Stochastic programming for outpatient scheduling with flexible inpatient exam accommodation

This study is concerned with the determination of an optimal appointment schedule in an outpatient-inpatient hospital system where the inpatient exams can be cancelled based on certain rules while the outpatient exams cannot be cancelled. Stochastic programming models were formulated and solved to tackle the stochasticity in the procedure durations and patient arrival patterns. The first model, a two-stage stochastic programming model, is formulated to optimize the slot size. The second model further optimizes the inpatient block (IPB) placement and slot size simultaneously. A computational method is developed to solve the second optimization problem. A case study is conducted using the data from Magnetic Resonance Imaging (MRI) centers of Lahey Hospital and Medical Center (LHMC). The current schedule and the schedules obtained from the optimization models are evaluated and compared using simulation based on FlexSim Healthcare. Results indicate that the overall weighted cost can be reduced by 11.6% by optimizing the slot size and can be further reduced by an additional 12.6% by optimizing slot size and IPB placement simultaneously. Three commonly used sequencing rules (IPBEG, OPBEG, and a variant of ALTER rule) were also evaluated. The results showed that when optimization tools are not available, ALTER variant which evenly distributes the IPBs across the day has the best performance. Sensitivity analysis of weights for patient waiting time, machine idle time and exam cancellations further supports the superiority of ALTER variant sequencing rules compared to the other sequencing methods. A Pareto frontier was also developed and presented between patient waiting time and machine idle time to enable medical centers with different priorities to obtain solutions that accurately reflect their respective optimal tradeoffs. An extended optimization model was also developed to incorporate the emergency patient arrivals. The optimal schedules from the extended model show only minor differences compared to those from the original model, thus proving the robustness of the scheduling solutions obtained from our optimal models against the impacts of emergency patient arrivals.

     

安徽省新冠肺炎定点医疗机构医院感染管理部门人力资源现状调查

目的 了解安徽省不同级别新冠肺炎定点医疗机构医院感染管理部门人力资源配置现状,分析存在问题及薄弱环节,为健全感控人才队伍建设提供依据。方法 通过调查问卷的形式,于2020年4月对安徽省各级新冠肺炎定点医疗机构医院感染管理部门基本情况、医院感染管理专职人员配置情况进行调查,并对结果进行分析。结果 共调查68所医疗机构,其中省级医院6所,市级医院19所,县级医院43所。省、市、县级医疗机构医院感染管理专职人员配比达标的医院分别占16.67%、26.32%、51.16%。全省医院感染管理专职人员中女性占84.82%;医院感染管理队伍以护理专业为主,占59.53%;高级职称人员仅占21.01%。不同级别医疗机构医院感染管理专职人员在专业、学历分布、医院感染管理工作年限方面比较,差异均有统计学意义（均P<0.05）。结论 安徽省新冠肺炎定点医疗机构医院感染管理部门存在专职人员配备不足、专业单一、学历偏低、职称晋升困难等情况,人力资源配置有待进一步优化,医疗机构及相关管理部门应加强感染监控人才队伍建设,推动疫情防控常态化下感染监控工作的有效落实。     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。     

西安市134例百日咳疑似病例不同标本百日咳鲍特菌检测阳性率比较

目的比较百日咳疑似病例鼻、咽和鼻咽拭子标本百日咳鲍特菌(Bordetella pertussis,Bp)检测阳性率。方法选择西安市两家医院2018年1-7月134例百日咳疑似病例,同时采集鼻、咽和鼻咽拭子标本,进行Bp分离培养和实时荧光定量聚合酶链反应核酸检测。结果百日咳疑似病例的Bp检测总阳性率为44.78%(60/134),其中鼻、咽、鼻咽拭子阳性率分别为36.57%、32.09%、39.55%(χ²=1.64,P=0.440);发病后0-7d、8-14d、15-21d、22-28d、29d采样的阳性率分别为23.33%、64.52%、63.89%、42.86%、23.33%(χ²=22.13,P=0.000)。鼻、咽、鼻咽拭子Bp核酸检测阳性率分别为36.57%、32.09%、39.55%(χ²=1.64,P=0.440);分离培养阳性率分别为0.00%、0.00%、4.59%(Fisher精确概率法,P=0.036)。在Bp核酸阳性病例中鼻和/或咽、鼻和/或鼻咽、咽和/或鼻咽拭子阳性分别占93.33%、91.67%、100%(Fisher精确概率法,P=0.080)。结论百日咳疑似病例鼻、咽和鼻咽拭子Bp检测总阳性率相当;核酸检测阳性率以鼻咽拭子最高,组合采样可提高Bp核酸检测阳性率;分离培养仍建议选择鼻咽拭子。     

传染性病毒性肺炎的中医四季防护

中医作为传统医学对于疾病的预防治疗有着不可取代的优势,2020年年初武汉暴发新型瘟疫以来,中医中药在防护和阻止病情进展的过程中发挥了重要作用,而且疗效确切,备受推崇.本文从生活起居、四季饮食药膳、中医保健预防等几个方面介绍中医防护传染性病毒性肺炎的一些措施与可操作的方法.     

四川省凉山州4个重点贫困县6~24月龄婴幼儿营养及喂养现状调查

目的 了解凉山州贫困地区4个重点贫困县6~24月龄婴幼儿营养状况和家长喂养行为,为开展儿童营养与健康干预促进工作提供依据。方法 2018年4-7月采用多阶段随机抽样法,抽取4个重点县1 244名6~24月龄婴幼儿进行体格测量、血红蛋白含量检测和家长问卷调查。结果 凉山州4个重点县6~24月龄婴幼儿贫血患病率为51.9%,低体重率为9.5%,生长迟缓率为25.6%。多因素分析显示,婴幼儿性别、月龄、母亲学历、母亲职业、是否认为满3个月就可以添加辅食、是否知道谷类泥糊状食物是最适合首先添加的辅食、是否知道动物血或红肉是婴幼儿补铁的最好来源、是否知道贫血与铁缺乏有关、是否吃过母乳、6月龄后是否继续母乳喂养是影响婴幼儿营养状况的主要因素(P<0.05)。结论 凉山州贫困地区6~24月龄婴幼儿营养状况亟待改善,婴幼儿看护人喂养知识不足。应加强宣传教育,提高家长的育儿素养,掌握营养包的有效服用方法,纠正不正确的的喂养方式。     

Undocumented Migrants Reintroducing COVID-19, Yunnan Province,China

To limit the spread of severe acute respiratory syndrome coronavirus 2, the government of China has been monitoring infected travelers and minimizing cold-chain contamination. However, other factors might contribute to recurring outbreaks. We analyze the role of undocumented migrants as potential transmitters of severe acute respiratory syndrome coronavirus 2 in China.     

Engineered NS1 for Sensitive,Specific Zika Virus Diagnosis from Patient Serology

Dengue virus (DENV) and Zika virus (ZIKV) belong to the Flaviviridae family of viruses spread by Aedes aegypti mosquitoes in tropical and subtropical areas. Accurate diagnostic tests to differentiate the 2 infections are necessary for patient management and disease control. Using characterized ZIKV and DENV patient plasma in a blind manner, we validated an ELISA and a rapid immunochromatographic test for ZIKV detection. We engineered the ZIKV nonstructural protein 1 (NS1) for sensitive serologic detection with low cross reactivity against dengue and developed monoclonal antibodies specific for the ZIKV NS1 antigen. As expected, the serologic assays performed better with convalescent than acute plasma samples; the sensitivity ranged from 71% to 88%, depending on the performance of individual tests (IgM/IgG/NS1). Although serologic tests were generally less sensitive with acute samples, our ZIKV NS1 antibodies were able to complement the serologic tests to achieve greater sensitivity for detecting early infections.     

ELABELA通过调控AKT信号通路影响滋养细胞侵袭的研究

目的 探讨ELABELA(ELA)对妊娠滋养细胞(Bewo细胞)侵袭行为的影响及其可能的作用机制。方法 用siRNA-ELA转染处于对数生长期的Bewo细胞,分为siRNA-ELA转染组,阴性对照组(细胞转染无意义序列)及空白组,细胞转染后于倒置显微镜下观察转染效率,采用实时荧光定量聚合酶链反应(qRT-PCR)检测转染后各组细胞中ELA mRNA表达并明确沉默效率。划痕实验测定各组细胞迁移能力,Transwell实验测定各组细胞的迁移、侵袭能力。蛋白质免疫印迹法检测各组细胞p-AKT、MMP9蛋白表达水平。结果 si-ELA组的ELA表达量明显低于si-NC组及空白组(P<0.001),且si-NC组与空白组差异无统计学意义(P>0.05);siRNA-ELA组细胞的迁移及侵袭能力均明显低于空白组(P<0.01;P<0.01);siRNA-ELA组p-AKT蛋白及MMP9蛋白表达水平明显低于空白组(p-AKT P<0.01;MMP9 P<0.001)。结论 敲低ELA可抑制滋养细胞的侵袭及迁移能力,其机制可能与AKT信号通路有关。