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Li N, Arnold DM, Down DG, Barty R, Blake J, Chiang F, Courtney T, Waito M, Trifunov R, Heddle NM. From demand forecasting to inventory ordering decisions for red blood cells through integrating machine learning, statistical modeling, and inventory optimization. Transfusion 2021; 62:87-99. [PMID: 34784053 DOI: 10.1111/trf.16739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 09/13/2021] [Accepted: 10/16/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The demand and supply of blood are highly variable over time. Blood inventory management that relies heavily on experience-based decisions may not be adaptive to real demand, leading to high operational costs, wastage, and shortages. METHODS We combined statistical modeling, machine learning, and optimization methods to develop a data-driven demand forecasting and inventory management strategy for red blood cells (RBCs). We then used the strategy to inform daily blood orders. A secondary semi-weekly (twice per week) ordering strategy was developed to handle the last-mile split delivery problem for blood suppliers, characterized by multi-deliveries to the same location multiple times during a short period of time. Both strategies were evaluated using the TRUST database including all patient data across four hospitals in Hamilton, Ontario. RESULTS We identified 227,944 RBC transfusions for 40,787 patients in Hamilton, Ontario from 2012 to 2018. The predicted daily demand from the hybrid demand forecasting model was not significantly different from the actual daily demand (paired t-test p-value = 0.163); however, the proposed daily ordering quantity from the model was significantly lower than the actual ordering quantity (p-value <0.001). The proposed daily ordering strategy reduced inventory levels by 38.4% without risk of shortages, leading to an overall cost reduction of 43.0% (95% confidence interval [CI]: 42.3%, 43.7%) compared with the actual cost. The semi-weekly ordering strategy reduced ordering frequency by 62.6% (95% CI: 61.5%, 63.7%). CONCLUSION The proposed data-driven ordering strategy combining demand forecasting and inventory optimization can achieve significant cost savings for healthcare systems and blood suppliers.
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Affiliation(s)
- Na Li
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Douglas G Down
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Southwest Region, Ontario Regional Blood Coordinating Network, Hamilton, Ontario, Canada
| | - John Blake
- Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fei Chiang
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Tom Courtney
- Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Marianne Waito
- Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Rick Trifunov
- Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Integrated Supply Chain and Analytics, Canadian Blood Services, Ottawa, Ontario, Canada
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van Dijk WEM, Nijdam JS, Haitjema S, de Groot MCH, Huisman A, Punt MC, Evers ACC, Schutgens REG, Lely AT, van Galen KPM. Platelet count and indices as postpartum hemorrhage risk factors: a retrospective cohort study. J Thromb Haemost 2021; 19:2873-2883. [PMID: 34339085 PMCID: PMC9292153 DOI: 10.1111/jth.15481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Severe postpartum hemorrhage (SPPH) is the leading cause of maternal mortality and morbidity worldwide. Platelet anomalies frequently occur during pregnancy. However, their role in the etiology of SPPH is largely unknown. OBJECTIVE To study the relation between platelet parameters and SPPH. METHODS This retrospective single-center cohort included deliveries between 2009 and 2017. SPPH was defined as ≥1000 ml blood loss within 24 h after delivery. Platelet parameters were measured within 72 h before delivery. Multiple imputation was performed for missing data. Odds ratios were adjusted (aORs) for maternal age, multiple gestation, macrosomia, induction of labor, preeclampsia, and hemolysis, elevated liver enzymes, and low platelets syndrome. RESULTS A total of 23 205 deliveries were included. Of the 2402 (10.4%) women with thrombocytopenia (<150 × 109 /L), 10.3% developed SPPH, compared with 7.6% of women with a normal platelet count (aOR: 1.34, 95% CI: 1.14-1.59). Women with a platelet count of <50 × 109 /L were most at risk (aOR of 2.24 [1.01-4.94]) compared with the reference group with normal platelet counts; the aOR was 1.22 (0.77-1.93) for the 50-99 × 109 /L platelet count group and 1.31 (1.10-1.56) for the 100-149 × 109 /L platelet count group. Plateletcrit was associated with SPPH (aOR 1.15 [1.08-1.21] per 0.05% decrease), and, although rarely present, a platelet distribution width (PDW) ≥23% (n = 22) also increased the odds of SPPH (aOR 6.05 [2.29-16.20]). CONCLUSION Different degrees of thrombocytopenia were independently associated with the occurrence of SPPH. Despite their relation to SPPH, plateletcrit and a PDW of ≥23% have limited additional value in addition to platelet count.
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Affiliation(s)
- Wobke E. M. van Dijk
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | | | - Saskia Haitjema
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Mark C. H. de Groot
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Albert Huisman
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marieke C. Punt
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | | | - Roger E. G. Schutgens
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | - A. Titia Lely
- Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Karin P. M. van Galen
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
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Küçükcan NE, Kanmaz MA. Can we determine recurrent epistaxis by hemogram parameters in children? Int J Pediatr Otorhinolaryngol 2021; 146:110747. [PMID: 33945954 DOI: 10.1016/j.ijporl.2021.110747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/21/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Epistaxis in children is a common reason for admission at otolaryngology outpatient clinics. Patients are diagnosed by clinical examination and laboratory tests. We aimed to evaluate epistaxis using simple blood parameters useful for diagnosis. MATERIAL AND METHODS This study includes a retrospective analysis of 240 patients, including 120 study group and 120 healthy pediatric patients, who applied to the ENT outpatient clinic with the diagnosis of epistaxis between 2018 and 2020. This study is designed to analyze the predictive values of neutrophil-lymphocyte ratio (NLR), eosinophil-LR (ELR), platelet-LR (PLR), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) in pediatric epistaxis. RESULTS Serological factors were assessed and no statistical associations in MPV, PDW, PLR, and ELR values were found. However, significant changes were found for PCT and NLR within the patient and control groups. The average PCT was lower in the study group in comparison to the controls (p = 0.022). The average NLR was higher in the study group in comparison to the controls (p = 0.004). CONCLUSION The examination of children with epistaxis, as well as their management, following admission to the outpatient clinic continues to evolve. Although many studies have investigated the hemogram parameters and platelet indices, the PCT value has never been investigated in epistaxis. To our knowledge, our study is the first to demonstrate a relationship to PCT values and epistaxis.
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Ameya G, Biresaw G, Mohammed H, Chebud A, Meskele M, Hussein M, Endris M. Epistaxis and Its Associated Factors Among Precollege Students in Southern Ethiopia. J Blood Med 2021; 12:1-8. [PMID: 33442314 PMCID: PMC7797310 DOI: 10.2147/jbm.s285403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Epistaxis is one of the most common otorhinolaryngological emergencies affecting the majority of the population in their lifetime, with some of them requiring serious medical attention. This study aimed to assess the prevalence and associated factors of epistaxis among pre-college students in Wolaita Sodo, Ethiopia. Methods An institution-based cross-sectional study was conducted. Data were collected using a pre-tested interviewer administered questionnaire. The study participants were selected by systematic random sampling technique. A logistic regression analysis was employed to assess the presence and strength of association factors with epistaxis. An adjusted odds ratio with 95% confidence interval was used to determine the presence and strength of the association at 0.05 level of significance. Results Of 387 participants, 57.1% of them were male, and the mean age of all participant was 18.05±1.401 SD years. The overall epistaxis prevalence was 108 (27.9%). Blood group O, which accounted for about 43.4% was more prevalent. Blood group O (AOR=3.96, 95% CI=1.5-10.4), participants who drink coffee daily (AOR=2.75, 95% CI=1.0-7.4), and participants who took a bath frequently with both hot and cold-water (AOR=4.55, 95% CI=1.1-18.6) were significantly associated with epistaxis. Conclusion The type of blood group, interval of coffee drinking, and type of bathing were significantly associated with epistaxis. Working on the identified associated factor and increased awareness about epistaxis for the students with effective first aid training is mandatory.
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Affiliation(s)
- Gemechu Ameya
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Hayat Mohammed
- Department of Medical Laboratory Science, College of Medicine and Health Science, Jimma University, Jimma, Ethiopia
| | | | - Melese Meskele
- Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia
| | | | - Muktar Endris
- Galikoma Health Center, Afar Region, Galikoma, Ethiopia
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Bedel C, Korkut M, Karancı Y, Duyan M. Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests? JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2020. [DOI: 10.5799/jcei/7839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Li K, Liu SX, Yang CY, Jiang ZC, Liu J, Fan CQ, Li T, Dong XM, Wang J, Ran RY. A routine blood test-associated predictive model and application for tuberculosis diagnosis: a retrospective cohort study from northwest China. J Int Med Res 2019; 47:2993-3007. [PMID: 31154881 PMCID: PMC6683917 DOI: 10.1177/0300060519851673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives This study aimed to use the results of routine blood tests and relevant parameters to construct models for the prediction of active tuberculosis (ATB) and drug-resistant tuberculosis (DRTB) and to assess the diagnostic values of these models. Methods We performed logistic regression analysis to generate models of plateletcrit-albumin scoring (PAS) and platelet distribution width-treatment-sputum scoring (PTS). Area under the curve (AUC) analysis was used to analyze the diagnostic values of these curves. Finally, we performed model validation and application assessment. Results In the training cohort, for the PAS model, the AUC for diagnosing ATB was 0.902, sensitivity was 82.75%, specificity was 82.20%, accuracy rate was 81.00%, and optimal threshold value was 0.199. For the PTS model, the AUC for diagnosing DRTB was 0.700, sensitivity was 63.64%, specificity was 73.53%, accuracy rate was 89.00%, and optimal threshold value was −2.202. These two models showed significant differences in the AUC analysis, compared with single-factor models. Results in the validation cohort were similar. Conclusions The PAS model had high sensitivity and specificity for the diagnosis of ATB, and the PTS model had strong predictive potential for the diagnosis of DRTB.
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Affiliation(s)
- Kui Li
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China.,2 The Sixth Clinical Medical School of Hubei University of Medicine, Hubei, China
| | - Sheng-Xi Liu
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China.,2 The Sixth Clinical Medical School of Hubei University of Medicine, Hubei, China
| | - Cai-Yong Yang
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China.,2 The Sixth Clinical Medical School of Hubei University of Medicine, Hubei, China
| | - Zi-Cheng Jiang
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China.,2 The Sixth Clinical Medical School of Hubei University of Medicine, Hubei, China
| | - Jun Liu
- 3 Laboratory of Molecular Pathology and Tuberculosis Diseases, Ankang Central Hospital, Shaanxi, China
| | - Chuan-Qi Fan
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China
| | - Tao Li
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China
| | - Xue-Min Dong
- 3 Laboratory of Molecular Pathology and Tuberculosis Diseases, Ankang Central Hospital, Shaanxi, China
| | - Jing Wang
- 4 Nanmen Primary School, Hanbin District, Shaanxi, China
| | - Ren-Yu Ran
- 1 Department of Infectious Diseases, Ankang Central Hospital, Shaanxi, China
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Aksakal C, Şahin M. Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study. Pan Afr Med J 2019; 32:154. [PMID: 31303925 PMCID: PMC6607328 DOI: 10.11604/pamj.2019.32.154.18372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/24/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction the aim of this study was to investigate the possible relationship of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and routine hematological parameters with recurrent epistaxis in children. Methods İn this retrospective case-controlled study, 294 patients aged between 2 and 18 years who applied to the Tokat State Hopital Ear Nose Throat Clinic due to recurrent epistaxis between January 1st 2013 and December 31st December 2017 and 329 sex-and age-matched controls were investigated. Results NLR was 1.45±0.75 in the study group and the 1.35±0.7 in the control group. There was no significant difference between the groups (p>0.05). PLR values were found significantly (p<0.05) higher in the study group than in the control group (103,21±29.57 vs. 97,3±30.38). Red Blood Cell Distribution Width (RDW) values were found significantly (p<0.05) lower in the study group than in the control group (39,56±2,87 and 38,92±2,46). Conclusion the increase of PLR, an inflammatory marker, in epistaxis supports the effect of inflammatory factors in the etiology of epistaxis. However, more study in future is needed to support this.
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Affiliation(s)
- Ceyhun Aksakal
- Tokat State Hospital, Department of Otolaryngology, Tokat, Turkey
| | - Mehmet Şahin
- Tokat State Hostital, Department of Biochemistery, Tokat, Turkey
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