Introduction: Lean healthcare outcome is usually measured with multiple key performance metrics but there is a lack of tools that enabled efficiency assessment. This research aimed to assess the efficiency among lean public emergen- cy departments (ED) through Slack-Based Measure Data Envelopment Analysis (SBM-DEA) and evaluate the impact of lean on the efficiency in public emergency departments. Methods: A retrospective observational study design using data on the number of support staff, number of doctors, number of discharge, arrival to consultant and length of stay. Efficiency scores of 20 Malaysian public EDs were computed using SBM-DEA modelling and compared be- tween before and after lean implementation. Results: A total of 13 out of 20 public EDs exhibited improvement in ar- rival to consultant and length of stay upon lean implementation. However, only 9 out of the 13 public EDs have had an improvement in efficiency score. Conclusion: Lean healthcare demonstrated a positive impact on the efficiency level of some public EDs. The SBM-DEA model offers the benchmarking capability and slack elimination information that may complement the lean continuous improvement philosophy.
Diagnosis of pulmonary embolism (PE) remains a challenge in clinical practice, especially in emergency setting despite availability of various diagnostic tools. It is desirable to have a rapid and accurate bedside test to rule out PE.The aim of this study is to evaluate the diagnostic accuracyof CUEPED, a novel method of ruling out pulmonary embolism using a combination of end-tidal CO2(ETCO2), Compression Ultrasonography (CUS) and Transthoracic Echocardiography (TTE).In this pilot study, patients who presented to the Emergency Department at Univers it y Malaya Medical Centre with suspected acute PE from December 2013 to October 2014,who fulfilled the inclusion and exclusion criteria, were assessed using CUEPED. CUEPED was considered positive if the measured ETCO2 was less than 35 mmHg, or if there was presence of venous incompressibility in lower limb ultrasonography orif tricuspid annular plane systolic excursion (TAPSE) in transthoracic echocardiography was less than 1.6. All patients received a computed tomography pulmonary angiography (CTPA) for confirmation of diagnosis. Data obtained was analyzed to determine if a negative CUEPED has the potential to accurately rule out a PE. 30 patients (mean age = 48 years [SD = 13.6]) were involved with an equal distribut io nbetween gender. The incidence of PE was 56.7%. CUEPED had a sensitivity of 100% for PE. Negative CUEPED ruled out PE with a negative predictive value of 100%. Positive CUEPED ruled in PE with a low specificity of 53.8% and moderate positive predictive value of 73.9%. This diagnostic study showedthat a negative CUEPED is potentially accurate in ruling out PE.
The practice of allowing family members to witness on-going active resuscitation has been gaining ground in many developed countries since it was first introduced in the early 1990s. In many Asian countries, the acceptability of this practice has not been well studied.
Employing aerobic fermentation, Gram-negative bacteria belonging to the genus Xanthomonas produce the high molecular weight natural heteropolysaccharide known as xanthan. It has various amounts of O-acetyl and pyruvyl residues together with D-glucosyl, D-mannosyl, and D-glucuronyl acid residues in a molar ratio of 2:2:1. The unique structure of xanthan allowed its various applications in a wide range of industries such as the food industry, pharmacology, cosmetics and enhanced oil recovery primarily in petroleum. The cultivation medium used in the manufacture of this biopolymer is critical. Many attempts have been undertaken to generate xanthan gum from agro-based and food industry wastes since producing xanthan gum from synthetic media is expensive. Optimal composition and processing parameters must also be considered to achieve an economically viable manufacturing process. There have been several attempts to adjust the nutrient content and feeding method, temperature, pH, agitation and the use of antifoam in xanthan fermentations. Various modifications in technological approaches have been applied to enhance its physicochemical properties which showed significant improvement in the area studied. This review describes the biosynthesis production of xanthan with an emphasis on the importance of the upstream processes involving medium, processing parameters, and other factors that significantly contributed to the final application of this precious polysaccharide.