A data-driven newsvendor model for elective-emergency admission control under uncertain inpatient bed capacity.

OBJECTIVE: Elective-emergency admission control referred to allocating available inpatient bed capacity between elective and emergency hospitalization demand. Existing approaches for admission control often excluded several complex factors when making decisions, such as uncertain bed capacity and unknown true probability distributions of patient arrivals and departures. We aimed to create a data-driven newsvendor framework to study the elective-emergency admission control problem to achieve bed operational efficiency and effectiveness. METHODS: We developed a data-driven approach that utilized the newsvendor framework to formulate the admission control problem. We also created approximation algorithms to generate a pool of candidate admission control solutions. Past observations and relevant emergency demand and bed capacity features were modeled in a newsvendor framework. Using approximation algorithmic approaches (sample average approximation, separated estimation and optimization, linear programing-LP, and distribution-free model) allowed us to derive computationally efficient data-driven solutions with tight bounds on the expected in-sample and out-of-sample cost guaranteed. RESULTS: Tight generalization bounds on the expected out-of-sample cost of the feature-based model were derived with respect to the LP and quadratic programing (QP) algorithms, respectively. Results showed that the optimal feature-based model outperformed the optimal observation-based model with respect to the expected cost. In a setting where the unit overscheduled cost was higher than the unit under-scheduled cost, scheduling fewer elective patients would replace the benefit of incorporating related features in the model. The tighter the available bed capacity for elective patients, the bigger the difference of the schedule cost between the feature-based model and the observation-based model. CONCLUSIONS: The study provides a reference for the theoretical study on bed capacity allocation between elective and emergency patients under the condition of the unknown true probability distribution of bed capacity and emergency demand, and it also proves that the approximate optimal policy has good performance.

The mutual overlapping impact of stress and infection on mental health problems in adolescents and youths during and after COVID-19 pandemic in China.

BACKGROUND: It is unclear about the mutual impact of COVID-19 related psychological stress and infection on mental health of adolescent and youth students. This study aimed to explore the mutual impact of COVID-19 related psychological stress and infection on mental health problems among students. METHODS: This study was conducted from December 14, 2022 to February 28, 2023 in Sichuan, China. Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Insomnia Severity Index, and Internet Addiction Test were used. Participants were grouped by COVID-19 infection and psychological stress level. The differences among groups were compared, and logistic regression analysis was used to investigate risk factors for depression, anxiety, PTSD and insomnia among groups. RESULTS: Of 90,118 participants, 82,873 (92.0 %) finished the questionnaires and were included in the study. Of 82,873 participants, 33,314 (40.2 %) reported to be infected with COVID-19. Participants had depression symptoms (38.1 %), anxiety symptoms (31.8 %), PTSD (33.9 %), insomnia (34.0 %), and internet addiction (60.3 %). Compared with participants uninfected with low psychological stress level, the risk for symptoms of depression, anxiety, PTSD and insomnia increased by 9.6 %, 12.3 %, 6.6 %, and 12.0 % in participants infected with low psychological stress level (p < 0.001), 106.8 %, 125.9 %, 125.2 %, and 95.7 % in participants uninfected with high psychological stress level (p < 0.001), and 147.3 %, 161.1 %, 158.7 %, and 141.0 % in participants infected with high psychological stress level (p < 0.001). LIMITATION: This study is a cross-sectional design, and no causal associations should be inferred. Infection status was based on self-report of participants with infectious symptoms. CONCLUSION: COVID-19 related psychological stress and infection per se have mutually overlapping impacts on mental health problems among students. Further health policies and psychosocial interventions should be developed to reduce mutually overlapping impact and improve the long-term mental health among students.

Academic performance and mental health among Chinese middle and high school students after the lifting of COVID-19 restrictions.

Background: Although the COVID-19 pandemic has greatly changed the way students studied, it is still unknown about the impact of the COVID-19 pandemic on students' academic performance and mental health. Objective: To explore the academic performance and mental health status of middle and high school students after the lifting of COVID-19 restrictions in China. Methods: An online survey was conducted in Sichuan province, China from Dec 14, 2022 to Feb 28, 2023. All participants were students in middle and high schools, recruited via their teachers. The general information, COVID-19-related information, and academic performance were collected. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Internet Addiction Test (IAT) were used to assess the mental health problems. Results: Of 60,268 participants, 36,247 (60.2%) middle and high school students reported that their studies were affected by the COVID-19 pandemic, and 24,864 (41.2%) reported that their academic performance had worsened. The prevalence of depression and anxiety symptoms was 38.4 and 32.7%, respectively. There was a significant association between academic performance change and mental health problems. The logistic regression analysis showed that improved academic performance was a protective factor for depression, and declined academic performance was a risk factor for depression and anxiety. Being COVID-19 infected, family members being infected, with quarantine experience, and with COVID-19-related stigma were risk factors for depression and anxiety. Conclusion: Academic studies and mental health status of middle and high school students in Sichuan, China have been negatively impacted by the COVID-19 pandemic, even after the lifting of COVID-19 restrictions. Students' academic performance, academic concerns, and mental health status should be considered for educational policymakers and institutions to improve students' academic studies and mental well-being.

The association between air pollutants and hospitalizations for asthma: an evidence from Chengdu, China.

Background: Exposure to air pollutants has been linked to the exacerbation of asthma, and it has become a risk to human welfare and health throughout the globe. Previous works did not achieve a systematic study by considering interactive effects of age, gender, and meteorological factors on the exposure-effect relationship between air pollutants and asthma. We aimed to quantitatively investigate the effects of air pollutants on hospitalizations for asthma in Chengdu, China. Methods: This is a retrospective and population-based study. Data of asthma hospitalization records for residents, the average daily concentrations of air pollutants including SO2, CO, NO2, O3, PM10, and PM2.5, and meteorological variables from 1 January 2014 to 31 December 2014 in Chengdu, China, were obtained from several government departments. A generalized additive model (GAM) was used to analyze the exposure-effect relationship between air pollutants and daily asthma hospitalizations after controlling the long-time seasonal trend, "day-of-week (DOW)" effect, holiday effect, and confounding meteorological factors. Results: A total of 7,503 hospitalizations were assessed. Significant associations between hospitalizations and air pollutants were found. The relative risk (RR) for hospitalizations for every 10 µg/m3 increase in PM2.5 and PM10 for the male group were 1.0121 [95% confidence interval (CI): 1.0012-1.0232] and 1.0075 (95% CI: 1.0001-1.015), respectively. The elderly (≥65 years old) tended to have a higher RR (1.0022; 95% CI: 1.0001-1.0043) for each 10 mg/m3 increase in CO than the other age groups. All pollutants had slightly protective effects on the younger age group (≤14 years old). O3 had more significant effects in cold season, whereas SO2 impacted more significantly in warm seasons, particularly for females and adults (14-65 years old). Conclusions: Adverse effects of ambient concentrations of air pollutants on hospitalizations for asthma are evident, especially in specific population groups. Male patients were more susceptible to PM2.5 and PM10, and the elderly were more sensitive to CO. The effects of O3 in China were significant in the cold season, whereas SO2 impacted more significantly in the warm season particularly on females and adults. The study would be meaningful for asthma intervention and corresponding healthcare resource management.

Big Data-Enabled Analysis of Factors Affecting Patient Waiting Time in the Nephrology Department of a Large Tertiary Hospital.

The length of waiting time has become an important indicator of the efficiency of medical services and the quality of medical care. Lengthy waiting times for patients will inevitably affect their mood and reduce satisfaction. For patients who are in urgent need of hospitalization, delayed admission often leads to exacerbation of the patient's condition and may threaten the patient's life. We gathered patients' information about outpatient visits and hospital admissions in the Nephrology Department of a large tertiary hospital in western China from January 1st, 2014, to December 31st, 2016, and we used big data-enabled analysis methods, including univariate analysis and multivariate linear regression models, to explore the factors affecting waiting time. We found that gender (P=0.048), the day of issuing the admission card (Saturday, P=0.028), the applied period for admission (P < 0.001), and the registration interval (P < 0.001) were positive influencing factors of patients' waiting time. Disease type (after kidney transplantation, P < 0.001), number of diagnoses (P=0.037), and the day of issuing the admission card (Sunday, P=0.001) were negative factors. A linear regression model built using these data performed well in the identification of factors affecting the waiting time of patients in the Nephrology Department. These results can be extended to other departments and could be valuable for improving patient satisfaction and hospital service quality by identifying the factors affecting waiting time.

Gastrinoma in multiple endocrine neoplasia type 1 after total pancreatectomy: A case report.

RATIONALE: Surgery for patients with multiple endocrine neoplasia type 1(MEN-1) related gastrinoma remains controversial and total pancreatectomy (TP) has rarely been performed. We reported a case of patient with MEN-1 related gastrinoma treated by TP. PATIENT CONCERNS: A 46-year-old female was admitted to our hospital due to abdominal distension and diarrhea for 2 years. The patient underwent pituitary tumor resection and kidney stone lithotripsy 10 years ago. DIAGNOSES: Abdominal computed tomography showed single lesion in the duodenum and multiple lesions throughout the pancreas. The patient's gastrin level was significantly increased (1080 pg/ml). These findings in combination with the pituitary tumor history suggested the presence of gastrinoma associated with MEN-1 syndrome. INTERVENTION: An exploratory laparotomy was performed. Intraoperative ultrasound confirmed the numerous tumors diffusely distributed throughout the pancreas and the patient eventually underwent TP. OUTCOMES: Twelve months later, the patient was hospitalized again for anastomotic fistula and underwent a partial gastrectomy, small bowel resection and drainage of the abscess. One month later, she received gastrostomy and jejunostomy due to digestive tract fistula, and died a month later (14 months after TP). LESSONS: There still might be the possibility of recurrence even after radical surgical resection of gastrinomas, and we suggest the need to measure the basal acid output and maintain regular anti-acid therapy in the long-term follow-up of patients with MEN-1 related gastrinoma.

A core collection of pan-schizophrenia genes allows building cohort-specific signatures of affected brain.

To investigate whether pan-schizophrenia genes could be leveraged for building cohort-specific signatures reflecting the functioning of the affected brain, we first collected 1,518 schizophrenia-related genes upon analysis of 12,316 independent peer-reviewed literature sources. More than half of these genes have been reported in at least 3 independent studies, and a majority (81.4%) were enriched within 156 functional pathways (p-values < 1e-15). Gene expression profiles of brain tissues were extracted from 14 publicly available independent datasets, and classified into "schizophrenia" and "normal" bins using dataset-specific subsets of core schizophrenia collection genes built with either a sparse representation-based variable selection (SRVS) approach or with analysis of variance (ANOVA)-based gene selection approach. Results showed that cohort-specific classifiers by both SRVS and ANOVA methods are capable of providing significantly higher accuracy in the diagnosis of schizophrenia than using the whole core genes (p < 3.38e-6), with relatively low sensitivity to the ethnic backgrounds or areas of brain biopsies. Our results suggest that the formation of consensus collection of pan-schizophrenia genes and its dissection into the functional components could be a feasible alternative to the expansion of sample size, which is needed for further in-depth studies of the pathophysiology of the human brain.

A Data-Driven Hybrid Three-Stage Framework for Hospital Bed Allocation: A Case Study in a Large Tertiary Hospital in China.

Beds are key, scarce medical resources in hospitals. The bed occupancy rate (BOR) amongst different departments within large tertiary hospitals is very imbalanced, a situation which has led to problems between the supply of and the demand for bed resources. This study aims to balance the utilization of existing beds in a large tertiary hospital in China. We developed a data-driven hybrid three-stage framework incorporating data analysis, simulation, and mixed integer programming to minimize the gaps in BOR among different departments. The first stage is to calculate the length of stay (LOS) and BOR of each department and identify the departments that need to be allocated beds. In the second stage, we used a fitted arrival distribution and median LOS as the input to a generic simulation model. In the third stage, we built a mixed integer programming model using the results obtained in the first two stages to generate the optimal bed allocation strategy for different departments. The value of the objective function, Z, represents the severity of the imbalance in BOR. Our case study demonstrated the effectiveness of the proposed data-driven hybrid three-stage framework. The results show that Z decreases from 0.7344 to 0.0409 after re-allocation, which means that the internal imbalance has eased. Our framework provides hospital bed policy makers with a feasible solution for bed allocation.

Using machine-learning methods to support health-care professionals in making admission decisions.

BACKGROUND: Large tertiary hospitals usually face long waiting lines; patients who want to receive hospitalization need to be screened in advance. The patient admission screening process involves a health-care professional ranking patients by analyzing registration information. OBJECTIVE: The purpose of this study was to develop a machine-learning approach to screening, using historical data and the experience of health-care professionals to develop a set of screening rules to help health-care professionals prioritize patient needs automatically. METHODS: We used five machine-learning methods to sequence and predict elective patients: logistic regression (LR), random forest (RF), gradient-boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and an ensemble model of the four models. RESULTS: The results indicate that all of the five models showed a good prioritization performance with high predictive values. In particular, XGBoost had the best predictive performance compared with others in terms of the area under the receiver operating characteristic curve (AUC), with the AUC values of LR, RF, GBDT, XGBoost, and the ensemble model being 0.881, 0.816, 0.820, 0.901, and 0.897, respectively. CONCLUSION: The results reported here indicate that machine-learning techniques can be valuable for automating the screening process. Our model can assist health-care professionals in automatically evaluating less complex cases by identifying important factors affecting patient admission.

Modeling the Length of Stay of Respiratory Patients in Emergency Department Using Coxian Phase-Type Distributions With Covariates.

Variability and unpredictability are typical features of emergency departments (EDs) where patients randomly arrive with diverse conditions. Patient length of stay (LOS) represents the consumption level of hospital resources, and it is positively skewed and heterogeneous. Both accurate modeling of patient ED LOS and analysis of potential blocking causes are especially useful for patient scheduling and resource management. To tackle the uncertainty of ED LOS, this paper introduces two methods: statistical modeling and distribution fitting. The models are applied to 894 respiratory diseases patients data in the year 2014 from ED of a Chinese public tertiary hospital. Covariates recorded include patient region, gender, age, arrival time, arrival mode, triage category, and treatment area. A Coxian phase-type (PH) distribution model with covariates is proposed as an alternative method for modeling ED LOS. The expectation-maximization (EM) algorithm is used to implement parameter estimation. The results show that ED LOS data can be modeled well by the proposed models. Distributions of ED LOS differ significantly with respect to patients' gender, arrival mode, and treatment area. Using the fitted Coxian PH model will assist ED managers in identifying patients who are most likely to have an extreme ED LOS and in predicting the forthcoming workload for resources.

Cross-sectional survey of the relationship of symptomatology, disability and family burden among patients with schizophrenia in Sichuan, China.

BACKGROUND: Schizophrenia is a chronic condition that leads to high rates of disability and high levels of family burden but the interactive relationship between these variables remains unclear, particularly in low- and middle-income countries where the vast majority of patients live with their families. AIM: Assess the symptom severity, level of disability, and family burden among clinically stable outpatients with schizophrenia in Sichuan, China. METHODS: A total of 101 clinically stable outpatients with schizophrenia who had a median duration of illness of five years were assessed using the World Health Organization Disability Assessment Scale 2.0 (WHODAS II), the Positive and Negative Syndrome Scale (PANSS) and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR); and their caregivers were surveyed using the Family Burden Interview Schedule (FBIS). RESULTS: Among the 101 patients, 92 lived with their immediate family members, 74 had clinically significant disability, and 73 were unemployed. The level of disability was associated with the severity of symptoms (r=0.50, p<0.001), duration of illnesses (r=0.22, p=0.028), age of onset (r=-0.22, p=0.024) and patients' level of satisfaction with family support (r=-0.30, p=0.020). Disability was also associated with the overall level of family burden (r=0.40, p<0.001), and with several subtypes of family burden: financial burden (r=0.21, p=0.040), the degree of disruption in family routines (r=0.33, p=0.001), the effect on family leisure activities (r=0.31, p=0.001) and the quality of family interactions (r=0.43, p< 0.001). Four variables remained significantly associated with the level of disability in the stepwise multivariate linear regression: duration of illness, severity of symptoms, patient satisfaction with family support, and the overall burden of the illness on the family. CONCLUSIONS: Even after adjusting for the severity of patients' symptoms, patient disability is independently associated with family burden. This highlights the importance of targeting both symptoms and disability in treatment strategies for this severe, often lifelong, condition. In countries like China where most individuals with schizophrenia live with their families, family burden is an important component of the impact of the illness on the community that should be included in measures of the relative social and economic importance of the condition.

[Negative symptoms predict the improvement of social functioning of patients with schizophrenia].

OBJECTIVE: To identify predictive factors associated with the improvement of social functioning of schizophrenia patients in a community. METHODS: 101 schizophrenia patients undergoing community rehabilitation were assessed with the Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSP), Self-Esteem Scale (SES), Family Function Questionnaire (APGAR), and the World Health Organization Disability Assessment Scale II (WHODAS-II) twice 6 months apart. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the improvement of social functioning. RESULTS: The increase of PSP score was correlated with age (r = 0.220), reduced PANSS negative score (r = 0.468), reduced PANSS general score (r = 0.392), reduced PANSS total score (r = 0.472), and reduced WHODAS-II Score (r = 0.247). The predictive factors of the change of PSP score followed the following order: change of PANSS negative score [the change of coefficient of determination (deltaR2 ) = 0.197], age of onset (deltaR2 = 0.048), change of WHODAS-II score and psychiatric rehabilitation (deltaR2 = 0.031). CONCLUSION: Improvement of negative symptoms predicts the short-term improvement of social functioning of schizophrenia patients.

[Clinical analysis of patients with acute and severe mental disorders complicated with hypokalemia].

OBJECTIVE: To study the occurrence and characteristics of hypokalemia to the patients with acute and severe mental disorders, and analyze its influencing factors. METHODS: There were 815 patients with actue and severe mental disorder admitted into our psychiatry department from June 2009 to May 2010, who all received the examination of potassium concentration routinely at the admission. The patients were divided into hypokalemia group and non-hypokalemia group, and the clinical information were surveyed and compared between the two groups to find out the influencing factors of hypokalemia. RESULTS: There were 177 patients with hypokalemia, and the proportion was 21.72%. Between the two groups, the difference of age, sex, admission season, whether with physical diseases and diagnosis were statistically significant (P < 0.05), while spiritual movement situation was not significant different (P > 0.05). Spearman rank correlation analysis showed that the incidence of hypokalemia was negatively correlated with age (r = -0.55, P = 0.00). Furthermore, multivariate analysis found that women, poor diet and physical disease were risk factors of hypolalemia (P < 0.05). CONCLUSION: There is relatively high probability of hypokalemia occurrence to the patients with acute and severe mental disorders, which should be distinguished and treated at the admission timely.

[Telephone follow-up improves quality of life of postoperative patients with severe acute pancreatitis].

OBJECTIVE: To evaluate the impact of telephone follow-up on the quality of life of postoperative patients with severe acute pancreatitis. METHODS: 109 postoperative patients with severe acute pancreatitis were divided into interventional and control groups randomly. Telephone follow-up was given to the patients in the interventional group 1 week, 1 month, 3 months and 6 months after discharge. The patients in the control group received routine discharge guidance only. The quality of life of the patients was assessed with the Generic Quality of Life Inventory 6 months after discharge. The disease-related knowledge and incidence of complications of the patients were also assessed. RESULTS: The patients who received telephone follow-up had greater quality of life scores in physical function, psychological function and social function than the controls (P < 0.05). The interventional group also had better disease-related knowledge (P < 0.05) and lower incidence of complications such as jejunostoma tube plugging and recurrence than the control group (P < 0.05). CONCLUSION: Telephone follow-up improves the quality of life of postoperative patients with severe acute pancreatitis and reduces the incidence of complications.

The relationship between neuroticism, major depressive disorder and comorbid disorders in Chinese women.

OBJECTIVE: The personality trait of neuroticism is a risk factor for major depressive disorder (MDD), but this relationship has not been demonstrated in clinical samples from Asia. METHODS: We examined a large-scale clinical study of Chinese Han women with recurrent major depression and community-acquired controls. RESULTS: Elevated levels of neuroticism increased the risk for lifetime MDD (with an odds ratio of 1.37 per SD), contributed to the comorbidity of MDD with anxiety disorders, and predicted the onset and severity of MDD. Our findings largely replicate those obtained in clinical populations in Europe and US but differ in two ways: we did not find a relationship between melancholia and neuroticism; we found lower mean scores for neuroticism (3.6 in our community control sample). LIMITATIONS: Our findings do not apply to MDD in community-acquired samples and may be limited to Han Chinese women. It is not possible to determine whether the association between neuroticism and MDD reflects a causal relationship. CONCLUSIONS: Neuroticism acts as a risk factor for MDD in Chinese women, as it does in the West and may particularly predispose to comorbidity with anxiety disorders. Cultural factors may have an important effect on its measurement.

[A study on the psychological state of nurse-students of a university in affected areas of Wenchuan earthquake].

BACKGROUND: The 8.0-magnitude earthquake that struck Wenchuan County in Sichuan was the most destructive earthquake to hit China since the People's Republic of China was founded in 1949. It caused great environmental harm and property damage, and brought considerable psychological stress and emotional problems to many in the population. PURPOSE: This study was designed to investigate the psychological state of nursing students studying at a university located within the Wenchuan earthquake zone. METHODS: Nurses were recruited using a striated cluster sampling approach. The study was conducted using a self-designed questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Social Support Rating Scale (SSRS) and Coping Style Questionnaire. RESULTS: Most (68.8%) participants lacked sufficient knowledge regarding the earthquake, and the social support condition of college nursing students was lower than the population average (p < .001). However, degree of anxiety and depression was higher than the population average (p < .001). SSRS scores and its three dimensions were positively correlated with SAS scores and negatively correlated with SDS scores (p < .001). Participants most often employed basic problem solving approaches to deal with psychological conflicts arising from their earthquake experience. No significant difference between nursing students in different class years in terms of study variables was identified. CONCLUSION: Nursing students in areas affected by the Wenchuan earthquake suffer from anxiety and depression disorders. Adequate social support represents an important intervention needed to maintain and enhance their mental health.