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Lean Management in Obstetrics and Gynecology: Application in the Ambulatory Clinic Pre- and Post-Kaizen

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Open Journal of Obstetrics and Gynecology 2018年第14期8卷 1604-1630页

作者： Michele Follen Leo Fradkin Joseph Crane Chuck Noon Kings County hospital Clarkson Brooklyn NY USA University of Tennessee Haslam College of Business Knoxville TN USA Brookdale hospital and Medcial Center One Brookdale Plaza Brooklyn NY USA Teamhealth INC Knoxville TN USA

OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the mo

关键词： Lean Management Healthcare LEAN and Obstetrics and Gynecology Lean and Ambulatory Care Lean and Women’s Health

Human equivalent dose of oral 4-aminopyridine differentiates nerve crush injury from transection injury and improves post-injury function in mice

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Neural Regeneration Research 2020年第11期15卷 2098-2107页

作者： Chia George Hsu M A Hassan Talukder Li Yue Loel CTurpin Mark Noble John C.Elfar Center for Orthopaedic Research and Translational Science Penn State Hershey College of MedicineMilton S.Hershey Medical CenterHersheyPAUSA Department of Medicine Aab Cardiovascular Research InstituteUniversity of Rochester School of Medicine and DentistryRochesterNYUSA Department of Orthopedics The Warren Alpert Medical School of Brown University/Rhode Island HospitalProvidenceRIUSA Department of Neuroscience The University of Rochester Medical CenterRochesterNYUSA Department of Biomedical Genetics The University of Rochester Medical CenterRochesterNYUSA

4-Aminopyridine(4-AP), an FDA-approved drug for the symptomatic treatment of multiple sclerosis, is used to improve neuromuscular function in patients with diverse demyelinating disorders. We recently demonstrated that local, transdermal or injectable forms of 4-AP improve myelination, nerve conduction velocity, muscle atrophy, and motor function after traumatic peripheral nerve injury in mice. While oral 4-AP is most commonly used in the clinic, it is unknown whether human equivalent oral doses of 4-AP have effects on traumatic peripheral nerve injury differentiation, myelination, muscle atrophy, functional recovery, and post-injury inflammatory processes in animals. Mice with sciatic nerve crush or denervation injury received oral or intraperitoneal 4-AP(10 μg) or vehicle alone and were examined for pharmacokinetics, motor function, muscle mass, intrinsic muscle force, nerve morphological and gene expression profiles. 4-AP showed linear pharmacokinetics and the maximum plasma 4-AP concentrations were proportional to 4-AP dose. Acute single dose of oral 4-AP administration induced a rapid transient improvement in motor function that was different in traumatic peripheral nerve injury with or without nerve continuity, chronic daily oral 4-AP treatment significantly enhanced post crush injury motor function recovery and this effect was associated with improved myelination, muscle mass, and ex vivo muscle force. Polymerase chain reaction array analysis with crushed nerve revealed significant alterations in gene involved in axonal inflammation and regeneration. These findings provide convincing evidence that regardless of the route of administration, 4-AP can acutely differentiate traumatic peripheral nerve injury with or without nerve continuity and can enhance in vivo functional recovery with better preservation of myelin sheaths, muscle mass, and muscle force. The animal experiments were approved by the University Committee on Animal Research(UCAR) at the University

关键词： 4-aminopyridine electron microscopy of nerves functional recovery gene expression muscle force muscle mass oral administration pharmacokinetics sciatic nerve crush injury sciatic nerve denervation injury

Liver transplantation for hepatocellular carcinoma

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World Journal of Gastroenterology 2009年第44期15卷 5511-5516页

作者： Sudeep Tanwar Shahid A Khan Vijay Paul Bob Grover Catherine Gwilt Belinda Smith Ashley Brown Department of Hepatology and Gastroenterology Imperial College LondonSt Mary's Hospital CampusPraed StreetLondon W2 1NYUnited Kingdom

Hepatocellular carcinoma (HCC) is the commonest primary malignancy of the liver. It usually occurs in the setting of chronic liver disease and has a poor prognosis if untreated. Orthotopic liver transplantation (OLT) is a suitable therapeutic option for early,unresectable HCC particularly in the setting of chronic liver disease. Following on from disappointing initial results,the seminal study by Mazzaferro et al in 1996 established OLT as a viable treatment for HCC. In this study,the "Milan criteria" were applied achieving a 4-year survival rate similar to OLT for benign disease. Since then various groups have attempted to expand these criteria whilst maintaining long term survival rates. The technique of living donor liver transplantation has evolved over the past decade,particularly in Asia,and published outcome data is comparable to that of OLT. This article will review the evidence,indications,and the future direction of liver transplantation for liver cancer.

关键词：肝移植肝癌治疗 OLT 恶性肿瘤肝细胞癌移植技术生存率

Polycations. 23. Antimicrobial Surfaces for Prevention of Pathogen Transmission

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International Journal of Clinical Medicine 2016年第9期7卷 559-565页

作者： Robert Engel Karin Melkonian Jay Ho Jaime Lee Iolani Rizzo Department of Chemistry and Biochemistry Queens College of the City University of New York Flushing NY USA Department of Biology Long Island University C.W. Post Campus Greenvale NY USA Department of Chemistry and Physical Sciences Pace University New York NY USA

The continued evolution of bacterial and fungal species poses a significant difficulty for the treatment of disease of microbial origin. Given this situation, the prevention of transmission of such microbial diseases becomes of increasing importance. Efforts of this laboratory have been directed toward the destruction of microbial species on environmental surfaces as a prophylaxis toward infection, and we herein report on the efficacy of a system that demonstrates activity against both Gram-positive and Gram-negative bacteria, as well as fungi. We report specifically herein on the use of fabric materials so activated for the destruction of these microbial species, useful for a variety of surfaces within hospital and related settings wherein transmission of microbial disease is a major problem, while these approaches are also applicable for a variety of other types of surfaces.

关键词： Antimicrobial Polycationic Organic Salts Cell Disruption Fabric Environmental Surfaces Prophylaxis

Novel Wavelet-Based Segmentation of Prostate CBCT Images with Implanted Calypso Transponders

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2017年第3期6卷 336-343页

作者： Yingxia Liu Ziad Saleh Yulin Song Maria Chan Xiang Li Chengyu Shi Xin Qian Xiaoli Tang Shandong Communication and Media college Jinan China Medical Physics Department Memorial Sloan Kettering Cancer Center New York NY USA Radiation Oncology North Shore Long Island Jewish Health System New Hyde Park NY USA

Segmentation of prostate Cone Beam CT (CBCT) images is an essential step towards real-time adaptive radiotherapy (ART). It is challenging for Calypso patients, as more artifacts generated by the beacon transponders are present on the images. We herein propose a novel wavelet-based segmentation algorithm for rectum, bladder, and prostate of CBCT images with implanted Calypso transponders. For a given CBCT, a Moving Window-Based Double Haar (MWDH) transformation is applied first to obtain the wavelet coefficients. Based on a user defined point in the object of interest, a cluster algorithm based adaptive thresholding is applied to the low frequency components of the wavelet coefficients, and a Lee filter theory based adaptive thresholding is applied on the high frequency components. For the next step, the wavelet reconstruction is applied to the thresholded wavelet coefficients. A binary (segmented) image of the object of interest is therefore obtained. 5 hypofractionated Calypso prostate patients with daily CBCT were studied. DICE, Sensitivity, Inclusiveness and ΔV were used to evaluate the segmentation result.

关键词： CBCT Prostate Segmentation Wavelets MWDH

Endo-hepatology:An emerging field

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World Journal of Gastrointestinal Endoscopy 2021年第8期13卷 296-301页

作者： Daniel E Hogan Michael Ma David Kadosh Alisha Menon Kana Chin Arun Swaminath Division of Gastroenterology Lenox Hill HospitalNorthwell HealthNew YorkNY 10075United States Department of Internal Medicine Lenox Hill HospitalNorthwell HealthNew YorkNY 10075United States Department of Internal Medicine Long Island Jewish Forest HillsNorthwell HealthNew YorkNY 11375United States

Gastroenterologists have long been spearheading the care of patients with various forms of liver *** diagnosis and management of liver disease has traditionally been a combination of clinical,laboratory,and imaging findings coupled with percutaneous and intravascular procedures with endoscopy largely limited to screening for and therapy of esophageal and gastric *** the applications of diagnostic and therapeutic endoscopic ultrasound(EUS)have evolved,it has found a particular niche within hepatology now *** we discuss several EUS-guided procedures such as liver biopsy,shear wave elastography,direct portal pressure measurement,paracentesis,as well as EUSguided therapies for variceal hemorrhage.

关键词： Endoscopic ultrasound Therapeutic endoscopic ultrasound Hepatology Liver disease Liver biopsy

Established and Emerging Optical Technologies for the Real-Time Detection of Cervical Neoplasia: A Review

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Journal of Cancer Therapy 2017年第13期8卷 1241-1278页

作者： Breana Hill Sylvia F. Lam Pierre Lane Calum MacAulay Leonid Fradkin Michele Follen New York Medical college Valhalla NY USA Department of Obstetrics and Gynecology Brookdale Hospital and Medical Center Brooklyn NY USA The British Columbia Cancer Research Centre Vancouver BC Canada

Cervical cancer remains a critically important problem for women, especially those women in the developing world where the case-fatality rate is high. There are an estimated 528,000 cases and 266,000 deaths worldwide. Established screening and detection programs in the developed world have lowered the mortality from 40/100,000 to 2/100,000 over the last 60 years. The standard of care has been and continues to be: a screening Papanicolaou smear with or without Human Papilloma Virus (HPV) testing;followed by colposcopy and biopsies and if the smear is abnormal;and followed by treatment if the biopsies show high grade disease (cervical intraepithelial neoplasia (CIN) grades 2 and 3 and Carcinoma-in-situ). Low grade lesions (Pap smears with Atypical Cells of Uncertain Significance (ASCUS), Low Grade Squamous Intraepithelial Lesions (LGSIL), biopsies showing HPV changes or showing CIN 1);are usually followed for two years and then treated if persistent. Treatment can be performed with loop excision, LASER, or cryotherapy. Loop excision yields a specimen which can be reviewed to establish the diagnosis more accurately. LASER vaporizes the lesion and cryotherapy leads to tissue destruction. Under long term study;loop excision, LASER, and cryotherapy have the same rate of cure. The standard of care is expensive and takes 6 - 12 weeks for the individual patient. During the last twenty years, new technologies that can view the cervix and even image the cervix with cellular resolution have been developed. These technologies could lead to a new paradigm in which diagnosis and treatment occurs at a single visit. These technologies include fluorescence and reflectance spectroscopy (probe or wide-field, whole cervix scanning approaches) and fluorescence confocal endomicroscopy or high resolution micro-endoscopy. Both technologies have received Federal Drug Administration (FDA) and have been commercialized. Research trials continue to show their remarkable performance. These techno

关键词： Cervical Cancer Detection Cervical Cancer Screening Cervical Cancer Diagnosis Optical Technologies Real-Time Diagnosis

Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

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World Journal of Clinical Cases 2013年第1期1卷 4-12页

作者： Marios G Lykissas Alexander Aichmair Department of Orthopaedic Surgery Spine and Scoliosis Service Hospital for Special Surgery Weill Cornell Medical College New York NY 10021 United States

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into subcategories based on the part of the vertebral column that is addressed(anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or trans-facet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine.

关键词： Spinal arthrodesis Lumbar spine Motionsparing implants Intrebody fusion

Circular smooth muscle contributes to esophageal shortening during peristalsis

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World Journal of Gastroenterology 2012年第32期18卷 4317-4322页

作者： Anil K Vegesna Keng-Yu Chuang Ramashesai Besetty Steven J Phillips Alan S Braverman Mary F Barbe Michael R Ruggieri Larry S Miller Department of Medicine Section of GastroenterologyHofstra Northshore Long Island Jewish HospitalHofstra University School of MedicineManhassetNY 11030United States Department of Medicine Section of GastroenterologyTemple University School of MedicinePhiladelphiaPA 19140United States Department of Anatomy and Cell Biology Temple University School of MedicinePhiladelphiaPA 19140United States Department of Urology Temple University School of MedicinePhiladelphiaPA 19140United States Department of Anatomy and Cell Biology and Department of Urology Temple University School of MedicinePhiladelphiaPA 19140United States

AIM:To study the angle between the circular smooth muscle(CSM) and longitudinal smooth muscle(LSM) fibers in the distal ***:In order to identify possible mechanisms for greater shortening in the distal compared to proximal esophagus during peristalsis,the angles between the LSM and CSM layers were measured in 9 *** outer longitudinal layer of the muscularis propria was exposed after stripping the outer *** inner circular layer of the muscularis propria was then revealed after dissection of the esophageal mucosa and the underlying muscularis *** of each specimen were taken with half of the open esophagus folded back showing both the outer longitudinal and inner circular muscle *** were measured every one cm for 10 cm proximal to the squamocolumnar junction(SCJ) by two independent *** human esophagi were obtained from organ transplant donors and the angles between the circular and longitudinal smooth muscle layers were measured using micro-computed tomography(micro CT) and Image J ***:All data are presented as mean ± *** CSM to LSM angle at the SCJ and 1 cm proximal to SCJ on the autopsy specimens was 69.3 ± 4.62 degrees vs 74.9 ± 3.09 degrees,P = *** CSM to LSM angle at SCJ were statistically significantly lower than at 2,3,4 and 5 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 82.58 ± 1.34 degrees,84.04 ± 1.64 degrees,84.87 ± 1.04 degrees and 83.72 ± 1.42 degrees,P = 0.013,P = 0.008,P = 0.004,P = 0.009 *** CSM to LSM angle at SCJ was also statistically significantly lower than the angles at 6,7 and 8 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 80.18 ± 2.09 degrees,81.81 ± 1.75 degrees and 80.96 ± 2.04 degrees,P = 0.05,P = 0.02,P = 0.03 *** CSM to LSM angle at 1 cm proximal to SCJ was statistically significantly lower than at 3,4 and 5 cm proximal to the SCJ,74.94 ± 3.09 degrees vs 84.04 ± 1.64 degrees,84.87 ± 1.04 degrees and 83.72 ± 1.42 degrees,P =

关键词：平滑肌食管蠕动计算机断层扫描圆形 CSM LSM 角度测量