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Background: ctDNA is an alternative test for detecting mutation of EGFR in lung cancer type adenocarcinoma if the tissue speciment can not be carried out. Sensitivity, specificity and accuration of ctDNA test is stil varied. This study is aimed to acknowledge sensitivity, specificity and accuration of ctDNA in detecting EGFR mutation in patient with lung cancer type adenocarcinoma in M Djamil Hospital. Methods: Design this study a diagnostik test comparing ctDNA to tissue speciment in detection EGFR mutation of 42 patients with lung cancer type adenocarcinoma in M Djamil Hospital. Sample was selected through consecutive technique. Results: Incidence of EGFR mutation in patients with lung cancer type adenocarcinoma from tissue speciment was higher than ctDNA ((42,9% vs 28,6%; p=0,031). There was significant diffierence of EGFR mutation detection between sex, smoking status, and TNM staging based on tissue/cytology examination and ctDNA (p=0,031). EGFR mutation in sitologic test and ctDNA was more likely detected in male patient (66.7% and 58.3%), ex-smoker (50% and 41.7%) and stage IV (88.9% and 91.7%). The results of sensitivity, specificity positive prediction value (PPV) and Negative prediction value (NPV) in ctDNA test to detect EGFR mutation were 66,7%, 100%, 100% dan 80% according to sitology test as gold standard. Furthermore, the ctDNA accuration was measured according to AUC score 0.833 (SE 0,072, CI 95%, 0,693-0,974, p=0.0001). Conclusion: ctDNA test have a good accuration with sensitiviy 66.7% and specificity 100% in detecting EGFR mutation in patients with lung cancer type adenocarcinoma.

Filler injections have become very popular in recent decades. Of the various injection procedures, lip injection is an important aspect of filler injection, especially for Caucasian patients. Asians tend to have fuller lips than Caucasians, necessitating a different approach to lip injection. Classification systems for the lip for aesthetic treatment purposes can help a physician assess a patient accordingly, and a simple classification of Asian lips into four types for injection approaches is proposed in this paper. Each patient type is discussed in terms of trait and categorization, injection area, injection techniques, injection goals, and sample patients with treatment results.

Introducción: Las fracturas del extremo distal de radio son un gran tema de controversia debido a su gran variabilidad de patrones radiológicos como de tipo de paciente. La discordancia clínico radiológica sigue sin resolver cual es el mejor método. Decidimos desarrollar nuestra experiencia con fijación externa y realizar una breve revisión sobre el tema. Objetivo: Se realizó una búsqueda bibliografía por dos de los buscadores más completos y actualizados sobre salud acerca de todo le referente a fracturas de extremo distal de radio tratados con fijadores externos en los últimos 30 años. Materiales y métodos: Se realizó una búsqueda con las siglas “fracture distal radius with external fixator” en el MEDLINE y ProQuest Health & Medical Complete donde se obtuvieron 1367 artículos en total de los cuales se seleccionaron 243 artículos que respondían a nuestro interés. Resultados y conclusiones: Los datos que obtuvimos fueron muy satisfactorios con respecto al tratamiento de fracturas del radio con fijadores externos. Podemos concluir que es un método indiscutido en algunos tipos de fracturas, que promueven el respeto a las partes blandas y al tratamiento biológico de las fracturas sin olvidarnos de la rápida rehabilitación que se logra con el fijador externo.

Common cause analysis of learning opportunities identified in a peer collaborative improvement process can gauge the potential risk to patients and opportunities to improve. To study rates of learning opportunities based on radiologist assignment, patient type and exam priority at an academic children’s hospital with 24/7 in-house attending coverage. Actively submitted peer collaborative improvement learning opportunities from July 2, 2016, to July 31, 2018, were identified. Learning opportunity rates (number of learning opportunities divided by number of exams in each category) were calculated based on the following variables: radiologist assignment at the time of dictation (daytime weekday, daytime weekend and holiday, evening, and night) patient type (inpatient, outpatient or emergency center) and exam priority (stat, urgent or routine). A statistical analysis of rate differences was performed using a chi-square test. Pairwise comparisons were made with Bonferroni method adjusted P-values. There were 1,370 learning opportunities submitted on 559,584 studies (overall rate: 0.25%). The differences in rates by assignment were statistically significant (P

Objective: This study aimed to understand the influencing factors of treatment completion among pulmonary tuberculosis (PTB) patients in Anhui province, eastern People's Republic of China, in order to provide scientific evidence for improving the follow-up rate and treatment completion rate. Methods: A total of 262 PTB patients in six counties (districts) of Anhui province were investigated by questionnaire, and data about treatment interruption were collected. Results: The main causes of treatment interruption were forgetting to take medicine (24.5%), drug side effects (23.3%), and symptomatic improvement (19.5%). The education background, patient type, cause of interruption, and tracking method were factors influencing completion of treatment (all P

Purpose To determine the layperson's esthetic preference to the visual display (presence) or lack thereof (absence) of the interdental papillae during minimum smiling or the low smile line patient type. Materials and methods Two hundred lay-people were shown three-paired smile images indicative of a low gingival smile line patient type in which the vermillion border of the maxillary lip covered the mid-facial gingiva of the anterior teeth. The three images differed only with respect to [1] presence of interdental papillae, [2] absence of the interdental papilla ("black triangle"), or [3] absence of the interdental papillae (replaced with a long restorative contact area). The three images were paired in multiple groupings; group-1 consisted of a comparison of the presence of interdental papillae vs the lack of the interdental papillae "black triangle," group-2 compared the long restorative contact compared to the presence of the interdental papillae and Group-3 compared the long restorative contact replacing a missing papilla to the absence of the interdental papillae "black triangle." The comparisons were designed to determine the subjective preference of lay individuals between these groupings. Results Ninety-eight percent of lay-people demonstrated a preference to the presence of the interdental papillae in the smile (image 1) when compared to its absence ("black triangle"; image 2) with a low smile line. Seventy percent preferred the visual display of the interdental papillae, that is, pink tissues (image 1), compared to the absence of the interdental papillae replaced with a long contact area (image 3), that is, white restorative materials, when viewing a low gingival smile line. And when comparing the absence of the interdental papillae "black triangle" to a long contact area, 92% of lay-people preferred a long contact area vs the absence of the interdental papillae with a "black triangle" with a low smile line. Conclusions The visual display [presence] of the interdental papillae, that is, pink tissues, is notably preferred to the absence of the interdental papillae when replaced by either a "black triangle" or long contact area in the commonly known low smile line. This emphasizes the need to assess the Interdental Smile Line (ie, visual display of interdental papillae during smiling) in all patients and the importance to preserve and/or re-establishment of the interdental papillae, that is, pink tissues, even in patients with a low smile line.

Background: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder of the gastrointestinal tract that requires lifetime management. Many studies have attempted to establish questionnaires and/or parameters to assess the quality of care for IBD patients. However, no study to date has investigated patients using Q-methodology, which is subjective and has been systematically studied, to identify and categorize their opinions and subjective thinking about their disease and treatment. Therefore, here we aimed to preliminarily examine Q-methodology to investigate the subjective thinking of IBD patients in Korea.Methods: Q-methodology, a method of analyzing the subjectivity of questionnaire items, was examined in this study. At Haeundae Paik Hospital, 50 IBD patients were classified into 34 normalized statements using a 9-point scale with a normal distribution. The collected data were analyzed using the QUANL PC program.Results: Using the Q-methodology, IBD patients were classified into type I, II, III, and IV treatment needs: medical staff–dependent, relationship-oriented, information-driven, and social awareness, respectively.Conclusion: The subjective needs and thoughts about the treatment of IBD patients can be classified into four types. Our findings suggest that we can establish a systematic strategy for personalized care according to patient type.

SUMMARY Umbilical reconstruction is a procedure with widespread indications in the setting of congenital or postsurgical loss. Reconstruction of the umbilicus when no remnant of the natural umbilicus is present is also called neoumbilicoplasty. Numerous neoumbilicoplasty techniques have been published, including cartilage grafts, full-thickness skin grafts, and multiflap reconstruction. No consensus has been reached regarding an optimal technique, and many procedures involve complicated designs with small flaps that are difficult to reproduce or explain. The authors divide patients into three types depending on the thickness of the adipose layer of the abdomen. With appropriate patient selection and minor variations depending on patient type, the technique can be applied to all patients. The umbilicus is marked in the appropriate position. Local anesthesia is infiltrated, and the area beneath the skin is defatted. The dermis is then applied to the underlying fascia with a superior shift. The authors describe the technique and its variations and present one illustrative case with additional supplemental digital content. The authors have gone through a progression of techniques to find a simple surgical method yielding consistently reproducible results with minimal complexity, limited morbidity, and an aesthetic final outcome. The authors believe that the technique described here achieves those goals. It can be performed under local anesthetic and with a simple occlusive dressing so that the patient can go on with most of his or her daily activities. There is no scar to suggest a surgical procedure, and patients are extremely happy with the aesthetic outcomes.

BACKGROUND Observation status could improve efficiency of healthcare resource use but also might shift financial burdens to patients and hospitals. Although the use of observation stays has increased for adult patient populations, the trends are unknown among hospitalized children. OBJECTIVE The goal of this study was to describe recent trends in observation stays for pediatric populations at children's hospitals. DESIGN, SETTING, AND PARTICIPANTS Both observation and inpatient stays for all conditions were retrospectively studied using the Pediatric Health Information System database (2010 to 2019). EXPOSURE, MAIN OUTCOMES, AND MEASURES Patient type was classified as inpatient or observation status. Main outcomes included annual percentage of observation stays, annual percentage of observation stays having prolonged length of stay (>2 days), and growth rates of observation stays for the 20 most common conditions. Risk adjusted hospital-level use of observation stays was estimated using generalized linear mixed-effects models. RESULTS The percentage of observation stays increased from 23.6% in 2010 to 34.3% in 2019 (P < .001), and the percentage of observation stays with prolonged length of stay rose from 1.1% to 4.6% (P < .001). Observation status was expanded among a diverse group of clinical conditions; diabetes mellitus and surgical procedures showed the highest growth rates. Adjusted hospital-level use ranged from 0% to 67% in 2019, indicating considerable variation among hospitals. CONCLUSION Based on the increase in observation stays, future studies should explore the appropriateness of observation care related to efficient use of healthcare resources and financial implications for hospitals and patients.

Introduction: The aim of this study was to investigate the accelerated emergence of telepractice in speech language pathology during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong-a small city with limited accessibility concern that telepractice has not been widely implemented. Method: An online survey of speech therapists in Hong Kong was conducted between February and March in 2020. The survey comprised up to 15 questions to assess participants' demographics, existing service delivery in telepractice, perception, and their training and knowledge on telepractice. Results: One hundred thirty-five speech (n = 135) speech language pathologists responded to the survey. About one-third (34.8%; n = 47) of participants reported having provided services through telepractice, whereas 72.3% of them started in

To compare two-dimensional (2D) and 3D imaging of the left ventricular outflow tract (LVOT) and to evaluate geometric changes pre- to post-cardiopulmonary bypass (CPB).Retrospective review of intraoperative transesophageal echocardiographic examinations.Single academic medical center.The study comprised 69 cardiac surgical patients-27 with aortic valve stenosis (AS) and 42 without AS.Two-dimensional and 3D analysis of the LVOT pre- and post-CPB.Pre- and post-CPB 2D assessment of LVOT diameter (2D LVOTd) was compared with 3D analysis of the minor (3D LVOTd-min) and major diameters. LVOT areas (LVOTa) were calculated using LVOTd to yield 2D LVOTa and 3D LVOTa-min. These were compared with LVOTa measured by planimetry (3D LVOTa-plan). An ellipticity ratio (ER) (ER = 3D minor/major axes) was calculated. The 2D LVOTd was larger than the 3D LVOTd-min before (2.12 v 2.02 cm respectively (resp); p0.001) and after (1.96 v 1.85 cm resp; p = 0.04) CPB. Compared with pre-CPB, there were significant decreases in the 2D LVOTd (p = 0.003) and the 3D LVOTd-min (p0.001) post-CPB. Ellipticity increased after CPB (ER 0.80 v 0.75; p = 0.004), and the 2D LVOTa was larger than the 3D LVOTa-min before CPB (3.60 cmThe LVOT is smaller and more elliptical after CPB. Patients with AS have a smaller LVOT compared with non-AS patients. LVOTa calculated using LVOTd underestimates the 3D LVOTa-plan by as much as 23% depending on patient type and timing of measurement. Accurate assessment of the LVOT requires 3D imaging.

Objective While there has been a substantial increase in health information exchange, levels of outside records use by frontline providers are low. We assessed whether integration between outside data and local data results in increased viewing of outside records, overall and by encounter, provider, and patient type. Materials and Methods Using data from UCSF Health, we measured change in outside record views after integrating the list of local (UCSF) and outside (other health systems on Epic [Epic Systems, Verona, WI]) encounters on the Chart Review tab. Previously, providers only viewed records from outside encounters on a separate tab. We used an interrupted time series design (with outside record viewing event counts aggregated to the week level) to measure changes in the level and trend over a 1-year period. Results There was a large increase in the level of outside record views of 22 920 per week (P Discussion While outside records were readily available before the encounter integration, the simple step of clicking on a separate tab appears to have depressed use. Conclusions User interface designs that comingle local and outside data result in higher levels of viewing and should be more broadly pursued.

The right amount and quality of amino acids (AAs) supplied to patients on parenteral nutrition (PN) reduces muscle mass loss, may preserve or even increase it, with significant clinical benefits. Several industrial PN mixtures are available so that nutrition specialists can choose the product closest to the patient’s needs. In selected cases, there is the possibility of personalizing compounded mixtures in a hospital pharmacy that completely meets the individual nutritional needs of PN patients. This narrative review deals with the AA solutions used in PN mixtures. The physiology, the methods to calculate the AA needs, and the AA and energy requirements suggested by scientific guidelines for each patient type are also reported.

Introduction Little is known about the requests for and recommendations from inpatient pediatric palliative care (PPC) consults and whether they differ by patient location (ward vs. intensive care unit) or patient type (new vs. established with PPC). Methods Single-center, retrospective cohort study comparing PPC consult requests and recommendations for children who received a PPC consult between January 1, 2018 and June 30, 2019. Comparisons were made by patient location and patient type using bivariate statistics. Results Three hundred twenty-seven PPC encounters were evaluated. Symptoms were more likely to be addressed in consults for ward patients than for intensive care unit patients. Compared with established patients, consults for new patients occurred significantly later in the hospital course and were more likely to be for psychosocial support or goals of care. Discussion We found variability in PPC consult requests and recommendations that may inform future work and targeted education for primary providers.

Objectives To determine the impact of systemwide charge display on laboratory utilization. Methods This was a randomized controlled trial with a baseline period and an intervention period. Tests were randomized to a control arm or an active arm. The maximum allowable Medicare reimbursement rate was displayed for tests in the active arm during the intervention period. Total volume of tests in the active arm was compared with those in the control arm. Residents were surveyed before and after the intervention to assess charge awareness. Results Charge display had no effect on order behavior. This result held for patient type (inpatient vs outpatient) and for insurance category (commercial, government, self-pay). Residents overestimated the charges of tests both before and after the intervention. Many residents failed to notice the charge display in the computerized order entry system. Conclusions The impact of charge display depends on context. Charge display is not always effective.

The accompanying article by Groat et al in this issue presents a methodology to compare glucose outcomes from insulin bolus dose recommendations observed retrospectively from a novel iDecide bolus calculator with glucose outcomes from the prospective bolus recommendations provided by a current insulin pump. The methodology in this article evaluates a bolus calculator algorithm and also evaluates calculations for two additional lifestyle behaviors, exercise and alcohol intake, that are modifiable risk factors associated with diabetes. This methodology for evaluation of glycemic outcomes from bolus calculators could be expanded further using much larger existing bolus calculator databases. This would complement current verifications done through in-silico testing with the University of Virginia/Padua 300 patient type 1 diabetes simulator. This approach merits serious consideration, yet the actual dose recommendations provided by the iDecide calculator introduce wider lessons on how bolus calculator glucose outcomes might be better optimized.

Patient heterogeneity in disease progression is prevalent in many settings. Treatment decisions that explic-itly consider this heterogeneity can lower the cost of care and improve outcomes by providing the right carefor the right patient at the right time. In this paper, we analyze the problem of designing ongoing treat-ment plans for a population with heterogeneity in disease progression and response to medical interventions.We create a model that learns the patient type by monitoring the patient health over time and updates apatient’s treatment plan according to the gathered information. We formulate the problem as a multivariatestate-space, partially observable Markov decision process (POMDP) and provide structural properties ofthe value function, as well as the optimal policy. We extend this modeling framework to a general class oftreatment initiation problems where there is a stochastic lead-time before a treatment becomes available oreffective. As a case study, we develop a data-driven, decision-analytic model to study the optimal timing ofvascular access surgery for patients with progressive chronic kidney disease, and we establish policies thatconsider a patient’s rate of disease progression in addition to the kidney health state. To circumvent thecurse of dimensionality of the POMDP, we develop several approximate policies, as well as simpler heuristics,and evaluate them against a high-quality lower-bound. Through a numerical study and several sensitivityanalyses, we establish the high quality and robustness of an approximate policy that we develop. We providefurther policy insights that sharpen existing guidelines for the case-study problem.

Diabetes melitus type 2 is one of disease that frequently happen and the prevalensi rate in a society tend to increase and this is an annual disease for the rest of our life. The purpose of this research is to find out the effect of glicemic in addition of black cumin oil to HbA1c (%) diabetes melitus type 2’s content. This research is an experimental research with pretest post test control group design. The subject in this research is diabetes melitus patient type 2 in Deli Serdang Region Hospital based on the inclution and exclution criteria in October2018 with total of 22 person which grouped into standart and control group. Each group (n=11) had been checked for their HbA1c (%) at the beginning and at the end research for 8 weeks. In control group’s patients had been given 500mg black cumin oil once a day as the addition of metformin. This research technique using purposive sampling and analyzing the data with paired sample t test with normality test using Shapiro-Wilk test. The result from this research that is we can see the HbA1c (%) average (last inspection) on patient with treatment (8,0889) is lower than the average HbA1c last inspection) on patient without treatment (8,4778). The result pairedsample t test P value = 0,017. There is a significant derivation with the diabetes melitus type 2 patients that had been treat with black cumin oil. Keywords: Black cumin oil, Diabetes, Poor glycemic control, Glycated hemoglobin (HbA1C)

There has been considerable research on developing symptom clusters for cancer patients but finding a consistent and replicable typology of patients in terms of the kinds of symptoms they experience remains elusive (e.g., [1]). One reason for lack of consensus may be that analyses are unfocused, and use different combinations of clustering variables. This paper identifies subgroups of similar cancer patients within a sample of 18,535 patients, based on the Edmonton Symptom Assessment System (ESAS) and also a set of inpatient and outpatient variables using linked administrative sources of Ontario healthcare data. K-means cluster analysis was performed on cancer patients having only one primary cancer type, and who had at least one emergency department (ED) visit. Only variables that had a Pearson correlation of at least 0.1 with the number of days until visiting an ED, after an assessment, were included in the cluster analysis. While information about next emergency department visit was not included as a clustering variable, the number of patient types was chosen so as to minimize the mean absolute error of predictions of next emergency department visits by cancer patients. The next emergency department visit, after the last assessment date of each patient, was predicted for each cluster solution. The cluster solution with maximum accuracy/minimum MAE was used to derive the final set of patient types. With the help of physicians, and guided by the results of these analyses, a description of each patient type was created. Based on our results we grouped cancer patients into four types that differ in terms of type of cancer, stage of cancer, and symptomology. Implications for symptom management and reduction of ED visits are discussed.

Background The provision of Emergency Obstetric and Neonatal Care (EmONC) is critical for reducing maternal mortality, yet little is known about the costs of EmONC services in developing countries. This study estimates these costs at six health facilities in Tanzania's Kigoma region. Methods The study took a comprehensive programmatic approach considering all sources of financial and in-kind support over a 1-year period (1 July 2012 to 30 June 2013). Data were collected retrospectively and costs disaggregated by input, sources of support, programmatic activity, and patient type (nonsurgical, surgical patients, and among the latter patients undergoing caesarean sections). Results The median per-patient cost across the six facilities was $290. Personnel and equipment purchases accounted for the largest proportions of the total costs, representing 32% and 28%, respectively. Average per-patient costs varied by patient type; cost per nonsurgical patient was $80, $258 for surgical patients and $426 for patients undergoing caesarean sections. Per-patient costs also varied substantially by facility type: mean per-patient cost at health centres was $620 compared with $169 at hospitals. Conclusions This study provides the first cost estimates of EmONC provision in Kigoma. These estimates could inform programme planning and highlight areas with potential scope for cost reductions.

Background: High blood pressure is one of the four values used for monitoring a patient’s health condition. However, there are no reports on this parameter in relation to populations at different geographical altitudes. This study’s main objective was to determine the mean values of blood pressure according to patient characteristics and geographic altitude of residence in Peru. Methods: This was a multicenter, cross-sectional study, taken by convenience sampling. Patients lived for more than six months in cities with altitudes ranging from sea level to 5100 meters above mean sea level (mamsl). Data was categorized using 2000-m ranges and obtained from normotensive patients with hypertension (HTN) with and without treatment. P values were obtained using a multivariate analysis using Stata (Stata Corp, Texas, USA).Results: Of the 5,236 participants, 3,305(63%) were women, and the median age was 42 years. The median systolic/diastolic blood pressures (mmHg) were 110/70, 115.5/75, and 103/63, for 0-2000 mamsl, 2001-4000 mamsl, and 4001-5100 mamsl, respectively (p < 0.001). When data was adjusted according to patient characteristics, most of the differences in values were statistically significant for treated hypertensive (systolic p < 0.001; diastolic p = 0.243) and normotensive (systolic and diastolic p < 0.001), compared to untreated hypertensive patients. Conclusion: The blood pressure values varied with the altitude of residence and type of patient. Furthermore, these parameters should be taken into account as reference values by physicians working at different geographical altitudes for management of their patients.

In hospitals, the operating room (OR) is a particularly expensive facility and thus efficient scheduling is imperative. This can be greatly supported by using advanced methods that are discussed in the academic literature. In order to help researchers and practitioners to select new relevant articles, we classify the recent OR planning and scheduling literature into tables regarding patient type, used performance measures, decisions made, OR up- and downstream facilities, uncertainty, research methodology and testing phase. Based on these classifications, we identify trends and promising topics. Additionally, we recognize three common pitfalls that hamper the adoption of research results by stakeholders: the lack of a clear choice of authors on whether to target researchers (contributing advanced methods) or practitioners (providing managerial insights), the use of ill-fitted performance measures in models and the failure to understandably report on the hospital setting and method-related assumptions. We provide specific guidelines that help to avoid these pitfalls. First, we show how to build up an article based on the choice of the target group (i.e., researchers or practitioners). Making a clear distinction between target groups impacts the problem setting, the research task, the reported findings, and the conclusions. Second, we discuss points that need to be considered by researchers when deciding on the used performance measures. Third, we list the assumptions that need to be included in articles in order to enable readers to decide whether the presented research is relevant to them.

Weaning from mechanical ventilation involves the reduction or withdrawal of ventilatory support in proportion to the patient's ability to sustain spontaneous ventilation. Protocolized weaning has been shown to reduce weaning duration; however, its weakness lies in the reliance on human intervention. Automated weaning is theoretically superior to manual weaning because of its ability to rapidly recognize deviations from desired behavior and enforce compliance with a standardized weaning strategy unencumbered by external influences. Whether currently available methods for automated weaning fulfill that potential to achieve superiority depends on patient type, care environment, and cause of ventilator dependence.

Aim: Exploring the impact of nephropathy patient characteristics on length of stay (LOS) grading, proposing a path of LOS classification based on the characteristics of patients, and providing suggestions for the accurate management of shunting of patients with nephropathy patient to promote the sustainable development of the hospital. Methods: The data of inpatients from the Department of Nephrology of a large hospital in 2016 were used, including five variables: gender, age, patient type, medical insurance type, and LOS. Based on quantifying patient attribute variables, We use three steps to finish the grading. Firstly, using the factor analysis to extracte the common factors of patient characteristics. Sencendly, according to the results of factor analysis, using k-means clustering analysis to classify the patients. Finally, According to the characteristics of different types of patients and the law of LOS differences, a LOS classification path based on patient characteristics is proposed. Results: The factor analysis shows that the LOS common factor characteristics are disease characteristics, attribute characteristics and reimbursement ratio characteristics. The k-means clustering indicates that the patients are divided into 5 categories: the mean LOS in category 1 is 15.78, Patient characteristics: Mostly elderly women with the blood resuscitates patients(38.2%) or tumor recovery patients(30.3%), city medical insurance(50%);the mean LOS in category 2 is 10.5, Patient characteristics: Mostly strong men with the ordinary patients(62.5%), City medical insurance(79.2%);the mean LOS in category 3 is 7.62, Patient characteristics: Mostly young men with the other patients(99.7%), Provincial medical insurance(73.1%);the mean LOS in category 4 is 13.7, Patient characteristics: Mostly women in pre-old age with the Ward daytime patient(38.9%) or other patients(31.8%), Urban rural medical insurance(60.6%);the mean LOS in category 5 is 6.73, Patient characteristics: Mostly young men with the other patients(99.3%), Provincial medical insurance(54.4%).According to the characteristic differences among patients and the law of LOS differences, a model of patients’ LOS classification path was proposed. Conclusion: The LOS classification path based on patient characteristics can realize the pre-classification management of patients, which has practical significance for early intervention of hospital resources.

A seller maximizes revenue from selling an object in a dynamic environment, with buyers that differ in their patience: Each buyer has a privately known deadline for buying and a privately known valuation. First, we derive the optimal mechanism, neglecting the incentive constraint for the deadline. The deadline of the winner determines the time of the allocation and therefore also the amount of information available to the seller when he decides whether to allocate to a buyer. Depending on the shape of the markup that the seller uses, this can lead to a violation of the neglected incentive constraint. We give sufficient conditions on the type distribution under which the neglected constraint is fulfilled or violated. Second, for the case that the constraint cannot be neglected, we consider a model with two periods and two buyers. Here, the optimal mechanism is implemented by a fixed price in period one and an asymmetric auction in period two. The asymmetry, which is introduced to prevent the patient type of the first buyer from buying in period one leads to pooling of deadlines at the top of the type space.

The west of Scotland heart and lung centre based at the Golden Jubilee National Hospital houses three national services (heart transplantation, pulmonary hypertension and adult congenital) and all adult cardiothoracic surgery for the region. Recent fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations leading to a desire by senior staff at the centre to review this valued service. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (Simul8) was used to assess if an optimized schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six different types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type’s pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from data stored in Excel files, which were then fitted to the simulation. The model proved successful as it showed figures that were close to what is observed in real life, including average patient LOS in different stages, the maximum and minimum LOS in the system, and most importantly, near-exact cancellation numbers. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results showed that the bottleneck was High Dependency Unit (HDU) beds, which were recovery beds used by most patients. Optimizing the schedule relied on leveling out the daily arrival of patients to HDUs, which caused cancellations to be reduced by 20%. However, coupling this technique with minor capacity reallocations caused cancellations to be reduced by up to 60%, and cancellations were completely eliminated for some patient types.

In this paper we have posited an alternative methodology for the least-cost diet selection problem subject to a given set of nutritional constraints. In order to better address the implicit compliance problem, we have re-cast the classical diet selection problem using a two-stage approach whereby in the first stage the dietician decides on the total number of least-cost combinations which satisfy the nutritional requirements and in the second stage, the dietician finds the optimal number of diet plans that have to be formulated. The second stage basically involves finding a reduced search space n* out of which the dietician will sequentially select one least-cost diet plan after another till a “match” is secured with the patient type to ensurecompliance, which we have argued based on prior literature to be needing more than simply finding the least-cost diet plan. Our posited approach addresses the compliance problem by making it endogenous to the optimal diet selection problem via consideration ...

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.

The methodology helps to identify the most common situations affecting blood glucose control for every single patient.Adjusting insulin therapy to the identified situations leads to more accurate blood glucose control.The insights provided by the method allow doctors and patients to understand and act properly in the daily life situations.The methodology can be easily integrated in the existing commercial platforms based on CGM-CSII systems. BackgroundThe large intra-patient variability in type 1 diabetic patients dramatically reduces the ability to achieve adequate blood glucose control. A novel methodology to identify different blood glucose dynamics profiles will allow therapies to be more accurate and tailored according to patient's conditions and to the situations faced by patients (exercise, week-ends, holidays, menstruation, etc). Materials and methodsA clustering methodology based on the normalized compression distance is applied to identify different profiles for diabetic patients. First, the methodology is validated using "in silico" data from 10 patients in 3 different scenarios: days without exercise, poor controlled exercise days and days with well-controlled exercise. Second, we perform a series of in vivo experiments using data from 10 patients assessing the ability of the proposed methodology in real scenarios. ResultsIn silico experiments show that the methodology is able to identify poor and well-controlled days in theoretical scenarios. In vivo experiments present meaningful profiles for working days, bank days and other situations, where different insulin requirements were detected. ConclusionsA tool for profiling blood glucose dynamics of patients can be implemented in a short term to enhance existing analysis platforms using combined CGM-CSII systems. Besides coping with the information overload, the tool will assist physicians to adjust and improve insulin therapy and patients in the self-management of the disease.

The literature expects PSM to affect behavior and ultimately performance; but little is known about the effect of PSM on actual behavior, since empirical studies typically investigate self-reported performance data. This article, therefore, investigates how PSM (specifically commitment to the public interest) affects the actual, not self-reported, behavior of Danish physiotherapists (n = 556). The analysis is based on register data on individual behavior combined with a web-based survey of PSM. We find that PSM positively affects the proportion of disabled patients. Services to this patient type are less lucrative, but disabled patients are seen as more needy, increasing the perceived contribution to society. The results imply that PSM helps secure the interests of weak and needy groups.

Anamnese und klinischer Befund: Wir berichten uber einen 17 Jahre alten Jungen mit erhohten Blutzuckerwerten, erhohten Leberwerten, Adipositas (BMI 32,3 kg/m2), einer Akanthosis nigricans und einer Vitiligo bei sonst unauffalligem Untersuchungsbefund. Untersuchungen: Der HbA1c-Wert lag bei 8,6 % (71 mmol/mol), die postprandialen C-Peptidwerte bei maximal 1,3 nmol/l. Die Typ-1-Diabetes-assoziierten Autoantikorper gegen die Proteintyrosinphosphatase IA-2 und gegen Zink-Transporter-8 waren positiv, die gegen Glutamatdecarboxylase und Insulin negativ. Es bestand keine Ketonurie. Sonografisch zeigte sich eine Steatosis hepatis. Therapie und Verlauf: Unter Therapie mit Metformin (2×1 g) normalisierten sich Blutzucker- und Leberwerte nach einigen Wochen. Nach 2 Monaten lag der HbA1c-Wert bei 6,0 % (42,1 mmol/mol), und es war bereits eine Gewichtsabnahme von 5 kg zu verzeichnen. Folgerung: Bei adiposen Jugendlichen mit Diabetes ist eine eindeutige Klassifikation von Beginn an nicht immer moglich, und es konnen charakteristische Befunde eines Typ-1- und Typ-2-Diabetes gleichzeitig vorliegen. Beim vorgestellten Patienten war im ersten Jahr die Therapie mit Metformin ausreichend. Engmaschige Kontrollen sind zwingend erforderlich, um den Ubergang in eine Insulinpflichtigkeit rechtzeitig zu erkennen.

This study was to determine the factors that affect the compliance of treatment of tuberculosis patients smear-positive pulmonary in Community Health Centers Cipondoh, Tangerang, Banten, the year 2015-2016. This research design was "case-control". The population was all positive pulmonary tuberculosis patients who received treatment and recorded in the listing sheet of TB-01 of Cipondoh Community Health Centers. Total samples were 35 people which been meet the inclusion and exclusion criteria. The result showed treatment compliance description which was 80% of tuberculosis pulmonary patients obedient to medication. A predisposing factor was 74.3% for men; 82.9% new types of sufferers; 82.9% duration of treatment 6 months. The enabling factor was 37.1% of the distance to the Community Health Centers 1.26 km. The reinforcing factor of 80% did not have supervisor taking medicine. Analysis of the correlation between predisposing factor and compliance of tuberculosis treatment of smear-positive pulmonary, there was no relationship for gender variable, patient type, duration of treatment, and distance of home to Community Health Centers. Analysis of the correlation between reinforcing factor with compliance of tuberculosis treatment of smear-positive obtained no relation for the variable status of supervisor taking medicine.

We have developed a methodology for allocating operating room capacity to specialties. Our methodology consists of a finite-horizon mixed integer programming (MIP) model which determines a weekly operating room allocation template that minimizes inpatients' cost measured as their length of stay. A number of patient type priority (eg emergency over non-emergency patient) and clinical constraints (eg maximum number of hours allocated to each specialty, surgeon, and staff availability) are included in the formulation. The optimal solution from the analytical model is inputted into a simulation model that captures some of the randomness of the processes (eg surgery time, demand, arrival time, and no-show rate of the outpatients) and non-linearities (eg the MIP assumes proportional allocation of demand satisfaction (output) with room allocation (input)). The simulation model outputs the average length of stay for each specialty and the room utilization. On a case example of a Los Angeles County Hospital, we show how the hospital length of stay pertaining to surgery can be reduced.

Objective Develop length of stay prediction models for neonatal intensive care unit patients. Study Design We used data from 2008 to 2010 to construct length of stay models for neonates admitted within 1 day of age to neonatal intensive care units and surviving to discharge home. Results Our sample included 23,551 patients. Median length of stay was 79 days when birth weight was

Over the past several decades healthcare delivery systems have received increased pressure to become more efficient from both a managerial and patient perspective. Many researchers have turned to simulation to analyze the complex systems that exist within hospitals, but surprisingly few have published guidelines on how to analyze models with multiple performance measures. Moreover, the published literature has failed to address ways of analyzing performance along more than one dimension, such as performance by day of the week, patient type, facility, time period, or some combination of these attributes. Despite this void in the literature, understanding performance along these dimensions is critical to understanding the root of operational problems in almost any daily clinic operation. This paper addresses the problem of multiple responses in simulation experiments of outpatient clinics by developing a stratification framework and an evaluation construct by which managers can compare several operationally different outpatient systems across multiple performance measure dimensions. This approach is applied to a discrete-event simulation model of a real-life, large-scale oncology center to evaluate its operational performance as improvement initiatives affecting scheduling practices, process flow, and resource levels are changed. Our results show a reduction in patient wait time and resource overtime across multiple patient classes, facilities, and days of the week. This research has already proven to be successful as certain recommendations have been implemented and have improved the system-wide performance at the oncology center.

The type of sport suggested for Diabetes Mellitus patient is Diabetes Gym, but most societies, especially diabetes mellitus patients are lazy to do it. On diabetes mellitus type 2, diabetes gym acts as glycemic control which manages and control blood sugar rate. This research purposes to know diabetes gym influence toward the decrease of blood sugar rate on Diabetes Mellitus patient type 2 in Puskesmas Pakis Surabaya. This research used quasy experiment design. Total of the population of all Diabetes Mellitus patients type 2 is 28 respondents taken by probability sampling - simple random sampling technique; 14 respondents in control group and 14 respondents in treatment group. The independent variable is Diabetes Gym and the dependent variable is the decrease of blood sugar rate. Data are collected by using Glucometer, striptest, needle and observation sheet. Data are analyzed by using Wilcoxon signed rank test with α < 0.05. The result of this research shows that almost all of the respondents in the treatment group have a good category of blood sugar decrease after performing gym, meanwhile almost all of the respondents in control group that do not perform gym have an adequate category of blood sugar decrease. Then, the result is analyzed by Wilcoxon signed rank test and obtained ρ (0,019) < α (0,05) so H0 is refused. It means that there is an influence of diabetes gym to the decrease of blood sugar on the Diabetes Mellitus patients type 2 in Puskesmas Pakis Surabaya. Performing Diabetes Gym influences in decreasing blood sugar rate. Therefore, nurse can take a part in leading diabetes patients to perform diabetes gym so it can be used as the therapy in controlling and decreasing blood sugar rate.

Current outpatient delivery systems have been problematic in their ability to effectively schedule appointments and grant patients access to care. A better appointment system has demonstrated improvement on these issues. The objective of this study is to develop a grid appointment system to further improve the scheduling flexibility by determining the minimum length of appointment slots that optimizes the total costs of patient waiting, physician idling, and overtime. This minimum length is used for the patient type requiring the least amount of treatment time such as return visit (RV), and multiplications of the minimum length are for patient types with longer treatment such as new patients (NP). The results indicated that the proposed grid system adjusts to demand changes at least 15% more cost-effective when grouping two RVs into an NP or dividing an NP into two RVs compared to the base-line scheduling approaches that build around the mean treatment time.

In the quest for the “ideal” soft tissue filler, many diverse products have been developed. The expanding market of available fillers is a testament that no one product will ideally suit all patients or clinicians. In addition, the challenge of satisfying the criteria of an ideal filler has driven researchers to take a variety of development paths. This has resulted in multiple categories to characterize soft tissue fillers. These fillers are categorized according to: (1) filler material, eg, autologous, natural, synthetic; (2) mechanism of action, eg, void filler, neocollagenesis, fibroblast stimulation; (3) patient type and profile, eg, younger versus older patient, rhytids versus “sinking and sagging” skin; or (4) durability of treatment effects, eg, temporary, semi-permanent, or permanent. Although strategies for soft tissue augmentation may be quite diverse, strategies should share a universal goal to address fat redistribution (atrophy and hypertrophy), the primary underlying morphological cause of facial aging. To accomplish this, volumizers are now available that are injected more deeply, resulting in the restoration of supportive structure and foundation. These can be used in combination with other products that are used more superficially for smoothing skin surfaces. As numerous soft tissue fillers enter the market, mechanisms and injection techniques become more divergent, and therefore require that the dermatologist and cosmetic surgeon receive adequate training to use products safely and effectively. This manuscript provides an overview of soft tissue fillers and their proper use.

This study investigates whether, and how, people's perception of risk and intended health behaviours are affected by whether a medicine is prescribed for themselves or for a young child. The question is relevant to the issue of whether it is beneficial to produce medicines information that is tailored to particular subgroups of the population, such as parents of young children. In the experiment, participants read scenarios which referred either to themselves or their (imagined) 1-year-old child, and were required to make a number of risk judgements. The results showed that both parents and non-parents were less satisfied, perceived side effects to be more severe and more likely to occur, risk to health to be higher, and said that they would be less likely to take (or give) the medicine when the recipient was the child. On the basis of the findings, it is suggested that it may well be beneficial to tailor materials to broader classes of patient type.

Chemotherapy patients are treated with cytostatic drugs. Cytostatic drugs can be produced if ordered or they can be produced to keep in stock. The time that cytostatic drugs can be kept in stock before being spoiled is limited. It is always possible that the patient cannot receive chemotherapy because he/she is not in the right condition. A simulation model is presented which allows to calculate for each combination of patient type and cytostatic drug type the effects on waiting times and costs. In practice actors will behave not as recommended by the simulation model. The cause of the latter is analyzed and solutions are proposed.

An intriguing aspect of the meta-analysis by Chiles, Lambert, and Hatch (this issue) is the finding that medical cost offsets associated with psychological interventions vary across patient populations. Our commentary describes four types of patients: the worried well, the worried unwell, the chronically disabled, and the chronically ill. We suggest the kinds of behavioral medicine interventions most likely to lead to restored health and decreased medical utilization for each patient type, and the changes in research and practice necessary to maximize clinical psychology's impact on physical health intervention.