Health Management - Science topic

"Digital technologies and the digital environment offer new opportunities for identifying needs and delivering health care (from prevention and health promotion to curative interventions and self-management). As such, they have the potential to transform healthcare services in ways that may contribute to health system goals. The nature and consequences of digital health services can differ substantially from case to case, emphasising the complexity of evaluating their contribution. The results and outcomes of digital transformation of health services (which is further defined later in the Opinion) will importantly depend on the quality of the process and the involved stakeholders. This includes end-users of digital health services (be it professionals, care users or citizens), developers of digital health services, producers of health services and governments. The success of digital transformations requires a sound understanding of the two basic interacting components, i.e. “the health service” and “the digital”, at all these different levels. The full process of their development, production, funding, implementation and evaluation requires careful consideration in this context. The innovative solutions that some digital health services represent can, if designed purposefully and implemented in a cost-effective way, provide better health outcomes and contribute to the sustainability of health systems. However, while digital health services can have this effect, they need not always have it. Evaluations and monitoring should establish whether this is the case for specific digital health services. The scope of such evaluations and monitoring needs to be set appropriately. This is underlined by the fact that, like other technologies, digitalisation in health care normally affects certain goals or certain groups positively, while at the same negatively affecting others. EU policies have consistently emphasised the importance of digital solutions such as eHealth and have accentuated positive aspects of how digital innovations can improve integration of care through up to date information channels and deliver more targeted, person-centred (or personalised), effective and efficient healthcare, reducing errors and length of hospitalisation. However, a balanced view of the effects of digitalisation remains needed and not all forms of digitisation may result in improved care and health system performance. Put differently, a health care service is not good (or bad) just because it is digital. Public expenditure on health and long-term care has been increasing over the last decades in all EU Member States and is expected to rise even further. In 2015, it accounted for 8.5% of GDP in the EU and could reach up to 12.5% of GDP in 2060.1 A substantial part of the increase has been attributed to the introduction and funding of new technologies in health care, including digital ones. In this context, there is a growing need for robust evidence to support arguments that digital health solutions (Car et al., 2008; WHO, 2016) - and the related new organisational models replacing the old - can bring better health outcomes for citizens and contribute to improving the effectiveness, accessibility and resilience of health systems. Given the diverse forms, usages and impacts of digital technologies in health care (ranging from general use of computers to algorithms designed to assist radiologists and radiotherapists in detecting and treating cancers, from robotic surgery to computer aided decision models, and from mobile device apps helping patients to self-manage their disease to electronic health records), this requires evaluations on different levels. Systematic assessment and evaluation of the impact of digital health services is, therefore, needed. To date, such assessments are relatively scarce, especially those addressing the transformative aspects of healthcare delivery on the organisational and operational level. The literature on the impact, for example, of telehealth solutions for chronic conditions suggests that telehealth in some cases may reduce hospital admissions and mortality patients suffering from chronic heart failure, may improve blood pressure control in patients with hypertension, may reduce hospital admissions for chronic obstructive pulmonary disease and may improve glycaemic control in diabetes (e.g. Brettle et al., 2013; Inglis et al., 2015; Flodgren et al., 2015). 2 However, the evidence-base concerning cost-effectiveness can be less clear as is the generalisability of such results. The same holds for equity impacts of introducing digital services, which has the risk of increasing the ‘digital divide’. Models for assessing the value of telemedicine, like MAST, 3 have been developed and used (e.g. Sorknaes et al., 2013), but their use may still be considered limited. The lack of robust evidence on cost-effectiveness is partly due to the absence of available data collected over long periods of time and may also be related to regulations and requirements for funding and reimbursement as well as to difficulties in determining cost-effectiveness in this context. This is especially the case when the introduction of some digital technology changes organisational structures. For some changes, it may not only take several years to see a clear impact at the health system level, but it may also be highly difficult to isolate the costs and effects of such changes in a developing health care environment. There are indeed examples which have demonstrated cost-effectiveness, for instance regarding telehealth, and even cost-savings (e.g. Darkins et al., 2015). 4 Again, the generalisability of such findings, as well as the quality and breadth of the evaluations performed, are important to consider. There are also examples of less favourable or more mixed results for digital health services (e.g. Maddison et al. 2015). A framework for the assessment of the digital transformation of health services and its impact is vital to generate the evidence required for decision-making on stimulating, using and/or funding digital health strategies at various levels in the health care system. In this Opinion, this issue is further addressed based on the terms of reference highlighted next. With it, we hope to support EU member states with decision-making in the domain of health, social and fiscal policies. Moreover, we also aim to help the Commission to shape further activities toward a better uptake of the digital health services at the EU level."

Your works at Qeios are developing well and may even become a greater collection of scientific research on that medical issue.

Success !

Dear researcher,

I do like to assist you. Is it possible to change from athletes to players. The process is right but when you did not get enough respondents, what to do?

In research it solve by two ways ( in my knowledge);

1. Small sample size: 25 number of respondents (you can read detailed).

2. Go for broader platform. The shift of athletes to players is the broader platform.

Lastly, knock institutions of players (athletes), approach them via email and ask for assistance.

Wish you accomplished soon.

It has a lot of factors involved. This is not a Yes\No question; we should consider:

1- Type of diabetes

2- duration of diabetes

3- patient factors like age, gender, and presence of other diseases.

4- patient's lifestyle

5- compliance.

so, In general, it could be beneficial for some cases and non-beneficial to others.

I would like to recommend two (2) areas of your interest. 1) On the clinical aspect: For a certain patient, are all laboratory requested covers within the required or clinical practice guideline (CPGs) of a specific specialty or disease? (by doing this, you have a documented baseline of lab request "overutilization")..2) On the laboratory aspect: I would like to recommend the review of turn around time of laboratory results from certain point to the lab result released?

(...) restrictions related to menstruation among young women from low socioeconomic background.

Not sure this is what you mean but these two items, a report for the UK Health Foundation and a paper might help?

The big difference is the focus of the education. The health management students focus on the management of health systems and health organisations which is fundamentally different from medical professions whose focus is on treatment/care of patients and/or research. Medical professions are often highly specialized in one or a few closely related fields. Health management professionals are broader trained.

I think the confusion comes from the fact that both groups are highly educated. If you compare it to other industries, the difference becomes much more clear: the management of big construction companies are often trained managers in the field of general management or finance. Very few CFO's in construction companies are craftsmen like carpenters.

We have developed a program that can 1. assess, 2. Provide an intervention 3. reassess and 4. report. We have recently published on the same.

While Prognostics Health Management is an established discipline in engineering, I don't see its application on human being in near future. I would be happy if you explain your intention further. Of course it can be very well applied to the equipment's used in hospitals

Great！I will be help you maybe

My dear friend,

My new book has published. It is about design

as you are in this field i hope you will like it

Please read it and share it with everyone. It is talking about prosumer also for the first time in this book we talk about magic and its power in product design. It is talking also about future of consumers .I request you put the link of book on your page and your school website for your students.

Name: Everyone Is a Designer

Author: Mohsen Jaafarnia

Publisher: MJ

Ghochan, 2017

In Persian, Chinese and English

Topic: Industrial Design

Jaafarnia, Mohsen (2017). Everyone Is Designer. Ghochan, Iran : MJ Publication. ISBN: 978-600-04-7870-4

thank's i'll try

This will depend on the country and in countries like the US will depend on what insurance one has. So you would need very specific information to look up the answer for one person.

Congratulation for your retirement. Hope that you can learn some qigong - Chinese exercises and keep happy that is the best way to keep away from illness. 

Dear Benedek and others on this String,

                                                                         Because of the genetic characteristic of "bounded rationality" (experimentally proved (Mallick(2007)) prehumans evolved by the "arrow of time" (Axiom of Econophysics (,Hamburger, Mallick, Mallick(2016,2017)) into human species but now "human species" cannot evolve into any of the "prehuman species" by " social Darwinism" "jump quantum" (Mallick et.al.as applied to physiology and medicinal systems) because of a Dbranes String Functor Category Systems Classification and Systems Integration (Mallick(1993,2014,2015),Mallick, Hamburger, Mallick(2016,2017)) of intergenerational and interregional (spacextime) geophysical "genetic quality"(Axiom of Econophysics (Mallick et.al.)) on www.researchgate.net/Soumitra K. Mallick. Hence the number of chromosomes has increased steadily in the Arrow of Time direction. Thus specialisation is now possible in human decision systems which are based on the above two Axioms, which we may proudly say we have discovered in data and on which our Dbranes String Theory for low dimensional systems functor category algebra and calculus for the Millenium Mathematics Prize is based.

Soumitra K. Mallick

for Soumitra K. Mallick, Nick Hamburger, Sandipan Mallick

we would like to thank Prof. T.Johnsen for results in "Social Darwinism" which creates the Social Medicine Field (Mallick et. al.).

I am not the author of this publication

Espero te sean útiles

Hello ...

I hope you are useful

The point of triangulation is to compare the results of different studies, so each study should be complete in its own terms. If all three of your interviews are qualitative, then the classic recommendation is to achieve saturation in order to have faith in your results, and you would need to do that in each sub-population.

Thank you Dr. Viswanatha for  your sharing but my topic is about bilateral choanal adenoids & not nasopharyngeal adenoids.

Hi Merve - the attached few articles may assist. They relate to nursing - but the principles are 'generic' in terms of workplace health promotion and the workplace as a health-promoting setting.

Good luck with your project,

Dean

Dear Harshvardhan and Nirmala.

Thank you so very much for your suggested resources with links and useful recomendations! Will come much in handy.

Thank you!

Kindest regards,

Carlos

Worker participation is also considered as a major shift. Worker can assist in the formation and implementation of the OSH management plan, enhance commitment etc.

This is the EU-OSHA guide:

Thanks Rebecca.. I am reviewing Assessment of Cost Trends... PDF file, that you uploaded. I think, It will be quite helpful. Best regards

Dear Amar,

Here are 6 evidence-based ways to lose belly fat.

1. Don’t Eat Sugar… and Avoid Sugar-Sweetened Beverages Like The Plague

Added sugar is extremely unhealthy.

Studies show that it has uniquely harmful effects on metabolic health.

Sugar is half glucose, half fructose… and fructose can only be metabolized by the liver in any significant amount.

When you eat a lot of refined sugar, the liver gets flooded with fructose, and is forced to turn it all into fat.

Numerous studies have shown that excess sugar, mostly due to the large amounts offructose, can lead to increased accumulation of fat in the belly.

Some believe that this is the primary mechanism behind sugar’s harmful effects on health… it increases belly fat and liver fat, which leads to insulin resistance and a host of metabolic problems.

Liquid sugar is even worse in this regard. Liquid calories don’t get “registered” by the brain in the same way as solid calories, so when you drink sugar-sweetened beverages, you end up eating more total calories.

Studies show that sugar-sweetened beverages are linked to a 60% increased risk of obesity in children… per each daily serving.

Make a decision to minimize the amount of sugar in your diet, and considercompletely eliminating sugary drinks.

This includes sugar-sweetened beverages, fruit juices, various sports drinks, as well as coffees and teas with sugar added to them.

Keep in mind that none of this applies to whole fruit, which are extremely healthy and have plenty of fiber that mitigates the negative effects of fructose.

The amount of fructose you get from fruit is negligible compared to what you get from a diet high in refined sugar.

Btw… if you want to cut back on refined sugar, then you must start reading labels. Even foods marketed as health foods can contain huge amounts of sugar.

Bottom Line: Excess sugar consumption may be the primary driver of belly fat accumulation, especially sugary beverages like soft drinks and fruit juices.

Protein is the most important macronutrient when it comes to losing weight.

It has been shown to reduce cravings by 60%, boost metabolism by 80-100 calories per day and help you eat up to 441 fewer calories per day.

If weight loss is your goal, then adding protein to your diet is perhaps the single most effective change you can do.

Not only will it help you lose… it can also help you avoid re-gaining weight if you ever decide to abandon your weight loss efforts.

There is also some evidence that protein is particularly effective against belly fat.

One study showed that the amount and quality of protein consumed was inversely related to fat in the belly. That is, people who ate more and better protein had much less belly fat.

Another study in Denmark showed that protein, especially animal protein, was linked to significantly reduced risk of belly fat gain over a period of 5 years.

This study also showed that refined carbs and vegetable oils were linked to increased amounts of belly fat, but fruits and vegetables linked to reduced amounts.

Many of the studies showing protein to be effective had protein at 25-30% of calories. That’s what you should aim for.

So… make an effort to increase your intake of unprocessed eggs, fish, seafood,meats, poultry and dairy products. These are the best protein sources in the diet.

If you struggle with getting enough protein in your diet, then a quality protein supplement (like whey protein) is a healthy and convenient way to boost your total intake.

If you’re a vegetarian, check out this article on how to increase your protein intake.

Bonus tip: Consider cooking your foods in coconut oil… some studies have shownthat 30 mL (about 2 tablespoons) of coconut oil per day reduces belly fat slightly.

Bottom Line: Eating enough protein is a very effective way to lose weight. Some studies suggest that protein is particularly effective against belly fat accumulation.

Carb restriction is a very effective way to lose fat.

This is supported by numerous studies… when people cut carbs, their appetite goes down and they lose weight.

 Over 20 randomized controlled trials have now shown that low-carb diets lead to 2-3 times more weight loss than low-fat diets.

This is true even when the low-carb groups are allowed to eat as much as they want, while the low-fat groups are calorie restricted and hungry.

Low-carb diets also lead to quick reductions in water weight, which gives people near instant results… a major difference on the scale is often seen within a few days.

There are also studies comparing low-carb and low-fat diets, showing that low-carb diets specifically target the fat in the belly, and around the organs and liver.

What this means is that a particularly high proportion of the fat lost on a low-carb dietis the dangerous and disease promoting abdominal fat.

Just avoiding the refined carbs (white breads, pastas, etc) should be sufficient, especially if you keep your protein high.

However… if you need to lose weight fast, then consider dropping your carbs down to 50 grams per day. This will put your body into ketosis, killing your appetite and making your body start burning primarily fats for fuel.

Of course, low-carb diets have many other health benefits besides just weight loss. They can have life-saving effects in type 2 diabetics, for example.

Bottom Line: Studies have shown that low-carb diets are particularly effective at getting rid of the fat in the belly area, around the organs and in the liver.

Dietary fiber is mostly indigestible plant matter.

It is often claimed that eating plenty of fiber can help with weight loss.

This is true… but it’s important to keep in mind that not all fiber is created equal.

It seems to be mostly the viscous fibers that can have an effect on your weight.

These are fibers that bind water and form a thick gel that “sits” in the gut.

This gel can dramatically slow the movement of food through your stomach and small bowel, and slow down the digestion and absorption of nutrients. The end result is a prolonged feeling of fullness and reduced appetite.

One review study found that an additional 14 grams of fiber per day were linked to a 10% decrease in calorie intake and weight loss of 2 kg (4.5 lbs) over 4 months.

In one 5-year study, eating 10 grams of soluble fiber per day was linked to a 3.7% reduction in the amount of fat in the abdominal cavity, but it had no effect on the amount of fat under the skin.

What this implies, is that soluble fiber may be particularly effective at reducing the harmful belly fat.

The best way to get more fiber is to eat a lot of plant foods like vegetables and fruit. Legumes are also a good source, as well as some cereals like oats.

Then you could also try taking a fiber supplement like glucomannan. This is one of the most viscous dietary fibers in existence, and has been shown to cause weight loss in many studies.

Bottom Line: There is some evidence that soluble dietary fiber may lead to reduced amounts of belly fat, which should cause major improvements in metabolic health.

Exercise is important for various reasons.

It is among the best things you can do if you want to live a long, healthy life and avoid disease.

Getting into all of the amazing health benefits of exercise is beyond the scope of this article, but exercise does appears to be effective at reducing belly fat.

However… keep in mind that I’m not talking about abdominal exercises here. Spot reduction (losing fat in one spot) is not possible, and doing endless amounts of crunches will not make you lose fat from the belly.

In one study, 6 weeks of training just the abdominal muscles had no measurable effect on waist circumference or the amount of fat in the abdominal cavity.

That being said, other types of exercise can be very effective.

Aerobic exercise (like walking, running, swimming, etc) has been shown to cause major reductions in belly fat in numerous studies.

Another study found that exercise completely prevented people from re-gaining abdominal fat after weight loss, implying that exercise is particularly important during weight maintenance.

Exercise also leads to reduced inflammation, blood sugar levels and all the other metabolic abnormalities that are associated with central obesity.

Bottom Line: Exercise can be very effective if you are trying to lose belly fat. Exercise also has a number of other health benefits.

What you eat is important. Pretty much everyone knows this.

However… surprisingly, most people actuallydon’t have a clue what they are really eating.

People think they’re eating “high protein,” “low-carb” or whatever… but tend to drastically over- or underestimate.

I think that for anyone who truly wants to optimize their diet, tracking things for a while is absolutely essential.

It doesn’t mean you need to weigh and measure everything for the rest of your life, but doing it every now and then for a few days in a row can help you realize where you need to make changes.

If you want to boost your protein intake to 25-30% of calories, as recommended above, just eating more protein rich foods won’t cut it. You need to actually measure and fine tune in order to reach that goal.

Hoping this will be helpful,

Rafik

I'm a supporter of plant-based diets, but Campbell's "China Study" is full of methodological errors and therfore of low scientific value. Take a look at this: http://rawfoodsos.com/the-china-study/

However, there are some evidences that link dairy products with breast and prostata cancer:

1) Qin LQ, Xu JY, Wang PY, Kaneko T, Hoshi K, Sato A. Milk consumption is a risk factor for prostate cancer: meta-analysis of case-control studies. Nutr Cancer. 2009;48(1):22–27

2) Dong JY, Zhang L, He K, Qin LQ. Dairy consumption and risk of breast cancer: a meta-analysis of prospective cohort studies. Breast Cancer Res Treat. 2011;127(1):23–31

There are many available article on health management and opinion of health professessional, for example are the attached documents

Health systems across the European Union  are managed in very different

ways. This report focuses on the role of local and regional authoritieswithin these systems in terms of power and responsibility, from the issuing of

legislation to policy development, implementation and funding.

Hi, looks at the studies (Pedro Pita Barros) Nova School Business and Economics.

The Health manager is the one who must be well informed about legal issues in the health sector. He/she must be able to understand relationships between the law, clinical ethics and risk management and where possible keep the health providers and the patients well informed about the issues in the health care management.

Health Managers often over see and interact with both health care providers and the patients and have different exposures towards the medico legal issues in a health facility setting. In legal studies a rich bunch of information of ethical issues in health care can be got from the health managers as key informants in legal matters.

one of the symptoms of shock (traumatic stress?) in humans is "...cool, clammy skin..." , which indicates that the phenomenon certainly exists.

Hello!

it depends on the content of the tool that you have selected. Basically the tool is made considering the target population. If the illiterate population has to be included, a picture based tool could be useful. The numbers of hours of sleep one had had could be marked in the specified box or space denoting the 

Each organissation develops their own clinical guidelines. Depending on your research you should target each country and the national organisation in charge of developing the guidelines. For Spain you can find the information on this website: :http://portal.guiasalud.es/web/guest/guias-practica-clinica. they collect all the different clinical guidelines developed by the different regional governments (17 in Spain), so usually if they exist you can find them on this website, if not I;m afraid that you should contact each autonomous community  one by one.

You could contact Guia Salud (through the website)and ask if they keep track of old guidelines.

For European Countries having different regional health governments (Germany, Italy) you will probably face the same problems of non-centralised information.

For UK, they use the guidelines of NECP , ATP III, as mentioned ,through the NIH you can find them easily on their website, the one I found is from 2002 and I also  found an 2004 update in an interesting  article: http://www.nhlbi.nih.gov/files/docs/guidelines/atp3upd04.pdf    ,page 237

Crepitation suggests sever chondromalacia (gr II and III). I have no experience with the measuring the level of destroying enzymes.

I am not an expert in healthcare only an interested researcher in understanding and solving problems in this critical area.  My expertise lies in something called “theory of constraints (TOC)”.  While it sounds horribly complex TOC is quite simple and easily applied.  In TOC we use the five focusing steps to continually improve a system‘s ability to produce goal units (in your case treated patients).  The five focusing steps are one of three processes on ongoing improvement (buffer management, frequently used in healthcare, and the change question sequence are the other two processes.). These five focusing steps are:

1. IDENTIFY the system's constraint(s).

2. Decide how to EXPLOIT the system's constraint(s).

3. SUBORDINATE everything else to the above decision.

4. ELEVATE the system's constraint(s).

5. WARNING!!!! If in the previous steps a constraint has been broken, go back to step 1, but do not allow INERTIA to cause a system's constraint.

I recently coauthored (Cox, Robinson, Maxwell; Sept/Oct 2014) an article in the Journal of Family Practice Management illustrating the application of these steps to an 11-provider practice.  I recommend this article if you want to see how to apply this focusing process in healthcare.  It is a quite simple example; just common sense. 

In your case the market (the patients coming into the emergency room) is the constraint most of the time.  Normally you are able to treat incoming patients in a standard manner.  BUT then you occasionally have overloads where you use up the protective capacity of the emergency department and a backup of untreated patients occurs.  Some of this backup occurs because there is no place to offload treated patients immediately so that the provider can move to the next untreated patient.  This situation might be caused by the hospital’s focusing on minimizing staffing in hospital wards to save money.   The TOC solution would be to add a space buffer behind the constraint (between the emergency department and the specialized wards (the UK system calls this department an assessment ward, a holding area as such).  Treated patients are released to this space buffer where trained staff (maybe some removed from the specialized wards) manage patient care until the treated patients are transferred to the wards.  This approach allows emergency department providers to focus on incoming patients instead of managing already treated patients until they can be transferred to wards thus increase the capacity of the emergency room. In academic terms this space buffer aggregates the statistical fluctuations of the various wards thus having less deviations (reduced standard deviation at the assessment ward than at the sum of the specialized wards).  

Several presentations of the TOC basic concepts and applications of the concepts in various industries are available on the TOCICO (Theory of Constraints International Certification Organization) website for free viewing.  See specifically the healthcare portal web link listed below:

There are seven videos available on this link for free viewing.  An annotated bibliography of healthcare presentations is available on this link also.  

Another related link to TOC in healthcare is provided by Alex Knight (also describes his work on the TOC link above) .  Alex has been implementing TOC in emergency rooms, hospitals and the healthcare supply chain for two decades.  He has been able to move hospitals as measured by responsiveness from the bottom of 500 hospitals to the top 10 in a matter of a few months.  He recently authored a novel (Pride and Joy) describing the application of TOC in hospitals (Similar to Eli Goldratt’s The Goal did in manufacturing in the 1980’s). Alex’s consulting organization provides significant educational materials on TOC in healthcare.  This link below is to articles on applying TOC in healthcare.  On the left of this page below are links to case studies (mostly hospitals) and testimonials.

More generally TOC is a management philosophy that focuses attention on the constraint (the leverage point) in any system and how to increase system throughput.  It is not a cost-cutting approach and provides better responsiveness and healthcare.    

I hope this is helpful.  Jim

One of the first rules for medicine should be "primum nil nocere" (first do no harm). So my question would be, why would you like to integrate herbal medicine into the existing healthcare system? Does integration absolutely have to happen or you can have two parallel systems (as in many other countries) and improve the safety of herbs delivered (as described by others above)? It seems you are aware there are very high risks at stake when it comes to ingesting/using substances. If you want integration of the systems, you would need to ensure nobody is harmed either by the dose they receive or potential pesticides or microbes. Can you build up a safe herb delivery system in Uganda? If not, you should not be advising your patients to consult a herbalist. There is of course a great potential placebo effect we are all aware. It would be pity to miss it, especially when resources are scarce and people cannot afford more advanced treatment. Jan has proposed many concepts that enabled acupuncture, massage, reiki, yoga and other similar therapies to be available to the patients. But in my opinion ensuring safety of herbal "medicines" is much more challenging than safety of these therapies. Also, environments are entirely different and people might have less official control and regulatory monitoring in Uganda than in western world. My advice is, if you want to integrate, make delivery of herbs safe first. That is a great focus to start with anyway. Basically, your second paragraph describes perfectly well where you could start - perhaps you should start with educating people delivering the herbs traditionally now, making sure that they know how to calculate doses and produce and deliver herbs in a safe way ("herb doctor workshops")? 

Underlying much of the discussion is the problematic nature of 'satisfaction' eluded to above (linked of course to problems in defining 'quality'). I think this is why the discussion (in the UK anyway) has more recently moved to a consideration of 'experiences' of patients. Patient experience is but one element of quality, but it becomes much clearer that if we are going to focus on this we need to determine what aspects of experience matter most to them. It will be culturally specific and, in some cases, may not be straightforwardly compatible with other elements of quality (e.g. effectiveness, safety, efficiency).  

The challenge for a 'quality' health service / provider is to recognize the challenge and achieve the best balance between these different aspects of quality. it does not translate into 'patient want injection ->give injection' but nor does it translate into simply ignoring those expectations because the care is not 'effective'.

1. I am not convinced that "accurately" and "estimate" should be used in the same sentence.

2. No, I haven't seen any new formulas for this particular problem, but it is an issue similar to predicting plasma concentrations of drugs when using exponential-based algorithms in syringe pumps. It relates to the ratio of fat to total body weight. There have been a number of ways of dealing with this that are accessible to internet search.

However, it boils down to how "accurate" you want your "estimate" to be. Bearing in mind that your lab blood Hb can be as much as 10 to 15% inaccurate, there doesn't seem to be a lot of point in obsessing about more accurate estimates of blood volume.

If you're stuck in a rural clinic and you can only measure height and weight, and the latter is going to give you a misleading answer, you're really only left with height.

What you are sort of saying is that blood volume does not relate to weight when the body weight is outside the "ideal" range of body weight, which varies with height. What you need to use to calculate blood volume outside this range is not the patient's actual weight, but what it should be.

Just roughly eyeballing the ideal body weight charts based on the Quetelet  formula, and extracting the weight ranges associated with "normal" BMIs in the range of 18.5 to 25 (heights 1.5 to 2 m) also gives you an average weight within that range.  Using these average weights with the Nadler formula gives you the average blood volume for each height. Linear regression on the data (R² 0.9996) gives you an approximate relationship of (6100 x body height in metres) - 5500. 

Applying the process to the outer ranges of normality for weight suggests that using the average weight for each height will be =/- 15% accurate for the range.

Is that an "accurate" enough "estimate" for you?. 

Brilliant, Paul. Well said! We are in complete agreement regarding the integration of all the required elements community by community for their individual attributes and uniqueness.

Hi Dave then I guess you research question is very valid then, now i see its application a little better. I think if you lack ALH's then adaptation is the only way forward, you can only work with whom you have or what you've got. Good luck in your research David nice talking with you by the way.

From the hospital organization point of view you can divide the elective patients from the emergency/urgent patients assigning to these a certain number of beds (about 10% of the total hospital beds).

If hospital space constrain doesn't permit so, check the LoS and the BOR (and benchmark them) to see if is a inefficiency or a structural problem. Tthe last one can't be solve easly, the first is a EBM/GL approach problem.

Hafiz, I don't understand your question. Could you kindly elaborate as to the basis for your question? It is too vague.