design issues relevant to medical simulation systems. Decision making in medical domains is an increasingly complex task that involves a number of stakeholders, sub-specialties and technologies. Medical simulation creates a lifelike situation for individuals to practice decision-making and procedural activities in a safe environment for the patients and professionals where it involves simulated human patients, emergency response and simulated animation. Evidence suggests that medical simulation improves the effectiveness, safety, and efficiency in health care services. Moreover, it has been shown to consistently deliver significant value to the organization, staff, or students in decision-making. Although medical simulation provided ideal approaches for addressing healthcare issues, the number of successful software implementation and development is relatively small compared with other established engineering disciplines, such as the manufacturing industry. Software quality models in particular offer the opportunity to systematically assess the level of compliance of software systems with industry standards. In addition, applying software quality models increase the customer satisfaction and decrease the quality cost.

Evaluation of efficiency of primary health cares in Konya city centre

AIM: It is often difficult to measure health-related outcomes. There is no standard method or tool to evaluate the performance and efficiency of health care services. A reliable, quantitative method of evaluating the performance of primary health care service is important to ensure the most efficient usage of finite resources. METHODS: We aimed to appraise the productivity of 33 health centers in the city of Konya using a quantitative analysis. A performance evaluation method employing input-oriented Data Envelopment Analysis (DEA) was used. A technical productivity score of 1.0 was used to score the most productive, efficient health care. RESULTS: Using the model developed in this study, 13 health centers (39%) were assessed technically as being fully efficient. Five health centers had a technical efficiency score of between 0.900 and 0.999. The number of health centers with an input excess was found to be higher than the number of centers that had an output deficiency. CONCLUSION: The difference in productivity between health centers was found to be due to the difference in input rather than output. Health service managers can use this method to assess the performance of different health centers using their own fixed variables. Furthermore they can distinguish analytically the most productive and unproductive health centers and at the same time identify the causes of inefficiency. This method can used by health care professionals to better manage their facilities and organisations.