Effective Optimisation of the Patient Circuits of an Oncology Day Hospital: Mathematical Programming Models and Case Study

In this paper, we first use the information we have on the patients of an oncology day hospital to distribute the treatment schedules they have in each of the visits to this centre. To do this, we propose a deterministic mathematical programming model in such a way that we minimise the duration of the waiting room stays of the total set of patients and taking into account the restrictions of the circuit. Secondly, we will look for a solution to the same problem under a stochastic approach. This model will explicitly consider the existing uncertainty in terms of the different times involved in the circuit, and this model also allows the reorganisation of the schedules of medical appointments with oncologists. The models are complemented by a tool that solves the problem of assigning nurses to patients. The work is motivated by the particular characteristics of a real hospital and the models are used and compared with data from this case.

Assessment of Metabolic Dysfunction in Sepsis in a Retrospective Single-Centre Cohort

Objective. Our primary aim was to assess selected metabolic dysfunction parameters, both independently and as a complement to the SOFA score, as predictors of short-term mortality in patients with infection admitted to the intensive care unit (ICU). Methods. We retrospectively enrolled all consecutive adult patients admitted to the eight ICUs of Lille University Hospital, between January 2015 and September 2016, with suspected or confirmed infection. We selected seven routinely measured biological and clinical parameters of metabolic dysfunction (maximal arterial lactatemia, minimal and maximal temperature, minimal and maximal glycaemia, cholesterolemia, and triglyceridemia), in addition to age and the Charlson’s comorbidity score. All parameters and SOFA scores were recorded within 24 h of admission. Results. We included 956 patients with infection, among which 295 (30.9%) died within 90 days. Among the seven metabolic parameters investigated, only maximal lactatemia was associated with higher risk of 90-day hospital mortality in SOFA-adjusted analyses (SOFA-adjusted OR, 1.17; 95%CI, 1.10 to 1.25; p < 0.001 ). Age and the Charlson’s comorbidity score were also statistically associated with a poor prognosis in SOFA-adjusted analyses. We were thus able to develop a metabolic failure, age, and comorbidity assessment (MACA) score based on scales of lactatemia, age, and the Charlson’s score, intended for use in combination with the SOFA score. Conclusions. The maximal lactatemia level within 24 h of ICU admission is the best predictor of short-term mortality among seven measures of metabolic dysfunction. Our combined “SOFA + MACA” score could facilitate early detection of patients likely to develop severe infections. Its accuracy requires further evaluation.

Dermatovenerological service of Ukraine in the context of ongoing reform

The problems of preserving the dermatovenerological health of the population are extremely relevant for Ukraine, where diseases of the skin and subcutaneous tissue occupy the 5th place in the structure of morbidity. Objective — study of the structure of the dermatovenerological service in the context of reforming the healthcare system at this stage (end of 2021) and its characteristics. Materials and methods. The results of the analysis of the state of resources of medical institutions of communal ownership of dermatovenerological profile in Ukraine are presented. Results and discussion. Today, in Ukraine, the number of hospital beds for 24-hour hospitals for adults is 188 in the regions (Zaporizhzhia, Rivne, Kharkiv, Cherkasy) and 220 beds in Kyiv city, which is extremely insufficient. There are 24 beds for the pediatric patients in the regions (Luhansk, Rivne, Cherkasy) and in the city of Kyiv — 60. The number of day hospital beds for adults has significantly decreased — to 248 in the regions (Dnipropetrovs’k, Zaporizhzhia, Kyiv, Lviv, Poltava, Kherson, Cherkasy, Chernivtsi and Kramatorsk city), for pediatric patients — 61 (Dnipropetrovs’k, Kropyvnytskyi, Mykolaiv, Poltava regions). In 2021, 11 dermatovenerologic dispensaries were liquidated. Instead of them, dermatovenero­logic centers and subdivisions subordinate to regional hospitals were formed. Thus, there is an unfavorable restructuring of the bed fund of institutions providing dermatovenerological care. Conclusions. A decrease in the number of state and municipal institutions providing free dermatovenerological care will lead to the worsening of the epidemic situation, the spread of sexually transmitted infections and reduction of the availability of specialized dermatovenerological care for the population in a difficult economic and social situation.

Engagement of Family in a Goal Setting Strategy: Impact Upon 30-Day Hospital Readmissions

Family-centered Function-focused Care (Fam-FFC) works with family caregivers as care partners in the assessment, function-promoting goal setting, implementation, and evaluation of goal attainment during hospitalization and immediate post-acute period. ANCOVA technique examined the preliminary impact of Fam-FFC upon 30-day hospital readmissions and logistic regression tested the association of goal attainment, measured with the Goal Attainment Scale (GAS) with 30-day hospital readmissions. The majority of the patients were Black (50%), female (62%), had a mean age of 81.6 (SD=8.4), mean Barthel Index of 60.29 (SD=27.7), and mean MoCA of 10.67 (SD=7.0). Goals represented six main categories: mobility, cognition, self-care, toileting, sleep, and pain management. Patients in the intervention group had less 30-day hospitalizations (F= 4.6, p=.033) and goal attainment was significantly associated with less recidivism (B=.179, Wald= 2.8 (1), p= .045). FamFFC shows promise in reducing 30-day hospital readmissions; results support the contribution of family engagement and use of GAS