RESUMO
Preparing a schedule for physicians in the emergency room is a complex task, which requires taking into account a large number of (often conflicting) rules, related to various aspects: limits on the number of consecutive shifts or weekly hours, special rules for night shifts and weekends, seniority rules, vacation periods, individual preferences,... In this paper, we present a mathematical programming approach to facilitate this task. The approach models the situation in a major hospital of the Montreal region (approximately 20 physicians are members of the working staff). We show that the approach can significantly reduce the time and the effort required to construct a six-month schedule. A human expert, member of the working staff, typically requires a whole dedicated week to perform this task, with the help of a spreadsheet. With our approach, a schedule can be completed in less than one day. Our approach also generates better schedules than those produced by the expert, because it can take into account simultaneously more rules than any human expert can do.
Assuntos
Serviço Hospitalar de Emergência , Corpo Clínico Hospitalar/provisão & distribuição , Modelos Teóricos , Admissão e Escalonamento de Pessoal/organização & administração , Humanos , Estudos de Casos Organizacionais , Quebeque , Recursos HumanosRESUMO
An 11-class patient classification system (PCS) has been built on a recode of two dimensions of the handicap code of the ICIDH: physical independence and mobility handicaps. The proposed system, called MAC XI, explains 78% of the variance of nursing care hours required by nursing-home residents and extended-care hospital patients. This percentage of variation is higher than the one explained by traditional dependency grids such as the Exton-Smith, Murphy, Kuntzmann and SMAF. MAC XI, based on two dimensions of the handicap code, is thus a powerful tool for predicting intensity of nursing care for staffing and budgeting purposes in long-term care institutions.
Assuntos
Pessoas com Deficiência/classificação , Cuidados de Enfermagem , Atividades Cotidianas , Grupos Diagnósticos Relacionados , Humanos , Assistência de Longa Duração , Reprodutibilidade dos TestesRESUMO
The loss of a maxillary incisor is traditionally treated with a three-unit bridge. The progress made in dental implantology since the demonstration of osseointegration by Brånemark and al. allows the overall replacement of the missing tooth. Furthermore, the use of osseointegrated implants makes the replacement of a single maxillary incisor reliable and aesthetic, even in cases of moderate gingival and bone recession. In respect of the rules set forth by Brånemark and al., it is essential to make a wax-up and a surgical stents. For anterior teeth, the single tooth abutment marketed by Nobelpharma allows the aesthetic margins of the prosthesis to be placed in a sub-gingival position. Once this component is positioned on the fixture, the achievement of the prosthesis is practically identical to traditional metal ceramic crown. The abutment is maintained on the fixture by a screw which can be easily removed and avoids an excess of subgingival cement. Nonetheless, its diameter means that it is reserved for relatively wide teeth. This type of treatment involves the development of a reliable and proven surgical planning for bone grafts, especially in cases of facial traumatism.
Assuntos
Implantação Dentária Endóssea , Incisivo , Avulsão Dentária/terapia , Dente Artificial , Adulto , Implantes Dentários , Feminino , Humanos , Maxila , OsseointegraçãoRESUMO
A multidisciplinary study of 57 patients with erection disorders included in addition to standard examinations: clinical, hormonal, vascular using Doppler and nervous with determination of latency time of bulbocavernous reflex, evaluation of effects of intracavernous papaverine injections completed by a manometric study of cavernous body filing by perfusion. A clear positive result of the papaverine test is considered to reflect integrity of vascularization of corpus cavernosum structure, and renders value less the continuation of vascular investigations. The appearance of an almost normal but delayed erection requiring high-dose papaverine administration is interpreted as being due to insufficiency of arterial origin without anomaly of venous return. The absence of erection after papaverine injection, whether in the presence or absence of an increase in penis volume, results from excessive venous return, insufficient arterial supply or both. Absence of erection despite a cavernous perfusion of more than 70 ml/min is due to excessive venous return that requires localization by cavernography. The onset of erection during cavernous body filling eliminates excessive venous return and results from arterial insufficiency that necessitates pelvic arteriography. A therapeutic attitude of logical consequence is proposed.
Assuntos
Disfunção Erétil/etiologia , Papaverina , Ensaios Clínicos como Assunto , Disfunção Erétil/diagnóstico , Disfunção Erétil/terapia , Humanos , Injeções , Masculino , Papaverina/administração & dosagem , Pênis/irrigação sanguíneaRESUMO
Two cases of rare vascular lesions of kidney are reported: a patient with a renal angioma and one with an aneurysm acquired after an oster type endocarditis. Both lesions were detected after severe hemorrhage and nephrectomy was performed in each case. Exact diagnosis was dependent on histopathologic findings. The relevant literature is reviewed.
Assuntos
Malformações Arteriovenosas/diagnóstico , Artéria Renal/anormalidades , Veias Renais/anormalidades , Adulto , Feminino , Hemangioma/congênito , Hematúria/etiologia , Humanos , Neoplasias Renais/congênito , Masculino , Pessoa de Meia-IdadeRESUMO
The method of treating urethral strictures described in this article is inspired from the technique for percutaneous angioplasty, using an inflatable catheter. It provides good immediate results in 80% of cases, regardless of the localization of the stricture and the previous treatment.