Home health care nurse routing and scheduling problem considering ergonomic risk factors.

Home health care routing and scheduling is a complex problem that requires many aspects to be considered simultaneously. One of the important aspects is ergonomics. Home health care nurses are at higher risk of work-related health problems such as musculoskeletal disorders and burnout since they are frequently exposed to physical, mental, and environmental ergonomic risks in their jobs. Therefore, it is essential to integrate ergonomic considerations into the construction of daily schedules for home health care nurses to mitigate these health risks. The purpose of this study is to present a mathematical model that incorporate ergonomic risks. We introduce a set of constraints into our model to prevent nurses from encountering excessive workloads. To assess the workload, we propose a subjective assessment method and employ a fuzzy inference system to calculate nurses' perceived workload levels. We applied our model to a several numerical examples to investigate the impact of workload on the nurse daily schedules. We observed that, at a specified workload level, there may be alternative solutions where the number of patients visited is the same. Therefore, we defined an objective function to maximize patient visits while minimizing nurses' workload levels as much as possible. As a result, our model generates solutions that effectively reduce nurse workloads, leading to more balanced schedules. Thus, our study offers a comprehensive approach to home health care scheduling by incorporating ergonomic considerations, ultimately enhancing both patient care and nurse well-being.

Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia.

Vaginal delivery of the macrosomic fetus may result in hemorrhage of intra-abdominal organs. Mostly affected organs are the liver and adrenal glands. Hemorrhage of liver is usually occurs as a subcapsular hemorrhage and it is clinically presented an abdominal mass without symptoms of anemia. But intraparenchymal hemorrhage of liver is very rare and there is no sign of abdominal mass. However, in contrast to subcapsular hemorrhage, symptoms of anemia are rapidly developed in newborns. A macrosomic newborn by vaginal delivery at term. Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level failed from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass. Intraparenchymal hemorrhage in the sixth segment of liver and right adrenal hemorrhage were detected on the ultrasonographic scan. Hepatic function tests were normal in the whole follow-up period, and hemorrhage resolved within two weeks. Following months after discharge, adrenal hemorrhage also resolved without any complication. Hepatic hemorrhages, causing hemorrhagic anemia in neonates, usually occur in subcapsular form. Intraparenchymal hepatic hemorrhage should especially be considered in those newborns, which are rapidly developed symptoms of anemia without any abdominal mass.