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The purpose of this paper is to investigate violations against work standards associated with using a new health information technology (HIT) system. Relevant recommendations for implementing HIT in rural hospitals are provided and discussed to achieve meaningful use.

An observational study is conducted to map medication administration process while using a HIT system in a rural hospital. Follow-up focus groups are held to determine and verify potential adverse factors related to using the HIT system while passing drugs to patients.

A detailed task analysis demonstrated several violations, such as only relying on the barcode scanning system to match up with patient and drugs could potentially result in the medical staff forgetting to provide drug information verbally before administering drugs. There was also a lack of regulated and clear work procedure in using the new HIT system. In addition, the computer system controls and displays could not be adjusted so as to satisfy the users’ expectations. Nurses prepared medications and documentation in an environment that was prone to interruptions.

Recommendations for implementing a HIT system in rural healthcare facilities can be categorized into five areas: people, tasks, tools, environment, and organization. Detailed remedial measures are provided for achieving continuous process improvements at resource-limited healthcare facilities in rural areas.

The learning outcomes of this paper are as follows: to understand the context of seaport logistics and supply chain design structure, to apply Monte Carlo simulation in the interface of the supply chain and to analyze the Monte Carlo simulation algorithm and statistical techniques for identifying the key seaport logistics factors.

It was 9:00 p.m. on November 10, 2020, and Nishadh Amonkar, the CEO of OCTO supply chain management (SCM) was glued to the television watching the final cricket match of the Indian Premier League, 2020. Amonkar’s mobile phone rang and it was a call from Vinod Nair, a member Logistics Panel of Ranji Industries Federation. Nair informed Amonkar that it was related to the rejection of several export consignments of agricultural products from Ranji (in the western part of India). The rejection was due to the deterioration in the quality of the exported agricultural products during transit from Ranji to various locations in Europe.

This course is suitable at the MBA level for the following courses: Operations research (Focus/Session: Applications on Monte Carlo Simulation). SCM (Focus/Session: Global SCM, Logistics Planning, Distribution Network). Logistics management (Focus/Session: Transportation Planning). Business statistics (Focus/Session: Application of Hypothesis Testing).

Teaching Notes are available for educators only.

CSS 9: Operations and logistics.

Planners and managers may be prisoners of their companies' accounting systems and not even know it. This is particularly true in companies that can make a variety of products by alternative processes, facilities, or machines. In these companies, top management periodically has to make strategic choices as to which products should be emphasized and how limited raw materials and production capacities should be allocated to those products in the medium to long term. These decisions are most commonly based on convential accounting figures—product costs and profits—which are developed with much effort and in great detail in most companies. This article points out the fallacies of total reliance on accounting profits for product mix selection.

The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework.

Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages.

SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders.

Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively.

Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.

This article aims to analyze existing and preferred labor divisions between physicians and nurses treating patients with hypertension and diabetes in managed care organizations.

A mail survey was conducted in 2002/2003 among a representative sample of 743 physicians employed by Israel's largest managed care health plans (78 percent response rate). A telephone survey among a representative sample of 1,369 hypertensive or diabetic patients (77 percent response rate) was also used.

Findings reveal a conspicuous gap between actual labor division and what physicians perceive to be ideal. Possible reasons for this gap are discussed and strategies for facilitating collaboration, which would improve service quality as well as work life quality for both physicians and nurses.

This study provides empirical data on the extent of nurse involvement in managed care organization chronic patient care, as well as comparing them to physicians' preferences regarding nurse involvement.

The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice.

This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods.

The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist.

The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists.

If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively.

More patients could benefit more quickly from more effective implementation of proven interventions.

The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

This paper explores the patterns of the current needs of users' social characteristics in post occupancy evaluation (POE) associated with the environmental performance of green buildings using systematic literature review (SLR). This paper aims to establish a conceptual nexus between environmental performance mandates and the current needs of the users' social characteristics.

This paper adopts a SLR approach designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses for 21 articles that were selected as qualitative synthesis in this study. The search parameter for the selected articles in this review was limited to publications in three databases, Scopus, Web of Science and Emerald, between January 2016 and January 2023, with the help of qualitative software ATLAS.ti 9© in the presentation of the network codes. The initial literature search has retrieved 99 papers which sequentially excluded 42 papers due to exclusion criteria, and the researcher was left with 57 papers. Out of 57, 14 papers were then removed due to duplication of records found in the Scopus and Web of Science databases, and 43 articles were further screened for qualitative synthesis. A thorough critical appraisal was applied to ensure that only selected papers were included, consensus was achieved among the authors and 22 papers were excluded. The qualitative synthesis has finalized 21 studies, and they are selected as confirmative findings.

Using network codes presentation of ATLAS.ti 9©, the result shows that the social characteristics are influenced by the evaluated building category and the users' category – the stakeholders (owners, designers) and the occupants. New-fangled elements in environmental performance mandates are legitimacy and accessibility. The users’ social characteristics are derived from the category of users, where the stakeholders (designers, owners) are relatively a novel benchmark in meeting the POE objectives towards environmental performance. The least attention on the users’ social characteristics based on the findings shows that image, experiential (conjoint), happiness, interactive behaviour, morale and values are depicted as the social current needs in the environmental performance using POE. However, all stakeholders and the building occupants’ social characteristics must have a confirmative relation to the performance mandates, especially for newly performance mandates elements: legitimacy and accessibility.

The research limits the literature search between the recent January 2016 and January 2023 in Scopus, Web of Science and Emerald databases. Limiting the year of publication to the recent years is important to select and rank relevant scientific papers which encompass the reviewed subject. Other limitations include the selection of papers focusing on the POE approach and environmental performance as the main subject of evaluation. Other evaluation purposes that are not related to environmental objectives are excluded in this study.

The characteristics of the social elements become a challenging subject in meeting the environmental performance needs as they lean more towards intangible elements. The novelty of the findings is drawn from the new pattern and current needs of users' social characteristics in POE for environmental performance.

Transitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care needs of a multi-morbid ageing population. This study aims to investigate the impact of transitional care programs (TCPs) on acute healthcare utilization.

A retrospective, longitudinal, interventional study was conducted. High-risk patients were enrolled into a transitional care program of local tertiary hospital. Patients received either telephone follow-up (TFU) or home-based intervention (HBI) with TFU. Readmission rates and LOS were assessed for both groups.

There was no statistically significant difference in readmissions or LOS between TFU and HBI. After excluding demised patients, TFU had statistically significant lower LOS than HBI. Both interventions demonstrated statistically significant reductions in readmissions and LOS in pre–post analyses.

TFU may be more effective than HBI in patients with lower clinical severity, despite both interventions showing statistically significant reductions in acute healthcare utilization. Study findings may be used to inform transitional care practices. Future studies should continue to examine the comparative effectiveness of transitional care interventions and the patient populations most likely to benefit.

Previous studies demonstrated promising outcomes for TFU and HBIs, but few have evaluated their comparative effectiveness on acute healthcare utilization and specific patient populations most likely to benefit. This study evaluated interventional effectiveness of both, which might be useful for informing allocation of resources based on clinical complexity and care needs.

This study aims to calculate the inequity in out of pocket expenditures and utilization of laboratory tests in Iran. Equal access to health services is an important part of human rights in health care. Out-of-pocket payment is a part of financial access to health care. In this study, the authors tried to find inequity in out-of-pocket payments and utilization of medical laboratory tests (MLTs) as a part of human rights in Iran in 2016.

Gini and concentration indices were calculated for this purpose, and regression models were estimated to show the relationship between different factors and utilization and out-of-pocket.

The average out-of-pocket payment for all of the households was US$1.56 (urban areas: 1.97 and rural areas: 1.31). Moreover, the average utilization of MLTs was 0.079 (urban areas: 0.0908 and rural areas: 0.0753). Gini and concentration indices for out-of-pocket payments were 0.522 and 0.0701, respectively.

Out-of-pocket and utilization were low in lower in less developed regions of ease and southeast regions of the country and were related to access to health insurance, income and wealth deciles.

This study presents the improvements of the multicomponent Armstrong–Frederick model with multiplier (MAFM) performance through a numerical optimisation methodology available in a commercial software. Moreover, this study explores the application of a multiobjective optimisation technique for the determination of the parameters of the constitutive models using uniaxial experimental data gathered from aluminium alloy 7075-T6 specimens. This approach aims to improve the overall accuracy of stress–strain response, for not only symmetric strain-controlled loading but also asymmetrically strain- and stress-controlled loading.

Experimental data from stress- and strain-controlled symmetric and asymmetric cyclic loadings have been used for this purpose. The analysis of the influence of the parameters on simulation accuracy has led to an adjustment scheme that can be used for focused optimisation of the MAFM model performance. The method was successfully used to provide a better understanding of the influence of each model parameter on the overall simulation accuracy.

The optimisation identified an important issue associated with competing ratcheting and mean stress relaxation objectives, highlighting the issues with arriving at a parameter set that can simulate ratcheting and mean stress relaxation for load cases not reaching at complete relaxation.

The study uses a strain-life fatigue application to demonstrate the importance of incorporating a technique such as the presented multiobjective optimisation method to arrive at robust parameters capable of accurately simulating a variety of transient cyclic phenomena.

The proposed methodology improves the accuracy of cyclic plasticity phenomena and strain-life fatigue simulations for engineering applications. This study is considered a valuable contribution for the engineering community, as it can act as starting point for further exploration of the benefits that can be obtained through material parameter optimisation methodologies for models of the MAFM class.