A Health Technology Assessment in Maxillofacial Cancer Surgery by Using the Six Sigma Methodology

Evaluation of sarcopenia and sarcopenic obesity in patients affected by oral squamous cell carcinoma: A retrospective single-center study

This retrospective single-center study aimed to evaluate the relevance of sarcopenia and sarcopenic obesity as negative prognostic factors in patients with oral squamous cell carcinoma (OSCC). The study was performed on patients who underwent oral squamous cell carcinoma resection surgery. Patients' demographic and clinical variables were collected at diagnosis (sex, age, height, weight, comorbidities, smoke and alcohol consumption, HPV positivity, TNM-stage) and corrected for known prognostic factors (age, body mass index, TNM-stage). The Skeletal Muscle Mass (SMM) and the Cross-Sectional Area (CSA) on pre-treatment CT scans and Body Mass Index (BMI) were measured to assess sarcopenia and sarcopenic obesity correlated to overall survival (OS). Chi-square statistics were used to analyze the differences between the frequencies of each categorical variable with the presence or absence of sarcopenia and sarcopenic obesity. The cumulative overall survival was calculated by the Kaplan-Meier method, and the differences between curves were evaluated by the log-rank test. A Cox proportional hazard regression model was used for univariate and multivariate analysis of the overall survival. Within the limitations of the study, in this sample, sarcopenia did not seem to cause a statistically significant reduction in the overall survival in patients with oral squamous cell carcinoma (Log Rank χ2 = 3.67, p = 0.055; HR 0.996, 95% CI 0.732-1.354, p = 0.979), however, sarcopenic obesity showed a meaningful negative prognostic impact on it (Log Rank χ2 = 5.71, p = 0.017; HR 0.985, 95% CI 0.424-2.286, p = 0.972). Within the limitations of the study it seems that sarcopenic obesity, age, BMI, and TNM-stage are more relevant negative prognostic factors, influencing overall survival in surgically treated OSCC, than sarcopenia.

Analysis of Effect of Six Sigma Method Combined with CI Strategy on Improving of Nursing Quality in Outpatient Infusion Rooms

Objective. The infusion room is the last part of an outpatient visit, with high patient density, large staff mobility, and a wide variety of conditions. In addition, most patients are accompanied by their families during infusion, and nursing staff in infusion rooms have to face more trivial and miscellaneous tasks than nursing staff in other treatment departments, which are more complex. The purpose of this research is to explore the impact of the Six Sigma method and CI strategy on the quality of nursing management in infusion rooms, so as to provide reference for clinical research. Methods. A total of 2142 patients treated in our outpatient infusion rooms from June 2019 to June 2020 was included into this retrospective analysis. Of these, 1105 patients admitted before 2020 received routine care management services and were considered as the control group. Another 1037 patients were admitted after 2020 and received the Six Sigma method combined with CI strategic care management and were considered as the research group. The incidence of adverse events during treatment was counted in both groups, and patients’ compliance behavior and psychology were investigated. After treatment, patients’ evaluation of the quality of nursing and their satisfaction with the nursing were investigated. Results. The incidence of adverse events during infusion in the research group was dramatically lower than that in the control group, while the compliance behavior scores were higher ( $P<0.05$ ). In addition, SAS and SDS in the research group were lower than those in the control group, while the quality of nursing were higher ( $P<0.05$ ). It was also clear that the research group had 93.39% satisfaction with nursing, which was also higher than the control group ( $P<0.05$ ). Conclusion. Implementation of infusion room nursing management according to the Six Sigma method with CI strategic plan can avoid adverse events and improve infusion nursing satisfaction. It also helps reduce the incidence of dispute events.

Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC

The reduction of healthcare-associated infections (HAIs) is one of the most important issues in the healthcare context for every type of hospital. In three operational units of the Scientific Clinical Institutes Maugeri SpA SB, a rehabilitation hospital in Cassano delle Murge (Italy), some corrective measures were introduced in 2017 to reduce the occurrence of HAIs. Lean Six Sigma was used together with the Define, Measure, Analyze, Improve, Control (DMAIC) roadmap to analyze both the impact of such measures on HAIs and the length of hospital stay (LOS) in the Rehabilitative Cardiology, Rehabilitative Neurology, Functional Recovery and Rehabilitation units in the Medical Center for Intensive Rehabilitation. The data of 2415 patients were analyzed, considering the phases both before and after the introduction of the measures. The hospital experienced a LOS reduction in both patients with and without HAIs; in particular, Cardiology had the greatest reduction for patients with infections (-7 days). The overall decrease in HAIs in the hospital was 3.44%, going from 169 to 121 cases of infections. The noteworthy decrease in LOS implies an increase in admissions and in the turnover indicator of the hospital, which has a positive impact on the hospital management as well as on costs.