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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

醫療用血管理策略發展--以提昇分離術血小板運用績效為例 / The Development Strategy on Medical-use Blood Management --Take promoting the perfermance on the use of Apheresis platelet as the example

黃谷鶯 Unknown Date (has links)
在醫療體系中,醫療血液的管理和調整,是一件很重要的任務,供應鏈管理的重要性是不容忽視的。其中含括了捐血中心、醫院、甚至用血病患和捐血人。在其他方面因為高品質醫療血液的需求增加則使分離術血小板變成了重要要素。在醫療用血中象徵是高品質的血小板,然而因為他簡短的生命週期和避免輸血感染,因此供應鏈管理變的更加重要且複雜,身為捐血中心的一員對於分離術血小板的捐入與供應是需要有全面性的理解與認知的。為了能夠快速反應的執行,這研究的目標是找出分離術血小板推測影響因素和分離術血小板使用的預測期望;通過經驗資料和專家採訪, 我們首先設定一個研究框架,其中包含了使用病患的特質、醫院的類型,運用(率)以及他們與預測期望的關聯性。 在六年資料裡的首要分析中,我們第一次透過時間序列的方法去測試資料即ARIMA。結果顯示ARIMA(1,1,2)是被最多人認為其運用是沒有季節的影響,進一步的研究通過要素分析被採用於尋找交互作用在分離術血小板的病人特徵和運用之間, 並也用在捐血條件和供血。最後一點, 本篇報告代表交叉比對在上述的資料和結果的解釋。更具體的報告將被做為表現改進計劃。被察覺的問題的作用和流程管理潛在的發展是值得進一步的研究。 / Medical Blood Handling is mission-critical and can be seen as Supply Chain Management (SCM) including Spending Centre, Hospitals and even blood consumers and spender. Among others, Aphaeresis Platelet (AP) becomes a crucial element due to increasing higher quality demands on medical blood. However, it in turn makes the SCM more complicated because of its short life-time and infection-sensitivity. Hence, there is need for comprehensive understanding on its supply and consume. In order to be capable of quick response, the aim of this research is to figure out the influence factors to and a forecast model for the usage of AP. By means of experience data and expert interview, we have at first set up a research framework, which involves patient characteristics, type of hospitals, utilization (rate) and their relation to derive the forecasting model. After a priori-analysis on the data of 6 years, we have at first test the data by means of regression, viz. ARIMA. The result shows ARIMA(1,1,2) is most sound to this work and there is no influence of seasons to the utilization. Further studies by means of factor analysis was adopted to search for the correlation between patient characteristics and utilization of AP, as well as the spending conditions and blood supply. Last but not least, this paper presents cross-check on aforementioned data and interpretation of the result. More structured report is to be made for performance improving plan. The effects of perceived issues and potential developemnt of BPM are worthy of further investigation.
2

以資訊系統穩定血液供需之研究

凃玲珍 Unknown Date (has links)
血液資源的有效利用一直是各國捐血機構努力的目標,但由於血液提供者的來源有限、捐血法規的限制、又常受季節性波動影響;捐入之血液必須經過嚴格的檢驗與品管、短暫的產品效期、又必須維持安全庫存量;對於醫院端病患的需求無法事先掌握、必須配對使用等特性,使得這資源的取得與耗用在維持動態平衡上具挑戰性,如何藉助資訊技術,提升需求端與供應端資訊的透通性與即時性,是本研究探討的主要議題。 由於血液的品質攸關用血人的生命安全,各國都訂定捐血相關的醫療政策與法規,以防止傳染性疾病藉由捐血傳染,並遏止捐血人藉由捐血檢驗疾病的危險行為。捐血法規的重重限制,影響部分捐血人持續捐血的意願;科技的進步使血液的篩檢項目持續增加,有助於血液品質的提升,但相對的也增加了血液機構財務面的負荷; 捐血人口通常是由年輕且健康的個體組成,而大部份需要輸血的病患都是老年人口;在已開發國家的未來人口變化,少子化社會使得年輕血源捐血比率下降,老齡化社會將有用血量增加的趨勢,所以統計人口的趨勢將會成為未來的血液供給的關鍵因素。 台灣地區的醫療院所用血需求由台灣血液基金會統籌負責,血源的企劃、採集、檢驗、血品分離、供應,整個流程均已電腦化作業,滿足各醫療院所的用血需求,但仍無法避免季節性缺血的現象。醫療院所與血液機構只透過傳真或電子郵件等方式訂血及資料交換,並未有即時交換訊息之機制。 本研究運用捐血機構資料庫中捐血人資料,並藉由資訊科技的方法,將用血需求與血源招募鏈結,在這有限的資源與用血需求間建立一套機制,使其供應與需求達到動態的平衡,將有助於血液的有效利用,也提升了血液機構與醫療院所間資訊的即時性與透通性。將來更可擴充與醫療院所間之即時互動功能,如高危險群通報作業、輸血不良反應通報作業、細菌檢測通報作業等加值服務,達到血液預警平台之效益。

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