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1.
IEEE Transactions on Automation Science & Engineering ; 19(2):709-723, 2022.
Article in English | Academic Search Complete | ID: covidwho-1788779

ABSTRACT

This article addresses a weekly physician scheduling problem in Covid-19. This problem has arisen in fever clinics in two collaborative hospitals located in Shanghai, China. Because of the coronavirus pandemic, the hospitals must consider some specific constraints in the scheduling problem. For example, due to social distance limitation, the patient queue lengths are much longer in the coronavirus pandemic, even with the same waiting patients. Thus, the hospitals must consider the maximum queue length in the physician scheduling problem. Moreover, the fever clinic’s scheduling rules are different from those in the common clinic, and some specific regulatory constraints have to be considered in the epidemic. We first build a mathematical model for this problem, in which a pointwise stationary fluid flow approximation method is used to compute the queue length. Some linearization techniques are designed to make the problem can be solved by commercial solvers, such as Gurobi. We find that solving this model from practical applications of the hospital within an acceptable computation time is challenging. Consequently, we develop an efficient two-phase approach to solve the problem. A staffing model and a branch-and-price algorithm are proposed in this approach. The performances of our models and approaches are discussed. The effectiveness of the proposed algorithms for real-life data from collaborative hospitals is validated. Note to Practitioners—This article is motivated by our collaborations with two hospitals in Shanghai, China. Covid-19 has swept the world since 2019 and is still raging in many regions, posing an unprecedented challenge to healthcare systems in countries worldwide. The hospitals are the frontlines of healthcare service, and the physicians are the most critical resource in the battles to coronavirus pandemic. In China, many large-scale hospitals establish fever clinics to serve fever patients. The physician scheduling for such clinics is different and complicated in the Covid-19 due to many specific constraints. We find that the managers are tough to give high-quality schedules to physicians. Thus, we propose a set of algorithms to solve this problem. Especially, a two-phase approach that consists of a staffing standard and a branch-and-price algorithm is designed. Based on hospitals’ real-life data, we show that the methods presented in this article can be used to help hospital managers obtain more reasonable scheduling solutions that can improve the service quality without increasing the workloads of physicians. [ FROM AUTHOR] Copyright of IEEE Transactions on Automation Science & Engineering is the property of IEEE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325222

ABSTRACT

BACKGROUND: Previous study suggested that Chinese Herbal Medicine (CHM) Formula Huashibaidu granule might shorten disease course of Corona Virus Disease 2019 (COVID-19) patients. Our research aims to investigate the early treatment effect of Huashibaidu granule in mild COVID-19 patients under well clinical management.METHODS: An unblended cluster-randomized clinical trial was conducted at the Dongxihu FangCang hospital. 2 cabins were randomly allocated to CHM or control group, with 204 randomly sampled mild COVID-19 patients in each cabin. All participants received a 7-day conventional treatment, and CHM group cabin used additional Huashibaidu granule 10g twice daily. Participants were followed up until they met clinical endpoint. The primary outcome was patient become worsening before clinical endpoint occurred. The secondary outcomes was discharge with cure before clinical endpoint occurred and relief of composite symptoms after 7 days treatment.FINDINGS: All 408 participants were followed up to meet clinical endpoint and included in statistical analysis. The baseline characteristics were comparable between 2 groups. The number of worsening patients in the CHM group was 5 (2.5%), and that in the control group was 16 (7.8%). There was a significant difference between groups (P=0.014). 8 foreseeable mild adverse events occurred without statistical difference between groups.INTERPRETATION: 7-day early treatment with Huashibaidu granule reduced worsening conversion of mild COVID-19 patients. Our study supports Huashibaidu Granule as an active option for early treatment of mild COVID-19 in similar medical locations with well management.TRIAL REGISTRATION: The Chinese Clinical Trial Registry: ChiCTR2000029763.FUNDING: This study was supported by “National Key R&D Program of China” (No.2020YFC0841500).DECLARATION OF INTERESTS: The authors guaranteed that there existed no competing interest in this paper.ETHICS APPROVAL STATEMENT: Ethics Review Committee of Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Approval of Ethical Review Acceptance Number: S2020-001;Approval Number: P20001/PJ01.

3.
International Journal of Production Research ; : 1-24, 2022.
Article in English | Taylor & Francis | ID: covidwho-1617041
4.
Front Med (Lausanne) ; 8: 696976, 2021.
Article in English | MEDLINE | ID: covidwho-1450816

ABSTRACT

Background: Previous research suggested that Chinese Medicine (CM) Formula Huashibaidu granule might shorten the disease course in coronavirus disease 2019 (COVID-19) patients. This research aimed to investigate the early treatment effect of Huashibaidu granule in well-managed patients with mild COVID-19. Methods: An unblinded cluster-randomized clinical trial was conducted at the Dongxihu FangCang hospital. Two cabins were randomly allocated to a CM or control group, with 204 mild COVID-19 participants in each cabin. All participants received conventional treatment over a 7 day period, while the ones in CM group were additionally given Huashibaidu granule 10 g twice daily. Participants were followed up to their clinical endpoint. The primary outcome was worsening symptoms before the clinical endpoint. The secondary outcomes were cure and discharge before the clinical endpoint and alleviation of composite symptoms after the 7 days of treatment. Results: All 408 participants were followed up to their clinical endpoint and included in statistical analysis. Baseline characteristics were comparable between the two groups (P > 0.05). The number of worsening patients in the CM group was 5 (2.5%), and that in the control group was 16 (7.8%) with a significant difference between groups (P = 0.014). Eight foreseeable mild adverse events occurred without statistical difference between groups (P = 0.151). Conclusion: Seven days of early treatment with Huashibaidu granule reduced the likelihood of worsening symptoms in patients with mild COVID-19. Our study supports Huashibaidu granule as an active option for early treatment of mild COVID-19 in similar well-managed medical environments. Clinical Trial Registration:www.chictr.org.cn/showproj.aspx?proj=49408, identifier: ChiCTR2000029763.

5.
Phytomedicine ; 91: 153671, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1313371

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of Hua Shi Bai Du Granule (Q-14) plus standard care compared with standard care alone in adults with coronavirus disease (COVID-19). STUDY DESIGN: A single-center, open-label, randomized controlled trial. SETTING: Wuhan Jinyintan Hospital, Wuhan, China, February 27 to March 27, 2020. PARTICIPANTS: A total of 204 patients with laboratory-confirmed COVID-19 were randomized into the treatment group and control group, consisting of 102 patients in each group. INTERVENTIONS: In the treatment group, Q-14 was administered at 10 g (granules) twice daily for 14 days, plus standard care. In the control group, patients were provided standard care alone for 14 days. MAIN OUTCOME MEASURE: The primary outcome was the conversion time for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral assay. Adverse events were analyzed in the safety population. RESULTS: Among the 204 patients, 195 were analyzed according to the intention-to-treat principle. A total of 149 patients (71 vs. 78 in the treatment and control groups, respectively) tested negative via the SARS-CoV-2 viral assay. There was no statistical significance in the conversion time between the treatment group and control group (Full analysis set: Median [interquartile range]: 10.00 [9.00-11.00] vs. 10.00 [9.00-11.00]; Mean rank: 67.92 vs. 81.44; P = 0.051). The recovery time for fever was shorter in the treatment group than in the control group. The disappearance rate of symptoms like cough, fatigue, and chest discomfort was significantly higher in the treatment group. In chest computed tomography (CT) examinations, the overall evaluation of chest CT examination after treatment compared with baseline showed that more patients improved in the treatment group. There were no significant differences in the other outcomes. CONCLUSION: The combination of Q-14 and standard care for COVID-19 was useful for the improvement of symptoms (such as fever, cough, fatigue, and chest discomfort), but did not result in a significantly higher probability of negative conversion in the SARS-CoV-2 viral assay. No serious adverse events were observed. TRIAL REGISTRATION: ChiCTR2000030288.


Subject(s)
COVID-19 , Drugs, Chinese Herbal/therapeutic use , COVID-19/therapy , China , Female , Humans , Male , Middle Aged , Treatment Outcome
6.
Phytomedicine ; 81: 153367, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-837550

ABSTRACT

BACKGROUND: Treatments for coronavirus disease 2019 (COVID-19) are limited by suboptimal efficacy. METHODS: From January 30, 2020 to March 23, 2020, we conducted a non-randomised controlled trial, in which all adult patients with laboratory-confirmed COVID-19 were assigned to three groups non-randomly and given supportive treatments: Group A, Lopinavir-Ritonavir; Group B, Huashi Baidu Formula (a Chinese medicineformula made by the China Academy of Chinese Medical Sciences to treat COVID-19, which is now in the clinical trial period) and Lopinavir-Ritonavir; and Group C, Huashi Baidu Formula. The use of antibiotics, antiviruses, and corticosteroids was permitted in Group A and B. Traditional Chinese medicine injections were permitted in Group C. The primary outcomes were clinical remission time (interval from admission to the first time the patient tested negatively for novel coronavirus or an obvious improvement was observed from chest CT) and clinical remission rate (number of patients whose clinical time was within 16 days/total number of patients). RESULTS: A total of 60 adult patients with COVID-19 were enrolled at sites in Wuhan, China, and the sample size of each group was 20. In Groups A, B and C, the clinical remission rates were 95.0%%(19/20), 100.0%%(20/20) and 100.0%%(20/20), respectively. Compared with Groups A and B, the clinical remission time of Group C was significantly shorter (5.9 days vs. 10.8 days, p < 0.05; 5.9 days vs. 9.7 days, p < 0.05). There was no significant difference among Groups A, B, and C in terms of the time taken to be released from quarantine. The clinical biochemical indicators and safety indexes showed no significant differences among the three groups. CONCLUSIONS: Our findings suggest that Lopinavir-Ritonavir has some efficacy in the treatment of COVID-19, and the Huashi Baidu Formula might enhance this effect to an extent. In addition, superiority was displayed in the treatment of COVID-19 through a combination of the Huashi Baidu Formula and traditional Chinese medicine injection. In future, well-designed prospective double-blinded randomised control trials are required to confirm our findings.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Lopinavir/therapeutic use , Ritonavir/therapeutic use , Adult , Aged , Aged, 80 and over , Antiviral Agents/adverse effects , COVID-19/diagnostic imaging , Drug Combinations , Drug Therapy, Combination , Drugs, Chinese Herbal/adverse effects , Female , Humans , Lopinavir/adverse effects , Male , Medicine, Chinese Traditional , Middle Aged , Patient Safety , Prospective Studies , Ritonavir/adverse effects , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome
7.
Medicine (Baltimore) ; 99(34): e21874, 2020 Aug 21.
Article in English | MEDLINE | ID: covidwho-733315

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused serious damage to public health. COVID-19 has no vaccine or specific therapy; its mortality rate increases significantly once patients deteriorate. Furthermore, intensive monitoring of COVID-19 is limited by insufficient medical resources and increased risks of exposure to medical staff. We therefore aim to build an early warning and rapid response system (EWRRS) to address these problems. METHOD: The research is designed as a prospective cohort study, to verify a dynamic and interactive evaluation system; it includes patient self-reporting, active monitoring, early alarming and treatment recommendations. Adult patients diagnosed with COVID-19 will be recruited from Sept 2020 to Aug 2021 at a tertiary contagious hospital. Patients with life expectancy <48 hours, pregnant or lactating, in immunosuppression states or end-stage diseases will be excluded. The intervention is implementation of EWRRS to detect early signs of clinical deterioration of COVID-19 patients, to provide timely and efficient treatment suggestions by the system. EWRRS can determine the classification and interactive evaluation of patient information; the determination is based on the application of 3 different scenario modules, separately driven by patients, nurses, and physicians. The primary outcome is change in disease severity category after treatment. Secondary outcomes include the proportion of patients with different disease severity types; critical deterioration events; patients who had unplanned transfers to an intensive care unit (ICU) and required critical care interventions; intervals from warning to implementation of clinical interventions; hospital mortality; length of ICU and hospital stay; workload of medical staff and risks of exposure to COVID-19. DISCUSSION: Our hypothesis is that EWRRS provides an example of an early identification, warning, and response system for COVID-19. In addition, EWRRS can potentially be extended to use as a grading metric for general critically ill patients in an ICU setting.


Subject(s)
Clinical Deterioration , Coronavirus Infections/physiopathology , Critical Illness , Pneumonia, Viral/physiopathology , Betacoronavirus , COVID-19 , Humans , Intensive Care Units , Monitoring, Physiologic , Pandemics , Prospective Studies , Research Design , Risk Assessment , SARS-CoV-2 , Severity of Illness Index
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