RESUMO
BACKGROUND: Determining the required daily number of platelet units in hospitals is a challenging task due to the high uncertainty in daily usage and short shelf life of platelets. STUDY DESIGN AND METHODS: We developed a linear prediction model to guide the daily ordering quantity of platelet units at a hospital that orders the required units from a central supplier. The predictive model relies on historical demand data and other information from the hospital's information system. The ordering strategy is to place an order at the end of each day to bring the platelet inventory to the predicted demand for the next day. Unlike typical prediction models, the quality of the predictions is measured with respect to the resulting inventory costs of wastage and shortage. We used data from two hospitals in Hamilton, Ontario from 2015 to 2016 to train our model and evaluated its performance based on the resulting wastage and shortage rates in 2017. RESULTS: In 2017, respectively 1915 and 4305 platelet units were transfused at the two hospitals, with daily average (SD) usage of 5.2 (3.7) and 11.8 (4.4). The expiry (estimated shortage) rates were 8.67% (13.86%), and 2.28% (8.48%) at the two hospitals, respectively. Our baseline model would have reduced the expiry (shortage) rates to 2.54% (4.01%) and 0.05% (0.44%) for the two hospitals, respectively. DISCUSSION: Guiding daily ordering decisions for platelets using our proposed model could lead to a significant reduction of wastage and shortage rates at hospitals.
Assuntos
Plaquetas , Hospitais , Humanos , Ontário , Registros , IncertezaRESUMO
Colchicine poisoning can occur not only by taking dosage form but also by ingesting a plant containing colchicine. A 39-year-old man presented to the emergency room with nausea, vomiting, and diarrhea 9 hours after ingestion of wild garlic. Symptoms attributed to food poisoning, and he received supportive cares and discharged. However, he was admitted to the hospital because of severe gastrointestinal presentations 4 hours later. He received treatments based on the diagnosis of acute gastroenteritis. The patient was in a fair condition during 30 hours of hospitalization until he suddenly developed respiratory distress and unfortunately died with cardiopulmonary arrest. The deceased body referred to our legal medicine center for determining cause of death and investigating possible medical staff malpractices. Postmortem examination, autopsy, macropathology and micropathology study, and postmortem toxicological analysis were performed. All results were submitted to the medical committee office for decision. The unknown cause of death was disclosed after determination of colchicine in the plant and botanical identification as Colchicum persicum. The committee determined the most probable cause of death as acute cardiopulmonary complications induced by colchicine poisoning and the manner of death as accidental. The medical staff was acquitted of the malpractice.