Emergency departments (EDs) provide medical treatment for a broad spectrum of illnesses and injuries to patients who arrive at all hours of the day. The quality and efficient delivery of health care ...in EDs are associated with a number of factors, such as patient overall length of stay (LOS) and admission, prompt ambulance diversion, quick and accurate triage, nurse and physician assessment, diagnostic and laboratory services, consultations and treatment. One of the most important ways to plan the healthcare delivery efficiently is to make forecasts of ED processes. The aim this study is thus to provide an exhaustive review for ED stakeholders interested in applying forecasting methods to their ED processes. A categorisation, analysis and interpretation of 102 papers is performed for review. This exhaustive review provides an insight for researchers and practitioners about forecasting in EDs in terms of showing current state and potential areas for future attempts.
Microspherophakia is a developmental disorder of the lens characterized by a small and spherical lens. Defective development of the lens fibers during embryogenesis was thought to be responsible for ...the abnormal size and shape of the lens. Weill-Marchesani syndrome (WMS) is the most common syndrome accompanying microspherophakia. The spherical shape of the lens increases the refractive power of the lens and leads to high myopia. Furthermore, due to zonular weakness, the small and spherical lens can easily move forward and lead to a pupil block. In this case report, we discussed a case of WMS with microspherophakia in which the yttrium-aluminium-garnet (YAG) laser iridotomy had been performed on multiple areas to prevent pupillary block, but glaucoma progressed despite multiple laser iridotomy treatments. We stressed that if YAG laser iridotomy is implemented as first-line treatment in microspherophakic patients with WMS, the patients should be closely monitored. We also emphasized that if glaucoma progression continues despite the effective YAG laser iridotomy, the ophthalmologist should not insist on YAG laser treatment, and surgical lens removal option should be considered.
The aim of this paper is to provide not only a hybrid theoretical methodology in multiple-attribute decision making problems but also a practical application in maritime transportation industry. The ...proposed hybrid approach integrates Analytic Hierarchy Process (AHP) method into VlseKriterijumska Optimizacijia I Kompromisno Resenje, (VIKOR) technique under interval type-2 fuzzy (IT2F) environment. While AHP and VIKOR provides a comprehensive framework to solve multiple-attribute decision making (MADM) problems in maritime transportation industry, the IT2F enables to deal with much uncertainty during linguistic assessment of decision-makers. The proposed approach is demonstrated with a hatch cover design selection problem since it has utmost importance in structure of bulk carrier ships to prevent water ingress and protect cargo form the external damages. Besides its robust theoretical insight, the paper has practical contribution to the naval engineers, classification societies and ship owners who have difficulty in deciding appropriate hatch cover type during construction of the ship.
•A hybrid theoretical methodology in multiple-attribute decision making problems.•A practical application in maritime transportation industry.•Integration of AHP and VIKOR under IT2FSs.•A practical solution for hatch cover design selection problem.
Diabetes mellitus (DM) is a chronic hyperglycemic state and is associated with microvascular structural alterations. This study aimed to investigate the diameters of capillary loops and ...morphostructural changes using nailfold video capillaroscopy (NVC) in patients with type 2 DM with and without diabetic retinopathy (DR).
This cross-sectional, single-center study was conducted in patients with type 2 DM who were followed in outpatient clinics of ophthalmology and internal medicine. General demographic data were collected from patients. An ophthalmologist examined all patients in terms of DR. A rheumatologist blinded to the clinical data performed NVC. The diameters of apical, arterial, and venous loop of capillaries were measured, and the microvascular changes of capillaries were scored.
In this study, 44 patients with type 2 DM with DR (47.7% males) and 20 patients with type 2 DM without DR (55% males) were included. In our study, patients with type 2 DM with DR had more frequent capillary hemorrhage, more frequent ectasia, more frequent giant capillary, and more frequent neo-angiogenesis than patients with type 2 DM without DR. However, these findings were not statistically significant.
Further controlled studies with large sample size are needed to determine the characteristic NVC findings of DR in patients with type 2 DM.
Varicocele occurs as a result of dilatation of the pampiniform plexus in the spermatic veins. In this study, our primary aim was to evaluate the effect of Transversalis Fascia Plane Block (TFPB) on ...pain scores in the postoperative period in patients undergoing varicocelectomy surgery, and our secondary aim was to evaluate the effect of TFPB on analgesic consumption.
The study was initiated following local ethics committee approval, and sixty ASA I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation were enrolled. Before the procedure, the patients were randomly assigned two groups: Transversalis Fascia Plan block group (Group TFPB) or surgical incision site infiltration group (Group I).All surgeries were carried out under general anesthesia, and microsurgery using the subinguinal approach. After surgical suturing, TFPB and local infiltration blocks were applied prior to termination of anesthesia.For each block, 20 mL of 0.25% bupivacaine was utilized. Patients' demographic information, passive and active VAS ratings after surgery, usage of non steroidal anti-inflammatory medications and rescue analgesia, and the requirement for rescue analgesia, were recorded.
A total of 60 patients were included in the study. In terms of demographic data, there was no difference between the groups. At all hours, there was a statistically significant decrease in favor of Group TFPB in terms of active and passive VAS scores (p < 0.001), non steroidal anti-inflammatory analgesic use (p < 0.05), and tramadol requirement (p < 0.001).
This study has shown that TFPB can provide a more effective analgesia when compared to surgical site infiltration.
Pectoral nNerve (PECS) block type-1 is an Ultrasound (US)-guided interfacial block that can be performed for postoperative analgesia management after breast surgery. In the procedure, a local ...anesthetic solution is injected into the interfacial area between the Pectoralis Major muscles (PMm) and Pectoralis minor muscles (Pmm). The present study compared PECS block type-1 administered preoperatively or postoperatively for postoperative analgesia after breast augmentation surgery.
The patients were randomly divided into three groups (n = 30 in each): a preoperative PECS block group (Pregroup), postoperative PECS block group (Postgroup), and control group (Group C). Opioid consumption and Visual Analogue Scale (VAS) scores were evaluated at postoperative period.
The pains scores in the Pregroup were significantly lower than those in the control group. Although there was no significantly difference in the VAS scores of the Postgroup and control group at postoperative 1 hour, the scores in the Postgroup were significantly lower than those in the control group at all the other evaluated times (p < 0.05). The VAS scores in the Pregroup were significantly lower than those in the Postgroup 8 hours after the surgery. Opioid consumption was significantly lower in the Pregroup as compared with that in the other two groups (p < 0.05). The use of rescue analgesia in the Pregroup was significantly lower than that in the other groups (p < 0.05).
Performing PECS block type-1 preoperatively reduced VAS scores and opioid consumption after breast augmentation.
To evaluate the functional and anatomical results of intravitreal ranibizumab (IVR) treatment in diabetic macular edema (DME) with and without serous retinal detachment (SRD).
Fifty-one eyes treated ...with three consecutive intravitreal injections of ranibizumab for DME with and without SRD were retrospectively analyzed. Patients were divided into two groups according to optical coherence tomography (OCT) findings. Group 1 consisted of 25 DME patients with SRD, Group 2 consisted of 26 DME patients without SRD. After three consecutive IVR injections, changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed and compared between groups.
The mean age was 64.16 ± 6.43 and 68.77 ± 7.19 years, respectively (p = 0.036). Initial BCVA was 0.55 ± 0.36, 0.62 ± 0.39 LogMAR, respectively (p: 0.613). Initial CMT was 548.7 ± 111.6 μm, 446.4 ± 104.1 μm in groups, respectively and it was significantly higher in Group 1 (p = 0.001). After three consecutive IVR, mean BCVA improved to 0.47 ± 0.30 LogMAR (p = 0.281) and CMT decreased to 331.6 ± 165.1 μm (p = 0.000) in Group 1. Mean BCVA improved to 0.40 ± 0.34 LogMAR (p = 0.005) and CMT decreased to 287.2 ± 148.8 μm (p = 0.000) in Group 2. While the decrease in CMT values was similar between the groups, the increase in BCVA was more pronounced in Group 2 after IVR treatment.
Similar morphological results were obtained in both of the groups, but the visual gain was lower in patients with SRD.
•Diabetic macular edema is a common cause of visual impairment in diabetic patients.•There are different patterns of diabetic macular edema such as diffuse retinal thickening, cystoid macular edema, and serous retinal detachment.•Anti-VEGF agents have been first-line treatment in diabetic macular edema.•The effect of anti-VEGF agents (bevacizumab, ranibizumab,aflibercept) on serous retinal detachment is unclear due to its nature.•Visual gain may be lower in diabetic macular edema with serous retinal detachment after the ranibizumab treatment.
Risk assessment is vital for cost-effective ship management in maritime industry since numerous maritime activities pose potential hazards according to the human causalities. Therefore, safety ...practitioners attempt to offer proactive approaches to mitigate risk as much as possible. In this context, this article presents a hybrid risk-based approach for maritime industry by adopting Fuzzy Analytic Hierarchy Process (FAHP) with fuzzy VIKOR (FVIKOR) methods under Fine-Kinney approach. To illustrate the hybrid risk-based approach, ballast tank maintenance process is handled since there are various hazards causing fatalities, severe injuries, and illness during ballast tank maintenance procedure than any other type of shipboard work. An extensive risk analysis is performed to enhance environment safety and operational reliability in maritime industry. Besides its theoretical contribution, the outcomes of the paper contribute to improve overall safety level of ship by considering potential hazards in risk management.
Rail transit is one of the most important public transportation types, especially in big and crowded cities. Therefore, getting a high customer satisfaction level is an essential task for ...municipalities and governments. For this purpose, a survey is conducted to question the attributes related to rail transit network (metros, trams, light rail and funicular) in Istanbul. In this study, we present a novel framework which integrates statistical analysis, SERVQUAL, interval type-2 fuzzy sets and VIKOR to evaluate customer satisfaction level for the rail transit network of Istanbul. Level of crowdedness and density in the train, air-conditioning system of trains' interior, noise level and vibration during the journey, and phone services are determined as the attributes need improvements. On the other hand, different improvement strategies are suggested for the rail transit network. The proposed approach provides directions for the future investments and can be generalized and applied to complex decision making problems encounter inexact, indefinite and subjective data or uncertain information.
•A multi-attribute customer satisfaction evaluation approach is proposed.•The proposed approach integrates statistical analysis, SERVQUAL, interval type-2 fuzzy sets and VIKOR methods.•A real case study for rail transit network of Istanbul based on a survey is conducted.•The attributes need to be improved for each line of rail transit network is determined and improvement suggestions are provided.•The proposed approach is generic so that can be applied to other systems.
Regional anesthesia has benefits beyond just treating acute postoperative pain. Interfascial plane blocks, which have been very popular with ultrasound in recent years, function primarily by ...administering a high volume of a local anesthetic to the fascial plane. Contrary to traditional peripheral nerve blocks, the targeted nerve or structure in interfacial plane blocks is not fully defined, and the indications have not been fully revealed yet. Anatomical, cadaveric, and radiological studies show how effective the interfascial plane blocks play a role. This review focuses on the benefits, techniques, indications, and complications of interfascial plane blocks in the context of breast, thoracic, and orthopedic surgery.
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