APPLICATION OF THE HOLT-WINTERS METHOD FOR FORECASTION HOSPITAL ADMISSIONS IN CITIES

The current situation of coronavirus infection necessitates the use of models and prediction methods for decision- making in a rapidly changing situation in large cities and towns. Due to the dynamics of the processes, it is necessary to use different models and forecasting methods for the development of the situation. The city of St. Petersburg is the object of study and an analysis of hospitalisation of patients is performed. St. Petersburg was chosen as the subject of the research. The presented research was carried out within the framework of the work "Mathematical modelling of logistic systems in medicine" during the performance of diploma projects on the assignment of St. Petersburg executive authorities in 2021. In the course of the study analytical data are collected, the city districts where the situation with transportation of patients to medical organizations is likely to be difficult to predict are identified, and the methodology of forecasting hospitalization of patients by ambulance cars is considered. In solving the problem of predicting the situation, forecasting methods in the class of polynomial models are used and the effectiveness of using the Holt-Winters method is justified.

Health care logistics: mapping and optimization of patients logistics

Healthcare logistics play an important role in management, being attributed the activities of acquisition, distribution and movement of materials, professionals and patients. This work aims to develop a study, using the healthcare logistics in the movement of patients in the third health region of Paraná, proposing a linear programming problem that will pass through a computational simulation, considering the existing demands and constraints in the system, aiming to optimize the flow of patients from this region. The present study developed four mathematical models, based on demands and constraints followed by linear programming in order to find the best possible solution for the flow of patients from the third health region of the state of Paraná. The study developed reached its goal of optimization, generating an economy in the transportation of patients. Through the analysis of the results, it is concluded that the model that best suits the presented problem is the one of costs minimization, since the one of vehicles presented higher costs. Possibly the model that minimizes the vehicles would bring better results if the vehicles were not outsourced, but of the Ponta Grossa City Hall (PMPG). Was possible to verify the importance of the theme, especially when referring to the flow of patients in the health services due to the lack of studies with this specific approach. Even with the scarcity of data, it is possible to notice the potential for improvements on this patient transport system.

Understanding the burden and mitigating risks in the utilisation of the Emergency Medical Services in the management of community mental health emergencies

Introduction Mental health disorders are highly prevalent globally with access to appropriate care oftentimes problematic. The Emergency Medical Services (EMS) have been suggested as a potential solution to improve access, however, it is unclear whether these services provide the most appropriate response with respect to the needs of patients experiencing a mental health emergency. Methods A multi-method study was conducted to assess the current burden and potential risks associated with the transportation of patients experiencing a mental health emergency by EMS. Part 1 utilised a cross-sectional study of routinely collected clinical data for the period January 2018 to December 2019. Part 2 employed a systematic risk identification methodology focused on identifying the hazards associated with the transportation of this patient cohort, to identify key action plans towards mitigating their occurrence. Results Patients experiencing a mental health emergency were transported at an average rate of 11.96 per 1000 transports. Approximately 7% were administered prehospital sedation, with Ketamine administered as the most common sedative. Altogether, 50 potential hazards were identified involving the transportation of patients experiencing a mental health emergency. The Patient Assessment subprocess contained the most potential hazards/failure points (n=13). Risks categorized as occasional (n=33) and moderate (n=16) made up the majority. Conclusion The burden of mental health emergencies on EMS is considerable, with the potential for several significant risks. Despite this, there was unequal focus on the development of care pathways and clinical guidance for this patient cohort compared with the more "traditional" case types serviced by EMS. Consequently, we identified several strategic-level action plans to mitigate these hazards and improve the delivery of care for these patients in the community.

An Approved Landing Site (ALS) improves the logistics of interhospital transfer of critically ill patients by helicopter

The COVID-19 pandemic limited hospital resources and necessitated interhospital transport of ICU-patients in order to provide critical care to all patients in the Netherlands. However, not all hospitals have an approved landing site. The ICU-transport operation was executed under HEMS-license and landing on non-aerodrome terrain was permitted. This allowed the search for an ad-hoc landing site in the direct vicinity of the ICU. The following characteristics were judged: slope, obstacles, size, soil conditions and the presence of foreign objects.Before the start of this transport operation, in two days, all hospitals in the Netherlands were visited and presumed landing sites explored, described, photographed and recorded in the electronic flight bag. At 71 (87,6 %) of the hospitals it was possible to install a temporary approved landing site in the direct vicinity of the ICU. 110 landings were made on these landing sites and 114 landings on approved heliports. Only 11 patients required secondary transport to or from the helicopter landings site. This occurred only in two patients from a heliport to a receiving hospital.The construction of pre-explored approved landing sites in the vicinity of hospitals allows safe transportation of patients by helicopter to hospitals without a heliport.

Features of interhospital transportation of patients requiring prosthetics of vital functions (on the example of the federal research and clinical center of intensive care medicine and rehabilitology)

One of the important features of patients in chronic critical illness is their need for prosthetics of vital functions. The provision of specialized medical care to all patients in need is impossible without resolving the issues of transportation to a specialized medical center. Inter-hospital transportation of resuscitated patients is one of the tasks of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. The greatest difficulty is the transportation of patients with unstable hemodynamics. The transportation service created in the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology is engaged in the development of issues of safe transport, including this category of patients by attracting organizational resources, forming a specialized team and equipping it. Medical and diagnostic, additional assessment of the patients condition on the spot. This approach makes it possible to increase the efficiency of intensive care during transportation and to eliminate mortality in this category of patients during transportation. Our experience of inter- and intra-hospital transportation of resuscitation patients was widely discussed at conferences, congresses and today is used in the work of mobile resuscitation teams.

INFLUENCE OF VARIOUS FACTORS ON THE FREQUENCY OF COMPLICATIONS IN SKELETAL POLYTRAUMA AFTER INTERHOSPITAL TRANSPORT AND AT THE INTENSIVE CARE UNIT

The study involved 240 patients with skeletal polytrauma. The aim of the study was to improve the results of treatment of victims with skeletal polytrauma by substantiating methods for predicting and preventing various complications after interhospital transportation and in the intensive care unit. We found that after interhospital transportation of patients, the following complications were detected: fatty embolism (11.6%), anemic syndrome (51.7%), acute respiratory failure (20.3%), pneumonia (13.4%). The main defects at the hospital stage were: incomplete laboratory and instrumental studies (81.7%), untimely surgical osteosynthesis (49.2%), undiagnosed complications (31.2%), underestimation of the severity of the condition (30%), inadequate correction of hypovolemia, anemic syndrome, coagulopathy (51.7%, 81.7%, 63.3%, respectively), inadequate prevention of thromboembolic complications and fatty embolism (70%, 51.7%), inadequate correction of acid-base disorders and dyselectrolytemia (100%).

Coping with difficulties faced in pre-hospital healthcare amid pandemics

EMS (Call number: 112 in Turkey) encompasses services provided by professional healthcare teams in case of diseases and injuries emerging acutely, accessed expediently following the event, using specialized equipment as necessary. The main purpose of this study is to determine the difficulties faced by 112 pre-hospital healthcare workers (HCWs) in the transfer of patients to hospital, during the COVID-19 pandemic period, and to examine ways to cope with these difficulties, with a case study method that examines unique cases. The study group of the research consists of Emergency Medical Technicians (EMTs) (n = 15; 30.6%), paramedics (n = 19; 38.8%) and doctors (n = 15; 30.6%). The forty-nine participants who comprise the study group were selected from ‘HCWs who worked in the ambulance service during the transportation of patients with COVID-19 to hospital’. Based on the narratives of the participants, two main themes were determined as difficulties experienced and strategies of coping with these difficulties. Under the theme of difficulties experienced, three subthemes and a total of thirty-one codes were created as problems originating from society, the system and the employee himself. The theme of the strategies used to cope with the difficulties experienced was determined under three subthemes; professional equipment and personal precautions, professional measures and system support. A total of twelve codes were created. The pandemic period has been a time when boundaries and durability have been questioned. The experience obtained during this period is a great knowledge base for future global and mass epidemics, attacks and disasters.

Anesthesia and intensive care for patients with COVID-19. Russian Federation of anesthesiologists and reanimatologists guidelines. Annals of Critical Care

The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was June 29, 2020. To develop the Guidelines for the recommendations, were used documents that directly describing the features of the management of patients with coronavirus disease COVID-19 (guidelines and guidelines - 16; randomized clinical trials and Cochrane Reviews - 8; observational and comparative studies - 77; other documents, notes and comments - 54) and describing anesthetic and resuscitation support in the general population of patients. The provisions of the recommendations highlight the specifics of anesthesia, intensive care, resuscitation, manipulation, and prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis are described. The features of the management of pregnant women, children of different age, patients with concomitant diseases, issues of transportation of patients are considered.