This paper concentrates on the finite-time Hsub.∞ control problem for a type of stochastic discrete-time Markovian jump systems, characterized by time-delay and partly unknown transition ...probabilities. Initially, a stochastic finite-time (SFT) Hsub.∞ state feedback controller and an SFT Hsub.∞ observer-based state feedback controller are constructed to realize the closed-loop control of systems. Then, based on the Lyapunov–Krasovskii functional (LKF) method, some sufficient conditions are established to guarantee that closed-loop systems (CLSs) satisfy SFT boundedness and SFT Hsub.∞ boundedness. Furthermore, the controller gains are obtained with the use of the linear matrix inequality (LMI) approach. In the end, numerical examples reveal the reasonableness and effectiveness of the proposed designing schemes.
En el artículo se establece la relación entre el sistema de gestión en inventarios y la satisfacción de los clientes de una empresa compresora peruana. Para implementar dicho sistema, se usó el ...método ABC para clasificar los inventarios de acuerdo con el valor monetario del producto. Luego de la implementación del sistema, hubo mejoras en: la atención al cliente, la reducción del costo respecto a la mano de obra y el equilibrio entre la compra y la venta de las existencias. En consecuencia, Aumentaron las utilidades de la empresa y su competitividad en el sector gracias a las mejoras en: la gestión de inventarios, el control y la reducción de costos.
Complex medical oncology patients admitted to the hospital are at higher risk for transfer to higher levels of care. At our medical academic institution, on average three patients are located on the ...intermediate-care/step down unit daily, as opposed to the 26-bed medical-surgical inpatient oncology unit due to complex clinical needs, which are outside of our current scope. Acuity-Adaptable Rooms (AARs) is a healthcare model aimed to provide care for patients from admission to discharge, with the flexibility of nursing staff to provide consistent care despite the changing patient needs. Literature suggests transitioning the inpatient oncology unit to the AAR model could decrease patient transfers and length of stay (LOS), resulting in cost savings that will justify the cost of investing in additional nurse education and training (Bonuel et al., 2013, p. 919). The purpose of this project is to evaluate the impact of an AAR model within the oncology setting. Nursing leadership, with the guidance of Critical Care and Intermediate Care educators, formulated a robust education plan aligned with ACCN guidelines to cross-train Oncology RNs to develop the competence needed to care intermediate-level of care patients. RN staff completed ECCO training and cardiac and pulmonary didactic courses to gain the knowledge and skills needed to manage CPAP/BiPAP, high-flow nasal cannula, low-dose cardiac drips, and other domains of monitoring that require 1-2 hour assessment and interventions. After training concludes in November 2022, six patient rooms on the medical-surgical oncology unit will be used to accommodate intermediate-level of care patients. Current average LOS is 6.9 days. AARs are associated with an average LOS decrease of 30% Bonuel et al., 2019). Once education and training has completed, a cost-analysis will be performed to determine total cost of RN training investment compared to potential cost savings resulting from a decreased LOS. Number of patient transfers will also be evaluated. Keeping patients on the oncology unit is also predicted to preserve patient safety, as well as improve patient and staff satisfaction. While there are financial impacts associated with the cross-training program, comparing the cost of training to improvements in clinical outcomes could contribute to a return on investment (Opperman, 2016). This will show the value of continued professional development for oncology nurses, and provide evidence for the further adaption of the AAR model within the inpatient oncology setting.
Abstract
Introduction
Sleep disorders are extremely common in the general population and are associated with an increased risk for fatal accidents, heart disease, stroke, neurocognitive decline, and ...diabetes. Sleep problems disproportionately affect socioeconomically disadvantaged and under resourced communities. We present here a 5-year analysis of a private-public partnership between a private sleep medicine practice (Redwood Pulmonary Medical Associates, RPMA) and county medical system (the Health Plan of San Mateo) to provide a coordinated, value-based sleep apnea program to adult residents of San Mateo County, CA.
Methods
Referring providers send referrals to a single location (RPMA), and sleep consultations, testing, follow-up care, and CPAP management occur out of the same location by a dedicated staff. Limited channel cardiopulmonary (CP) sleep testing initiated in the office and completed at home was done for most patients. Patients with AHI>5 plus daytime sleepiness were offered nasal CPAP, unlimited mask fittings, and compliance checks.
Results
2101 CP tests were successfully completed (93.5%). There were 49.6% females and 50.4% males, with an average age of 51.6 years. 31% had severe obstructive sleep apnea (OSA) and 59% were moderate or severe. 1471 (65%) of patients were given prescriptions for CPAP and 471 (32%) were still using CPAP at 5 years, 68.7% of whom were initiated within 3 years of the analysis. Of the patients returning satisfaction surveys, 97% would recommend the program to a relative or friend, and all respondents (99 to date) who were using CPAP felt it had benefitted their health overall. Comparing actual costs of the program to projected fee-for-service costs for the same services, the program saved the Health Plan of San Mateo $1,132,510, or 51.4%.
Conclusion
This program demonstrates the potential clinical and financial benefit of private-public partnerships in administering clinical programs to high risk populations, as private businesses can quickly adapt to new technologies, financial metrics, and standards of care.
Support
No outside financial support was provided
Background: Surgical tray configurations are rarely audited, which results in an often-overlooked source of perioperative inefficiency and unnecessary costs. The challenge in determining the ideal ...contents of a tray lies in the balance between clinical needs, costs, ease of batching, prevention of adverse clinical events and minimization of wear and tear. In our study, we developed a novel hybrid approach (HA) based on surveys and cost analyses to reduce the number of instruments on the laminectomy tray (LT) and the basic neurosurgery tray (BNT). We compared the reduction in the number of instruments as well as cost savings from our approach to 2 approaches previously described in the literature: clinician review (CR) and mathematical optimization (MO). Methods: Three approaches were tested: MO, CR and HA. A MO was performed via the mathematical analysis of 25 observations of the use of a LT and BNT tray. For the CR and HA approaches, we interviewed 5 neurosurgeons and 3 orthopedic surgeons who performed a total of 5437 spine cases, requiring the use of the LT and BNT, from Apr. 1, 2017, to Feb. 15, 2021, at Sunnybrook Health Sciences Centre. In the CR approach, surgeons suggested which surgical instruments should be removed. The HA approach was performed via a structured survey of the surgeon's estimated instrument usage, followed by a cost-based inflation point analysis. Results: The MO, CR and HA resulted in a total instrument reduction of 38%, 41% and 35%, respectively. Similarly, the total cost savings per annum were $44 417.60, $50 211.20 and $46 348.80, respectively. Conclusion: While hospitals continue to examine perioperative services for potential inefficiencies, surgical inventory will be increasingly scrutinized. Despite MO being the most accurate methodology to do so, our results suggest that savings were similar across all 3 methods. CR and HA are significantly less laborious and thus are viable alternatives.
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