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KAPLAN INTERNAL MEDICINE PDF 2013

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Kaplan Internal Medicine Pdf 2013

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Keywords also have not been considered: lean health care, lean health care management, planning lean health care management. The application of lean as a methodology for improving quality in health services is essential, since the methodology is approached from different perspectives, according to the need of each institution. Radnor et al. The keyword 'Six Sigma' has strong association with quality processes, management and operations. This methodology addresses procedures for eliminating or reducing errors in processes and procedures.

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Although difficult to implement in the service sector, its use has been increasing, especially when associated with other methodologies and quality tools.

Here, it appears as an alternative to associate lean tools and procedures. The words 'lean', 'health care' and 'management' are centralized in the keyword network. All of them connect with the other clusters and very intensively.

Lauren E. Kaplan, DO

The word 'lean' stands out for its connections with the words 'patient safety' and 'employee involvement'. The first is to emphasize the importance of patient safety and the second to validate the importance of patient safety, highlighting the involvement of employees in achieving satisfactory levels of safety.

The word 'health care' emphasizes that operations are paramount to achieve consistent quality health service objectives. The relationship between health care, reengineering, impact, and performance shows that processes influence institution structures; when applied correctly, they produce good performance in quality management. The word 'management' is the one that has the greatest relationship among all the other words in the network.

It is very strongly related to three clusters of the network of keywords: operations, quality and institutions. This word shows that quality management, when associated with the best operations guidelines, is fundamental for health institutions.

Discussion According to Table 1 , subjects related to processes and services dominate the discussion about lean health care, corresponding to This is the foundation of kaizen, which aims to continuously improve the culture of the institution, impact on service improvement, reducing waiting times and improving patient care, with more organized spaces and better use and with changes in the flow of processes for workers and patients Radnor et al.

This shows that the use of lean tools has great insertion capacity, mainly for the continuous improvement of processes. Figure 2 shows that was the year with the highest number of publications related to the lean health care subject.

Relationship networks play an important role between authors and their works.

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They show the major influencers in the theme, the countries with the largest number of publications, which encourage carrying out related studies and the connection between the keywords used by the authors.

The social network of countries shows the place where there is a greater concentration of published articles. England stands out for its robust and comprehensive health system, which results in many experiments and, consequently, many articles related to this system.

In addition, Figure 3 shows that England has connections with practically all countries, with the exception of Japan, Switzerland, and Senegal. Northern Ireland, which integrates the United Kingdom and has a health care system similar to that of England, also stands out for the number of articles referenced. In relation to the database, it is important to map the theme in relation to the 13 most cited articles that composed the guiding axis of this work. In this article, the authors state that the health sector, as occurs with the manufacturing sector, is composed of a series of processes or actions aimed at creating value to patients and that, although there are differences between patients and products, health organizations are complex, with thousands of processes interacting.

This causes hospitals to work towards a good understanding of the patient's needs, requirements or how he interprets a service with high added value, so that there is ambiguity and uncertainty in what should be implemented with Lean Radnor et al.

Moraros et al. The application of specific lean tools, such as kaizen and continuous improvement, tend to produce small and localized productivity gains Radnor et al. Their goal was to show that although manufacturing works with different objectives, lean can also be applied to other areas, including health care. However, it is most commonly treated with a topical ophthalmic antibiotic.

Discussion Neonatal red eye With eye drainage: perform Gram stain and culture for N. Orbital cellulitis is an emergent condition and needs immediate referral to ophthalmology.

MRI of the orbit and surrounding tissue should be performed to aid surgical drainage.

Start IV antibiotics immediately. Final Diagnosis Bacterial conjunctivitis CASE REVIEW Bacterial Conjunctivitis Red eye with discharge History of crusting Typically painless Topical antibiotic treatment Viral Conjunctivitis Associated with upper respiratory infection 20 Look for clear discharge Glaucoma Painful, blepharospasm, tearing, megalocornea Abnormal pupil response Ophthalmologist consultation necessary Corneal Abrasion Painful Photophobia Trauma with abrasion Fluorescein stain for corneal abrasion Prophylactic topical antibiotics Uveitis Painful Visual disturbances Abnormal pupils Slit lamp examination: inflammatory cells in anterior chamber Treat underlying disease with or without topical steroids 21 Case 2 Chief Complaint Rash on legs History and Physical Examination A 6-year-old boy is brought to the office because of a rash that started as a superficial accumulation of several small vesicles on his legs below the knees.

There is no fever or chills. He lives in the suburbs and often walks outside in the local woods in short pants. Vital signs are T Physical examination shows honey-brown, crusted lesions with an erythematous base on both legs. There are other lesions as well, in various stages of crusting and openness.

The examination is otherwise normal. Differential Diagnosis 1. Impetigo 2. Cellulitis 3. Erysipelas Varicella Folliculitis S. The presence of lesions on exposed legs the patient wore short pants and walking outside in the woods suggest some form of problem secondary to contact.

Skin lesions due to staphylococcal infections are more likely to occur at the base of follicles and will range from papulovesicular to bullae. There is no evidence of any deeper or more widespread disease, such as cellulitis, erysipelas, or staphylococcal scalded skin syndrome.

Patients with staphylococcal scalded skin appear much more toxic.

Unilateral versus bilateral erythema is a good first step in thinking about the differential diagnosis. Viral conjunctivitis is likely to be bilateral with a watery discharge.

Allergic conjunctivitis should have itchiness, be bilateral and watery, and have a seasonal component and perhaps other history of allergic disease. With no history of pain or trauma caused by a foreign body, chemical conjunctivitis or corneal abrasion is highly unlikely.

Normal vision and no ophthalmoplegia or proptosis, normal and symmetric pupillary size and reaction rule out anterior uveitis, orbital cellulitis, and glaucoma.

Perform fundoscopic examination. However, it is most commonly treated with a topical ophthalmic antibiotic. Discussion Neonatal red eye With eye drainage: Orbital cellulitis is an emergent condition and needs immediate referral to ophthalmology.

MRI of the orbit and surrounding tissue should be performed to aid surgical drainage. Start IV antibiotics immediately. There is no fever or chills.

Clinical trial discussion, referral, and recruitment: physician, patient, and system factors.

He lives in the suburbs and often walks outside in the local woods in short pants. Vital signs are T Physical examination shows honey-brown, crusted lesions with an erythematous base on both legs.

There are other lesions as well, in various stages of crusting and openness.

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The examination is otherwise normal. Differential Diagnosis 1. Impetigo 2. Cellulitis 3. Erysipelas Varicella Folliculitis S. The presence of lesions on exposed legs the patient wore short pants and walking outside in the woods suggest some form of problem secondary to contact. Skin lesions due to staphylococcal infections are more likely to occur at the base of follicles and will range from papulovesicular to bullae. There is no evidence of any deeper or more widespread disease, such as cellulitis, erysipelas, or staphylococcal scalded skin syndrome.

Patients with staphylococcal scalded skin appear much more toxic. Over-the-counter combinations of bacitracin-neomycin-polymixin B are less effective. Oral treatment is warranted if there are widespread lesions or bullous lesions. If methicillin-resistant S.

Vancomycin is not recommended for oral use but is highly effective intravenously, especially for MRSA. Discussion A summary of vesicles and bullae is as follows.The lymphatics also remove proteins from the interstitium.

With no history of pain or trauma caused by a foreign body, chemical conjunctivitis or corneal abrasion is highly unlikely. Kaplan, Inc. The following representreasonableequilibrium potentialsfor the key electrolytes:.

The baby is transferred to the neonatology ICU.

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