...Hernia * is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it * The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined. * Inguinal hernia: Makes up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women. * Any condition that increases the pressure in the intra-abdominal cavity may cause the formation of a hernia, including the following: * Marked obesity * Heavy lifting * Coughing * Straining * Family history of hernias * Asymptomatic hernia * Presents as a swelling at the hernia site * No true pain or tenderness upon examination * Enlarges with increasing intra-abdominal pressure and/or standing * Incarcerated hernia * Painful enlargement of a previous hernia or defect * Cannot be manipulated (either spontaneously or manually) through the fascial defect * Nausea, vomiting, and symptoms of bowel obstruction (possible) * Strangulated hernia * Symptoms of an incarcerated hernia present combined with a toxic appearance * Systemic toxicity secondary to ischemic bowel is possible * Strangulation is probable if pain and tenderness of an incarcerated hernia persist after reduction * Direct Hernia * is most often an “acquired lesion”. *...
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...The Diaphragm and Congenital Diaphragmatic Hernia The diaphragm is a commonly misunderstood body part. Those who sing appreciate it purely due to their ability to control the diaphragm to enhance their singing. However, its real purpose in the human body is more important than that. The diaphragm plays such a crucial role in everyday life to the extent that one cannot survive without it. In this paper we will consider the role of the diaphragm through its anatomy and physiology. We will then review a congenital birth defect known as Congenital Diaphragmatic Hernia (CDH) and how it changes the anatomy and physiology of the body. We will also look at current research and prognosis of the disease in an effort to gain a better understanding of this often-fatal defect. The diaphragm is located almost centrally in the body. It is a continuous sheet of muscle that spreads across the bottom of the rib cage creating a divide between the thoracic cavity and the abdominal cavity. As detailed in the text Gray’s Anatomy, the convex upper surface of the diaphragm faces the thorax and forms the bottom of the thoracic cavity. The concave inferior surface is pointed towards the abdomen and is mostly covered in peritoneum forming the superior part of the abdominal cavity. The right side of the diaphragm is superior to the right lobe of the liver, the right kidney, and the right adrenal gland. The left side of the diaphragm lays over the left lobe of the liver, the fundus of...
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... 2ND JUNE 2014 INTRODUCTION The Shouldice Hospital, located in Thornhil, Ontario is considered a global leader in hernia repair and recovery. The Shouldice Hospital was established in 1945 by Dr. Edward Earle Shouldice. Major Dr. Edward Earl Shouldice saw many men denied enlistment into the army because they were deemed physically unfit to serve due to the need of hernia surgery. Dr. Shouldice developed an innovative technique to repair hernias during this World War II era and has been known in the medical world for his superior methods ever since. Shouldice created a method that included factors such as a local anesthetic, the abnormal nature of the surgical procedure itself, encouraging movement following the surgery, and many other postoperative methods used by his team. Using these factors, Dr. Shouldice developed a surgical technique for repairing hernias that were superior and much more efficient than other methodologies. HISTORY Dr. Edward Earle Shouldice graduated from the University of Toronto in 1916. During World War II, he was called to serve on the Medical Examining Board. Dr. Shouldice, a major in the army, found that many young men willing to serve their country had to be denied enlistment. These men needed surgical treatment to repair their hernias before they could be pronounced physically fit for military training. In 1940, hospital space and doctors were scarce, especially for this non-emergency surgery...
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...Executive summary or Conclusion Shouldice Hospital was founded in 1945 by Dr. Earle Shouldice. It is a well known hospital in Ontario, Canada for its extraordinary service and care of hernia repair. The hospital is famous for lots of notable features in its service delivery system - superior surgery technique, effective recovery methods and comfortable and friendly environment with gregarious staff and service. Shouldice Hospital is a small 90-bed hospital with averaged 7,000 operations annually. However, the demand on the hernia operation is much grater than the Hospital’s current capacity. The management of Shoudice is thinking to expand the hospital’s capacity to service unmet demand. There are two expansion options to consider, one is to add Saturday to the existing five day operation’s schedule to increase capacity by 20%; another is to increase the number of beds by 50% by adding another floor of rooms to the hospital. But another opinion within the hospital is that further expansion of capacity might make it hard to maintain current high quality of service delivered. By analyzing, calculating and comparing current situation and the proposed options, the recommendations are made as below: Add Saturday operation to existing five days schedule to increase 20% capacity in the short term. This method is simple to follow and will solve the need of increasing demand with very minimal impact on current quality of service. Within in the next five years, add additional...
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...Discuss how the following organizations would be arranged in terms of the depth and breadth of their product lines: A solo-practice family practitioner who does not deliver babies A multi-specialty group practice that provides primary care at five (5) satellite locations An academic medical center Shouldice Hospital in Toronto, which specializes in short-stay surgery for hernia repair According to our text, breadth "refers to the number of different product lines in the mix." (Berkowitz, 2011, pg 263) and depth "refers to the nimber of product items within each product line." (Berkowitz, 2011, pg 263) For a solo-practice family practitioner who does not deliver babies, the breadth of this organization is very narrow. The practitioner only has one practice and they have excluded themselves from delivering babies, which may be something wanted from a growing family. On the other hand, the depth of this organization can possibly still be great. They can offer family counseling services, perscription services on site, and other services that may fill other needs of the family. A multi-specialty group practice that provides primary care at five satellite locations, has great breadth. They have extended their services to additional locations and they cater to multiple needs. They would also have great depth because they would have to offer multiple services under each specialty group. An academic medical center shows that is has a small amount of breadth...
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...UNIVERSIDAD SIMÓN BOLÍVAR Departamento de Procesos y Sistemas Casos de Estudio de Gerencia - PS6170 Enero - Marzo 2013 Caso de Estudio #4 Shouldice Hospital Integrantes: Ronald Batista 07-40635 Isabel Blanch 07-40657 Jocelyn Machado 08-10659 Eduardo Rocco 08-10947 Stephanie Ziritt 08-11220 Profesor: Manuel Martín Sartenejas, Febrero de 2013 1. CONTEXTO El hospital Shouldice (nombrado luego de su fundador, Earle Shouldice) es un centro clínico donde se operan únicamente hernias abdominales externas. El 82% de los procedimientos quirúrgicos que realiza el hospital son operaciones primarias (operaciones realizadas por primera vez que requieren intervenciones de 45 minutos de duración) y el 18% restante se compone de pacientes con hernias recidivantes, reparadas anteriormente en otra clínica. Earle Shouldice desarrolló una técnica quirúrgica para la operación de hernias que supera a otras técnicas en cuanto a procedimiento, anestesia necesaria, tiempo y recuperación del paciente. Esta técnica es utilizada por todos los médicos cirujanos que trabajan en la clínica, sin embargo, el método Shouldice no es un método público conocido por otros médicos fuera del hospital. El hospital se compone de 5 quirófanos, un laboratorio, sala de reanimación y un área de aprovisionamiento central donde se limpian y esterilizan los instrumentos quirúrgicos. Cuenta con oficinas de recepción y contabilidad, una gran sala de espera (con una capacidad para 50 personas)...
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...Brief review of Shouldice hospital operations management SHOULDICE HOSPITAL 1. In your view, what are the most important elements of the Shouldice system? Shouldice method Specialize in hernia repair – a niche market with substantial size Based on an innovative idea: Preliminary selection Early ambulation Procedure technique Comfortable environment reducing anxiety and encouraging quick recovery Focus on maximum value: perceived quality/value of the service provided to patients minus cost Proved efficiency 2. Assume that Shouldice, under new management, aspires to increase it volume by a factor of 10 over 5 years by expanding in 10 large cities in North America. List the changes you would implement at Shouldice to achieve this goal. (For this assignment, assume that financing could be secured, and the markets are available. Concentrate on the operational issue) 3. Which of the elements listed in section 1 will survive under the test of section 2, and which will have to be replaced? Challenges Key challenge – limited capacity and inability to satisfy demand. Risk of competitors responding to the demand with similar business model , changing the market in the longer term. Key question to stakeholders – stay small or grow? Solution - low cost/short term 1. Objective – to improve turnover by reducing average time spent in hospital. Time: Change schedule and have operations during the weekend. Involve patients in preparing for operation and reduce...
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...1. Direct hernia: Usually resulting from stress, causing the peritoneum to bulge through the fascia in the groin area. The peritoneal bulge (sac) may contain abdominal viscera. 2. Indirect Hernia: Caused by a congenital defect in the internal abdominal ring, causing the peritoneum to bulge along the spermatic cord. It may or may not contain abdominal viscera. * A hernia can occur within an old scar that is usually located in the abdominal (ventral)region, and is referred to as an incision hernia. * Hernias are either reducible or irreducible that is incarcerated. The contents of an incarcerated hernia may become strangulated, compromising the viability of trapped tissues and thus necessitating their resection in addition to the herniography. Position * Supine, with arms extended on arm boards Incision Site * Groin area, right or left oblique. Packs/Drapes * Laparotomy pack or minor pack * Four-folded towels Instrumentation * Basic tray or minor tray * Self retraining retractor Supplies/ Equipment * Basin set * Suction * Needle counter * Penrose drain * Dissector sponges * Sutures * Solutions – saline, water * Synthetic mesh * Skin closure strips Procedure 1. The surgeon begins the procedure by incising the groin. 2. The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders. 3. Both blunt and sharp dissections are used to gain access to the hernia. 4. After...
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...Executive Summary Shouldice Hospital is the world’s leading centre of excellence in abdominal wall hernia repair . Shouldice’s reputation has been built on an exterior quality service and a high rate of successful hernia repair operation. A 99% success rate in hernia surgery has long been the benchmark for medical professionals internationally. Shouldice has averaged 7,000 operations annually, while last year it performed 7,500 operations. The patient number increased a lot in recent years. The hospital’s current capacity cannot meet extensive increased patient demand. The senior manager of the hospital needs to find the best option to expand the capacity to service unsatisfied demand while maintaining control over the high quality service delivered. Shouldice Hospital has a unique operation system to ensure its success. The notable features contributed to its service delivery system are innovative hernia repair technique; specialized program of care and recovery; and sociable atmosphere in the hospital. However, the utilization of overall capacity is not high. Current operation system does not run very efficiently. Shouldice needs to take steps to redesign its operation system to increase the capacity utilization. External analysis shows that Shouldice can use currently available high technology to further improve its operation quality. There are certain medical and health related laws to regulate hospital’s operation. In addition, Shouldice needs to commit to social responsibility...
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...Module 9 1. What is the market for this service? How successful is Shouldice Hospital? What makes Shouldice Hospital’s market unique is its limited to external (versus internal) abdominal hernias. Shouldice also focuses on quick recovery usually first-time repairs “primaries” are straightforward requiring 45 minutes to 90 minutes if the doctors experience a difficult hernia and within 4-days patients can resume normal activities. In addition, a high portion of their operations was on males, estimating over 1,000,000 operations in total. Although, Shouldice owes its success to word-of-mouth referrals which have increased throughout the years. Not to mention, their reasonable rates which general hospitals cannot compare. As Alan O’Dell states,...
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...The Shouldice Hospital was created by Dr. Edward Earle Shouldice who is the inventor of the Shouldice method which is a hernia surgery designed to reduce recovery time and improve surgical results. The method was in response to men who couldn’t enlist in the military due to complications and it would quickly restore their physical fitness for military training. Due to high demand and scarce hospital space, Dr. Shouldice decided to open up his own hospital specializing in his unique hernia repair method. At the Shouldice hospital, only external types of hernias were performed creating a facility that offers expertise and specialization in their service. There are numerous characteristics of the Shouldice hospital that differ from most other hospitals. The most significant difference is the performance of a single operation and nothing else. This helps provide customers were assurance that they are being taken care of by knowledgeable professionals who have performed hundreds of similar operations. Not only were they getting a quality service, but a speedy recovery time helped to add value to their experience. In addition to the surgery received, the entire experience of a quick check in, a comfortable atmosphere, an opportunity to create relationships, well prepared meals, and the freedom to move around are all services which help to differentiate themselves from your typical hospital. This helps to relieve stress and anxiety many people have when getting a surgical procedure...
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...Do you think Shouldice Hospital should expand off-site? If so, Where and why? Yes I believe there is a great potential for the Hospital to expand internationally. The US is the obvious choice, since as the case states 42% of their patients come from the United States, so this might be the obvious choice. However, this statistics are from 1982, when the US dollar was a lot stronger than the Canadian dollar ($1US : $0.80CND), which in itself represented a 20% discount from the beginning. Nevertheless, again as the case states that in 1980 it is estimated that 600,000 hernia operations performed in the US alone”. Comparing the 6850 surgeries done by Shouldice Hospital and taking into account that no marketing nor advertising is done to attract any more clients, it should be safe to assume that, tackling the US as an option, it would be profitable. 4. Increase the size of the plant where the service is provide involved a large capital investments and time. The construction could be causing discomfort between patients, quality and country club atmosphere , also to expand the capacity, Shouldice needs to hire new specialist and nurses to deal with the expanded capacity. In addition of Saturday operations will result in increased workload for the personal. they should develop a self-contained branch in northern part of USA. they can brass to offer new specialty medical service first in Toronto. If the demand is enough, they can expand their new specialty medical care...
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...Introduction Hernia is the protrusion of viscera from their normal anatomical position in another area. Hernias are divided into internal and external. In external hernias the protrusion of the viscus is through a defect of the abdominal wall. Regarding the internal hernias the protrusion is through a defect that is located inside the abdominal cavity. This defect can be congenital or acquired. Congenital defects are created due to some embryological mistake that is made between the 5th and 7th week of embryonic development, during which the rotation of the abdominal organs and the merge of the visceral peritoneum with the parietal in specific locations occur. The acquired defects are created after surgical procedures, injury or inflammation...
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...ldi Case Study 1: Shouldice Hospital Limited 1. What has the leadership of Shouldice been excellent at? Shouldice leadership has been able to develop one of its surgical service lines, inguinal hernia repair, to an “internationally-recognized” brand. This has allowed Shouldice to dominate the market share and create a demand for its specialized services resulting in financial stability. The creation of this brand also has a strong influence with how the organization functions and how it is perceived. Levey (n.d.) reveals why branding creates organizational value. Levey expresses that “from a marketing or consumer perspective, it is the promise and delivery of an experience.” Shouldice leadership has also created an organizational culture that provides employees a sense of purpose, motivation, and opportunity to enhance their skills. Levey (n.d.) adds that a “brand is the greatest asset for uniting employees around a singular culture and mission.” 1. What has the leadership of Shouldice been excellent at? Shouldice leadership has been able to develop one of its surgical service lines, inguinal hernia repair, to an “internationally-recognized” brand. This has allowed Shouldice to dominate the market share and create a demand for its specialized services resulting in financial stability. The creation of this brand also has a strong influence with how the organization functions and how it is perceived. Levey (n.d.) reveals why branding creates organizational...
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...Abstract There are many different types of hernias. The most common type is inguinal which occurs in the groin (Balentine, J.R, 2010). Other types of hernias are femoral, umbilical, incisional, hiatal, sports, and congenital diaphragmatic. Symptoms of a hernia may include pain or discomfort and localized swelling on the abdomen or in the groin area. If a hernia is found the usual treatment is surgery. Most common surgery is laparoscopic. What is a hernia? Why do we get them? What are symptoms caused by hernias? Who is more likely to get a hernia? How to help prevent from getting a one? These are all questions many people have. A hernia is any condition in which the viscera protrude through a weak point in the muscular wall of the abdominopelvic cavity (Saladin, 2010). This may cause a bulge or tear in the abdominal wall. This can be more noticeable when the muscles in the stomach are tightened causing pain. Lifting weights or heavy objects, running, or straining to have a bowel movement can put strain on the abdominal area and worsen the hernia. A hernia may be likened to a failure in the sidewall of a tire. The tire’s inner tube behaves like the organ and the side wall like the body cavity wall providing the restraint. A weakness in the sidewall allows a bulge to develop allowing the inner tube to protrude leading to the eventual failure of the tire. (Hernia Symptoms, 2007-2008) There are many different types of hernias that effect men, women, and children....
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