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Managing uncertainty

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https://www.readbyqxmd.com/read/29332055/operating-room-scheduling-and-surgeon-assignment-problem-under-surgery-durations-uncertainty
#1
Hongwei Liu, Tianyi Zhang, Shuai Luo, Dan Xu
BACKGROUND: Scientific management methods are urgently needed to balance the demand and supply of heath care services in Chinese hospitals. Operating theatre is the bottleneck and costliest department. Therefore, the surgery scheduling is crucial to hospital management. OBJECTIVE: To increase the utilization and reduce the cost of operating theatre, and to improve surgeons' satisfaction in the meantime, a practical surgery scheduling which could assign the operating room (OR) and surgeon for the surgery and sequence surgeries in each OR was provided for hospital managers...
December 29, 2017: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/29331965/right-iliac-fossa-pain-treatment-rift-study-protocol-for-an-international-multicentre-prospective-observational-study
#2
Dmitri Nepogodiev
INTRODUCTION: Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy)...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331740/development-and-validation-of-a-new-population-based-simulation-model-of-osteoarthritis-in-new-zealand
#3
Ross Wilson, J Haxby Abbott
OBJECTIVE: To describe the construction and preliminary validation of a new population-based microsimulation model developed to analyse the health and economic burden and cost-effectiveness of treatments for knee osteoarthritis (OA) in New Zealand (NZ). METHOD: We developed the New Zealand Management of Osteoarthritis (NZ-MOA) model, a discrete-time state-transition microsimulation model of the natural history of radiographic knee OA. In this article, we report on the model structure, derivation of input data, validation of baseline model parameters against external data sources, and validation of model outputs by comparison of the predicted population health loss with previous estimates...
January 10, 2018: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/29330699/accounting-of-ghg-emissions-and-removals-from-forest-management-a-long-road-from-kyoto-to-paris
#4
REVIEW
Joachim H A Krug
BACKGROUND: Forests have always played an important role in agreeing on accounting rules during the past two decades of international climate policy development. Starting from activity-based gross-net accounting of selected forestry activities to mandatory accounting against a baseline-rules have changed quite rapidly and with significant consequences for accounted credits and debits. Such changes have direct consequences on incentives for climate-investments in forestry. There have also been strong arguments not to include forests into the accounting system by considering large uncertainties, procedural challenges and a fear of unearned credits corrupting the overall accounting system, among others...
January 3, 2018: Carbon Balance and Management
https://www.readbyqxmd.com/read/29328796/eappendicitis-diagnostic-uncertainty-in-appendicitis-and-the-role-of-ehealth-does-it-help
#5
Jeremy Batt, James Kynaston, James Oliver
The availability of medical information on the World Wide Web has grown as information technology has become more accessible. Patients seeking online information may be able to selfselect conditions having been adequately informed. This study evaluates the effect of eHealth information on those presenting to hospital with a suspected appendicitis and its effect on their management and clinical outcome. Patients who had performed online reading were more likely to go to theatre but were less likely to have a confirmed histological diagnosis of appendicitis...
November 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29327894/cell-therapy-for-heart-disease-current-status-and-future-directions
#6
Arunpreet Kahlon, Gaurang Vaidya, Roberto Bolli
Treatment of ischemic heart disease has evolved considerably over time, seeing a technological impetus in recent times. Prompt diagnosis and progressively earlier reperfusion of the infarct artery have become the cornerstone of the early myocardial ischemia management. However, treatment of post-infarction sequelae resulting from ischemic damage sustained within the myocardium remains a considerable challenge. In this setting, stem cell therapy has emerged as an exciting regenerative modality with a promise to arrest or even reverse the pathological myocardial remodeling...
January 10, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29327140/children-s-experiences-of-congenital-heart-disease-a-systematic-review-of-qualitative-studies
#7
REVIEW
Lauren S H Chong, Dominic A Fitzgerald, Jonathan C Craig, Karine E Manera, Camilla S Hanson, David Celermajer, Julian Ayer, Nadine A Kasparian, Allison Tong
We aimed to describe the experiences of children and adolescents with congenital heart disease (CHD). Electronic databases were searched until August 2016. Qualitative studies of children's perspectives on CHD were included. Data was extracted using thematic synthesis. From 44 studies from 12 countries involving 995 children, we identified 6 themes: disrupting normality (denying the diagnosis, oscillating between sickness and health, destabilizing the family dynamic), powerlessness in deteriorating health (preoccupation with impending mortality, vulnerability to catastrophic complications, exhaustion from medical testing), enduring medical ordeals (traumatized by invasive procedures, disappointed by treatment failure, displaced by transition, valuing empathy and continuity in care, overcoming uncertainty with information), warring with the body (losing stamina, distressing inability to participate in sport, distorted body image, testing the limits), hampering potential and goals (feeling disabled, unfair judgment and exclusion, difficulties with academic achievement, limiting attainment and maintenance of life milestones), and establishing one's own pace (demarcating disease from life, determination to survive, taking limitations in their stride, embracing the positives, finding personal enrichment, relying on social or spiritual support)...
January 11, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29323209/hydrological-simulation-and-uncertainty-analysis-using-the-improved-topmodel-in-the-arid-manas-river-basin-china
#8
Lianqing Xue, Fan Yang, Changbing Yang, Guanghui Wei, Wenqian Li, Xinlin He
Understanding the mechanism of complicated hydrological processes is important for sustainable management of water resources in an arid area. This paper carried out the simulations of water movement for the Manas River Basin (MRB) using the improved semi-distributed Topographic hydrologic model (TOPMODEL) with a snowmelt model and topographic index algorithm. A new algorithm is proposed to calculate the curve of topographic index using internal tangent circle on a conical surface. Based on the traditional model, the improved indicator of temperature considered solar radiation is used to calculate the amount of snowmelt...
January 11, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29321159/impact-of-specialist-palliative-care-on-coping-with-parkinson-s-disease-patients-and-carers
#9
Nathan J Badger, Dorothy Frizelle, Debi Adams, Miriam J Johnson
OBJECTIVES: UK guidelines recommend palliative care access for people with Parkinson's disease; however, this remains sporadic, and it is unknown whether specialist palliative care helps patients and carers cope with this distressing condition. This study aimed to explore whether, and how, access to specialist palliative care services affected patients' and carers' coping with Parkinson's disease. METHODS: Semistructured interviews were conducted, audio-recorded and verbatim transcribed...
January 9, 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29320603/drug-management-for-acute-tonic-clonic-convulsions-including-convulsive-status-epilepticus-in-children
#10
REVIEW
Amy McTague, Timothy Martland, Richard Appleton
BACKGROUND: Tonic-clonic convulsions and convulsive status epilepticus (currently defined as a tonic-clonic convulsion lasting at least 30 minutes) are medical emergencies and require urgent and appropriate anticonvulsant treatment. International consensus is that an anticonvulsant drug should be administered for any tonic-clonic convulsion that has been continuing for at least five minutes. Benzodiazepines (diazepam, lorazepam, midazolam) are traditionally regarded as first-line drugs and phenobarbital, phenytoin and paraldehyde as second-line drugs...
January 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29318007/severe-haematuria-of-lower-urinary-tract-origin-with-low-dose-dabigatran-use-in-three-indian-elderly-patients-unresolved-issues-in-the-safety-of-novel-oral-anticoagulants
#11
Upinder Kaur, Sankha Shubhra Chakrabarti, Sukdev Manna, Indrajeet Singh Gambhir
Dabigatran is a newer oral direct thrombin inhibitor approved by the United States Food and Drug Administration and the European Medicines Agency (EMA). The proper dosage of the drug, the potential for adverse drug reactions and the nature of bleeds with use of this drug as with other novel oral anticoagulants (NOACs), in the elderly population are still areas of uncertainty. Despite the existence of a specific antibody, idarucizumab which is an antidote to dabigatran toxicity, management of dabigatran-induced bleeds is an undefined area especially in resource constrained settings...
January 2018: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/29317954/a-multiple-treatment-comparison-of-eleven-disease-modifying-drugs-used-for-multiple-sclerosis
#12
Vida Hamidi, Elisabeth Couto, Tove Ringerike, Marianne Klemp
Background: Several disease-modifying drug therapies are available for the treatment of multiple sclerosis (MS). To ensure the most appropriate MS management, we assessed the effectiveness and cost-effectiveness of the disease-modifying medicines used for MS. Methods: We conducted a systematic review including 11 disease-modifying drugs used for treatment of adult patients diagnosed with relapsing-remitting MS. We performed a network meta-analysis using both direct and indirect evidence...
February 2018: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29317849/is-medical-treatment-of-alcohol-withdrawal-syndrome-a-stag-hunt-challenges-and-opportunities-in-managing-risk-and-uncertainty-in-addiction-cessation
#13
Roger Lee Mendoza
Purpose: While the individual and social costs of alcoholism or alcohol use disorder are well established, few are aware that medical problems can arise during detoxification, some of which can be life-threatening. This study determines if sustained treatment for Alcohol Withdrawal Syndrome (AWS) might be based on the strategic choices and expectations of patients and health care providers alike, as well as the risk mitigation options available to them. Design/approach: AWS was modeled as a Stag Hunt to explain both risk and decision-making in medical treatments for detoxification, since it can deduce a set of equilibrium strategies available to both patient and provider...
2018: Risk Management and Healthcare Policy
https://www.readbyqxmd.com/read/29317139/female-gender-and-mortality-risk-in-decompensated-heart-failure
#14
Domenico Scrutinio, Pietro Guida, Andrea Passantino, Rocco Lagioia, Rosa Raimondo, Mario Venezia, Enrico Ammirati, Fabrizio Oliva, Miriam Stucchi, Maria Frigerio
BACKGROUND: Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). METHODS: We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1year...
January 6, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29316514/risk-based-cost-benefit-analysis-for-evaluating-microbial-risk-mitigation-in-a-drinking-water-system
#15
Viktor Bergion, Andreas Lindhe, Ekaterina Sokolova, Lars Rosén
Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant...
December 27, 2017: Water Research
https://www.readbyqxmd.com/read/29316189/acute-lumbar-paraspinal-compartment-syndrome-a-systematic-review
#16
REVIEW
William Alexander, Nelson Low, George Pratt
While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro-osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of 'paraspinal compartment syndrome' revealed 21 articles. The details from a case encountered by the authors are also included...
January 8, 2018: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29316137/have-we-really-demonstrated-the-cardiovascular-safety-of-antihyperglycemic-drugs-rethinking-the-concepts-of-macrovascular-and-microvascular-disease-in-type-2-diabetes
#17
REVIEW
Milton Packer
A primary goal of the treatment of type 2 mellitus is the prevention of morbidity and mortality due to cardiovascular disease. However, antihyperglycemic drugs have the capacity to cause deleterious effects on the circulation, a risk that is not adequately reflected by the endpoints selected for emphasis in large-scale clinical trials that are designed to evaluate cardiovascular safety. The primary endpoint of the large-scale studies mandated by regulatory authorities focuses only on 3-4 events that depict only a limited view of the circulatory system...
January 5, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29314320/patient-agitation-and-its-management-in-adult-critical-care-a-systematic-review-and-narrative-synthesis
#18
REVIEW
Samantha Freeman, Janelle Yorke, Paul Dark
AIM: To critically review the evidence relating to the management of agitation within the Adult Critical Care Unit (ACCU) environment and identify any risks and benefits of current management strategies. BACKGROUND: Admission to an ACCU can be traumatic and potentially life altering for the patient. Patient agitation is common in ACCUs and is associated with the potential for harm. Despite inherent safety risks, there is a paucity of evidence-based guidance underpinning the care of agitation in patients with critical illness...
January 4, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29311470/associations-between-lifestyle-related-diseases-and-transporters-involved-in-intestinal-absorption-and-biliary-excretion-of-cholesterol
#19
Yoshihide Yamanashi, Tappei Takada, Hiroshi Suzuki
Westernization of dietary habits leads to an increase in lipid intake and is thought to be responsible for an increase in patients with dyslipidemia. It is a well-known fact that the impaired cholesterol homeostasis is closely related to the development of various lifestyle-related diseases such as fatty liver, diabetes, and gallstone as well as dyslipidemia leading to atherosclerosis and cardiovascular diseases such as heart attack and stroke. Therefore, appropriate management of cholesterol levels in the body is considered important in prevention and treatments of these lifestyle-related diseases and in addition, molecular mechanisms controlling plasma (and/or hepatic) cholesterol levels have been intensively studied...
2018: Biological & Pharmaceutical Bulletin
https://www.readbyqxmd.com/read/29310703/management-of-persistent-epistaxis-using-floseal-hemostatic-matrix-vs-traditional-nasal-packing-a-prospective-randomized-control-trial
#20
Scott Murray, Adrian Mendez, Alexander Hopkins, Hamdy El-Hakim, Caroline C Jeffery, David W J Côté
BACKGROUND: Epistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis...
January 8, 2018: Journal of Otolaryngology—Head & Neck Surgery
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