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Relevance. The development of computer technology in recent years is increasingly being introduced into the medical field. Modern programs make it possible to perform imitation modeling of a medical unit in the mode of daily activities and in emergency situations, allow predicting the required number of personnel and bed capacity. Intention. To study the possibilities of computer simulation to optimize the work of an inpatient emergency department in emergency conditions. Methodology. With the help of software, a simulation model of a real inpatient emergency department was developed, experiments were carried out with the formation of emergency situations, the results were compared with data obtained in practice. Results and Discussion. Upon admission of 50 patients per hour, the optimal solution was the conversion of 5 beds of the dynamic observation ward into intensive care beds and the placement of 10 additional beds in the waiting room, as well as the allocation of additional personnel in case of an emergency: 8 doctors, 6 nurses and 2 paramedics, 4 medical registrars. In the experiment of work in the conditions of the first wave of the COVID-19 pandemic, the capacity of the department was sufficient to admit 164 patients in 24 hours, the duration of their stay in the department was (110.0 ± 4.6) minutes. The second wave demonstrated the need to apply simulation modeling as a whole for the entire medical institution, and not just for individual structural units. Conclusion. Planning the work of an inpatient emergency department in an emergency requires preparedness for massive admission of patients. In this case, it is advisable to solve tactical issues in advance, using modern technologies, such as computer simulation. © 2022 Proceedings of the National Academy of Sciences of Belarus. Medical series. All rights reserved.
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The article presents the experience of using simulation modeling to optimize inpatient emergency department as an admission unit of a hospital — Center for treatment of patients with new coronavirus infection COVID-19. It was noted that the inpatient emergency department effectively performed the functions of the inpatient department of the Center for treatment of patients with new COVID-19 coronavirus infection for a total of more than 7 months. A correct calculation of staffing and a competent use of the department "zones" ensured efficient and rapid reception of patients during both "waves" of the pandemic. The model also proved positive role of such departments with a large number of patients in a multimillion metropolis needed to be hospitalized on a daily basis. © Burnasyan FMBC FMBA.
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BACKGROUND: Several anti-cytokine therapies were tested in the randomized trials in hospitalized patients with severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Previously, dexamethasone demonstrated a reduction of case-fatality rate in hospitalized patients with respiratory failure. In this matched control study we compared dexamethasone to a Janus kinase inhibitor, ruxolitinib. METHODS: The matched cohort study included 146 hospitalized patients with COVID-19 and oxygen support requirement. The control group was selected 1:1 from 1355 dexamethasone-treated patients and was matched by main clinical and laboratory parameters predicting survival. Recruitment period was April 7, 2020 through September 9, 2020. RESULTS: Ruxolitinib treatment in the general cohort of patients was associated with case-fatality rate similar to dexamethasone treatment: 9.6% (95% CI [4.6-14.6%]) vs 13.0% (95% CI [7.5-18.5%]) respectively (p = 0.35, OR = 0.71, 95% CI [0.31-1.57]). Median time to discharge without oxygen support requirement was also not different between these groups: 13 vs. 11 days (p = 0.13). Subgroup analysis without adjustment for multiple comparisons demonstrated a reduced case-fatality rate in ruxolitnib-treated patients with a high fever (≥ 38.5 °C) (OR 0.33, 95% CI [0.11-1.00]). Except higher incidence of grade 1 thrombocytopenia (37% vs 23%, p = 0.042), ruxolitinib therapy was associated with a better safety profile due to a reduced rate of severe cardiovascular adverse events (6.8% vs 15%, p = 0.025). For 32 patients from ruxolitinib group (21.9%) with ongoing progression of respiratory failure after 72 h of treatment, additional anti-cytokine therapy was prescribed (8-16 mg dexamethasone). CONCLUSIONS: Ruxolitinib may be an alternative initial anti-cytokine therapy with comparable effectiveness in patients with potential risks of steroid administration. Patients with a high fever (≥ 38.5 °C) at admission may potentially benefit from ruxolitinib administration. Trial registration The Ruxolitinib Managed Access Program (MAP) for Patients Diagnosed With Severe/Very Severe COVID-19 Illness NCT04337359, CINC424A2001M, registered April, 7, 2020. First participant was recruited after registration date.