Search Results (61)

Background: Healthcare systems are increasingly strained by limited operating room resources and rising demand, a situation intensified by the COVID-19 pandemic. These pressures have resulted in overcrowded surgical departments, prolonged waiting times for elective procedures, worsened patient health outcomes, and increased hospital expenditure costs. Methods: To address these challenges, this study proposes a multi-objective mathematical optimization model as the analytical core of a decision support approach for OR resource allocation. The model considers multiple constrained resources, including OR time, intensive care units, medium care units, and nursing staff, and aims to minimize both elective patients’ waiting times and total incurred costs over a one-week planning horizon. Developed using real hospital data from a large facility in Thailand, the model was implemented in LINGO version 16.0, and a sensitivity analysis was conducted to assess the impact of surgical department priorities and overtime allowances. Results: Compared to current practices, the optimized OR schedule reduced average waiting times by approximately 7% and total costs by 5%, while balancing resource utilization. Conclusions: This study provides a data-driven tool to support hospital resource planning, improve OR efficiency, and respond effectively to future healthcare crises. Full article

Background/Objectives: This study evaluates the outcomes of extracorporeal membrane oxygenation (ECMO), in venoarterial configuration, and short-term ventricular assist devices (VADs) used as a bridge to heart transplantation (HT). The primary objective was to identify predictors of in-hospital mortality among patients on the urgent HT waiting list receiving short-term mechanical circulatory support, including direct ECMO-to-HT, direct short-term VAD-to-HT, and ECMO as a bridge to short-term VAD followed by HT (ECMO bridge-to-bridge). Secondary objectives included identifying predictors of in-hospital mortality in transplanted patients and assessing their long-term survival. Methods: A single-center, retrospective, observational, and analytical study conducted at a tertiary care hospital, including patients supported with ECMO and short-term VAD support as a bridge to HT between 2007 and 2024. Results: A total of 183 patients were included: 110 in the ECMO-to-HT group, 51 in the VAD-to-HT group, and 22 in the ECMO bridge-to-bridge group. Among them, 147 underwent HT (80.3%). Overall in-hospital mortality was 37.2% (115 of 183 patients survived), while in-hospital mortality among transplanted patients was 21.8% (115 of 147 survived). Independent predictors of in-hospital mortality included infection, ECMO bridge-to-bridge strategy, higher body mass index (BMI), older age, and neurological complications. In the transplanted subgroup, predictors of both in-hospital and long-term mortality were ECMO support and older recipient age. Notably, a donor BMI exceeding that of the recipient by more than 10% was associated with improved survival. Conclusions: The complexity of patients requiring mechanical circulatory support and the physiological effects of different devices necessitate early, individualized management based on the etiology of cardiogenic shock and urgency status. Full article

(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for rotator cuff tears. (2) Methods: All patients on the waiting list for arthroscopy of cuff tears in a single center between 2013 and 2015 were analyzed. They were divided into two groups: those who underwent surgery (arthroscopy group) and those who declined the procedure (orthopedic group). The primary endpoint was shoulder functionality, evaluated with the CMS, SST, and SPADI-SP questionnaires. Inverse probability of treatment weighting (IPTW) was used to account for differences between the groups. (3) Results: Of 57 patients (67 (62–71) years old, 47% women), 32 were in the arthroscopy group and 25 in the orthopedic group. Functionality was assessed at a median of 7 (7–8) years after diagnosis. The patients in the arthroscopy group were younger (p = 0.023) and more frequently women (p = 0.074). No significant differences were observed in the type of tear (p = 0.205) or laterality (p = 0.164). Functional outcome analysis showed more favorable scores in the surgical group: constant (74.5 ± 16.6 vs. 58.4 ± 23, p = 0.016), SST (7.3 ± 3.1 vs. 4.9 ± 4.2, p = 0.016), and SPADI-SP (35.7 ± 26.6 vs. 56.1 ± 30.4, p = 0.006). (4) Conclusions: In this cohort of patients with cuff tears, arthroscopic repair was associated with better clinical and functional midterm results compared to conservative treatment, although the benefit was less evident in older patients and those with complete tears. Full article

This study applies stochastic discrete event modeling to demonstrate that reducing wait times for specialized outpatient clinics in the Costa Rican public healthcare system is possible. The classification process identified four medical specialties with the longest wait times. It includes the creation of a separate queuing theory model for each specialty. The birth and death model allowed for estimating the number of arrivals and consultations in the simulation. Validation was performed by comparing the model’s input and output data with real-world statistical reports. An analysis of medical specialists revealed that approximately 22% of patients referred to secondary care did not require specialized medical consultation. Through simulation and the use of stochastic input data, patient waiting times decreased. In an optimistic scenario, waiting times decreased steadily across all specialties over 24 months. Ophthalmology and orthopedics reduced their waiting times to less than 300 days. Otorhinolaryngology decreased from 370 to 250 days, and urology showed the most significant improvement, decreasing from 350 to 100 days in the first year and remaining stable. This evidence transforms the traditional paradigm of increasing capacity as the only solution to the waiting list problem and positions improving the referral process as an alternative. To achieve these results, the study highlights the importance of implementing improved triage protocols in primary care, integrating decision-support tools for general practitioners using machine learning, for example, to reduce unnecessary referrals. Training programs and feedback mechanisms could also align referral practices with specialty criteria. While these strategies were not implemented in this study, the simulation results provide a solid basis for their design and future evaluation. Full article

Background/Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in Saudi Arabia, yet challenges remain in diagnosis and treatment accessibility. This study examined healthcare practitioners’ clinical approaches to ADHD diagnosis and management in Saudi Arabia and identified gaps in practice. Methods: This cross-sectional study included healthcare practitioners working in various healthcare settings across Saudi Arabia. The sample included psychiatrists, pediatricians, psychologists, and other relevant specialists. Clinical practices regarding ADHD diagnosis, the use of ADHD screening tools, adherence to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, treatment strategies, medication prescription protocols, and reported challenges were investigated. Results: A total of 43 licensed healthcare practitioners with a minimum of 2 years of clinical experience managing ADHD participated. Among participants, 81.4% were psychiatrists, and 53.5% managed ADHD cases in children/adolescents exclusively. Approximately 86.0% of the sample used screening tools, with the Vanderbilt Assessment Scale being the most used (67.6%). However, only 55.8% addressed all 18 DSM-5 ADHD symptoms during the evaluation. Combined pharmacological and non-pharmacological treatment approaches (74.4%) were preferred. Interestingly, only 7.0% prescribed amphetamine-based stimulants due to the lack of clear guidelines. Key barriers included a lack of early screening programs (65.1%), limited ADHD medication option availability (51.2%), and extended referral waiting lists (44.2%). Conclusions: Significant variability in ADHD diagnosis and treatment practices was evident among healthcare providers in Saudi Arabia. Specifically, a large proportion of healthcare providers do not fully comply with the standard DSM-5 diagnosis criteria. Major barriers to ADHD diagnosis and treatment in Saudi Arabia include extended referral waiting lists, limited availability of psychostimulant medications, and standardized clinical guidelines. A national ADHD protocol must be advocated, and access to diverse treatment options should be improved. Full article

Background: The most common cause of chronic liver disease is now known to be non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic-associated fatty liver disease (MAFLD). This review aims to synthesize current evidence on the pathophysiology and clinical implications of nephrological, pulmonary, and dermatological manifestations among NAFLD/MAFLD patients. In order to find safe and efficient treatments, NAFLD/MAFLD has emerged as a primary concern for hepatologists worldwide. Methods: We conducted a comprehensive review of the literature from major databases, focusing on studies that evaluated the extrahepatic manifestations of NAFLD/MAFLD. Emphasis was placed on identifying pathophysiological mechanisms and assessing their clinical impact on renal, pulmonary, and dermatological systems. Results: Recent developments in the management of chronic viral hepatitis have lowered the mortality rate associated with chronic liver disease. However, the prevalence of NAFLD/MAFLD continues to rise, making chronic liver disease a significant health concern for the future. An increasing percentage of patients on liver transplant waiting lists now have cirrhosis and hepatocellular carcinoma due to non-alcoholic liver disease. Furthermore, the incidence and prevalence of chronic kidney disease have surged, linking NAFLD/MAFLD to higher morbidity, mortality, and healthcare costs. Conclusions: NAFLD/MAFLD is underdiagnosed and underappreciated, yet its incidence is rapidly increasing, raising concerns about a potential global epidemic. Given its multisystemic impact—extending to renal, pulmonary, and dermatological complications—it is crucial to develop interdisciplinary strategies for early detection and effective management of the disease. Full article

Background and Objective: Crohn’s Disease (CD) is a chronic inflammatory condition with significant physical and psychological impacts, often requiring comprehensive self-management. This study examines the effects of COBMINDEX (Cognitive–Behavioral and Mindfulness Intervention with Daily Exercise) on coping strategies and life satisfaction in CD patients, focusing on gender-specific responses. Study objectives were to assess the impact of COBMINDEX on adaptive and maladaptive coping strategies and life satisfaction in CD patients, and to examine gender differences in these outcomes. Materials and Methods: A pre-planned secondary analysis of a randomized controlled trial, conducted from 2018 to 2021, at two public tertiary hospitals in Israel. A total of 120 CD patients (45 men and 75 women) were randomly assigned to either theCOBMINDEX group or a wait-list control group. Participants were assessed at baseline and post-intervention for coping strategies, mindfulness, psychological symptoms, and life satisfaction using validated scales. Quantile regression explored the gender-specific predictors of life satisfaction. This study was registered at ClinicalTrials.gov (NCT05085925) and Israel Ministry of Health (MOH_2020- 02- 24_008721. asp). Results: Both genders showed significant improvements in mindfulness, emotion-focused coping, and active coping (p < 0.05). Women exhibited reduced dysfunctional coping and greater emotional support use. For men, emotion-focused coping and mindfulness positively predicted life satisfaction, while for women, reductions in psychological symptoms and dysfunctional coping were significant predictors (p < 0.01). Conclusions: COBMINDEX enhances coping strategies and life satisfaction in CD patients, with notable gender differences. These findings highlight the importance of gender-tailored psychological interventions to improve overall patient well-being. Full article

Background/objectives: Anderson-Fabry disease (FD) is a rare hereditary disorder caused by deficient alpha-galactosidase A activity, which leads to multisystemic complications, including significant cardiac involvement. In this case report, we describe two siblings with distinct cardiac manifestations of FD. Methods: The medical data of two siblings who were managed and treated at a tertiary hospital center in Croatia were obtained by detailed analysis of electronic medical records. All available data were structured in chronological order. Results: A 42-year-old male with chronic renal failure and severe left ventricular hypertrophy (LVH) was diagnosed with FD during testing for inclusion on the kidney transplant waiting list. The diagnosis was confirmed by cardiac magnetic resonance imaging (CMR), which revealed non-ischemic fibrosis typical of FD. Following enzyme replacement therapy (ERT), he underwent a successful kidney transplantation. The second case describes the 36-year-old brother, who was diagnosed through family screening and, despite normal initial cardiac ultrasound findings, exhibited early cardiac involvement through reduced T1-mapping values. Immediate initiation of ERT led to normalization of T1 values and successful renal transplantation. Conclusions: This report underscores the importance of family screening and early diagnosis in FD and highlights the role of CMR in detecting preclinical cardiac involvement. Full article

The number of older adults undergoing organ transplantation, and waiting lists are increasing. The epidemiological data on infections in older transplant patients are scarce. The objective of the study was to investigate the incidence and distribution of infectious complications in older patients according to post-transplant periods. This retrospective study was conducted in a university hospital between 1 January 2018 and 31 March 2023. All infectious episodes were analyzed over three post-transplant periods. Forty-four patients were enrolled. The median age was 67 years (min: 65 and max: 87 years). Patients experienced a total of 98 infectious episodes. The median number of infectious events per patient was 1.0 (min: 0 and max: 8). The overall incidence rate of infectious events was 2.18 infectious episodes per 1000 transplant days. Of the patients at risk, 18.2% had 12 (12.4% of all infections) infections in the first month (9.09 episodes per 1000 transplant days), 56.8% had 52 (53.1%) infections between 1 and 6 months (7.88 episodes per 1000 transplant days), and 40.9% had 34 (35%) infections >6–12 months post-transplant (0.92 episodes per 1000 transplant days) The most prevalent type of infection was bacterial (79.6%, n = 78) followed by viral (18.4%, n = 18) and fungal (2.0%, n = 2) infections. The overall mortality rate of the 44 patients was 13.6%. The bacterial infections were more prevalent, and the incidence of infection was high during all post-transplant periods. These results may guide infection management in older transplant patients. Full article

The study site, a major teaching hospital in Dublin, Ireland, addressed significant challenges within its dermatology service through a comprehensive improvement initiative using a person-centred Lean Six Sigma methodology. Initially, the hospital’s dermatology department faced excessive outpatient waiting times, with 3736 patients awaiting appointments, and 1615 waiting over 12 months. The person-centred Lean Six Sigma approach, which combines Lean techniques to reduce non-value add and Six Sigma methods to eliminate variation through a person-centred lens, was applied to overhaul the referral, triage, and scheduling processes. Key interventions included standardising triage categories, centralising the triage process, and redistributing referrals equitably among consultants. A new centralised triage system was established, leading to a more efficient allocation of appointments and better management of urgent cases. Post-implementation data showed a 40% reduction in the overall waiting list and a 60% reduction in the number of patients waiting over 12 months. The initiative significantly decreased the wait times across all urgency categories, with the most notable improvements in soon and urgent referrals. These changes were also the impetus for a follow-up design-led innovation phase, where the team worked with partners across the educational and healthcare system to enable disruptive change. The success of this project provides a scalable model for improvements in similar healthcare settings. Full article

Hepatitis C virus (HCV) has emerged as a major global health concern and, if left untreated, can lead to significant liver damage, including cirrhosis, decompensated liver disease, and hepatocellular carcinoma (HCC). Approximately 40% of patients with HCV infection experience extrahepatic manifestations, including renal involvement. HCV-related renal disease is of significant importance among patients with chronic kidney disease (CKD), leading to higher morbidity and mortality. The renal damage due to HCV infection primarily results from cryoglobulinemia and glomerulonephritis, with conditions such as membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN) being most prevalent. Despite advancements in treatment, including the use of directly acting antiviral agents (DAAs), renal complications remain a significant burden in untreated patients. HCV-positive patients on hemodialysis (HD) or those who have undergone kidney transplantation face increased mortality rates compared to their HCV-negative counterparts. Managing HCV infection before kidney transplantation is crucial to mitigate the risk of HCV-related renal complications. Conversely, kidney transplantation from HCV-infected donors is well established, as post-transplant treatment for HCV is safe and effective, potentially reducing mortality and morbidity for patients on transplant waiting lists. This review aims to provide a comprehensive analysis of the renal manifestations of HCV, emphasizing the importance of early diagnosis and treatment to improve patient outcomes. Full article

In this study, the concept of symmetry is employed to implement an intelligent fuzzy traffic signal control system for complex intersections. This approach suggests that the implementation of reduced fuzzy rules through the reduction method, without compromising the performance of the original fuzzy rule base, constitutes a symmetrical approach. In recent decades, urban and city traffic congestion has become a significant issue because of the time lost as a result of heavy traffic, which negatively affects economic productivity and efficiency and leads to energy loss, and also because of the heavy environmental pollution effect. In addition, traffic congestion prevents an immediate response by the ambulance, police, and fire brigades to urgent events. To mitigate these problems, a three-stage intelligent and flexible fuzzy traffic control system for complex intersections, using a novel hybrid reduction approach was proposed. The three-stage fuzzy traffic control system performs four primary functions. The first stage prioritizes emergency car(s) and identifies the degree of urgency of the traffic conditions in the red-light phase. The second stage guarantees a fair distribution of green-light durations even for periods of extremely unbalanced traffic with long vehicle queues in certain directions and, especially, when heavy traffic is loaded for an extended period in one direction and the short vehicle queues in the conflicting directions require passing in a reasonable time. The third stage adjusts the green-light time to the traffic conditions, to the appearance of one or more emergency car(s), and to the overall waiting times of the other vehicles by using a fuzzy inference engine. The original complete fuzzy rule base set up by listing all possible input combinations was reduced using a novel hybrid reduction algorithm for fuzzy rule bases, which resulted in a significant reduction of the original base, namely, by 72.1%. The proposed novel approach, including the model and the hybrid reduction algorithm, were implemented and simulated using Python 3.9 and SUMO (version 1.14.1). Subsequently, the obtained fuzzy rule system was compared in terms of running time and efficiency with a traffic control system using the original fuzzy rules. The results showed that the reduced fuzzy rule base had better results in terms of the average waiting time, calculated fuel consumption, and CO₂ emission. Furthermore, the fuzzy traffic control system with reduced fuzzy rules performed better as it required less execution time and thus lower computational costs. Summarizing the above results, it may be stated that this new approach to intersection traffic light control is a practical solution for managing complex traffic conditions at lower computational costs. Full article

Background: In systemic sclerosis (SSc), cardiac involvement is frequent, heterogeneous, and related to a poor prognosis. Due to a longer life expectancy, the development of degenerative aortic stenosis (AS) is not uncommon. The aim of this article is to report the characteristics of AS in SSc, analyzing the rate of progression, the management, and the outcome. Methods: This is a case series conducted at the Department of Cardiology of Monaldi Hospital, Naples, Italy. Results: From January 2007 to December 2022, we analyzed 234 patients with SSc. Ten/234 patients (4.3%) showed severe AS and were included in the analysis (age 75.5 years [IQR 58–84], nine females). Nine had limited and one diffuse SSc. Two patients were in NHYA/WHO II and eight in NYHA/WHO III. All had degenerative three-leaflet AS. Two patients showed severe AS at the first evaluation, and eight developed severe AS during the follow-up, with a time progression from moderate to severe AS of 3.2 ± 1.1 years (progression rate −0.190 ± 0.012 cm²/year for aortic valve area, 8.6 ± 6.1 mmHg/year for mean aortic gradient, 16 ± 7 mmHg/year for peak aortic gradient, and 0.5 ± 0.3 m/s/year for aortic peak velocity). Seven out of 10 patients underwent transcatheter aortic valve implantation (TAVI), one underwent surgical aortic valve replacement (SAVR), one was left untreated, and one was on a waiting list for TAVI. No major complications after TAVI or SAVR occurred. At a mean follow-up of 5.9 ± 3.9 years, eight patients are alive and two died. Conclusion: Severe AS is a relevant cardiac complication of SSc and must be considered in the screening and during the follow-up. Its rapid progression rate may tentatively be due to autoimmunity, degenerative burden, and chronic inflammation. Full article

Background: The accelerated aging of the world’s population will lead to an increase in the number of older people in the workforce. Computerized Cognitive Training (CCT) is effective in improving cognitive outcomes, but its benefits for older workers remain controversial. We investigate the real-world efficacy of CCT in the workplace, focusing on employees aged 50+ years from a public sector agency. Methods: Case managers (n = 82) were randomized to either an intervention group (24 40 min CCT sessions two times per week) or a waiting list passive control group. Cognitive ability, well-being, job satisfaction, and productivity outcome measures were collected and assessed before and after CCT or the comparable control wait time. Results: Participants undergoing CCT improved on a task of executive functioning (p = 0.04). There was a trend toward a change in work productivity after CCT (p = 0.09), with the control group showing a significant decrease (p = 0.02), while the intervention group remained stable. Conclusions: CCT during office hours has a positive effect on cognition and well-being without affecting productivity among white-collar office workers. CCT could be considered as an intervention to support the older workforce in managing the cognitive and behavioral challenges of changing workplace demands. Full article

Smart cities facilitate the comprehensive management and operation of urban data generated within a city, establishing the foundation for smart services and addressing diverse urban challenges. A smart system for public laundry management uses artificial intelligence-based solutions to solve the challenges of the inefficient utilization of public laundries, waiting times, overbooking or underutilization of machines, balancing of loads across machines, and implementation of energy-saving features. We propose SmartLaundry, a real-time system design for public laundry smart recommendations to better manage the loads across connected machines. Our system integrates the current status of the connected devices and data-driven forecasted usage to offer the end user connected via a mobile application a list of recommended machines that could be used. We forecast the daily usage of devices using traditional machine learning techniques and deep learning approaches, and we perform a comparative analysis of the results. As a proof of concept, we create a simulation of the interaction with our system. Full article