How can patient journey in surgical wards of a referral hospital be improved?

Background: We studied the patient journey in surgical wards in order to find an effective and efficient way of scheduling in surgical wards.Methods: We applied Root cause analysis (RCA) model within three months in a referral hospital. After understanding root causes of the events occurred through a focus discussion group, required interventions were proposed according to literatures, experiences, and preference of the stakeholders. Possible interventions were also analyzed based on its ability to reduce contributing factors in the events and the belief of process-owner that if interventions can be implemented.Results: The results were provided for five main steps: 1) the most important root cause was “not prioritizing patients and pre-scheduling the number of surgical procedures in the days before”. 2) Constraints indicated that workforce weren't allocated proportionally to the number of surgical operations in varying shift lengths, increased numbers of on-calls physicians increased related costs, the admission of patients in VIP wards have been getting a high priority, and surgeon compensation based on fee for service method was challenging. 3) The current situation of allocating three rooms on average for each physician can be changed depending on numbers of surgeries. 4) Proposed interventions are establishing a computer registration system, reforming payment methods, setting up an electronic waiting list, development of scheduling guidelines, and Applying MIP model.Conclusions: Implementing of scheduling reforms requires a comprehensive action plan system and predefined functional indicators. These should be achieved with considering comments of all clinical and technical groups to ensure the feasibility of an operating room schedule.Keywords: patient journey, surgery, scheduling, Root cause analysis (RCA), patient transfe

First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic oesophageal cancer: a phase II study

This phase II study assessed the safety and efficacy of oxaliplatin and capecitabine in patients with advanced oesophageal cancer. Fifty-one eligible patients received oxaliplatin 130 mg m−2 intravenously on day 1 and capecitabine 1000 mg m−2 orally twice daily on days 1 to 14 in a 21-day treatment cycle as first-line treatment for advanced oesophageal cancer. Grade 3 neutropenia was seen in one patient and anaemia in another patient. No grade 4 haematological toxicities were observed. Grade 4 non-haematological toxicity (lethargy) occurred in one patient (2%). Grade 3 non-haematological toxicity was seen in 14 (27%) patients (vomiting and polyneuropathy (8%); nausea (6%); lethargy and hand–foot syndrome (4%); and anorexia, diarrhoea, and hyperbilirubinaemia (each in one patient)). In 22% of the patients, toxicity was the reason for stopping the treatment. The overall response rate was 39%. The median overall survival was 8 months; the 1-year survival rate was 26%. In the quality of life (QoL) analysis, the emotional well-being improved during treatment, but the physical functioning scores declined. The fatigue score on the symptom scales increased. Overall, the global QoL score did not change during treatment. In conclusion, the activity of oxaliplatin and capecitabine is comparable with other chemotherapy regimens in advanced oesophageal cancer with a low frequency of grade 3/4 toxicity. Because this treatment can be given on an outpatient basis, it is probably less toxic than cisplatin-based therapy and preserves QoL during treatment, it is a viable treatment option in patients with advanced oesophageal cancer

Bioclimatic Architecture and Urban Morphology. Studies on Intermediate Urban Open Spaces

This paper deals with the interactions between biophysical and microclimatic factors on the one hand with, on the other, the urban morphology of intermediate urban open spaces, the relationship between environmental and bioclimatic thermal comfort, and the implementation of innovative materials and the use of greenery, aimed at the users’ well-being. In particular, the thermal comfort of the open spaces of the consolidated fabrics of the city of Rome is studied, by carrying out simulations of cooling strategies relating to two scenarios applied to Piazza Bainsizza. The first scenario involves the use of cool materials for roofs, cladding surfaces, and pavement, while the second scenario, in addition to the cool materials employed in the first scenario, also includes the use of greenery and permeable green surfaces. The research was performed using summer and winter microclimatic simulations of the CFD (ENVI-met v. 3.1) type, in order to determine the dierent influences of the materials with cold colors, trees, and vegetated surfaces on the thermal comfort of the urban morphology itself. Meanwhile, the comfort assessment was determined through the physiological equivalent temperature (PET) calculated with the RayMan program. The first scenario, with the use of cool materials, improves summer conditions and reduces the urban heat island eect but does not eliminate thermal discomfort due to the lack of shaded surfaces and vegetation. The second scenario, where material renovations is matched with vegetation improvements, has a slightly bad eect on winter conditions but drastically ameliorates the summer situation, both for direct users and, thanks to the strong reduction of the urban heat island eect, to urban inhabitants as a whole

Effects of urban green infrastructure (UGI) on local outdoor microclimate during the growing season

This study analyzed how the variations of plant area index (PAI) and weather conditions alter the influence of urban green infrastructure (UGI) on microclimate. To observe how diverse UGIs affect the ambient microclimate through the seasons, microclimatic data were measured during the growing season at five sites in a local urban area in The Netherlands. Site A was located in an open space; sites B, C, and D were covered by different types and configurations of green infrastructure (grove, a single deciduous tree, and street trees, respectively); and site E was adjacent to buildings to study the effects of their façades on microclimate. Hemispherical photography and globe thermometers were used to quantify PAI and thermal comfort at both shaded and unshaded locations. The results showed that groves with high tree density (site B) have the strongest effect on microclimate conditions. Monthly variations in the differences of mean radiant temperature (∆Tmrt) between shaded and unshaded areas followed the same pattern as the PAI. Linear regression showed a significant positive correlation between PAI and ∆Tmrt. The difference of daily average air temperature (∆Ta) between shaded and unshaded areas was also positively correlated to PAI, but with a slope coefficient below the measurement accuracy (±0.5 °C). This study showed that weather conditions can significantly impact the effectiveness of UGI in regulating microclimate. The results of this study can support the development of appropriate UGI measures to enhance thermal comfort in urban areas

Failure and Side Effects of Contraceptive Pills Used for Postponement of Menstrual Bleeding in Hajj Pilgrims of Kerman, 2000

Introduction: Use of contraceptive pills for postponement of menstruation has been a common practice for women traveling to the holy city of Mecca, although the side effects of this practice has not yet been studied. This research was carried out for determining the type and the prevalence of side effects of the contraceptive pills and for finding out the best type of regimens with least side effects in Hajj pilgrims from Kerman in 2001 Materials & Methods: In this research, 224 pilgrims were selected with similar backgrounds. A two part questionnaire was given to them during the last days of their pilgrimage. The first part was completed in the holy land of Arafat and the second part was answered two months later via telephone calls or postal service. Results: Menstruation had occurred in 2.1% of cases, 13.6% had experienced spotting, 19.5% nausea and in 11.4%, dizziness was reported. 81.1% had not experienced any side effects. 49.5% experienced normal bleeding during the first menstruation, while 66.1% had normal bleeding during the second menstruation. The rest had experienced either decreased or increased bleeding. 24.6% in the first menstruation and 20% in the second menstruation had experienced unusual pain. In 73% of the cases, the second menstruation had been normal. 2 tests showed a significant relation between the number of pills and duration of bleeding in the first menstruation (p=0.04%) and the second menstruation (p=0.03%). Conclusion: As the number and severity of side effects increase with an increase in dosage, it is recommended that lower dosages of pills should be used as far as possible. Also, since early start of pills does not decrease spotting, it is better if pills are started just a few days before the expected time of menstruation

Towards Urban Facilities Energy Performance Evaluation Using Remote Sensing

Urban facilities are major contributors to annual energy consumption and therefore, evaluating their energy efficiency and retrofit planning play a major role in achieving sustainability goals. For urban facilities, such as buildings, energy performance audits could be conducted by detailed evaluation at building level. However, at urban level, detailed evaluation is cost and time intensive. Therefore, in this study, we investigated the correlation between land surface temperature, obtained through satellite imagery, and energy consumption patterns at urban level to explore its feasibility for energy performance evaluations. New York City was used as the main case study for conducting the analysis. We have investigated the correlation between energy consumption intensity and temperature at city block level for selected points. The outcome demonstrates a strong correlation between energy consumption intensity and land surface temperature. The observed correlation could potentially be leveraged for developing an approach for energy performance auditing.Climate Design and Sustainabilit

A modified imperialist competitive algorithm for a two-agent single-machine scheduling under periodic maintenance consideration

Scheduling with periodic maintenance has been widely studied. However, multi-agent scheduling with simultaneous considerations of periodic maintenance has hardly been considered until now. In view of this, this research focuses on the problem of scheduling jobs that come from two agents on a single machine under periodic maintenance constraint with the objective of minimising the total completion time of the jobs of the first agent while keeping the maximum tardiness of other agent below or at a fixed level UB. We present some new dominance properties for this strongly NP-hard problem. And next, using these properties, we develop a novel imperialist competitive algorithm for the problem. Various parameters of the proposed algorithm are reviewed by means of Taguchi experimental design. For the evaluation of the proposed ICA, problem data was generated to compare it against a genetic algorithm. The results of computational experiments show the good performance of the proposed algorithm