Stochastic scheduling of chemotherapy appointments considering patient acuity levels

The uncertainty in infusion durations and non-homogeneous care level needs of patients are the critical factors that lead to difficulties in chemotherapy scheduling. We study the problem of scheduling patient appointments and assigning patients to nurses under uncertainty in infusion durations for a given day. We consider instantaneous nurse workload, represented in terms of total patient acuity levels, and chair availability while scheduling patients. We formulate a two-stage stochastic mixed-integer programming model with the objective of minimizing expected weighted sum of excess patient acuity, waiting time and nurse overtime. We propose a scenario bundling-based decomposition algorithm to find near-optimal schedules. We use data of a major university hospital to generate managerial insights related to the impact of acuity consideration, and number of nurses and chairs on the performance measures. We compare the schedules obtained by the algorithm with the baseline schedules and those found by applying several relevant scheduling heuristics. Finally, we assess the value of stochastic solution

Stochastic scheduling of chemotherapy appointments considering patient acuity levels

The uncertainty in infusion durations and non-homogeneous care level needs of patients are the critical factors that lead to difficulties in chemotherapy scheduling. We study the problem of scheduling patient appointments and assigning patients to nurses under uncertainty in infusion durations for a given day. We consider instantaneous nurse workload, represented in terms of total patient acuity levels, and chair availability while scheduling patients. We formulate a two-stage stochastic mixed-integer programming model with the objective of minimizing expected weighted sum of excess patient acuity, waiting time and nurse overtime. We propose a scenario bundling-based decomposition algorithm to find near-optimal schedules. We use data of a major university hospital to generate managerial insights related to the impact of acuity consideration, and number of nurses and chairs on the performance measures. We compare the schedules obtained by the algorithm with the baseline schedules and those found by applying several relevant scheduling heuristics. Finally, we assess the value of stochastic solution

Cytokine Profiles of Chronic Urticaria Patients and the Effects of Omalizumab Treatment

Introduction: Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU). Objectives: To investigate Th1, Th2, and Th17 cytokine profiles in CSU and to evaluate the possible effect of omalizumab treatment. Methods: Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status.   Results: Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels. Conclusions: The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients

Demonstration of the histopathological and immunohistochemical effects of a novel hemostatic agent, ankaferd blood stopper, on vascular tissue in a rat aortic bleeding model

Background: Ankaferd Blood Stopper®(ABS) is a folkloric medicinal plant extract used as a hemostatic agent in traditional Turkish medicine. This experimental study investigated the histopathological and immunohistochemical effects of ABS on vascular tissue in a rat model of aortic bleeding.Methods: Four groups of 11 Wistar albino rats were used. The abdominal aortas of the rats were wounded; an ABS-soaked tampon was applied to rats in Groups 1 and 3, and a plain gauze tampon was applied to rats in Groups 2 and 4 until the bleeding stopped. The bleeding time was recorded. Immediately following sacrificing, the arteriotomy sites from Groups 1 and 2 were removed. The abdominal incisions in Groups 3 and 4 were closed following hemostasis. On Day 7 of the study, Group 3 and 4 rats were sacrificed and the abdominal aorta arteriotomy sites were removed for histopathological and immunohistochemical evaluation.Results: The mean bleeding time in 15 animals in Groups 2 and 4 was 4.9 ± 0.6 s, and in 22 animals in Groups 1 and 3 was 3.1 ± 0.6 s. Distal aortic occlusion was not observed on either Day 1 or 7 in any group. Significantly more widespread and dense endothelial nitric oxide synthase (eNOS) staining was observed in Group 1 animals than Group 2. On Days 1 and 7 after application of ABS, histopathological changes, consisting of necrosis, inflammation, and endothelial cell loss, in the rat abdominal aortas did not differ between Groups 1 and 2. The basophilic discoloration in the ABS group on the operation day was a result of a foreign body reaction and hemosiderin-loaded histiocyte accumulation, which occurred on Day 7.Conclusions: In this study, hemostasis was successfully achieved with ABS in rat abdominal aortas. No histopathological change was found in the rat abdominal aortas between the ABS and control groups on Days 1 and 7. Further studies on the long-term effects of foreign body reactions and hemosiderin-loaded histiocyte accumulation are required. © 2010 Kandemir et al; licensee BioMed Central Ltd

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Materials and Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation

Changes in Total Phenols, Total Flavonoids, and Antioxidant Activities of Common Beans and Pinto Beans after Soaking, Cooking, and in vitro Digestion Process

WOS: 000279646100009Even though bean varieties are widely consumed all over the world, data related to how cooking methods and in vitro digestion affect bioactive compounds they contain and data related to bioavailability of polyphenols are limited. The aim of the present study was to investigate how some cooking methods and in vitro digestion influence antioxidant activity, total phenols (TP), and total flavonoids (TF) of widely consumed beans in Turkey. Soaking caused a significant decrease (25.61-38.63%) in the bioavailability of TP of dry common beans (CB). Soaking in cold water resulted in a significant decrease in TP bioavailability of dry pinto beans (PB). TF content was well retained in PB cooked without soaking but was not detected in CB after in vitro digestion. CB soaked in hot water and cooked with the addition of NaHCO3 showed the greatest inhibition effect on 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical (p<0.05). In vitro digestion caused increase in the antioxidant activity of both CB and PB

Seedling resistance of some bread wheat genotypes to Fusarium pseudograminearum

Fusarium pseudograminearum is one of the most damaging Fusarium species that causes root, crown, and foot rots in wheat. Identification of resistant germplasm is one of the most efficient and environmentally sound control methods. However, up to date, limited wheat genotypes with partial resistance are available. Therefore, in this study, the seedling resistance reaction of 200 bread wheat genotypes plus 6 control genotypes obtained from CIMMYT to Fusarium pseudograminearum was determined under growth room conditions. Out of the 200 tested genotypes; 1 (0.5%), 35 (17.5%), 112 (56%), 45 (22.5%), and 7 (3.5%) were resistant, moderately resistant, moderately susceptible, susceptible and very susceptible to Fusarium pseudograminearum, respectively. Resistant and moderately resistant genotypes could be used in breeding studies for developing crown rot-resistant cultivars

Non-Steroidal Anti-Inflammatory Drug Hypersensitivity In Adults And The Factors Associated With Asthma

Background: Characteristics of non-steroidal anti-inflammatory drug (NSAID)-hypersensitivity (NH) associated with underlying/accompanying diseases has not been studied in Turkey. In addition, the factors associated with asthma in NH patients are not well known. The present study aimed to investigate the relationship between NH and chronic urticaria, rhinitis/rhinosinusitis, and asthma in an effort to identify NH phenotypes. The study's secondary aim was to identify the factors associated with asthma in NH patients and the NSAID reaction pattern in asthmatics. Methods: Data for 1137 NH patients in our hospital's allergy clinic database were retrospectively analyzed. Patients were divided into 5 groups based on their accompanying diseases (chronic urticaria, asthma, rhinitis/rhinosinusitis). Asthmatic patients were compared to non-asthmatic patients to identify the factors associated with asthma. Results: Reaction patterns and patient characteristics in each group differed from those in the reference group (NH only group). Asthma in patients with NH was associated with female gender, sinonasal polyposis/polyp surgery, rhinitis/rhinosinusitis, NSAID-induced rhinitis/asthma or a blended reaction pattern, immediate reaction following NSAID intake, self-reported history of food allergy, and family history of asthma; the odds ratios and 95% CIs were 1.35 (1.02-1.78), 13.52 (8.74-20.9)/10.94 (6.73-17.77), 12.06 (9-16.17), 15.28 (10.45-22.36)/2.43 (1.70-3.45), 1.76 (1.31-2.35), 1.49 (1.04-2.14), and 3.1 (2.35-4.08), respectively. The characteristics of the asthmatic patients that had urticaria/angioedema-type reactions to NSAID intake (pseudo Samter's syndrome) differed from those in the asthmatics with rhinitis/asthma-type reactions. Conclusions: Chronic urticaria, rhinitis, and asthma commonly accompany NH. NSAID response patterns in NH patients may help differentiate groups of patients. The present study identified factors associated with asthma in NH patients and observed that there seems to be different phenotypes of Samter's syndrome, for which a new classification scheme was proposed. (C) 2013 Elsevier Ltd. All rights reserved.WoSScopu

Are elderly and aged asthma different diseases? Results of a multicenter study

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCEaydin, omur/0000-0002-3670-1728; GOKSEL, Ozlem/0000-0003-1121-9967; Dursun, A. Berna/0000-0002-6337-6326; Gemicioglu, Bilun/0000-0001-5953-4881WOS: 000455567107243[No abstract available]European Respiratory So

Our results of spontaneously conceived triplet pregnancies

The natural incidence of spontaneous triplet pregnancy is approximately 1 in 8000 births. Premature delivery of one fetus, compromise of one fetus, and death of one fetus of a multiple gestation with healthy co-fetuses are complications unique to multiple gestations. Our purpose was to evaluate the outcome of spontaneous triplet gestations. In this retrospective study, maternal, neonatal data were collected from 25 sets of triplet pregnancies that were diagnosed between 2011 March and December 2013 in Zekai Tahir Burak Womens Health Education and Research Hospital - Obstetric Department. There were 15 sets of trichorionic triamniotic triplet pregnancies and 10 sets of triplet pregnancies with a monochorionic pair (ie, dichorionic triamniotic triplets). The mean maternal age was 28 (20-33). 75% of patients were primigravida. 50% of patients (12 patient) had abortus (gave birth before 20 weeks). 3 patients gave birth about 33 weeks, birth weights were about 2100-2150 grams.4 patients gave birth about 30 weeks ,with birth weigths of 1800-1850 grams. 2 patients had spontaneous abortion of all fetuses after fetal reduction. Two patients (8%) had complication of postoperative endometritis. 3 patients had preeclampsia (12%). The incidence of dichorionicity in our study of spontaneous triplet pregnancy is 40%. Perinatal mortality was increased in dichorionic pregnancies. The abortus rate was 80%. Although abortus rate was high in spontaneous triplet pregnancy,gestational age at delivery was about 33 weeks. This is because of our hospitals condition to be a tertiary hospital in obstetrics and neonatology. [Med-Science 2018; 7(2.000): 312-4