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Simulation is a helpful preliminary step for implementing a patient workflow management system. Simulation is based on the process model (the clinical practice guideline) and the organization model (human and technological resources), permitting the detection of blockages in the care delivery organization and finding the optimal resource allocation. Our study uses stochastic Petri net (SPN) to illustrate part of the medical practice within a stroke unit. In particular, we modeled the medical activities following the guidelines for the ischemic stroke treatment adopted by the Thai Nguyen National Hospital Stroke Unit. Several parameters have been estimated using a database of about 100 ischemic stroke patients collected and eliciting knowledge from the neurologists. This is the first time we have applied SPN to model and analyze system performance for emergency stroke patients using the SPN model. We can apply it to any medical examination and treatment system if we need to survey the system's capacity. Thereby detecting barriers or limitations of the system to provide solutions to overcome and improve the system's efficiency. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a serious global public health problem. Detecting the changes of adenosine deaminase (ADA), interleukin (IL)-1ß, IL-2, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) released from macrophages and monocytes is greatly valuable in the diagnosis of TB. Hence, this study was designed to determine the optimal cut-off points of ADA, IL-1ß, IL-2, TNF-α, and IFN-γ, allowing to differentiate pleural TB (PLTB), peritoneal TB (PTB), and meningeal TB (MTB). The study included 386 patients with pleural effusion, 47 patients with peritoneal effusion, and 134 patients with encephalitis and meningoencephalitis suspect of TB. ADA was determined by an enzyme kinetics method; cytokine concentration was measured by a test based on the competitive enzyme-linked immunosorbent assay principle. Sensitivity, specificity, and positive and negative predictive value were calculated and described. In the aspiration fluid, ADA activity was greatly different between PLTB, PTB, and MTB groups with values of 37.5 U/L, 30.5 U/L, and 8.1 U/L and sensitivity and specificity of 87.7% and 83.4%; 100% and 88.9%; 97.3% and 98.6%, respectively. Similar, IFN-γ concentrations were distinctively different between PLTB, PTB, and MTB patients (with values of 120 pg/mL, 200 pg/mL, and 30 pg/mL with sensitivity and specificity of 80.3% and 80.9%; 80.0% and 92.6%; 98.6% and 61.7%, respectively). The determination of ADA and IFN-γ levels in the aspiration fluid is potentially considered a highly sensitive and specific test for differentiating PLTB, PTB, and MTB. [ABSTRACT FROM AUTHOR]