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Calha, Mário J. B., Valter F. Silva, and José A. G. Fonseca. "REAL-TIME PROCEDURES IN DISTRIBUTED SYSTEMS." IFAC Proceedings Volumes 38, no. 2 (2005): 24–31. http://dx.doi.org/10.3182/20051114-2-mx-3901.00005.
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Menon, Unnikrishnan K., Janhvi J. Bhate, and K. Madhumita. "A Stitch in Time." International Journal of Phonosurgery & Laryngology 3, no. 1 (2013): 31–33. http://dx.doi.org/10.5005/jp-journals-10023-1057.
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ABSTRACT Bilateral vocal cord paralysis is the one of the common childhood laryngeal lesions. The treatment modalities include interim tracheostomy and, where needed, permanent irreversible procedures. We report a case of idiopathic bilateral vocal cord palsy in a child, which was managed effectively by the procedure of suture lateralization of the vocal cord. The procedure, its rarity and follow-up of our case is described. How to cite this article Bhate JJ, Menon UK, Madhumita K. A Stitch in Time. Int J Phonosurg Laryngol 2013;3(1):31-33.
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H, Abdul Rasib A., and Mohamad Rafaai Z. F. "Non-valued Changeover Time Measures for Hiddxen Time Loss in Automotive Mechanical Component Production." International Journal of Engineering & Technology 7, no. 4.36 (December 1, 2018): 10. http://dx.doi.org/10.14419/ijet.v7i4.36.22704.
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Generally, Hidden Time Loss exists besides all procedures and thus it has the direct influence on the rate of productivity. In the line of production, the most prominent tool to measure the performance is Overall Equipment Efficiency. Availability of equipment is one of the component to measure Overall Equipment Efficiency to cater the Hidden Time Loss. Though, in manual assembly and semi-automatic assembly procedure, the Overall Equipment Efficiency is not good fit to measure operational performance of assembly procedure. Along the manual assembly and semi-automatic assembly procedures some Hidden Time Loss has occurred particularly when same line of production provides high variety of product. Therefore, the current research introduces the Non-valued Changeover Time as one component of Time Loss Measures in assemble produces. A comprehensive literature analysis is done on the production operations along with the measures of performance to develop the Non-valued Change-over Time structure. Basically, a case study of two companies of automotive manufacturing is used to find the validity of structure of Non-valued Change-over Time. It is concluded that Non-valued Change-over Time is one of the measure of Hidden Time Loss in manual as well as semi-automatic assembly procedures.
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Kohan, Donald E. "Procedures in Nephrology Fellowships: Time for Change." Clinical Journal of the American Society of Nephrology 3, no. 4 (May 7, 2008): 931–32. http://dx.doi.org/10.2215/cjn.01740408.
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Anyanwu, Emeka C., Victor Mor-Avi, and R. Parker Ward. "Automated Procedure Logs for Cardiology Fellows: A New Training Paradigm in the Era of Electronic Health Records." Journal of Graduate Medical Education 13, no. 1 (January 8, 2021): 103–7. http://dx.doi.org/10.4300/jgme-d-20-00642.1.
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ABSTRACT Background Procedural experience for residents and fellows is critical for achieving competence, and documentation of procedures performed is required. Procedure logs serve as the record of this experience, but are commonly generated manually, require substantial administrative effort, and cannot be corroborated for accuracy. Objective We developed and implemented a structured clinical-educational report template (CERT), which automatically generates procedure logs directly from the clinical record. Methods Our CERT aimed to replace the post-procedure note template for our cardiac catheterization laboratory and was incorporated into the electronic health record system. Numbers of documented procedures in automated CERT-derived procedure logs over a 1-year post-intervention period (2018–2019) were compared to manual logs and corrected for clinical volume changes. The CERT's impact on fellowship experience was also assessed. Results Automated CERT procedure logs increased weekly procedural documentation over manual procedure logs for total procedures (24.2 ± 6.1 vs 17.1 ± 6.8, P = .007), left heart catheterizations (14.5 ± 3.6 vs 10.8 ± 4.2, P = .039), total procedural elements (40.2 ± 11.4 versus 20.9 ± 12.5, P < .001), and captured procedural details not previously documented. The CERT also reduced self-reported administrative time and improved fellowship experience. Conclusions A novel CERT allows procedure logs to be automatically derived from the clinical record and increased the number of documented procedures, compared to manual logging. This innovation ensures an accurate record of procedural experience and reduces self-reported non-educational administrative time for cardiology fellows.
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Richards, Lucas, Shiv Dalla, Carissa Walter, and Aaron Rohr. "74957 Utilizing 3D Printing to Assist Planning of Percutaneous/Endovascular Procedures in Interventional Radiology." Journal of Clinical and Translational Science 5, s1 (March 2021): 62–63. http://dx.doi.org/10.1017/cts.2021.564.
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ABSTRACT IMPACT: We plan to measure the impact of integrating 3D printed models in the planning process of endovascular procedures with the goal of making a case for using this resource more often. OBJECTIVES/GOALS: To measure the impact of using 3D printed models of patient specific anatomy for pre-procedure planning and as an intra-procedure reference. Impact will be measured by: a. Radiation exposure ; b. Contrast dosage; c. Fluoroscopy time; d. Time to procedural completion; e. ‘Attempts at access,’ when applicable to the procedure METHODS/STUDY POPULATION: Retrospective data will be collected on every patient that received one of prostate artery embolism, transjugular intrahepatic portosystemic shunt placement, or endovascular stent repair in the 3 years prior to the first prospective case. An attempt will be made to create a procedure planning model for every patient that receives one of the three procedures of interest in the 5 months following the first prospective case and those that have a model included in their procedure planning process will be included as part of the experimental group. We anticipate this to not include every patient as there will need to be adequate time between the scheduling of the procedure and the procedure start time to be able to create a 3D model. This will make it impossible to include every patient. Our first prospective case was 11/12/20. RESULTS/ANTICIPATED RESULTS: At the time of submission we have very limited data and cannot confidently make a statement regarding results. We anticipate to measure a reduced time to procedural completion, and as a result, decreased radiation exposure, decreased contrast dosage, and decreased fluoroscopy time in the cases that included a 3D printed model in the planning of the procedures when compared to the procedures that did not include a model. DISCUSSION/SIGNIFICANCE OF FINDINGS: Few hospitals are using 3D printing as a regular tool that physicians can access as a part of their procedure preparation. If we are able to measure a significant impact on the efficiency and safety of procedures in interventional radiology, a much more robust argument can be made for including this technique in procedure planning with regularity.
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Kang, Heechan, and Mo Thoufeeq. "Size of colorectal polyps determines time taken to remove them endoscopically." Endoscopy International Open 06, no. 05 (May 2018): E610—E615. http://dx.doi.org/10.1055/a-0587-4681.
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Abstract Background an study aims Polypectomy and endoscopic mucosal resection (EMR) are effective and safe ways of removing polyps from the colon at endoscopy. Guidelines exist for advising the time allocation for diagnostic endoscopy but not for polypectomy and EMR. The aim of this study was to identify if time allocated for polypectomy and EMR at planned therapeutic lists in our endoscopy unit is sufficient for procedures to be carried out. We also wanted to identify factors that might be associated with procedures taking longer than the allocated time and to identify factors that might predict duration of these procedures. Patients and methods A retrospective case study of planned 100 lower gastrointestinal EMR and polypectomy procedures at colonoscopy and sigmoidoscopy was performed and analyzed with quantitative analysis. Results The mean actual procedural time (APT) for 100 procedures was 52 minutes and the mean allocated time (AT) was 43.05 minutes. Hence the mean APT was 9 minutes longer than the mean AT. Factors that were significantly associated with procedures taking longer than the allocated time were patient age (P = 0.029) and polyp size (P = 0.005). Factors that significant changed the actual procedure time were patient age (P = 0.018), morphology (P = 0.002) and polyp size (P < 0.001). Procedures involving flat and lateral spreading tumor (LST) type polyps took longer than the protruding ones. On multivariate analysis, polyp size was the only factor that associated with actual procedure time. Number of polyps, quality of bowel preparation, and distance of polyp from insertion did significantly change procedure duration. Conclusion Factors that significantly contribute to duration of polypectomy and EMR at lower gastrointestinal endoscopy include patient age and polyp size and morphology on univariate analysis, with polyp size being the factor with a significant association on multivariate analysis. We recommend that endoscopy units take these factors into consideration locally when allocating time for these procedures to be safe and effective.
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Peres, S. Camille, William D. Johnson, Sarah E. Thomas, and Paul Ritchey. "The Effects of Native Language and Gender on Procedure Performance." Human Factors: The Journal of the Human Factors and Ergonomics Society 61, no. 1 (August 24, 2018): 32–42. http://dx.doi.org/10.1177/0018720818793042.
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Objective: Evaluation of effects of native language—native (L1) versus nonnative (L2)—on procedure performance. Background: Written procedures are used by global industries to facilitate accurate and safe performance of hazardous tasks. Often companies require that all employees be sufficiently literate in English and to use only English versions. Method: Industrial tasks were tested using a virtual reality industrial environment (Second Life®) to explore effects on procedural performance and safety statement adherence. Fifty-four engineering students (27 L2) participated in the study to explore the native language variable. The participants completed the procedures under time pressure and were scored according to procedure performance and hazard comprehension. Results: Analysis of eight procedures showed significant differences between L1 and L2 for procedure performance (specifically for L2 females). There were no language fluency or hazard comprehension differences found between the two groups. Conclusion: The results suggest that (a) the lower procedure performance of L2 readers was not due to English proficiency but more likely to time pressure; (b) implications regarding single language procedures are not fully understood, particularly with regard to gender differences. Application: This research is applicable to high-risk industries providing single language, time critical procedures to multilingual workforces.
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Ibrir, Salim. "Finite-Time Stabilization Procedures for Discrete-Time Nonlinear Systems in Feedback Form." IEEE Access 9 (2021): 27226–38. http://dx.doi.org/10.1109/access.2021.3057484.
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Singh, Jasvinder A., and John Cleveland. "Epidemiology of cardiac or orthopedic procedures in gout versus rheumatoid arthritis: a national time-trends study." Therapeutic Advances in Musculoskeletal Disease 13 (January 2021): 1759720X2097391. http://dx.doi.org/10.1177/1759720x20973916.
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Aims: To examine the secular trends in the number and rates of in-hospital cardiac and orthopedic procedures in people with gout and rheumatoid arthritis (RA), and the United States (US) general population, from 1998 to 2014. Methods: We examined the frequency of seven common cardiac and orthopedic procedures in hospitalized people with gout, RA, or the general population using the 1998–2014 US National Inpatient Sample (NIS). Poisson regression evaluated the differences in frequencies in 1998 versus 2014, between gout and RA, and within each cohort. Results: Both in-hospital cardiac and orthopedic procedures increased in gout and RA with time, in contrast with declining cardiac procedures in the general US population. Cardiac procedures were significantly higher in gout versus RA in 1998 (59% higher) and 2014 (92% higher). The rate of cardiac procedures increased from 36.6 to 82.8 in gout and from 20.1 to 33.1 in RA per 100,000 NIS claims from 1998 to 2014. Orthopedic procedures became more common than cardiac procedures in gout and RA by 2014. In RA, the cardiac–orthopedic procedure volume difference was significant in 1998 and 2014. We noted no significant difference between cardiac versus orthopedic procedures in 1998 in gout, but the difference was significant in 2014. Orthopedic procedures in gout were significantly lower than RA in 1998 (33% lower), but were significantly higher than RA in 2014 (5% higher). Conclusion: Increasing in-hospital cardiac procedures in gout and RA contrasting with declining general US population rates indicated that optimal management of systemic inflammation and an early diagnosis of gout and RA are needed. The rate of increase in orthopedic procedures exceeded that in cardiac procedures. A much greater volume and rate of increase in common in-hospital cardiac and orthopedic procedures in gout compared to RA indicates that an aggressive approach to treat-to-target in gout is needed to potentially reduce the associated healthcare burden and cost. Plain language summary Cardiac and orthopedic procedures rising faster for gout compared to rheumatoid arthritis in the United States We performed a national US study of the most common cardiac versus orthopedic procedures from 1998 to 2014. We found that over time, the number and the rate of cardiac procedures increased in people with gout (2.2-fold higher) or rheumatoid arthritis (1.6-fold higher). This was surprising, since during the same time, we noted a decrease in cardiac procedures in the general U.S. population. The rate of cardiac procedures in gout was 2.5-fold higher than that in rheumatoid arthritis, 82.8 vs. 33.1 per 100,000 NIS claims in 2014. Interestingly, orthopedic procedures were more common than cardiac procedures in both gout and RA in all periods. Also, the difference in the numbers of cardiac vs. orthopedic procedures increased over time in both gout and RA. Gout outpaced rheumatoid arthritis for both the total number and the rate of cardiac or orthopedic procedures over time. Therefore, our study provides an understanding of an increasing procedure burden in gout compared to rheumatoid arthritis, and to the general U.S. people with these conditions.
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Vieira Junior, Francisco Ubaldo, Nilson Antunes, Reinaldo W. Vieira, Lúcia Madalena Paulo Álvares, and Eduardo Tavares Costa. "Hemolysis in extracorporeal circulation: relationship between time and procedures." Revista Brasileira de Cirurgia Cardiovascular 27, no. 4 (2012): 535–41. http://dx.doi.org/10.5935/1678-9741.20120095.
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Oliphant, Sallie S., Chiara Ghetti, Richard L. McGough, Li Wang, Clareann H. Bunker, and Jerry L. Lowder. "Inpatient procedures in elderly women: An analysis over time." Maturitas 75, no. 4 (August 2013): 349–54. http://dx.doi.org/10.1016/j.maturitas.2013.04.019.
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Abuzaid, A. H., I. B. Mohamed, and A. G. Hussin. "Procedures for outlier detection in circular time series models." Environmental and Ecological Statistics 21, no. 4 (April 24, 2014): 793–809. http://dx.doi.org/10.1007/s10651-014-0281-8.
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Nelson, Lawrence J. "Ethics consultations reduce time and procedures in intensive care." Evidence-based Healthcare 8, no. 2 (April 2004): 63–64. http://dx.doi.org/10.1016/j.ehbc.2004.02.010.
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Bergantini, Larissa Silva, Sueli Mutsumi Tsukuda Ichisato, Mariana Salvadego Águila Nunes, and Carlos Alexandre Molena Fernandes. "Preoperative fasting time in children undergoing elective surgical procedures." Rev Rene 22 (April 19, 2021): e61347. http://dx.doi.org/10.15253/2175-6783.20212261347.
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Objective: to verify the preoperative fasting time in children undergoing elective surgical procedures. Methods: cross-sectional study, carried out with information obtained from 20 children’s medical records, submitted to descriptive and inferential statistical analysis. Results: the median fasting time was 8.03 hours. The shortest time recorded was 7 hours and 45 minutes and the longest 17 hours and 30 minutes. School children had the longest pre-anesthetic fasting time. In 16 cases, fasting after midnight was prescribed. There was no statistically significant difference between fasting time and the variables age groups and surgical specialties. No correlation was found between the child’s age and fasting time. Conclusion: the median fasting time was shorter than that found in other studies. The patients fasted for longer intervals than recommended. Fasting time was not related to age group, surgical specialty, and age of the child.
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Oszvald, Ági, Hartmut Vatter, Christian Byhahn, Volker Seifert, and Erdem Güresir. "“Team time-out” and surgical safety—experiences in 12,390 neurosurgical patients." Neurosurgical Focus 33, no. 5 (November 2012): E6. http://dx.doi.org/10.3171/2012.8.focus12261.
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Object Quality and safety are basic concerns in any medical practice. Especially in daily surgical practice, with increasing turnover and shortened procedure times, attention to these topics needs to be assured. Starting in 2007, the authors used a perioperative checklist in all elective procedures and extended the checklist in January 2011 according to the so-called team time-out principles, with additional assessment of patient identity and the planned surgical procedure performed immediately before skin incision, including the emergency cases. Methods The advanced perioperative checklist includes parts for patient identification, preoperative assessments, team time-out, postoperative treatment, and imaging controls. All parts are signed by the responsible physician except for the team time-out, which is performed and signed by the theater nurse on behalf of the surgeon immediately before skin incision. Results Between January 2007 and December 2010, 1 wrong-sided bur hole in an emergency case and 1 wrong-sided lumbar approach in an elective case (of 8795 surgical procedures) occurred in the authors' department. Using the advanced perioperative checklist including the team time-out principles, no error occurred in 3595 surgical procedures (January 2011–June 2012). In the authors' department all team members appreciate the chance to focus on the patient, the surgical procedure, and expected difficulties. The number of incomplete checklists and of patients not being transferred into the operating room was lowered significantly (p = 0.002) after implementing the advanced perioperative checklist. Conclusions In the authors' daily experience, the advanced perioperative checklist developed according to the team time-out principles improves preoperative workup and the focus of the entire team. The focus is drawn to the procedure, expected difficulties of the surgery, and special needs in the treatment of the particular patient. Especially in emergency situations, the team time-out synchronizes the involved team members and helps to improve patient safety.
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Płotek, Włodzimierz, Małgorzata Sobol-Kwapinska, Marcin Cybulski, Anna Kluzik, Małgorzata Grześkowiak, and Leon Drobnik. "Time estimation and time perceiving in patients receiving intravenous anaesthesia for endoscopic procedures." Journal of Medical Science 84, no. 2 (June 30, 2015): 71–77. http://dx.doi.org/10.20883/medical.e19.
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Introduction. The basic goals of the study were to analyze how patients receiving intravenous anaesthesia for endoscopy produce one-minute time intervals after anaesthesia, and to characterize the relationship between attitude towards time and the production of one-minute intervals. Material and methods. Twenty four intravenously anesthetized patients constituted the Anaesthesia Group and 25 nonanesthetized patients formed the Control Group. The Mini-Mental State Examination and the Sense of Coherence Meaningfulness Subscale were used to recognize the problem of dementia and depression, the Time Metaphors Questionnaire was used for the assessment attitudes toward time. Time production of one-minute was measured three times in each of four sessions. Results. The tested participants of both groups shortened the one-minute intervals. Duration of anaesthesia did not affect the time production. Perceiving time as empty and meaningless was related with misestimating time after colonoscopy. Conclusions. Time interpretation by using metaphors and time production are related with each other.
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Samaranayaka, Chamil, Ari Samaranayaka, Dave Barson, and RK De Silva. "Factors influencing trends in trauma-associated orbital cavity reconstruction procedures and time delay: New Zealand national data 2000–2014." Trauma 20, no. 4 (July 18, 2017): 258–67. http://dx.doi.org/10.1177/1460408617719477.
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Aim Surgical reconstructions of orbital fractures due to trauma are increasing worldwide. This study identifies characteristics of patients facing such procedures, possible causes for increasing trends, and factors associated with the duration from trauma to surgical procedures. Methods Trauma-related orbital reconstruction procedures in New Zealand over a 15-year period were identified from Ministry of Health hospital discharge data. Age-standardised rates for each year and age-specific rates for each gender were calculated using age, sex and year-specific population data from New Zealand population censuses. The contribution of these procedures to total trauma-related maxillofacial procedures was assessed. Descriptive statistics were used to identify demographic, trauma-related, and procedure-related characteristics associated with higher frequency and increasing trends. Characteristics independently associated with time delay from trauma to surgery were identified by multivariable Cox regression modelling. Results Orbital procedures are most common among males and the young to middle aged, and trends in frequency and rates of procedures are sharply increasing outnumbering other types of trauma-related maxillofacial procedures, with interpersonal violence being a major contributor to this increase. Younger age and higher number of injuries are associated with less time delay from injury to procedure while Asian ethnicity, motor vehicle accidents, non-maxillofacial primary diagnoses, and higher number of medical comorbidities are associated with longer delay. Conclusion The first three findings are consistent with international literature, and could be considered by policy makers when deriving preventive measures. The findings related to time delay are new and could contribute information towards forming clinical guidelines if similar patterns were identified elsewhere.
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Kaylie, David M., Peter E. Andersen, and Mark K. Wax. "An Analysis of Time and Staff Utilization for Open Versus Percutaneous Tracheostomies." Otolaryngology–Head and Neck Surgery 128, no. 1 (January 2003): 109–14. http://dx.doi.org/10.1067/mhn.2003.18.
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OBJECTIVE: We examined staff utilization and procedure length for percutaneous and open bedside tracheostomies in an intensive care setting STUDY DESIGN: Prospective clinical outcomes study. METHODS: Intensive care unit (ICU) tracheostomy consults meeting criteria for bedside procedures were randomized to open or percutaneous procedures. The Cook percutaneous kit and a prepackaged tracheostomy tray were used. ICU nursing and respiratory therapy staff was present for all procedures. The total resident time, staff time, and procedure length were recorded. Twelve patients underwent percutaneous tracheostomy, and 12 received an open tracheostomy. RESULTS: An operating room nurse was present for 7 of the open procedures. Ancillary medical staff was present for 3 open tracheostomies: anesthesia for 2 and critical care for 1. Ancillary medical staff was present for 4 percutaneous tracheostomies: anesthesia staff for 1 and critical care for 3. The average resident presence, staff presence, and procedure length for open tracheostomies were 47, 30, and 12 minutes, respectively. For percutaneous tracheostomies, the times were 39, 29, and 12 minutes, respectively. One intraoperative complication occurred during a percutaneous procedure and 2 perioperative complications occurred: 1 in the open group and 1 in the percutaneous group. CONCLUSIONS: There was no significant difference in procedure length, resident time, or staff time between the 2 procedures. Ancillary staff was occasionally used but was not thought to be necessary for the majority of procedures. Both procedures can be safely and expediently performed in the ICU.
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Thomas, Anita A., Neil G. Uspal, Assaf P. Oron, and Eileen J. Klein. "Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department." Journal of Graduate Medical Education 8, no. 5 (December 1, 2016): 754–58. http://dx.doi.org/10.4300/jgme-d-15-00730.1.
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ABSTRACT Background Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. Objective We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Methods Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Results Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference −0.4 points). Conclusions Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.
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Dardick, Joseph, Stephanie Allen, Aleka Scoco, Richard L. Zampolin, and David J. Altschul. "Virtual reality simulation of neuroendovascular intervention improves procedure speed in a cohort of trainees." Surgical Neurology International 10 (September 20, 2019): 184. http://dx.doi.org/10.25259/sni_313_2019.
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Background: Realistic virtual reality (VR) simulators have greatly expanded the tools available for training surgeons and interventionalists. While this technology is effective in improving performance in many fields, it has never been evaluated for neuroendovascular procedures. This study aims to determine whether VR is an effective tool for improving neuroendovascular skill among trainees. Methods: Trainees performed two VR revascularizations of a right-sided middle cerebral artery (MCA) thrombosis and their times to procedural benchmarks (time to enter internal carotid artery [ICA], traverse clot, and complete procedure) were compared. To determine whether the improvement was case specific, trainees with less procedural exposure were timed during VR left-sided ICA (LICA) aneurysm coiling before or after performing MCA thrombectomy simulations. To determine the value of observing simulations, medical students were timed during the right MCA revascularization simulations after watching other VR procedures. Results: Trainees significantly improved their time to every procedural benchmark during their second MCA revascularization (mean decrease = 1.08, 1.57, and 2.24 min; P = 0.0072, 0.0466, and 0.0230). In addition, time required to access the LICA during aneurysm coiling was shortened by 0.77 min for each previous VR right MCA revascularization performed (P = 0.0176; r2 = 0.71). Finally, medical students’ MCA revascularization simulation times improved by 0.87 min for each prior simulation viewed (P < 0.0221; r2 = 0.96). Conclusion: Both performance and viewing of simulated procedures produced significant decreases in time to reach neuroendovascular procedural benchmarks. These data show that VR simulation is a valuable tool for improving trainee skill in neuroendovascular procedures.
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Hassler, Uwe, Paulo M. M. Rodrigues, and Antonio Rubia. "TESTING FOR GENERAL FRACTIONAL INTEGRATION IN THE TIME DOMAIN." Econometric Theory 25, no. 6 (December 2009): 1793–828. http://dx.doi.org/10.1017/s0266466609990338.
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We propose a family of least-squares–based testing procedures that look to detect general forms of fractional integration at the long-run and/or the cyclical component of a time series, and that are asymptotically equivalent to Lagrange multiplier tests. Our setting extends Robinson’s (1994) results to allow for short memory in a regression framework and generalizes the procedures in Agiakloglou and Newbold (1994), Tanaka (1999), and Breitung and Hassler (2002) by allowing for single or multiple fractional unit roots at any frequency in [0, π]. Our testing procedure can be easily implemented in practical settings and is flexible enough to account for a broad family of long- and short-memory specifications, including ARMA and/or GARCH-type dynamics, among others. Furthermore, these tests have power against different types of alternative hypotheses and enable inference to be conducted under critical values drawn from a standard chi-square distribution, irrespective of the long-memory parameters.
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Dexter, Franklin, Rodney D. Traub, Lee A. Fleisher, and Peter Rock. "What Sample Sizes are Required for Pooling Surgical Case Durations among Facilities to Decrease the Incidence of Procedures with Little Historical Data?" Anesthesiology 96, no. 5 (May 1, 2002): 1230–36. http://dx.doi.org/10.1097/00000542-200205000-00028.
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Background Better predictions of each case's duration would reduce operating room labor costs and patient waiting times. A barrier to using historical case duration data to predict the duration of future cases is the absence for some cases of previous data for the same scheduled procedure from the same facility. The authors examined sample size requirements for pooling case duration data from several facilities to create a 90% chance of having case duration data for almost all procedures. Methods Four academic medical centers provided data, totaling 200,401 cases classified by the scheduled Current Procedural Terminology codes. Results The 12% of cases in which procedures occurred once or twice accounted for 79% of procedures or combinations of procedures. When a procedure was being performed for the first time at a facility, that same procedure had been performed previously at least once at one or more of the other three facilities only 13-25% of the time. More than 1 million cases would be needed to have a 90% chance of having at least 3 cases for each procedure observed in the original 200,401 cases. However, with N = 200,401 cases in our initial data set, we observed less than one third of the estimated total number of possible procedures. Conclusions The lack of historical case duration data for scheduled procedures is an important cause of inaccuracy in predicting case durations. However, millions of cases probably would be required to provide historical case duration data for almost all procedures.
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Silber, Jeffrey H., Paul R. Rosenbaum, Xuemei Zhang, and Orit Even-Shoshan. "Influence of Patient and Hospital Characteristics on Anesthesia Time in Medicare Patients Undergoing General and Orthopedic Surgery." Anesthesiology 106, no. 2 (February 1, 2007): 356–64. http://dx.doi.org/10.1097/00000542-200702000-00025.
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Background Procedure time is a clinically important variable that is often analyzed when studying quality and efficiency. Norms for procedure length have not been reported from Medicare data sets, nor has the influence of patient and hospital characteristics on procedure time been estimated using Medicare data. Methods The authors obtained Medicare claims on all patients aged 65-85 years who underwent general surgical and orthopedic surgical procedures in Pennsylvania. Anesthesia procedure time was estimated from anesthesia time units bills supplied from Medicare on 20 common general and orthopedic surgery procedures, and models to determine the influence of hospital and patient characteristics were developed. Results Of the 77,638 patients, 31,472 had general surgery and 46,166 underwent orthopedic procedures. The median anesthesia time for general surgery was 133 min, and for orthopedic surgery it was 146 min. After adjusting for principal procedure, hospital, and physiologic severity, covariates associated with increased anesthesia time included: multiple procedure on same day + 18.3 min (P < 0.0001); transfer-in + 6.7 min (P = 0.0002); black race + 5.5 (P < 0.0001); coagulation disorders + 4.9 (P = 0.0012); and paraplegia + 4.5 (P = 0.0006). Lower-income black patients had significantly longer procedure times than lower-income white patients (+ 7 min; P < 0.0001). Among the 15 hospitals with the largest black surgical populations, 5 hospitals had statistically significant procedure lengths for black versus white patients, ranging from + 9 to + 16 min. Conclusions In addition to variation by patient comorbidities and procedure, anesthesia procedure time varies with hospital, medical history, and sociodemographic characteristics.
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Gianakos, Susan, Arlene W. Keeling, David Haines, and Kathryn Haugh. "Time in Bed After Electrophysiological Procedures (TIBS IV): A Pilot Study." American Journal of Critical Care 13, no. 1 (January 1, 2004): 56–58. http://dx.doi.org/10.4037/ajcc2004.13.1.56.
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• Background Electrophysiological studies of the heart became commonplace in the past decade. Like cardiac catheterizations, electrophysiological studies are often considered “same day” procedures; patients are admitted in the morning, undergo the procedure, recover for several hours while confined to bed, and then are discharged from the hospital. The requisite time in bed varies widely between institutions where electrophysiological studies are performed. Little has been published about the optimal time that patients should remain in bed.• Objective To determine if the requisite time in bed could be safely reduced by 2 hours for patients recovering from electrophysiological studies done via a femoral venous approach.• Methods An experimental-control group design was used. A total of 68 patients were randomized to 2 hours (n = 31) or 4 hours (n = 37) of bed rest. Groups were comparable in age and sex. Both groups were observed for 5 hours after the procedure.• Results The incidence of bleeding did not differ significantly between the experimental and control groups. Bleeding occurred in only 1 patient.• Conclusions The required 4 hours of bed rest after an electrophysiological study done via a femoral vein approach can safely be reduced to 2 hours. Early ambulation has implications for decreasing the cost of nursing care after the procedure and decreasing length of hospital stay, thus optimizing utilization of beds for recovery.
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Deib, Gerard, Alex Johnson, Mathias Unberath, Kevin Yu, Sebastian Andress, Long Qian, Gregory Osgood, Nassir Navab, Ferdinand Hui, and Philippe Gailloud. "Image guided percutaneous spine procedures using an optical see-through head mounted display: proof of concept and rationale." Journal of NeuroInterventional Surgery 10, no. 12 (May 30, 2018): 1187–91. http://dx.doi.org/10.1136/neurintsurg-2017-013649.
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Background and purposeOptical see-through head mounted displays (OST-HMDs) offer a mixed reality (MixR) experience with unhindered procedural site visualization during procedures using high resolution radiographic imaging. This technical note describes our preliminary experience with percutaneous spine procedures utilizing OST-HMD as an alternative to traditional angiography suite monitors.MethodsMixR visualization was achieved using the Microsoft HoloLens system. Various spine procedures (vertebroplasty, kyphoplasty, and percutaneous discectomy) were performed on a lumbar spine phantom with commercially available devices. The HMD created a real time MixR environment by superimposing virtual posteroanterior and lateral views onto the interventionalist’s field of view. The procedures were filmed from the operator’s perspective. Videos were reviewed to assess whether key anatomic landmarks and materials were reliably visualized. Dosimetry and procedural times were recorded. The operator completed a questionnaire following each procedure, detailing benefits, limitations, and visualization mode preferences.ResultsPercutaneous vertebroplasty, kyphoplasty, and discectomy procedures were successfully performed using OST-HMD image guidance on a lumbar spine phantom. Dosimetry and procedural time compared favorably with typical procedural times. Conventional and MixR visualization modes were equally effective in providing image guidance, with key anatomic landmarks and materials reliably visualized.ConclusionThis preliminary study demonstrates the feasibility of utilizing OST-HMDs for image guidance in interventional spine procedures. This novel visualization approach may serve as a valuable adjunct tool during minimally invasive percutaneous spine treatment.
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Hughes, Trudie A., Laura D. Fredrick, and Marie C. Keel. "Learning to Effectively Implement Constant Time Delay Procedures to Teach Spelling." Learning Disability Quarterly 25, no. 3 (August 2002): 209–22. http://dx.doi.org/10.2307/1511303.
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This study examined the effectiveness of a training procedure designed to teach a special education resource teacher the constant time delay procedures. In addition, the study examined the effectiveness of constant time delay procedures in teaching written spelling words to one 12-year-old male student with a learning disability. A multiple-probe design across behaviors was used to demonstrate the functional relationship between the time delay procedure and the student acquiring, maintaining, and generalizing 15 spelling words. The investigation specifically sought to address teacher-training issues related to instructional procedures, student acquisition, maintenance, and generalization. The teacher successfully implemented the procedure with 100% treatment integrity and the student learned to spell all 15 spelling words.
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Wells, William, Bradley Campbell, Yudu Li, and Stryker Swindle. "The characteristics and results of eyewitness identification procedures conducted during robbery investigations in Houston, TX." Policing: An International Journal of Police Strategies & Management 39, no. 4 (November 21, 2016): 601–19. http://dx.doi.org/10.1108/pijpsm-10-2015-0124.
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Purpose Social scientific research is having a substantial impact on eyewitness identification procedural reforms. Police agencies in the USA have changed their eyewitness practices based on the results of social scientific research. The purpose of this paper is to contribute new knowledge by using a unique set of data to describe detailed aspects of eyewitness identification procedures conducted as part of robbery investigations in Houston, TX. Design/methodology/approach Robbery investigators completed surveys following identification procedures conducted during a six-month period of time. The sample includes 975 identification procedures. The analysis describes important features of identification procedures and places results in the context of existing research. Findings Results show that photo spreads were the most frequently used lineup procedure and selection outcomes were similar to recent field studies conducted in the USA. Results also show that the type of procedure, presence of a weapon, cross-race identifications, and viewing opportunity were significantly correlated with selection outcomes. Originality/value Police are reforming their eyewitness identification procedures based on findings from social science research. The study measures and describe the characteristics of a large sample eyewitness procedures conducted by investigators in the field.
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Behrle, Natalie, Esma Birisci, Jordan Anderson, Sara Schroeder, and Abdallah Dalabih. "Intranasal Dexmedetomidine as a Sedative for Pediatric Procedural Sedation." Journal of Pediatric Pharmacology and Therapeutics 22, no. 1 (January 1, 2017): 4–8. http://dx.doi.org/10.5863/1551-6776-22.1.4.
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OBJECTIVE This study seeks to evaluate the efficacy and safety of intranasal (IN) dexmedetomidine as a sedative medication for non-invasive procedural sedation. METHODS Subjects 6 months to 18 years of age undergoing non-invasive elective procedures were included. Dexmedetomidine (3 mcg/kg) was administered IN 40 minutes before the scheduled procedure time. The IN dexmedetomidine cohort was matched and compared to a cohort of 690 subjects who underwent sedation for similar procedures without the use of dexmedetomidine to evaluate for observed events/interventions and procedural times. RESULTS One hundred (92%) of the 109 included subjects were successfully sedated with IN dexmedetomidine. There were no significant differences in the rate of observed events/interventions in comparison to the non-dexmedetomidine cohort. However, the IN dexmedetomidine group had a longer postprocedure sleep time when compared to the non-dexmedetomidine cohort (p < 0.001), which had a significant effect on recovery time (p = 0.024). Also, the dexmedetomidine cohort had longer procedure time and total admit time (p < 0.001 and p = 0.037, respectively). CONCLUSIONS IN dexmedetomidine may be used for non-invasive pediatric procedural sedation. Subjects receiving IN dexmedetomidine had a similar rate of observed events/interventions as the subjects receiving non-dexmedetomidine sedation, with the exception of sleeping time. Also, patients sedated with IN dexmedetomidine had longer time to discharge, procedure time, and total admit time in comparison to other forms of sedation.
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Gorgone, Matthew, Brian McNichols, Valerie J. Lang, William Novak, and Alec B. O'Connor. "The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures." Journal of Graduate Medical Education 10, no. 5 (October 1, 2018): 583–86. http://dx.doi.org/10.4300/jgme-d-18-00399.1.
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ABSTRACT Background Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.
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Kaya, İbrahim. "Glove perforation time and frequency in total hip arthroplasty procedures." Acta Orthopaedica et Traumatologica Turcica 46, no. 1 (2012): 57–60. http://dx.doi.org/10.3944/aott.2012.2660.
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Guay, Michel, and Alan W. Salmoni. "An Examination of Self-Pacing Procedures in Human Time Estimation." Perceptual and Motor Skills 64, no. 3_suppl (June 1987): 1231–36. http://dx.doi.org/10.2466/pms.1987.64.3c.1231.
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The main purpose of the present research was to investigate the role of self-pacing trial procedures in time estimation. Auditory durations of 1, 4, and 8 sec. were estimated by 12 subjects under the method of reproduction. Different features of performance were investigated using several dependent variables. When left to themselves, subjects chose a relatively short intertrial interval, the duration of which did not differ across the three criterion durations. This finding seemed best explained as an attempt by the subjects to minimize boredom and maximize alertness. Also, subjects waited for a short time before reproducing the criterion duration, and again this period did not differ across the three criterion durations. A significant relationship was found between the duration of the self-paced intertrial interval and self-paced retention interval for all criterion durations. It appeared that subjects were attempting to maximize their time-estimation performance by either minimizing the retention interval or by developing a trial-interval rhythm. Finally, subjects were more variable in their estimates as the criterion duration increased.
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Haldar, Rudrashish, Hemant Bhagat, GokulR Toshniwal, and HariH Dash. "Conventional axillary rolls in prolonged neurosurgical procedures: Time for reconsideration." Asian Journal of Neurosurgery 12, no. 3 (2017): 583. http://dx.doi.org/10.4103/1793-5482.145538.
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Hayes, Ian J. "Procedures and parameters in the real-time program refinement calculus." Science of Computer Programming 64, no. 3 (February 2007): 286–311. http://dx.doi.org/10.1016/j.scico.2006.06.002.
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Saiganesh, Harish, David E. Stein, and Juan L. Poggio. "Body mass index predicts operative time in elective colorectal procedures." Journal of Surgical Research 197, no. 1 (July 2015): 45–49. http://dx.doi.org/10.1016/j.jss.2015.02.067.
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Starodubov, V. I., I. M. Son, M. A. Ivanova, E. V. Tsybikova, and V. V. Liutsko. "Work time expenditures of doctors in accomplishment of endoscopic procedures." Endoskopicheskaya khirurgiya 23, no. 1 (2017): 29. http://dx.doi.org/10.17116/endoskop201723129-32.
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Williams, Jill Schlabig. "New Procedures Bring Nurses Clean, Functioning Equipment Just in Time." Biomedical Instrumentation & Technology 40, no. 4 (July 1, 2006): 303–4. http://dx.doi.org/10.2345/i0899-8205-40-4-303.1.
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Lanne, Markku, Helmut Lutkepohl, and Pentti Saikkonen. "Test Procedures for Unit Roots in Time Series with Level Shifts at Unknown Time*." Oxford Bulletin of Economics and Statistics 65, no. 1 (February 2003): 91–115. http://dx.doi.org/10.1111/1468-0084.00036.
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Sattelmayer, Martin, Roger Hilfiker, and Gillian Baer. "A systematic review of assessments for procedural skills in physiotherapy education / Assessment von prozeduralen Fähigkeiten in der physiotherapeutischen Ausbildung: Ein systematischer Review." International Journal of Health Professions 4, no. 1 (June 30, 2017): 53–65. http://dx.doi.org/10.1515/ijhp-2017-0008.
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Abstract Introduction Learning of procedural skills is important in the education of physiotherapists. It is the aim of physiotherapy degree programmes that graduates are able to practice selected procedures safely and efficiently. Procedural competency is threatened by an increasing and diverse amount of procedures that are incorporated in university curricula. As a consequence, less time is available for the learning of each specific procedure. Incorrectly performed procedures in physiotherapy might be ineffective and may result in injuries to patients and physiotherapists. The aim of this review was to synthesise relevant literature systematically to appraise current knowledge relating to assessments for procedural skills in physiotherapy education. Method A systematic search strategy was developed to screen five relevant databases (CINAHL, Cochrane Central, SportDISCUS, ERIC and MEDLINE) for eligible studies. The included assessments were evaluated for evidence of their reliability and validity. Results The search of electronic databases identified 560 potential records. Seven studies were included into this systematic review. The studies reported eight assessments of procedural skills. Six of the assessments were designed for a specific procedure and two assessments were considered for the evaluation of more than one procedure. Evidence to support the measurement properties of the assessment was not available for all categories. Discussion It was not possible to recommend a single assessment of procedural skills in physiotherapy education following this systematic review. There is a need for further development of new assessments to allow valid and reliable assessments of the broad spectrum of physiotherapeutic practice
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Bugan, Barıs, Erkan Yıldırım, Murat Celik, Uygar Cagdas Yuksel, and Emre Yalçınkaya. "The Risk of Increased Procedure Time and Radiation Exposure Should be Kept in Mind for Radial Procedures." Heart, Lung and Circulation 22, no. 12 (December 2013): 1063. http://dx.doi.org/10.1016/j.hlc.2013.04.117.
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Lazarus, Matthew S. "Radiation Dose and Procedure Time for 994 CT-guided Spine Pain Control Procedures." May 2017 4, no. 20;4 (May 10, 2017): E585—E591. http://dx.doi.org/10.36076/ppj.2017.e591.
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Background: Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time. Objective: To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance. Study Design: Retrospective evaluation. Setting: Department of radiology in single academic medical center. Methods: Institutional review board approval was obtained. We reviewed CT-guided spine procedures performed over a 12-month period from January 2012 to December 2012. Procedure type, procedure time, and dose-length product were recorded. Patient age and gender were recorded for each case; additionally, demographic and medical history data were obtained for a sub-group of patients. Results: Nine hundred ninety-four studies (performed in 699 patients) were reviewed, including 585 epidural steroid injections, 228 nerve root blocks, and 90 facet blocks. For all studies, procedure time averaged 7:34 ± 5:05, and dose-length product averaged 75 mGy·cm ± 61. Additional medical history (available for 483 patients) revealed high rate of obesity (body mass index [BMI] = 30 ± 6.8, with 76% of patients overweight [BMI > 25] and 42% obese [BMI > 30]), and frequent medical comorbidities (including hypertension [n = 179], diabetes [n = 101], renal failure [n = 30], and heart failure [n = 17]). Limitations: This study was performed retrospectively, and limited to a single institution. Conclusion: These findings add to the growing evidence that CT guidance is a safe and effective technique for epidural steroid injection. These results further demonstrate that other spine intervention procedures, including nerve root block and facet block, can also be performed under CT guidance with short procedure time and reasonable levels of radiation exposure. This approach can be effectively used in a patient population with a high rate of obesity and medical comorbidities. Key words: Epidural steroid injection, nerve root block, facet block, CT-guidance, spine intervention, radiation dose
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Trasolini, R., B. Zhao, D. Chahal, and E. Lam. "A89 IMPLEMENTING ENDOSCOPIC SUBMUCOSAL DISSECTION IN A WESTERN CANADIAN SETTING: OUTCOMES, LEARNING CURVE AND LOGISTICAL CONSIDERATIONS." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 103–4. http://dx.doi.org/10.1093/jcag/gwz047.088.
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Abstract Background Endoscopic submucosal dissection (ESD) is an advanced resection technique for large gastrointestinal lesions. ESD was developed in Japan and is popular in countries with gastric cancer screening and a high incidence of gastric cancer. ESD has benefits over endoscopic mucosal resection (EMR) such as increased complete resection, en bloc resection and lower recurrence. However, ESD is a longer procedure and is difficult to master in countries with low incidence of early gastric neoplasia which is the ideal anatomic location for learning. There is increasing interest in using ESD techniques including hybrid ESD/EMR in western centers. Barriers include procedure time, perforation risk and challenges accumulating sufficient experience. Aims To present our experience implementing an ESD program in British Columbia including outcomes and logistical considerations of interest. Methods All ESD procedures since implementation of the program in May 2015 to July 2019 were included. Descriptive statistics and performance indicators over time are reported. All procedures were performed by a staff endoscopist after specialized training. Procedures were performed at two hospitals in British Columbia. Cases were referred from endoscopists and were assessed with dedicated endoscopy with or without endoscopic ultrasound prior to booking ESD. Results 40 procedures were performed, though only one procedure was performed in the first year (Mean age 70, 67.5% male). ASA class ranged from 1–4 (mean 2.08). 22 lesions were gastric, 13 were rectal, with the remainder throughout the colon. Mean lesion size was 25mm in maximum dimension (interquartile range 15-30mm). 18 procedures were performed under general anesthesia and the remainder using procedural sedation. Total surgical time ranged from 22 to 398 minutes. Mean surgical time was 104 minutes, or 126 minutes including anesthesia. 50% of procedures were performed using hybrid ESD/EMR technique. R0 resection rate across all cases was 68% (60% for hybrid procedures, 80% for strict ESD). En bloc resection rate was 60%. Recurrence rate was 10%. Complication rate was 7.5% all were post-procedure bleeds requiring hospitalization. No perforations occurred. 3 patients required surgery for incomplete resection or invasive cancer on pathology, 3 required repeat endoscopic resection. Surgical time per cm of lesion improved significantly from the first 10 cases to the last 10 (time per cm resected 75 min to 32 min p<0.006). Conclusions ESD is an effective therapy for GI neoplasia. ESD is feasible in a Canadian setting. Hybrid techniques tend to be faster though at the expense of R0 resection. Patient centered outcomes in this sample are favorable and comparable to large ESD series. Monitoring of ESD quality is critical for comparison with standard of care as experience with ESD in Canada grows. Funding Agencies None
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Hari, C. K., R. Powell, and G. M. Weiner. "Time trend analysis of otological procedures performed in England, 1989 to 2005." Journal of Laryngology & Otology 121, no. 12 (October 2, 2007): 1135–39. http://dx.doi.org/10.1017/s0022215107000576.
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AbstractObjective:To observe trends in the number of major otological procedures performed in England, in the context of advances in the understanding of disease.Methods:The data used were obtained from the Hospital Episode Statistics statistical database, published by the UK Department of Health, for England, 1989 to 2005. Specific otological procedures were identified using the Classification of Surgical Operations and Procedures system (fourth revision) of the Office of Population, Censuses and Surveys. Trend analysis of different procedures was performed using exponential smoothing (using the Statistical Package for the Social Sciences version 13 software).Results:Our study did not confirm any reduction in the number of surgical procedures performed for cholesteatoma or otosclerosis. We noted a sharp decline in the number of endolymphatic sac surgical procedures performed, probably attributable to the increased use of intratympanic therapy.Conclusion:The number of major otological procedures (other than endolymphatic sac surgery) was consistent over the period examined. The generally perceived reduction in the number of procedures performed by individual surgeons may be due to a dilutional effect. This can only support the need for subspecialisation, particularly regarding the training of junior surgeons.
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Jamison, Dean T., and Julian Jamison. "Characterizing the Amount and Speed of Discounting Procedures." Journal of Benefit-Cost Analysis 2, no. 2 (April 25, 2011): 1–56. http://dx.doi.org/10.2202/2152-2812.1031.
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This paper introduces the concepts of amount and speed of a discounting procedure in order to generate well-characterized families of procedures for use in social project evaluation. Exponential discounting sequesters the concepts of amount and speed into a single parameter that needs to be disaggregated in order to characterize nonconstant rate procedures. The inverse of the present value of a unit stream of benefits provides a natural measure of the amount a procedure discounts the future. We propose geometrical and time horizon based measures of how rapidly a discounting procedure acquires its ultimate present value, and we prove these to be the same. This provides an unambiguous measure of the speed of discounting, a measure whose values lie between 0 (slow) and 2 (fast). Exponential discounting has a speed of 1. A commonly proposed approach to aggregating individual discounting procedures into a social one for project evaluation averages the individual discount functions. We point to serious shortcoming with this approach and propose an alternative for which the amount and time horizon of the social procedure are the averages of the amounts and time horizons of the individual procedures. We further show that the social procedure will in general be slower than the average of the speeds of the individual procedures. For potential applications in social project evaluation we characterize three families of two-parameter discounting procedures – hyperbolic, gamma, and Weibull – in terms of their discount functions, their discount rate functions, their amounts, their speeds and their time horizons. (The appendix characterizes additional families, including the quasi-hyperbolic one.) A one parameter version of hyperbolic discounting, d(t) = (1+rt)-2, has amount r and speed 0, and this procedure is our candidate for use in social project evaluation, although additional empirical work will be needed to fully justify a one-parameter simplification of more general procedures.
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Konnor, Rebecca, Victoria Russo, Margaret A. Dudeck, and Katherine Allen-Bridson. "A Descriptive Analysis of Infection Present at Time of Surgery (PATOS) in NHSN Surgical Site Infection (SSI) Data, 2015–2018." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s94. http://dx.doi.org/10.1017/ice.2020.593.
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Background: In 2015, the CDC NHSN introduced infection present at time of surgery (PATOS) as a required data element for reporting surgical site infections (SSIs). PATOS is the documented observation that infection was visualized during the operative procedure and at the same tissue level of subsequent SSI. PATOS SSIs are excluded from CDC calculations of SSI summary measures, the standardized infection ratios (SIRs), including the SSI SIRs used by CMS public reporting and payment programs. The characteristics of PATOS SSIs have not been assessed since its introduction, prompting interest in the review of these SSIs. This study describes PATOS SSI surveillance for 2015–2018, with specific focus on infections following colon surgery (COLO), the NHSN operative procedure category with highest reported incidence of PATOS. Methods: We analyzed all procedures and SSIs reported to the NHSN. Using measures of frequency, we quantified the proportion of SSI and PATOS SSI attributed to all procedures and to COLO specifically. The mid-p method was used for proportion comparison. Procedure and SSI data were described by year and characteristics. Results: Between 2015 and 2018, 12,046,033 procedures and 188,770 SSIs (2%) were reported. Of these SSIs, 22,096 (12%) were PATOS SSIs (Fig. 1). COLO accounted for 11% of all procedures reported, for a total of 1,328,852 procedures with 72,891 (5%) resulting in SSI. COLO accounted for 64% of PATOS SSIs. The proportion of SSIs reported as PATOS SSIs resulting from COLO increased from 18% in 2015 to 22% by 2018 (Fig. 2). The proportion of COLO PATOS SSIs was statistically different from the proportion of PATOS SSIs for all other procedures each year (P < .0001). Organ-space (OS) SSIs accounted for 76% of COLO PATOS SSIs (10,558 of 13,911), and most of these SSIs were SSI intra-abdominal infections (IABs) (91%). The proportion of COLO PATOS SSI superficial incisional primary (SIP) was statistically different from non-COLO PATOS SSI SIP (P = .0105) (Fig. 2). Of COLOs linked to PATOS SSIs, 53% were assigned dirty or infected wound classification. Conclusions: The increase in PATOS SSIs linked to COLO procedures underscores the importance of monitoring PATOS SSIs at the facility level. Focused validation of PATOS data is needed to identify reasons for this increase, which may include misapplication or misunderstanding of PATOS determinations. Validation may highlight the potential need for prevention strategies or interventions related to PATOS.Funding: NoneDisclosures: None
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Jeganathan, P. "ON ASYMPTOTIC INFERENCE IN COINTEGRATED TIME SERIES WITH FRACTIONALLY INTEGRATED ERRORS." Econometric Theory 15, no. 4 (August 1999): 583–621. http://dx.doi.org/10.1017/s0266466699154057.
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Vector valued autoregressive models with fractionally integrated errors are considered. The possibility of the coefficient matrix of the model having eigenvalues with absolute values equal or close to unity is included. Quadratic approximation to the log-likelihood ratios in the vicinity of auxiliary estimators of the parameters is obtained and used to make a rough identification of the approximate unit eigenvalues, including complex ones, together with their multiplicities. Using the identification thus obtained, the stationary linear combinations (cointegrating relationships) and the trends that induce the nonstationarity are identified, and Wald-type inference procedures for the parameters associated with them are constructed. As in the situation in which the errors are independent and identically distributed (i.i.d.), the limiting behaviors are nonstandard in the sense that they are neither normal nor mixed normal. In addition, the ordinary least squares procedure, which works reasonably well in the i.i.d. errors case, becomes severely handicapped to adapt itself approximately to the underlying model structure, and hence its behavior is significantly inferior in many ways to the procedures obtained here.
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Sharpley, Christopher. "Fallability in the Visual Assessment of Behavioural Interventions: Time-Series Statistics to Analyse Time-Series Data." Behaviour Change 3, no. 1 (March 1986): 26–33. http://dx.doi.org/10.1017/s0813483900009074.
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The use of visual analysis alone to determine the presence of significant and generalizable effects in typical behavioural interventions is subject to a series of possible errors which result in high levels of unreliability when data are analysed in this way. The presence of autocorrelation in most behavioural data poses a serious threat to visual and traditional analysis of such data, a threat which can be avoided by use of the more appropriate interrupted time-series (TMS) statistics. Although previously suggested as reasons for not using TMS procedures, the issues of model-identification and number of data points required for TMS are discussed and shown to be invalid arguments against the use of TMS. A case is made for visual analysis of behavioural data as an appropriate procedure only under certain constrained clinical conditions.
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Lyall, Elizabeth A., and Barry Cooper. "The Impact of Trends in Complexity in the Cockpit on Flying Skills and Aircraft Operation." Proceedings of the Human Factors Society Annual Meeting 36, no. 15 (October 1992): 1181–84. http://dx.doi.org/10.1518/107118192786749667.
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Models of human performance which include concepts of task or procedural complexity have been used to evaluate the design of specific procedures which are dictated either by the airline or the flight environment (such as a specific airport). The procedures and environment as they currently exist can be modeled producing a profile across time of the output variable of the model. The variable that has been of most interest to us is pilot workload. One way in which we are using these modeling procedures is to compare a complex departure procedure with another departure procedure which is considered to be typical of most departures. Pilot workload profiles were obtained for the pilot-flying and the pilot-not-flying for each departure. A comparison was made of the profiles from the two departures and it was indicated that the more complex departure greatly increased the workload of the pilots, especially the pilot-flying. The complex departure procedure was analyzed looking particularly at the requirements that produced large peaks in pilot workload for either pilot, and recommendations are being made for changes to the procedure based on this analysis. The value of using such a modeling procedure in the airline environment will be discussed including other possible application areas.
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Ballard, A., C. Khadra, S. Adler, E. Parent, E. D. Trottier, B. Bailey, N. Poonai, and S. Le May. "LO33: External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomized controlled non-inferiority trial." CJEM 21, S1 (May 2019): S19. http://dx.doi.org/10.1017/cem.2019.76.
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Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.
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Mori, Shinsuke, Keisuke Hirano, Masahiro Yamawaki, Norihiro Kobayashi, Yasunari Sakamoto, Masakazu Tsutsumi, Yohsuke Honda, Kenji Makino, Shigemitsu Shirai, and Yoshiaki Ito. "A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention." Journal of Interventional Cardiology 2020 (September 8, 2020): 1–8. http://dx.doi.org/10.1155/2020/7342732.
Full textAbstract:
Objectives. To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background. Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported. Method. Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups. Results. The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study. Conclusion. The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.