Objective Healthcare system now, with global budget payment, is facing an increasing challenge mainly due to patient oriented environment, more demand for service quality and organizational re-arrangement. Also due to the high cost of personalle and equipments in the operation room , it is quite important to maintain the high efficiency of management to encompass high volume of surgeries. Staffing and scheduling is the most important issue in the management of the operating room and has direct impact on the operational efficiency, cost and revenue. The purpose of this study is to investigate the influence of staffing and scheduling of the operating room on its efficiency. How we control the sum of the patients requiring operation under present circumstances lies on whether or not we have efficient management of the operation room. The most important part among it depends on the ability of schedule arrangement, which directly influence the performance audit and cost. Materials and Methods:The purpose of this study is to discuss the impact of schedule arrangement on cost in the operation room of one medical center. Retro spective descriptive design. Those first operations performed from July 1st, 2003 to June 30th, 2004 were collected into the controlled group while those performed from July 1st, 2004 to June 30th, 2005 were gathered into the experimental group. Indicators of the effect including the sum of the patients receiving operation, the utilization rate of the operation room, the cancellation rate of scheduled operation, the number of overtime nursing staff and overtime payment, the delayed rate and time of the first operation. We use ANOVA, x2 test, multiple logistic regression and t test to analyze these data. We will discuss issues as the followings to smooth our operation schedule: the arrangement of the fist operation by program manager, setting up a flow chart for nursing staff while admitting the patients, establishing a check-in flow chart for patients of out-patient department and deployment of pageboys. Results: The data showed that the incidence of delaying surgery were decreased by 8.4% in the experiment group as compared to the control group. The operation room occupation rate increased to 84.3% in control group, as compared to 78.25% in experiment group. There is 0.76% decrease in the rate of canceling operation schedule . The number of nursing staff who worked overtime and the overtime payment decreased significantly. The time needed from patients entering operation room to the operation began also decreased significantly. The rate of delaying the first scheduled operation decreased from 52.8% to 12.3%. Conclusion: Operation room managers, leader in department of surgery, and hospital managers could take our results as reference in improving efficiency and decreasing cost.

Практическая значимость данной выпускной квалификационной работы связана с изложенной в ней разработкой системы централизованного управления трансляцией контента, которая успешно реализуется на рынке. С внедрением информационных технологий в нашу жизнь изменяется характер предоставления публичной информации в обществе. На смену бумажным вариантам объявлений и вывесок приходят электронные аналоги, отличающиеся высокой яркостью, динамичность, скоростью обновления информации. Высокий спрос на оперативное, централизованное обновление транслируемого на экраны контента, способствовал появлению на рынке “цифровых вывесок” систем Digital Signage, позволяющих централизованно управлять показываемым контентом на распределенной сети медиа устройств, обновлять его, не производя манипуляций непосредственно с каждым девайсом. Результатом работы является разработанная система управления контентом MMVS Digital Signage, которая успешно реализуется на рынке и дает компании ряд конкурентных преимуществ. Результаты работы подтверждены расчетами экономических показателей. / The practical significance of this final qualifying work is associated with the development of a system for centralized content broadcasting management, which is successfully implemented on the market, as described in it. With the introduction of information technology into our life, the nature of the provision of public information in society is changing. The paper versions of advertisements and signs are being replaced by electronic counterparts, which are distinguished by high brightness, dynamism, and the speed of information updating. The high demand for prompt, centralized updating of content broadcasted to screens has contributed to the appearance on the market of “digital signage” of Digital Signage systems, which allow centrally managing the displayed content on a distributed network of media devices, updating it without manipulating directly with each device. The result of the work is the developed content management system MMVS Digital Signage, which is successfully implemented in the market and gives the company a number of competitive advantages. The results of the work are confirmed by calculations of economic indicators.

Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone. Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated. Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively. Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.

Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone. Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated. Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively. Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.

Aim: Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation. Methods: In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 320/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support. Results: All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support. Conclusion: This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.

Améliorer la gestion et l’organisation des blocs opératoires est une tâche critique dans les hôpitaux modernes, principalement à cause de la diversité et l’urgence des activités impliquées. Contrairement à l’aviation civile, qui a su optimiser organisation et sécurité, le management de bloc opératoire est plus délicat. Le travail ici présenté abouti au développement et à l’installation de nouvelles technologies assistées par ordinateur résolvant les problèmes quotidiens des blocs opératoires. La plupart des systèmes existants modélisent le flux chirurgical et sont utilisés seulement pour planifier. Ils sont basés sur des procédés stochastiques, n’ayant pas accès à des données sûres. Nous proposons une structure utilisant un modèle multi-agent qui comprend tous les éléments indispensables à une gestion efficace et au maintien de la sécurité dans les blocs opératoires, allant des compétences communicationnelles du staff, au temps nécessaire à la mise en place du service de nettoyage. Nous pensons que la multiplicité des ressources humaines engagées dans cette structure cause des difficultés dans les blocs opératoires et doit être prise en compte dans le modèle. En parallèle, nous avons construit un modèle mathématique de flux d’air entre les blocs opératoires pour suivre et simuler la qualité de l’environnement de travail. Trois points sont nécessaires pour la construction et le bon fonctionnement d’un ensemble de bloc opératoire : 1) avoir accès au statut du système en temps réel grâce au placement de capteurs 2) la construction de modèles multi-échelles qui lient tous les éléments impliqués et leurs infrastructures 3) une analyse minutieuse de la population de patients, du comportement des employés et des conditions environnementales. Nous avons développé un système robuste et invisible qui permet le suivi et la détection automatique d’événements dans les blocs. Avec ce système nous pouvons suivre l’activité à la porte d’entrée des blocs, puis l’avancement en temps réel de la chirurgie et enfin l’état général du bloc. Un modèle de simulation numérique de mécanique des fluides de plusieurs blocs opératoires est utilisé pour suivre la dispersion de fumée chirurgicale toxique, ainsi qu’un modèle multi-domaine qui évalue les risques de propagation de maladie nosocomiale entre les blocs. La combinaison de ces trois aspects amène une nouvelle dimension de sensibilisation à l’environnent des blocs opératoires et donne au staff un système cyber-physique capable de prédire des événements rares impactant la qualité, l’efficacité, la rentabilité et la sécurité dans l’hôpital. / Improving operating room management is a constant issue for modern large hospital systems who have to deal with the reality of day to day clinical activity. As opposed to other industrial sectors such as air civil aviation that have mastered the topic of industry organization and safety, progress in surgical flow management has been slower. The goal of the work presented here is to develop and implement technologies that leverage the principles of computational science to the application of OR suite problems. Most of the currently available models of surgical flow are used for planning purposes and are essentially stochastic processes due to uncertainties in the available data. We propose an agent-based model framework that can incorporate all the elements, from communication skills of the staff to the time it takes for the janitorial team to go clean an OR. We believe that human factor is at the center of the difficulty of OR suite management and should be incorporated in the model. In parallel, we use a numerical model of airflow at the OR suite level to monitor and simulate environment conditions inside the OR. We hypothesize that the following three key ingredients will provide the level of accuracy needed to improve OR management : 1) Real time updates of the model with ad hoc sensors of tasks/stages 2) Construction of a multi-scale model that links all key elements of the complex surgical infrastructure 3) Careful analysis of patient population factors, staff behavior, and environment conditions. We have developed a robust and non-obtrusive automatic event tracking system to make our model realistic to clinical conditions. Not only we track traffic through the door and the air quality inside the OR, we can also detect standard events in the surgical process. We propose a computational fluid dynamics model of a part of an OR suite to track dispersion of toxic surgical smoke and build in parallel a multidomain model of potential nosocomial contaminant particles flow in an OR suite. Combining the three models will raise the awareness of the OR suite by bringing to the surgical staff a cyber-physical system capable of prediction of rare events in the workflow and the safety conditions.