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Geraili Z, HajianTilaki K, Bayani M, Hosseini SR, Khafri S, Ebrahimpour S, Javanian M, Babazadeh A, Shokri M. Joint modeling of longitudinal and competing risks for assessing blood oxygen saturation and its association with survival outcomes in COVID-19 patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:91. [PMID: 38726068 PMCID: PMC11081430 DOI: 10.4103/jehp.jehp_246_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND The objective of the present study is to evaluate the association between longitudinal and survival outcomes in the presence of competing risk events. To illustrate the application of joint modeling in clinical research, we assessed the blood oxygen saturation (SPO2) and its association with survival outcomes in coronavirus disease (COVID-19). MATERIALS AND METHODS In this prospective cohort study, we followed 300 COVID-19 patients, who were diagnosed with severe COVID-19 in the Rohani Hospital in Babol, the north of Iran from October 22, 2020 to March 5, 2021, where death was the event of interest, surviving was the competing risk event and SPO2 was the longitudinal outcome. Joint modeling analyses were compared to separate analyses for these data. RESULT The estimation of the association parameter in the joint modeling verified the association between longitudinal outcome SPO2 with survival outcome of death (Hazard Ratio (HR) = 0.33, P = 0.001) and the competing risk outcome of surviving (HR = 4.18, P < 0.001). Based on the joint modeling, longitudinal outcome (SPO2) decreased in hypertension patients (β = -0.28, P = 0.581) and increased in those with a high level of SPO2 on admission (β = 0.75, P = 0.03). Also, in the survival submodel in the joint model, the risk of death survival outcome increased in patients with diabetes comorbidity (HR = 4.38, P = 0.026). CONCLUSION The association between longitudinal measurements of SPO2 and survival outcomes of COVID-19 confirms that SPO2 is an important indicator in this disease. Thus, the application of this joint model can provide useful clinical evidence in the different areas of medical sciences.
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Affiliation(s)
- Zahra Geraili
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah HajianTilaki
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Masomeh Bayani
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyed R. Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehran Shokri
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Ilczak T, Micor A, Waksmańska W, Bobiński R, Kawecki M. Factors which impact the length of hospitalisation and death rate of COVID-19 patients based on initial triage using capillary blood gas tests: a single centre study. Sci Rep 2022; 12:17458. [PMID: 36261609 PMCID: PMC9580438 DOI: 10.1038/s41598-022-22388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
An important element in the effective treatment of patients infected with the SARS-CoV-2 virus during the pandemic is an effective early triage to determine patient allocation and in-patient therapy. This paper assesses the prognostic value of capillary blood gas tests in predicting extended hospitalisation and death due to COVID-19. This retrospective statistical research is based on a group of 200 patients, hospitalised from 15 October 2020 to 08 March 2021. The study utilised the treatment documentation of these patients hospitalised due to COVID-19 at the Pulmonology and Thoracic Surgery Centre in Bystra (Southern Poland) during this period. The hospital has 50 beds with access to oxygen for COVID-19 patients and a five-bed intensive care unit. On the basis of the obtained results, conclusions were drawn that the need for early oxygen therapy with an oxygen mask and low pH values in capillary blood are significant risk factors for prolonging hospitalisation due to COVID-19. Age, the need for early oxygen mask therapy and low oxygen saturation are important risk factors for death from COVID-19. Capillary blood gas analysis is a simple and effective method of early in-patient segregation of COVID-19 patients.
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Affiliation(s)
- Tomasz Ilczak
- grid.431808.60000 0001 2107 7451Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland ,European Pre-Hospital Research Network, Nottingham, United Kingdom
| | - Alicja Micor
- Pulmonology and Thoracic Surgery Centre in Bystra, Bystra, Poland
| | - Wioletta Waksmańska
- grid.431808.60000 0001 2107 7451Department of Public Health, Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biała, Poland
| | - Rafał Bobiński
- grid.431808.60000 0001 2107 7451Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biała, Poland
| | - Marek Kawecki
- grid.431808.60000 0001 2107 7451Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
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De Freitas VM, Chiloff DM, Bosso GG, Teixeira JOP, Hernandes ICDG, Padilha MDP, Moura GC, De Andrade LGM, Mancuso F, Finamor FE, Serodio AMDB, Arakaki JSO, Sartori MGF, Ferreira PRA, Rangel ÉB. A Machine Learning Model for Predicting Hospitalization in Patients with Respiratory Symptoms during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154574. [PMID: 35956189 PMCID: PMC9369854 DOI: 10.3390/jcm11154574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
A machine learning approach is a useful tool for risk-stratifying patients with respiratory symptoms during the COVID-19 pandemic, as it is still evolving. We aimed to verify the predictive capacity of a gradient boosting decision trees (XGboost) algorithm to select the most important predictors including clinical and demographic parameters in patients who sought medical support due to respiratory signs and symptoms (RAPID RISK COVID-19). A total of 7336 patients were enrolled in the study, including 6596 patients that did not require hospitalization and 740 that required hospitalization. We identified that patients with respiratory signs and symptoms, in particular, lower oxyhemoglobin saturation by pulse oximetry (SpO2) and higher respiratory rate, fever, higher heart rate, and lower levels of blood pressure, associated with age, male sex, and the underlying conditions of diabetes mellitus and hypertension, required hospitalization more often. The predictive model yielded a ROC curve with an area under the curve (AUC) of 0.9181 (95% CI, 0.9001 to 0.9361). In conclusion, our model had a high discriminatory value which enabled the identification of a clinical and demographic profile predictive, preventive, and personalized of COVID-19 severity symptoms.
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Affiliation(s)
- Victor Muniz De Freitas
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Daniela Mendes Chiloff
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giulia Gabriella Bosso
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | | | - Maira do Patrocínio Padilha
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giovanna Corrêa Moura
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | - Frederico Mancuso
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Francisco Estivallet Finamor
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Aluísio Marçal de Barros Serodio
- Sector of Bioethics, Department of Surgery, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Jaquelina Sonoe Ota Arakaki
- Pneumology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Marair Gracio Ferreira Sartori
- Department of Obstetrics, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Paulo Roberto Abrão Ferreira
- Infectious Disease Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Érika Bevilaqua Rangel
- Nephrology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
- Correspondence:
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Ventura CAI, Denton EE, David JA, Schoenfelder BJ, Mela L, Lumia RP, Rudi RB, Haldar B. Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:249-272. [PMID: 35669176 PMCID: PMC9165654 DOI: 10.2147/oaem.s366006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.
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Affiliation(s)
- Christian Angelo I Ventura
- Department of Graduate Medical Sciences, Boston University School of Medicine Boston, Boston, MA, USA
- Department of Health, Behavior and Society (Incoming), Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, USA
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Correspondence: Christian Angelo I Ventura, Tel +1 (732) 372-2141, Email ;
| | - Edward E Denton
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Department of Emergency Medicine, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR, USA
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR, USA
| | - Jessica Anastacia David
- Department of Biochemistry and Microbiology, Rutgers University New Brunswick, Brunswick, NJ, USA
| | | | - Lillian Mela
- Department of Nursing, Simmons University Boston, Boston, MA, USA
| | - Rebecca P Lumia
- Department of Biology, Northeastern University Boston, Boston, MA, USA
| | - Rachel B Rudi
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
| | - Barnita Haldar
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham School of Medicine Birmingham, Birmingham, AL, USA
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Marincowitz C, Sutton L, Stone T, Pilbery R, Campbell R, Thomas B, Turner J, Bath PA, Bell F, Biggs K, Hasan M, Hopfgartner F, Mazumdar S, Petrie J, Goodacre S. Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study. Emerg Med J 2022; 39:317-324. [PMID: 35140074 PMCID: PMC8844966 DOI: 10.1136/emermed-2021-211934] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/02/2022] [Indexed: 12/24/2022]
Abstract
Background Tools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting. Methods An observational cohort study using linked ambulance service data for patients attended by Emergency Medical Service (EMS) crews in the Yorkshire and Humber region of England between 26 March 2020 and 25 June 2020 was conducted to assess performance of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) tool, National Early Warning Score (NEWS2), WHO algorithm, CRB-65 and Pandemic Medical Early Warning Score (PMEWS) in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support. Results Of the 7549 patients in our cohort, 17.6% (95% CI 16.8% to 18.5%) experienced the primary outcome. The NEWS2 (National Early Warning Score, version 2), PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40). Conclusion Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Tony Stone
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Richard Campbell
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Benjamin Thomas
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Janette Turner
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Peter A Bath
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.,Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Frank Hopfgartner
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Suvodeep Mazumdar
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study. Medicina (B Aires) 2021; 57:medicina57121362. [PMID: 34946307 PMCID: PMC8707267 DOI: 10.3390/medicina57121362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was “Low SpO2” defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2–10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8–15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3–38.3) and at 30 days (OR = 3.9, 95% CI 1.4–10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.
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Ortíz-Barrios MA, Coba-Blanco DM, Alfaro-Saíz JJ, Stand-González D. Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8814. [PMID: 34444561 PMCID: PMC8392152 DOI: 10.3390/ijerph18168814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.
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Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
| | - Dayana Milena Coba-Blanco
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Daniela Stand-González
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia; (D.M.C.-B.); (D.S.-G.)
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