Outpatient management of community-acquired pneumonia

The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns.info:eu-repo/semantics/publishedVersio

asking the same questions but expecting different answers

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Ventilator-associated pneumonia prevention: one good turn does not always deserve another

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Planning a sustainable reverse logistics system: balancing costs with environmental and social concerns

The present work aims to support tactical and operational planning decisions of reverse logistics systems while considering economical, environmental and social objectives. In the literature, when addressing such systems economical aspects have been often used, while environmental concerns have been only recently emerging. The social component is the one less studied, and rarely the combination of the three concerns has been analyzed. This work address the three objectives and was motivated by the challenge of supporting decisions makers when managing a real case study of a recyclable waste collection system, where strategic decisions on the number and location of depots, vehicles and containers were taken beforehand. Tactical and operational decisions are studied involving the establishment of service areas for each depot and the definition and scheduling of collection routes for each vehicle. Such decisions should represent a compromise solution between the three objectives considered and support a sustainable reverse logistics plan. A multi-objective solution approach based on mixed-integer linear programming models is developed. Trade-offs between the objectives are discussed. Moreover the solutions obtained when each objective is tackled individually are compared between themselves and with the balanced solution.info:eu-repo/semantics/publishedVersio

application of lean methodologies

Poster presentationHealthcare acquired infections (HAI) are an important cause of morbidity and mortality. Hand hygiene (HH) is one of the most effective measures for preventing HAI. However, stirring healthcare workers to comply with HH remains a challenge. Two common barriers often found are forgetfulness and the lack of time. We hypothesize that the perception of lack of time and forgetfulness stems from the pressure of too much tasks in a short period of time. Therefore, it is rational to search for efficiency and minimize waste. This study aims at exploring the use of LEAN methodologies to improve nurses’ work processes in an ICU ward. A design science research approach was used. A questionnaire was applied to the nurses followed by an observational study of an 8-hour work shift to identify nurses’ activities, processes of care, and to describe HH compliance. Next, a value stream map (VSM) was designed and the analysis performed with the nurses, which helped to identify points of possible improvement in the process of care. After this, weekly LEAN workshops were held with the objective of improving workflow efficiency. From the initial observational study, we found that a nurse may take on average 16% of their work time using the information system, and the overall rate of HH was 63%. The full compliance to HH would amount to 13% of a nurse’s workload. Three processes were identified as the most relevant HH compliance drivers: the reorganization of essential supplies, the optimal provision of medicines and monitoring equipment automatic data collection. The participant nurses defined as objectives to reduce the supplies’ delivering time and establish a stock management system. To achieve it the reorganization of the storage with the ABC method, with the nurses deciding the layout of the storage space, was essential. The use of LEAN methods permitted to detect and address improvement opportunities with significant benefits. Moreover, nurses’ participation in the process enriched the experience, helping to design a customized intervention and heightened their sense of teamwork.publishersversionpublishe

Economic and environmental concerns in planning recyclable waste collection systems

This paper addresses the planning of recyclable waste collection systems while accounting for economic and environmental concerns. Service areas and vehicle routes are defined for multiple-depot logistics networks where different products have to be collected. The problem is modeled as a multi-product, multi-depot vehicle routing problem with two objective functions: distance and CO2 emissions minimization. A decomposition solution method is developed and applied to a real case-study. Six scenarios are studied regarding different service areas configuration and different objective functions. Savings up to 22% in distance and 27% in CO2 emissions are achieved, excelling economical and environmental goals.info:eu-repo/semantics/publishedVersio

The smart waste collection routing problem: alternative operational management approaches

Waste collection is nowadays an increasingly important business. However, it is often an inefficient op- eration due to the high uncertainty associated with the real waste bins’ fill-levels. To deal with such uncertainty the use of sensors to transmit real time information is seen as possible solution. But, in order to improve operations’ efficiency, the sensors’ usage must be combined with optimization procedures that inform on the optimal collection routes to operationalize, so as to guarantee a maximization of the waste collected while also minimizing transportation costs. The present work explores this challenge and studies three operational management approaches to define dynamic optimal routes, considering the access to real-time information on the bins’ fill-levels. A real case study is solved and important results were found where significant profit improvements are observed when compared to the real operation. This shows the potential of the proposed approaches to build an expert system, which can support the operations manager’s decisions.info:eu-repo/semantics/acceptedVersio

LP-based heuristic procedure for the optimal design of water using networks with multi-contaminants

This paper proposes a new strategy for the optimal design of water-using networks in industrial systems featuring possibly more than a single water source and multiple contaminants. The model formulation is supported on a superstructure that exploits reuse opportunities and gives rise to a non-convex nonlinear which often leads to local optimal solutions. To overcome this, the new approach generates multiple initialization points, one for each possible sequence of operations, where a particular starting point is obtained by the sequential solution of a small set of related linear programs. The best solution of the several non-linear problems that are solved is then assumed to be the global optimal solution. The results obtained for a set of case studies have shown that the best initialization point is often the global optimal solution and that the procedure as a whole is efficient in escaping local optima

Clinicopathological features as prognostic predictors of poor outcome in papillary thyroid carcinoma

Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.This study was supported by FCT, the Portuguese Foundation for Science and Technology through a PhD grant to E.T. SFRH/BD/143458/2019. This work was financed by FEDER—Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020—Operacional Programme for Competitiveness and Internationalization (POCI), Portugal 2020. Additional funding by the European Regional Development Fund (ERDF) through the Operational Programme for Competitiveness and Internationalization— COMPETE2020, and Portuguese national funds via FCT, under project POCI-01-0145-FEDER-016390: CANCEL STEM and from the FCT under the project POCI-01-0145-FEDER-031438: The other faces of telomerase: Looking beyond tumor immortalization (PDTC/MED_ONC/31438/2017). Additional funding through the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo-BOLSA SPEDM PARA PROJECTO DE INVESTIGAÇÃO-2017