Dynamically accepting and scheduling patients for home healthcare

The importance of home healthcare is growing rapidly since populations of developed and even developing countries are getting older and the number of hospitals, retirement homes, and medical staff do not increase at the same rate. We consider the Home Healthcare Nurse Scheduling Problem where patients arrive dynamically over time and acceptance and appointment time decisions have to be made as soon as patients arrive. The objective is to maximise the average number of daily visits for a single nurse. For the sake of service continuity, patients have to be visited at the same day and time each week during their episode of care. We propose a new heuristic based on generating several scenarios which include randomly generated and actual requests in the schedule, scheduling new customers with a simple but fast heuristic, and analysing results to decide whether to accept the new patient and at which appointment day/time. We compare our approach with two greedy heuristics from the literature, and empirically demonstrate that it achieves significantly better results compared to these other two methods

Home healthcare routing and scheduling of multiple nurses in a dynamic environment

Human resource planning in home healthcare is gaining importance day by day since companies in developed and developing countries face serious nurse and caregiver shortages. In the problem considered in this paper, the decision of patient assignment must be made immediately when the patient request arrives. Once patients have been accepted, they are serviced at the same days, times and by same nurse during their episode of care. The objective is to maximise the number of patient visits for a set of nurses during the planning horizon. We propose a new heuristic based on generating several scenarios which include current schedules of nurses, the new request under consideration, as well as randomly generated future requests to solve three decision problems: first, do we accept the patient? If so, which nurse services the patient? Finally, which days and times are weekly visits of the patient assigned to? We compare our approach with a greedy heuristic from the literature by considering some real-life aspects such as clustered service areas and skill requirements, and empirically demonstrate that it achieves significantly higher average daily visits and shorter travel times compared to the greedy method

Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism.

Published onlineJournal ArticleCONTEXT: Congenital hyperinsulinism (CHI), the commonest cause of persistent hypoglycaemia, has two main histological subtypes: diffuse and focal. Diffuse CHI, if medically unresponsive, is managed with near-total pancreatectomy. Post-pancreatectomy, in addition to persistent hypoglycaemia, there is a very high risk of diabetes mellitus and pancreatic exocrine insufficiency. SETTING: International referral centre for the management of CHI. PATIENTS: Medically unresponsive diffuse CHI patients managed with near-total pancreatectomy between 1994 and 2012. INTERVENTION: Near-total pancreatectomy. MAIN OUTCOME MEASURES: Persistent hypoglycaemia post near-total pancreatectomy, insulin-dependent diabetes mellitus, clinical and biochemical (faecal elastase 1) pancreatic exocrine insufficiency. RESULTS: Of more than 300 patients with CHI managed during this time period, 45 children had medically unresponsive diffuse disease and were managed with near-total pancreatectomy. After near-total pancreatectomy, 60% of children had persistent hypoglycaemia requiring medical interventions. The incidence of insulin dependent diabetes mellitus was 96% at 11 years after surgery. Thirty-two patients (72%) had biochemical evidence of severe pancreatic exocrine insufficiency (Faecal elastase 1<100 µg/g). Clinical exocrine insufficiency was observed in 22 (49%) patients. No statistically significant difference in weight and height standard deviation score (SDS) was found between untreated subclinical pancreatic exocrine insufficiency patients and treated clinical pancreatic exocrine insufficiency patients. CONCLUSIONS: The outcome of diffuse CHI patients after near-total pancreatectomy is very unsatisfactory. The incidence of persistent hypoglycaemia and insulin-dependent diabetes mellitus is very high. The presence of clinical rather than biochemical pancreatic exocrine insufficiency should inform decisions about pancreatic enzyme supplementation

In vitro effectiveness of Castellani solution including various ingredients against different microorganisms

Objective: As the external auditory canal is a moisturearea, it facilitates the growth of bacteria and fungi. Infectionsand inflammation due to Staphylococcus aureus,Pseudomonas aeruginosa, Aspergillus spp. and Candidaalbicans can develop in this area. Classical Castellanisolution including boric acid, fenol, fucsin, resorcinol, acetone,and alcohol is used for external ear tract infectionsdue to fungi and bacteria, and also for the superficial dermatophytoses,and eczematous dermatitis of the externalear tract infections.The purpose of this study is to investigate of the in vitroeffectiveness of classical Castellani solution and its differentformulations with different dilutions against the standardyeast and bacteria strains.Methods: C. albicans ATCC 10231, C. krusei ATCC6258, C. dubliniensis CD 36, C. guilliermondii ATCC6260, C. parapsilosis ATCC22019, E. coli ATCC 25922,P. aeruginosa ATCC 27853, MRSA ATCC 43300, Staphylococcusaureus ATCC 25923, and S. epidermidis ATCC12228 strains were included in the study. Broth microdilutionmethod was used for each microorganism and Castellaniformulation. The tests are repeated at least twice.Results: The inhibitory concentration of classical Castellanisolution against bacteria and fungi is 1/64-1/256,1/32-1/64 for fuchsin free solution, 1/32-1/128 for boricacid-free solution and, 1/64-1/128 for resorcinol-free solution.Conclusions: As a conclusion we think that the classicalCastellani solution and its different formulations at variousdilutions may be effective antimicrobial agents for differentpatient populations. J Clin Exp Invest 2013; 4 (3):302-305Key words: Castellani solution, antimicrobial activity, in vitr

Remote Caring for Older People: Future Trends and Speculative Design

The present chapter explores IoT trends and applications' current and speculative futures to support older people living independently, focusing on the bathroom area, one of the most dangerous domestic places for ageing bodies. The chapter first presents literature on IoT devices and older people ageing-in-place, discussing their relationship, the blurring into cyborg territories and the ramifications. Next, technology uptake is discussed, with an example from a previous research study. Next, healthy ageing, active ageing, and quality of life are discussed through the medical and social models of health, and a new model of technological enhancement & monitoring is proposed. The vulnerabilities of older people and the risks and ethical implications of IoT for them are also covered, followed by current IoT trends and applications complementing an accessible bathroom, with pros and cons for each. The following section introduces speculative design approaches to explore and understand the possibilities and implications on the future of caring for older people, illustrated with three examples: two speculative projects and one science fiction movie. The final section discusses the inclusive nature of caring and the importance of inclusive design approaches to designing and implementing IoT healthcare products and remote-age-care systems for older people and their families/caregivers

Clinical characteristics and molecular genetic analysis of 22 patients with neonatal diabetes from the South-Eastern region of Turkey: predominance of non-KATP channel mutations.

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThis is an open access article available at http://www.eje-online.org/content/172/6/697.BACKGROUND: Neonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes and usually presents in the first 6 months of life. We aimed to describe the clinical characteristics and molecular genetics of a large Turkish cohort of NDM patients from a single centre and estimate an annual incidence rate of NDM in South-Eastern Anatolian region of Turkey. DESIGN AND METHODS: NDM patients presenting to Diyarbakir Children State Hospital between 2010 and 2013, and patients under follow-up with presumed type 1 diabetes mellitus, with onset before 6 months of age were recruited. Molecular genetic analysis was performed. RESULTS: Twenty-two patients (59% males) were diagnosed with NDM (TNDM-5; PNDM-17). Molecular genetic analysis identified a mutation in 20 (95%) patients who had undergone a mutation analysis. In transient neonatal diabetes (TNDM) patients, the genetic cause included chromosome 6q24 abnormalities (n=3), ABCC8 (n=1) and homozygous INS (n=1). In permanent neonatal diabetes (PNDM) patients, homozygous GCK (n=6), EIF2AK3 (n=3), PTF1A (n=3), and INS (n=1) and heterozygous KCNJ11 (n=2) mutations were identified. Pancreatic exocrine dysfunction was observed in patients with mutations in the distal PTF1A enhancer. Both patients with a KCNJ11 mutation responded to oral sulphonylurea. A variable phenotype was associated with the homozygous c.-331C>A INS mutation, which was identified in both a PNDM and TNDM patient. The annual incidence of PNDM in South-East Anatolian region of Turkey was one in 48 000 live births. CONCLUSIONS: Homozygous mutations in GCK, EIF2AK3 and the distal enhancer region of PTF1A were the commonest causes of NDM in our cohort. The high rate of detection of a mutation likely reflects the contribution of new genetic techniques (targeted next-generation sequencing) and increased consanguinity within our cohort.The genetic testing was funded by the Wellcome Trust (Senior Investigator Award to Profs S Ellard and A T Hattersley), and by Diabetes UK (Project funding to Dr D J Mackay). H Demirbilek was funded by European Society for Paediatric Endocrinology (ESPE) and The Scientific and Technological Research Council of Turkey (TUBITAK) for his 1 year clinical fellowship at University College London (UCL), Institute of Child Health, Great Ormond Street Hospital for Children, NHS Trust, Department of Paediatric Endocrinology