A hierarchical multiple criteria mathematical programming approach for scheduling general surgery operations in large hospitals

Limited staff and equipment within surgical services require efficient use of these resources among multiple surgeon groups. In this study, a set of hierarchical multiple criteria mathematical programming models are developed to generate weekly operating room schedules. The goals considered in these models are maximum utilization of operating room capacity, balanced distribution of operations among surgeon groups in terms of operation days, lengths of operation times, and minimization of patient waiting times. Because of computational difficulty of this scheduling problem, the overall problem is broken down into manageable hierarchical stages: (1) selection of patients, (2) assignment of operations to surgeon groups, and (3) determination of operation dates and operating rooms. Developed models are tested on the data collected in College of Medicine Research Hospital at Cukurova University as well as on simulated data sets using MPL optimization package.     

ABC连续性排班与分层级管理在病房中的实施效果评价

目的:探讨ABC连续性排班模式联合分层级管理的临床应用效果.方法:抽取实行新模式前、后5个月中各50例患者及27名护士,进行护理工作的满意度问卷调查,并对护理质量进行对比研究.结果:实行ABC连续性排班模式及分层级管理后,一级、二级护理及病例文书规范、消毒隔离措施、护理安全等评分均较实行前明显提高(P<0.01);且患者对护理质量的评分较实行前明显提高(P<0.01),总分亦显著高于实行前(P<0.01);实行后,护士在护理工作、护士自身感受、医护关系、决策、专业地位、自主性、专业发展、收入、护理行政管理及享受工作方面的满意评分均较实行前明显升高(P<0.05~P<0.01).结论:ABC连续性排班模式联合分层级管理,优化了人力资源,提升了护士及患者对护理工作的满意度,有效地提高了工作效率及整体的护理质量,值得临床推广.     

‘It is Time to Prepare the Next patient’ Real-Time Prediction of Procedure Duration in Laparoscopic Cholecystectomies

Operating Room (OR) scheduling is crucial to allow efficient use of ORs. Currently, the predicted durations of surgical procedures are unreliable and the OR schedulers have to follow the progress of the procedures in order to update the daily planning accordingly. The OR schedulers often acquire the needed information through verbal communication with the OR staff, which causes undesired interruptions of the surgical process. The aim of this study was to develop a system that predicts in real-time the remaining procedure duration and to test this prediction system for reliability and usability in an OR. The prediction system was based on the activation pattern of one single piece of equipment, the electrosurgical device. The prediction system was tested during 21 laparoscopic cholecystectomies, in which the activation of the electrosurgical device was recorded and processed in real-time using pattern recognition methods. The remaining surgical procedure duration was estimated and the optimal timing to prepare the next patient for surgery was communicated to the OR staff. The mean absolute error was smaller for the prediction system (14 min) than for the OR staff (19 min). The OR staff doubted whether the prediction system could take all relevant factors into account but were positive about its potential to shorten waiting times for patients. The prediction system is a promising tool to automatically and objectively predict the remaining procedure duration, and thereby achieve optimal OR scheduling and streamline the patient flow from the nursing department to the OR.     

A MIP Model for Rolling Horizon Surgery Scheduling

Most surgery scheduling is done 1 day in advance. Caused by lack of overall planning, this scheduling scheme often results in unbalanced occupancy time of the operating rooms. So we put forward a rolling horizon mixed integer programming model for the scheduling. Rolling horizon scheduling refers to a scheduling scheme in which cyclic surgical requests are taken into account. Surgical requests are updated daily. The completed surgeries are eliminated, and new surgeries are added to the scheduling list. Considering day-to-day demand for surgery, we develop a non-rolling scheduling model (NRSM) and a rolling horizon scheduling model (RSM). By comparing the two, we find that the quality of surgery scheduling is significantly influenced by the variation in demand from day to day. A rolling horizon scheduling will enable a more flexible planning of the pool of surgeries that have not been scheduled into this main blocks, and hence minimize the idle time of operating rooms. The strategy of the RSM helps balance the occupancy time among operating rooms. Using surgical data from five departments of the West China Hospital (WCH), we generate surgical demands randomly to compare the NRSM and the RSM. The results show the operating rooms’ average utilization rate using RSM is significantly higher than when applying NRSM.     

海上前沿外科手术队编配方案的仿真与优化

目的 探讨海上前沿外科手术队的编配方案,推算相应的技战术指标.方法 借鉴外军前沿外科手术队的理念与经验,通过头脑风暴法和德尔菲法进行勤务咨询,构建海上前沿外科手术队的概念模型和3种编配方案.运用专业仿真软件ProModel对3种方案进行仿真与优化.结果 方案1:适用于1张手术台,编配6人,术后床位2张,昼夜伤员通过量为10人.方案2:适用于2张手术台,编配10人,术后床位4张,昼夜手术量为21人.方案3:适用于3张手术台,编配15人,术后床位6张,昼夜手术量为31人.结论 3种方案的提出、仿真和优化为海上前沿外科手术队的建设提供了决策支持.     

分层次管理对护理人员理论掌握水平和实际操作能力的影响

目的探讨分层次管理应用于临床护理管理中对护理人员理论掌握水平和实际操作能力的影响,为临床护理管理开辟一条新路径。方法选取2010年3月～2013年10月海军总医院78名护理人员作为研究对象,按随机数字表法分为研究组与对照组,每组各39名。其中对照组护理人员采取常规的临床护理管理模式。研究组护理人员采取分层次管理模式。考察并比较管理前后两组护理人员的理论知识掌握水平和实际操作能力,调查患者对护理工作的满意度。结果两组管理前的理论知识水平及操作水平差异无统计学意义（P＞0．05）;管理后,研究组的理论知识水平及操作水平均高于对照组,差异有统计学意义（P＜0．05）。研究组护理人员工作满意度为97．4％,对照组为79．5％,差异有统计学意义（P＜0．05）。结论分层次管理应用于临床护理管理是一条切实可行的新途径,可有效提升护理人员的理论水平与实际操作能力,有利于提高患者对护理工作的满意度,增近护患关系,减少护患纠纷,值得在临床上进一步推广。     

安徽省紧密型城市医联体核心医院医务人员对双向转诊运行现状的认知及满意度研究

目的 探讨安徽省紧密型城市医联体核心医院医务人员对双向转诊运行现状的认知、满意度及影响因素,为提升医疗卫生服务的连续性,推进分级诊疗制度落地做实。方法 采用多阶段分层随机抽样抽取皖中合肥市第二人民医院紧密型城市医联体、皖北宿州市立医院紧密型城市医联体和皖南池州市人民医院紧密型城市医联体核心医院的511名医务人员为调查对象。采用自制问卷调查医务人员对双向转诊运行现状的认知和满意度情况,并采用二元回归模型分析影响医务人员满意度的因素。结果139名（27.20%）医务人员对双向转诊运行现状表示满意。二元回归分析结果显示,性别、职称、是否了解双向转诊、所在单位对双向转诊宣传力度、双向转诊制度必要性认知是影响其满意度的因素（P均<0.05）。调查的511名核心医院医务人员中有397人（77.69%）认为患者不信任基层医疗机构的服务能力、338人（66.14%）认为基层医疗机构的服务水平有限、222人（43.44%）认为医疗机构间经济利益分配不均衡、341人（66.73%）认为没有统一的双向转诊标准和指南、323人（63.21%）配套的政策支持不到位、301人（58.90%）认为医疗机构间缺...     

分级调度实时架构中处理器资源预设值的预借性

分层多级自适应调度（AdHierSched）架构是Linux操作系统中的虚拟实时架构,在系统运行时,它通过监测各子系统对处理器资源的需求动态调整资源分配。本文在分级调度架构中提出了处理器资源预借机制（BBM）,通过服务器间资源的动态分配达到处理器资源在各个实时系统中优化配置的目的,并针对AdHierSched架构中资源预设值的预借性进行设计和实现,通过静态任务和动态任务对该资源预设值预借控制器进行实验评估。实验结果表明：当AdHierSched架构伴随着处理器预借机制和资源调整机制同时运行时,内部运行任务整体的截止期限超出率减小。此外,资源预借性机制的添加导致的系统额外开销相比系统总的开销很小,表明该方案适合在实际分级调度实时系统内推广使用。     

Process Modeling of ICU Patient Flow: Effect of Daily Load Leveling of Elective Surgeries on ICU Diversion

Despite the considerable number of publications on ICU patient flow and analysis of its variability, a basic and practically important question remained unanswered: what maximum number of elective surgeries per day should be scheduled (along with the competing demand from emergency surgeries) in order to reduce diversion in an ICU with fixed bed capacity to an acceptable low level, or prevent it at all? The goal of this work was to develop a methodology to answer this question. An ICU patient flow simulation model was developed to establish a quantitative link between the daily load leveling of elective surgeries (elective schedule smoothing) and ICU diversion. It was demonstrated that by scheduling not more than four elective surgeries per day ICU diversion due to ‘no ICU beds’ would be practically eliminated. However this would require bumping ‘extra’ daily surgeries to the block time day of another week which could be up to 2 months apart. Because not all patients could wait that long for their elective surgery, another more practical scenario was tested that would also result in a very low ICU diversion: bumping ‘extra’ daily elective surgeries within less than 2 weeks apart, scheduling not more than five elective surgeries per day, and strict adherence to the ICU admission/discharge criteria.     

以“住-专一体化”为导向的分级带教模式在口腔颌面外科基地的实践研究

目的 以上海交通大学医学院附属第九人民医院口腔颌面外科基地为研究对象,探索“住-专一体化”分级带教模式在口腔颌面外科住培与专培中的实践效果。方法 在2022年6月至2023年4月期间,共计入组学员144名,其中试验组（住培72人、专培16人）和对照组（住培72人、专培16人）。分别采用传统模式与“住-专一体化”分级带教模式制订临床及学习任务,并记录学员在理论考核和自我评估中的表现。采用 SPSS 23.0进行t 检验。结果 “住-专一体化”分级带教模式在理论考核和学员自我评估中均取得了明显的效果。专培学员中,试验组（84.56±4.05）与对照组（81.13±2.78）之间分数差异具有统计学意义（P<0.05）。住培学员中,试验组（84.74±4.85）相对于对照组（82.10±4.34）表现更好,组间差异具有统计学意义（P<0.01）。自我评估问卷结果显示,试验组学员在多项自评指标中的积极评价比例高于对照组。结论 本研究的结果表明,“住-专一体化”分级带教模式为口腔颌面外科住培与专培教育提供了一种有效的教学模式。该模式有助于提高学员学科兴趣、促进临床实践能力,并为我国医学教育提供有益经验和未来发展方向。     

全麻术后患者转运安全现状与临床工作人员运动性疲劳的关系

目的 调查全麻术后患者转运安全性现状,探讨其与临床工作人员运动性疲劳的相关性。方法 采用便利抽样法,选取2022年8～10月上海交通大学医学院附属瑞金医院403例全麻术后患者,按照患者转运安全性的评判标准,分为风险组（转运存在风险,n=46）和安全组（转运安全,n=357）;按照患者转运后引流管滑脱情况,分为滑脱组（n=38）和未滑脱组（n=365）。记录患者一般资料与搬运时间,观察转运前后生命体征、氧饱度和疼痛变化,分析转运安全性的影响因素;选择参与上述403例患者转运的工作人员（1 209名临床工作人员）,采用主观疲劳量表进行测评,分析其与转运安全性的相关性。结果 全麻术后患者搬运时间为（53.98±6.67）s,临床工作人员运动性疲劳总体得分为（13.12±2.60）分;二元logistic回归分析显示：性别、手术部位、搬运时间与疼痛变化幅度是全麻术后患者转运发生风险的重要影响因素。临床工作人员在风险组患者的运动性疲劳得分高于安全组,在滑脱组患者的运动性疲劳得分高于未滑脱组。Spearman相关性分析显示：患者转运前后心率与收缩压变化幅度与临床工作人员的运动性疲劳均呈正相关（P ...     

Elevation of procalcitonin level in patients with pulmonary tuberculosis and in medical staff with close patient contact

BACKGROUND: Several studies have shown that serum procalcitonin levels increase conspicuously in acute and systemic inflammatory diseases. However, there is insufficient information concerning its activity in chronic infectious diseases such as tuberculosis. In this study, we aimed to assess serum level of procalcitonin in patients with active pulmonary tuberculosis and in medical staff at high risk due to close patient contact (high-risk staff). METHODS: For this purpose, 30 patients (6 female, 24 male) and 20 staff (8 female, 12 male) were evaluated. Twenty eight healthy blood donors (9 female, 19 male) made up the control group. RESULTS: Serum procalcitonin level in patients with tuberculosis was 0.76 +/- 0.20 ng/mL. Procalcitonin levels in active tuberculosis patients and staff were not significantly different (p=0.381); however, differences between active tuberculosis patients and control group were significant (p<0.001). In addition, serum procalcitonin levels were also different in staff and control groups (p<0.001). CONCLUSIONS: This study showed that procalcitonin levels increased both in patients with pulmonary tuberculosis and in the staff. This result considered that procalcitonin could be a good indicator of inflammation in patients with chronic diseases and in persons exposed to long-lasting infections.     

Routine intubation in the prone position

Abstract

Background. Tracheal intubation in the prone position has previously been reported only as a necessity in a very few emergency situations. It emerged at our clinic as a routine after invention of a test aimed at pinpointing a painful motion segment in patients with chronic low back pain who were candidates for lumbar fusion operation.

Material and methods. During a 6-year period 247 consecutive patients were treated at our clinic, 91 men and 156 women, mean age 42.8 years, range 25.3–62.8. Classification of the pharyngeal structures according to Mallampati et al. was done the day before surgery, and grading of visualization of the glottis as described by Cormack and Lehane was done during intubation, with the aim of revealing factors of importance for the possibility of performing tracheal intubation in the prone position.

Results. The large majority of patients classified preoperatively as Mallampati class 1 had Cormack and Lehane grade 1 at laryngoscopy, although some patients had grades 2, 3, and 4. Most problems with intubation in the prone position were anticipated among those classified preoperatively as Mallampati class 3, but tracheal intubation in the prone position was still possible in 21 of the 23 patients in this group. In all, tracheal intubation in the prone position was successful in 244 of the 247 patients (98.8%).

Conclusion. Routine tracheal intubation in the prone position can be performed effectively by experienced anaesthesiologists, but this requires continuous training and good support from the anaesthesiology staff.     

Effect of Transcranial Magnetic Stimulation on the Expression of c-Fos and Brain-derived Neurotrophic Factor of the Cerebral Cortex in Rats with Cerebral Infarct

The effect of transcranial magnetic stimulation （TMS） on the neurological functional recovery and expression of c-Fos and brain-derived neurotrophic factor （BDNF） of the cerebral cortex in rats with cerebral infarction was investigated. Cerebral infarction models were established by using left middle cerebral artery occlusion （MCAO） and were randomly divided into a model group （n=40） and a TMS group （n=40）. TMS treatment （2 times per day, 30 pulses per time） with a frequency of 0.5 Hz and magnetic field intensity of 1.33 Tesla was carried out in TMS group after MCAO. Modified neurological severity score （NSS） were recorded before and 1, 7, 14, 21, and 28 day（s） after MCAO. The expression of c-Fos and BDNF was immunohistochemically detected 1, 7, 14, 21, and 28 day（s） after infarction respectively. Our results showed that a significant recovery of NSS （P〈0.05） was found in animals treated by TMS on day 7, 14, 21, and 28 as compared with the animals in the model group. The positive expression of c-Fos and BDNF was detected in the cortex surrounding the infarction areas, while the expression of c-Fos and BDNF increased significantly in TMS treatment group in comparison with those in model group 7, 14, 21, and 28 days （P〈0.05） and 7 14, 21 days （P〈0.01） after infarction, respectively. It is concluded that TMS has therapeutic effect on cerebral infarction and this may have something to do with TMS＇s ability to promote the expression of c-Fos and BDNF of the cerebral cortex in rats with cerebral infarction.     

A Simulation Approach for Scheduling Patients in the Department of Radiation Oncology

Physical therapy, hemodialysis and radiation oncology departments in which patients go through lengthy and periodic treatments need to utilize their limited and expensive equipment and human resources efficiently. In such departments, it is an important task to continue to treat current patients without any interruption along with incoming patients. In this study, a patient scheduling approach for a university radiation oncology department is introduced to minimize delays in treatments due to potential prolongations in treatments of current patients and to maintain efficient use of the daily treatment capacity. A simulation analysis of the scheduling approach is also conducted to assess its efficiency under different environmental conditions and to determine appropriate scheduling policy parameter values. Also, the simulation analysis of the suggested scheduling approach enables to determine appropriate scheduling parameters under given circumstances. Therefore, the system can perform more efficiently.     

层级管理在三级综合医院护理管理中的应用分析

目的探讨层级管理在医院护理管理中的应用,以进一步为患者提供更优质的服务。方法采取分层次使用护理人员,对比分析层级管理前后医院护理质量、护理工作满意度、护理缺陷及不良事件发生情况,以确保护理质量持续改进。结果我院护理质量、患者满意度通过层级管理后（2013年）明显比层级管理前（2012年）提高,前后比较差异有统计学意义（P〈0.01）;层级管理后护理投诉及不良事件发生率明显比层级管理前下降,前后比较差异有统计学意义（P〈0.01）。结论层级管理是一种有效的护理管理手段,它能促进优质护理服务的可持续发展,值得医院临床推广应用。     

高危人群规避模式应用对急诊科护理人员伤害发生率及护理满意度的影响

目的 研究高危人群规避模式在急诊科护理人员中的应用现状,观察高危人群规避模式应用后护理人员伤害率的变化及调查患者对护理人员的满意度。 方法 选取2013年12月-2015年12月浙江医院急诊科护理人员62例作为调查对象,男性4例,女性58例;年龄23~47岁,平均(30.1±12.6)岁;工作年限1~25年,平均(10.3±8.7)年。通过应用高危人群规避模式,记录高危人群规避模式应用前后调查的62例急诊科护理人员所受伤害详细情况(包括受伤害程度、急诊就诊次数)、发生率以及患者对护理人员服务满意度。 结果 比较高危人群规避模式应用前后各1个月伤害事件发生情况,应用前伤害事件发生情况中一级损伤、二级损伤及言语伤害均高于应用后(P<0.05),这提示高危人群规避模式对于急诊科伤害事件的数量有规避作用。比较高危人群规避模式应用前后急诊就诊次数及伤害发生次数,并计算伤害率,应用高危人群规避模式后伤害率降至9.9%,低于高危人群规避模式应用前的伤害率26.7%(P<0.05),提示高危人群规避模式对于急诊科伤害事件的数量有规避作用。高危人群规避模式应用前后急诊就诊患者对护理人员的满意情况,高危人群规避模式应用后的总满意率为72.6%,远高于高危人群规避模式应用前的总满意率54.8%(P<0.05)。 结论 高危人群规避模式在急诊护理人员中的应用,有效降低伤害发生率,同时能有效增加患者对护理服务满意度,值得临床推广应用。      

浅谈内蒙古医科大学附属医院日间手术运营现状

日间手术指病人在一日(24小时)内入、出院完成的手术或操作,是对病人有计划进行的手术和操作,不含门诊手术。可以减少住院时间、降低患者费用,是一种新型医疗模式,合理的管理模式和流程设置是日间手术推广和开展的必要条件, 其中流程的合理化、精细化是日间手术成功开展的关键。流程化的管理模式、医护人员的紧密配合,临床医技科室的支持,切实保证了日间手术的运行和实施。     

不同切口白内障超声乳化及人工晶状体植入术后泪膜稳定性观察

目的探讨透明角膜切口与巩膜隧道切口白内障超声乳化及人工晶状体植入术后泪膜稳定性的差异。方法抽取拟行白内障超声乳化术的老年性白内障患者60例68眼,随机分为两组,A组30例32眼,予透明角膜切口施术,B组30例36眼,予巩膜隧道切口施术。检测两组术前1天,术后1、7、14、30天的泪膜破裂时间(BUT)、基础泪液分泌试验(Sit)、角膜荧光素染色积分(FL)以及患者主观干眼感觉症状。结果 A组术后第1天较术前BUT明显缩短,Sit、角膜荧光素染色积分明显增高(P<0.05或0.01);第7天时Sit,第30天时BUT、角膜荧光素染色积分恢复至术前水平(P>0.05)。B组术后第1天BUT明显缩短,Sit明显增高(P<0.05或0.01),角膜荧光染色积分比较差异无统计学意义(P>0.05);术后第7、14、30天,BUT、Sit逐渐恢复至术前水平(P>0.05)。两组主观干眼感觉症状,术后第1天均明显增高(P<0.05),14天后基本恢复到术前状况(P>0.05)。结论巩膜隧道切口泪膜的稳定性较透明角膜切口白内障摘除术显著降低,但主观感觉无明显差异。