Bed Management Research Articles

EGS SO08 - How best to time the operative management of acute cholecystitis: Is there a difference in outcomes between hot and smouldering cholecystectomy?

Abstract Background Laparoscopic Cholecystectomy (LC) is the main treatment for symptomatic gallstone disease. Acute cholecystitis (AC) is a common emergency presentation in the UK and the 2015 AUGIS guidelines recommend emergency cholecystectomy within 72 hours of admission if the patient is fit. On a practical level this can sometimes be difficult to implement and often patients are discharged to return for an elective procedure (the smouldering gallbladder). We aimed to analyse our practice at a large district general hospital for the management of patients with AC and their post-operative outcomes. Method All patients undergoing LC between 1st July 2020 and 30th June 2022 were identified. Patients with an ICD-10 code of K81 (AC) associated with an inpatient stay within a year of their operation were included. Those admitted and operated on during that admission were classified as hot cholecystectomies (HC), whereas those admitted and discharged for an elective procedure were termed smouldering cholecystectomies (SC). Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Results 276 patients underwent cholecystectomy for AC with 52.2% elective and 47.8% emergency (91% within 72 hours of admission). HC patients were younger (52.3 vs. 57.5, p<0.01) and less-comorbid (1.67 vs 2.12, p<0.05). The subtotal cholecystectomy rate was comparable between the groups (9.8% vs 16.0%, p=0.131). HC patients had more post-operative drains (38.6% vs 27.1%, p<0.05) and thick-walled gallbladders (92.4% vs 64.6%, p<0.001). Median post-operative length of stay was 1 day for HC and 0 days for SC. No difference was observed for 30-day readmission (4.5% vs 7.6%, p=0.286), morbidity (12.9% vs 11.8%, p=0.786) or mortality (0.8% vs 0.7%, p=0.951). Conclusion This study adds to the evidence that emergency cholecystectomy is as safe an option as discharging patients to return for an elective procedure in the future. Although a proportion of those discharged to return for an elective operation will have thin-walled gallbladders, the rate of subtotal cholecystectomy remains similar, if not slightly higher in the elective group (although not reaching statistical significance). Most emergency cholecystectomy patients were discharged the following day, therefore demonstrating that they do not significantly contribute to bed blocking and reduce the burden on already strained elective waiting lists.

A Scientific Approach for Optimizing Patient Bed Occupancy in an Overcrowded Teaching Hospital in Sri Lanka

Background: In Sri Lanka, the healthcare system predominantly relies on the public sector, which delivers nearly 95% of inpatient care and approximately 50% of outpatient care. Effective monitoring of bed occupancy rates is crucial for optimizing resource allocation amidst limited hospital resources and fluctuating patient demands.Objectives: This study aims to develop a scientific approach to enhance patient bed utilization at Colombo South Teaching Hospital (CSTH) in Sri Lanka.Methodology: A mixed-method approach was employed, integrating quantitative analysis of historical patient data from CSTH's medical record room with qualitative insights from key stakeholders, including hospital administrators, consultants, medical officers, and nursing staff.Results and Discussion: In 2023, CSTH reported an overall bed occupancy rate of 80%, surpassing both national and global averages, indicating strain on healthcare delivery. The study identifies disparities in occupancy rates across different wards, highlighting overcrowding in medical and surgical units alongside underutilization in other specialities.Recommendations and Conclusions: Revising the consultant-based ward allocation system, implementing patient-centric ward clustering based on occupancy rates, appointing bed managers, and expanding facilities in high-demand units like Medical, Accident Service Unit, Emergency Treatment Unit, and Nephrology. Implementing these strategies could mitigate overcrowding, improve bed availability, and enhance the quality and safety of patient care services at CSTH.

The Contribution of Dairy Bedding and Silage to the Dissemination of Genes Coding for Antimicrobial Resistance: A Narrative Review.

Antimicrobial resistance (AMR) is a concern in the dairy industry. Recent studies have indicated that bedding serves as a reservoir for antimicrobial-resistant bacteria and antimicrobial-resistance genes (ARGs), while silage has been proposed as another possible source. The impact of AMR in dairy farming can be significant, resulting in decreased productivity and economic losses for farmers. Several studies have highlighted the safety implications of AMR bacteria and genes in bedding and silage, emphasizing the need for further research on how housing, bedding, and silage management affect AMR in farm environments. Exposure to sub-lethal concentrations of antibiotics, such as those from contaminated bedding and silage, can prompt bacteria to develop resistance mechanisms. Thus, even if antimicrobial usage is diminished, ARGs may be maintained in the dairy farm environment. By implementing proactive measures to tackle AMR in dairy farming, we can take steps to preserve the health and productivity of dairy cattle while also protecting public health. This involves addressing the prudent use of antibiotics during production and promoting animal welfare, hygiene, and management practices in bedding and farm environments to minimize the risk of AMR development and spread. This narrative review compiles the growing research, positioning the contribution of bedding and silage to the prevalence and dissemination of AMR, which can elicit insights for researchers and policymakers.

The Barren Berry phenotype: untangling cranberry (Vaccinium macrocarpon Ait.) genetic contamination in central Wisconsin and beyond

Wisconsin is the world’s leading producer of cranberries (Vaccinium macrocarpon Ait.; 2n = 2x = 24). The state produces over twenty-thousand acres that contribute to more than 50% of the global total production, with more than one billion dollars in value. Cranberry growers in the “central sands” of Wisconsin have been experiencing yield decline due to vegetative unproductive genotypes, popularly known as “Barren Berry’’, which consistently remain vegetative and produce no fruit. The purpose of this study was to compare visual inspection in the field to DNA fingerprinting for the early detection of unproductive/barren genotypes. Additionally, the study served as a survey of unproductive genotypes in central Wisconsin, the largest growing region in the world. A total of 839 cranberry leaf samples, from 14 growers representing plantings to four cultivated varieties, were submitted for DNA testing of two visually determined phenotypes: unproductive or barren (n = 646; those that produced little to no fruit), versus productive or fruiting (n = 193). We conducted genetic fingerprinting on the leaf tissue using nine microsatellite markers previously shown to differentiate cranberry genotypes. This study identified a barren berry genotype unique to central Wisconsin, which we denoted “Barren Berry 1”. This genotype accounted for 43% of samples submitted as the barren berry phenotype. Genetic fingerprinting revealed sixty-five different genotypes in beds which were thought to be monocultures of just four cultivated genotypes. Early detection of genetic contamination through visual inspection, genetic testing, and responsible propagation can drastically aid in the management and longevity of cranberry beds, and in turn save time and money to the growers.

Feasibility of forecasting future critical care bed availability using bed management data

ObjectivesThis project aims to determine the feasibility of predicting future critical care bed availability using data-driven computational forecast modelling and routinely collected hospital bed management data.MethodsIn this proof-of-concept, single-centre data...

COVID-19 Bed Management Using a Two-Step Process Mining and Discrete-Event Simulation Approach

The sudden admission of many patients with similar needs caused by the COVID-19 (SARS-CoV-2) pandemic forced health care centers to temporarily transform units to respond to the crisis. This process greatly impacted the daily activities of the hospitals. In this paper, we propose a two-step approach based on process mining and discrete-event simulation for sizing a recovery unit dedicated to COVID-19 patients inside a hospital. A decision aid framework is proposed to help hospital managers make crucial decisions, such as hospitalization cancellation and resource sizing, taking into account all units of the hospital. Three sources of patients are considered: (i) planned admissions, (ii) emergent admissions representing day-to-day activities, and (iii) COVID-19 admissions. Hospitalization pathways have been modeled using process mining based on synthetic medico-administrative data, and a generic model of bed transfers between units is proposed as a basis to evaluate the impact of those moves using discrete-event simulation. A practical case study in collaboration with a local hospital is presented to assess the robustness of the approach. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —In this paper we develop and test a new decision-aid tool dedicated to bed management, taking into account exceptional hospitalization pathways such as COVID-19 patients. The tool enables the creation of a dedicated COVID-19 intensive care unit with specific management rules that are fine-tuned by considering the characteristics of the pandemic. Health practitioners can automatically use medico-administrative data extracted from the information system of the hospital to feed the model. Two execution modes are proposed: (i) fine-tuning of the staffed beds assignment policies through a design of experiment and (ii) simulation of user-defined scenarios. A practical case study in collaboration with a local hospital is presented. The results show that our model was able to find the strategy to minimize the number of transfers and the number of cancellations while maximizing the number of COVID-19 patients taken into care was to transfer beds to the COVID-19 ICU in batches of 12 and to cancel appointed patients using ICU when the department hit a 90% occupation rate.

Comparison between tritium breeders with pebble bed and Gyroid block configurations using numerical investigation: Flow behavior and heat transfer performance

This study proposed using a Gyroid structure, a type of triply periodic minimal surface (TPMS), to replace conventional pebble bed configurations and address drawbacks such as inherently low packing fractions, extensive stress concentrations, high flow resistance, and low thermal conductivity. The feasibility of the Gyroid block configuration was evaluated by comparing it with a pebble bed configuration regarding the flow behaviors and heat transfer performance. The flow behavior of the porous block configuration was superior to that of the pebble bed configuration. At the same inlet velocity of 0.1–0.2 m/s, the porous block configuration had a ∼56 % higher average flow velocity and only half the pressure drop. The convective heat transfer coefficient and Nusselt numbers in the porous block configuration were 56–84 % and 2.6–3.1 times higher, respectively, than those in the pebble bed configuration. The effective thermal conductivity of the porous block configuration increased by ∼18 % at an inlet velocity of 0.15 m/s and a temperature of 773–1173 K. This study preliminarily verified the feasibility of the Gyroid structures for tritium breeders in engineering applications and is anticipated to provide new opportunities for the design of tritium breeders with higher lithium densities, remarkable flow behavior, and outstanding thermal performance.

Seedbed management, transplanting methods and irrigation regimes influence the growth, productivity and economics of summer rice (Oryza sativa L.)

A field experiment was conducted during the rabi (winter) seasons of 2017–2018 and 2018–2019 at the Central Research Farm under Bidhan Chandra Krishi Viswavidyalaya, West Bengal, India, to study the effects of planting techniques, irrigation regimes, and nursery bed management on the growth, yield, nutrient dynamics, water productivity, and economics of summer rice (cv. Shatabdi) production. The experiment was performed in a strip-split plot design with twelve treatment combinations, which were replicated three times. The design consisted of two types of transplanted rice establishment methods (viz., puddled transplanted rice (PTR) and nonpuddled transplanted rice (NPTR)) allocated to the main plot, three irrigation regimes (three-day intervals; six-day intervals; nine-day intervals) allocated to the subplot, and two nursery bed management practices (conventional seedbed and improved seedbed) allocated to the subplot. Higher growth attributes, such as plant height, tiller count, biomass, and LAI, were found under nonpuddled conditions at the time of harvesting. Similarly, a three-day irrigation interval and improved seedlings led to better growth traits. The yield attributes and yield varied nonsignificantly among the crop establishment methods. However, the lowest irrigation intervals accounted for 53.78% and 43.02% greater grain yield than did the nine-day intervals in two consecutive years, respectively, and produced statistically similar yields with six-day intervals. The percentage of seedlings transplanted from improved seedbeds was 4.01 and 4.13% greater than that from conventional seedlings. A similar trend was observed for both input and irrigation water productivity, except that the nine-day irrigation interval resulted in significantly greater water productivity than did the other intervals. The treatment consisted of nonpuddled transplanted rice along with six six-day irrigation intervals and improved seedbed management, resulting in the highest net return and benefit:cost ratio due to the low production cost. Thus, it can be concluded that transplanting seedlings into nonpuddled soil from an improved seedbed with intermittent irrigation might be the most judicious and recommended in terms of productivity as well as profitability for summer rice production.

Health and Thermal Comfort of Dairy Cattle in Compost-Bedded Pack Barns and Other Types of Housing: A Comparative Systematic Review

This systematic review was conducted to describe and discuss the main research findings available in the literature concerning the health and thermal comfort of dairy cattle housed in Compost-Bedded Pack Barn (CBP) systems, in comparison to Free Stall (FS), Tie-Stall (TS), and/or Loose Housing (LH) systems. Searches for peer-reviewed experimental articles in English were performed in the Scopus and Web of Science databases. Forty-three non-duplicated scientific articles were obtained and subjected to a four-stage evaluation process, according to the PRISMA methodology and predefined eligibility criteria. This process resulted in the selection of 13 articles for inclusion. Regarding animal health, the results provide evidence that the incidence of problems such as lameness, limb injuries, and reproductive disorders is lower in CBP systems. However, if bedding management is not effective in ensuring the provision of dry and comfortable surfaces, an increase in somatic cell count (SCC) and prevalence of mastitis incidence (PMI) may occur. For thermal comfort, it was found that the CBP system exhibited higher temperatures during summer and lower temperatures during winter when compared to FS with cross-ventilation in association with evaporative cooling. However, no differences were observed in terms of thermal comfort in spring and autumn. As this is a recent research area, caution should be exercised when extrapolating the results, considering the specificities of each cited study.

The epidemiology and treatment outcomes of COVID-19 patients admitted to an intensive care unit in an Iranian hospital in Neyshabur city.

The COVID-19 pandemic and the infection of numerous individuals from diverse societies have emerged as major global challenges. Given the limited resources in intensive care units, effective bed management and resource allocation require a deep understanding of the disease. This study aimed to assess the epidemiology and treatment outcomes of COVID-19 patients admitted to an intensive care unit in an Iranian hospital in Neyshabur city. This cross-sectional study was conducted on COVID-19 patients hospitalized in intensive care units in Razavi Khorasan, Iran in 2021. Census sampling was used to include all intensive care units. Of the initial 480 cases, 54 cases were excluded based on the exclusion criteria, leaving 426 cases for the study. Data were collected with the help of a data collection form that was designed by the researcher and its content validity and reliability were measured with Cronbach's alpha coefficient (α = 89%.). Data were analyzed with SPSS version 20 software. Descriptive and inferential statistics were used to analyze the data. Mean, standard deviation, and interquartile range indicators were used for descriptive statistics, and absolute frequency and relative frequency (percentage) were used to show numbers and ratios. The mean (SD) age of the patients was 66.33 (15.05) years, and 49.3% were female. The results showed that arterial blood oxygen saturation, respiratory rate, and Alzheimer's disease were significant variables for predicting mortality. Furthermore, arterial blood oxygen saturation, respiratory rate, and the need for transfusion of blood products were significant variables in predicting hospitalization and the risk of acute respiratory distress syndrome (ARDS). This study demonstrated that arterial blood oxygen saturation, respiratory rate, and Alzheimer's disease are crucial variables for predicting death. Furthermore, arterial blood oxygen saturation and respiratory rate are significant factors in predicting the risk of ARDS.

The Rhetoric and Reality of Choice and Autonomy When Older People Are Discharged from Community Hospital at the End-of-Life in England: A Constructivist Grounded Theory Study

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.

The design of the Inpatient Care Monitoring and Evaluation System for the Executive Report at X Hospital

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;One of the information systems needed in a hospital to support services is the inpatient information system. Several field constraints that often occur and can impede patient services include: limited bed space, hindered coordination between units or rooms, sudden changes in bed space requirements, the lack of integration of information systems, incomplete and inaccurate documentation of patient mobilization, the length of the patient discharge process, unavailable facilities in rooms, and the existence of hospital service indicators that must be achieved. Based on the above, a real-time and integrated information system is required, starting from the registration of inpatients to their discharge, in order to improve the quality of service and patient satisfaction. The design of the Inpatient Monitoring and Evaluation System for the Executive Report is an enhancement of the hospital information system that integrates all inpatient patient service activities, including supporting facilities, to generate useful information for monitoring and developing inpatient care services. This information can be used as a basis for decision-making by the leaders. The design of the Inpatient Monitoring and Evaluation System for the Executive Report utilizes the Systems Development Life Cycle (SDLC) method in the form of a prototype, with the drafting phase starting from design to development. The final result of this information system design consists of comprehensive, integrated, and real-time information related to patient activities from admission to discharge, presented in a dashboard that is useful for monitoring and evaluating inpatient care services. It can also serve as a basis for decision-making by hospital leaders and achieving hospital indicators.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: Bed management, dashboard, information, inpatient, integration&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Boarding in the emergency department: challenges and mitigation strategies.

Herein, we conducted a review of the literature to better understand the issue of prolonged emergency department (ED) boarding by providing an overview of the current evidence on the available causes, consequences, and mitigation strategies. Severely ill patients awaiting transfer to intensive care units (ICU) imposes additional burdens on the emergency care team from both a clinical and management perspective. The reasons for prolonged ED boarding are multifactorial. ED boarding compromises patients' safety and outcomes, and is associated with increased team burnout and dissatisfaction. Mitigation strategies include the optimization of patients' flow, the establishment of resuscitative care units, deployment of mobile critical care teams, and improvements in training. Staffing adjustments, changes in hospital operations, and quality improvement initiatives are required to improve this situation, while active bed management and implementation of capacity command centers may also help. Considering the characteristics of healthcare systems, such as funding mechanisms, organizational structures, delivery models, access and quality of care, the challenge of ED boarding of critically ill patients requires a nuanced and adaptable approach. Solutions are complex but must involve the entirety of the hospital system, emergency department, staff adjustment, and education.

Taxonomic and functional β-diversity patterns reveal stochastic assembly rules in microbial communities of seagrass beds.

Microorganisms are important members of seagrass bed ecosystems and play a crucial role in maintaining the health of seagrasses and the ecological functions of the ecosystem. In this study, we systematically quantified the assembly processes of microbial communities in fragmented seagrass beds and examined their correlation with environmental factors. Concurrently, we explored the relative contributions of species replacement and richness differences to the taxonomic and functional β-diversity of microbial communities, investigated the potential interrelation between these components, and assessed the explanatory power of environmental factors. The results suggest that stochastic processes dominate community assembly. Taxonomic β-diversity differences are governed by species replacement, while for functional β-diversity, the contribution of richness differences slightly outweighs that of replacement processes. A weak but significant correlation (p < 0.05) exists between the two components of β-diversity in taxonomy and functionality, with almost no observed significant correlation with environmental factors. This implies significant differences in taxonomy, but functional convergence and redundancy within microbial communities. Environmental factors are insufficient to explain the β-diversity differences. In conclusion, the assembly of microbial communities in fragmented seagrass beds is governed by stochastic processes. The patterns of taxonomic and functional β-diversity provide new insights and evidence for a better understanding of these stochastic assembly rules. This has important implications for the conservation and management of fragmented seagrass beds.

Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study

BackgroundIdentifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.MethodsA multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.ResultsOf the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children’s EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children’s) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children’s only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2–2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7–2.9), referral from primary health aOR:1.5 (95%CI: 1.4–1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5–2.8 and aOR:1.5, 95%CI: 1.4–1.6, respectively). Predictors were similar when each site was considered separately.ConclusionsAlthough the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.

Choosing home: discharge to assess and the Health and Care Act 2022

In the early stages of the coronavirus pandemic National Health Service hospitals were instructed to rapidly discharge patients from wards with consequences which, in the case of some care homes, has been claimed to be catastrophic due to lack of effective testing and isolation. These tragic events also highlight a longer-term issue, namely hospital discharge policies and their relationship with obligations placed on local authorities to assess needs of individuals under the Care Act 2014. Concerns have been expressed for some time regarding the delays in getting patients discharged from hospitals – with them being labelled inappropriately as ‘bed blockers’. The Health and Care Act 2022 includes new statutory measures concerning discharge to facilitate rapid discharge of patients from hospitals. This can be seen as a solution to a major resource problem, but could this ultimately undermine choice and respect for individual wellbeing?The article explores the background to the recent controversies concerning hospital discharge decisions and their relationship with the Care Act 2014. It demonstrates that, while the current debates and controversies regarding hospital discharge decisions are nothing new and pre-date the pandemic by decades, hospital discharge processes accelerated during the pandemic and have left a problematic legacy. It interrogates the Health and Care Act 2022 discharge provisions and whether these will be an effective integration of health and social care provision going forward or whether there is a real risk of undermining individual autonomy, the Care Act 2014 obligations concerning promotion of well-being and a person’s choice of their ‘home’.

Hospitalization forecast to inform COVID-19 pandemic planning and resource allocation using discrete event simulation

Purpose: This study aims to address the pressing need for accurate forecasting of healthcare resource demands during the COVID-19 pandemic. It presents a novel approach that combines a stochastic Markov model and a discrete event simulation model to dynamically predict hospital admissions and daily occupancy of hospital and ICU beds.Design/methodology/approach: The research builds upon existing work related to predicting COVID-19 spread and patient influx to hospital emergency departments. The proposed model was developed and validated at San Juan de Alicante University Hospital from July 10, 2020, to January 10, 2022, and externally validated at Hospital Vega Baja. The model involves an admissions generator based on a stochastic Markov model, feeding data into a discrete event simulation model in the R programming language. The probabilities of hospital admission were calculated based on age-stratified positive SARS-COV-2 results from the health department's catchment population. The discrete event simulation model simulates distinct patient pathways within the hospital to estimate bed occupancy for the upcoming week. The performance of the model was measured using the median absolute difference (MAD) between predicted and actual demand.Findings: When applied to data from San Juan hospital, the admissions generator demonstrated a MAD of 6 admissions/week (interquartile range [IQR] 2-11). The MAD between the model's predictions and actual bed occupancy was 20 beds/day (IQR 5-43), equivalent to 5% of total hospital beds. For ICU occupancy, the MAD was 4 beds/day (IQR 2-7), constituting 25% of ICU beds. Evaluation with data from Hospital Vega Baja showcased an admissions generator MAD of 2.42 admissions/week (IQR 1.02-7.41). The MAD between the model's predictions and actual bed occupancy was 18 beds/day (IQR 19.57-38.89), approximately 5.1% of hospital beds. The ICU occupancy MAD was 3 beds/day (IQR 1-5), making up 21.4% of ICU beds.Practical implications: The dynamic predictions of hospital admissions, ward beds, and ICU occupancy for COVID-19 patients proved highly valuable to hospital managers, facilitating early and informed planning of resource allocation. Additionally, this study underscores the importance of utilizing simulation techniques to predict and manage hospital occupancy levels, thereby enhancing decision-making in hospital bed management, not only during pandemics but also during regular periods.Originality/value: This study introduces a novel hybrid approach that combines stochastic modeling and discrete event simulation to forecast healthcare resource demands during the COVID-19 pandemic. The methodology's effectiveness in predicting admissions and bed occupancy contributes to improved resource planning and situational awareness.

Treatable mortality and health care related factors across European countries.

Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU. This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019. We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women. The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality. Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.

Evaluation of Nurse Workload in Patient Units

The inpatient room at a tertiary referral eye hospital includes eye surgery services and infection treatment for adult and pediatric patients. Nurse workload greatly influences the quality of service in the inpatient unit. However, data regarding the workload of nurses in inpatient units at tertiary referral eye hospitals is still limited. Objective: To determine the workload of nurses in the inpatient ward of a tertiary referral eye hospital. Method: This research is a quantitative descriptive study, which provides an overview of the workload of nurses in the inpatient ward of a tertiary referral eye hospital. The research was carried out from March to May 2023. The total sampling of research respondents was 25 nurses in inpatient treatment rooms for class 2 and 3 patients. Data collection used a workload questionnaire. Data analysis uses cross tabulation. The validity test was declared valid using the Pearson product moment correlation with results for the physical aspect of 0.396, the psychological aspect of 0.396 and the time aspect of 0.396 (0.396 &gt; 0.312). Reliability test usingCronbach's alphawith a coefficient of more than 0.6, it is declared reliable, where the physical aspect is 0.945, the psychological aspect is 0.903 and the time aspect is 0.906. This research has received ethical approval number: LB.02.01/2.3/5440/2023. Results: research shows that the workload of nurses on the physical aspect is high, namely 76%, and the workload of nurses on the psychological aspect is high, namely 96%. Discussion: Several factors causing the high workload of nurses include the large number of patients entering the inpatient room, the bed management system which is not yet optimal, and the limited treatment space but continuous use of beds. Conclusion: The high workload of nurses has an impact on the quality of nursing services.

Effects of Aquaculture and Thalassia testudinum on Sediment Organic Carbon in Xincun Bay, Hainan Island

Eutrophication due to aquaculture can cause the decline of seagrasses and impact their carbon storage capacity. This study explored the effects of aquaculture on the sediment organic carbon (SOC) in Thalassia testudinum seagrass beds using enzyme activity and microorganisms as indicators. Our results showed that the distance to aquaculture significantly increased the SOC and TN of sediments; the C/N ratio of sediments was reduced by the distance to aquaculture. Distance to aquaculture and seagrasses significantly impacted the δ13C of sediments, and their significant interactive effects on the δ13C of sediments were found. Distance to aquaculture and seagrasses had significantly interactive effects on the cellulase activity of sediments. Distance to aquaculture and seagrasses separately reduced the invertase activity of sediments. SOC in the seagrass bed was significantly positively impacted by cellulase activity and polyphenol oxidase activity in sediments. Firmicutes, Desulfobacterota and Chloroflexi were the dominant taxa in the S1 and S2 locations. From the S1 location to the S2 location, the relative abundances of Firmicutes and Desulfobacterota increased. The functional profiles of COG were relatively similar between the S1 and S2 locations. BugBase phenotype predictions indicated that the microbial phenotypes of all the seagrass sediment samples were dominated by anaerobic bacteria in terms of oxygen utilizing phenotypes. FAPROTAX functional predictions indicated that aquaculture affects functions associated with seagrass bed sediment bacteria, particularly those related to carbon and nitrogen cycling. This study can provide an important basis for understanding the response mechanism of global carbon sink changes to human activities such as aquaculture and supply more scientific data for promoting the conservation and management of seagrass beds.