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Ricciardi C, Marino MR, Trunfio TA, Majolo M, Romano M, Amato F, Improta G. Evaluation of different machine learning algorithms for predicting the length of stay in the emergency departments: a single-centre study. Front Digit Health 2024; 5:1323849. [PMID: 38259256 PMCID: PMC10800466 DOI: 10.3389/fdgth.2023.1323849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Recently, crowding in emergency departments (EDs) has become a recognised critical factor impacting global public healthcare, resulting from both the rising supply/demand mismatch in medical services and the paucity of hospital beds available in inpatients units and EDs. The length of stay in the ED (ED-LOS) has been found to be a significant indicator of ED bottlenecks. The time a patient spends in the ED is quantified by measuring the ED-LOS, which can be influenced by inefficient care processes and results in increased mortality and health expenditure. Therefore, it is critical to understand the major factors influencing the ED-LOS through forecasting tools enabling early improvements. Methods The purpose of this work is to use a limited set of features impacting ED-LOS, both related to patient characteristics and to ED workflow, to predict it. Different factors were chosen (age, gender, triage level, time of admission, arrival mode) and analysed. Then, machine learning (ML) algorithms were employed to foresee ED-LOS. ML procedures were implemented taking into consideration a dataset of patients obtained from the ED database of the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital (Salerno, Italy) from the period 2014-2019. Results For the years considered, 496,172 admissions were evaluated and 143,641 of them (28.9%) revealed a prolonged ED-LOS. Considering the complete data (48.1% female vs. 51.9% male), 51.7% patients with prolonged ED-LOS were male and 47.3% were female. Regarding the age groups, the patients that were most affected by prolonged ED-LOS were over 64 years. The evaluation metrics of Random Forest algorithm proved to be the best; indeed, it achieved the highest accuracy (74.8%), precision (72.8%), and recall (74.8%) in predicting ED-LOS. Conclusions Different variables, referring to patients' personal and clinical attributes and to the ED process, have a direct impact on the value of ED-LOS. The suggested prediction model has encouraging results; thus, it may be applied to anticipate and manage ED-LOS, preventing crowding and optimising effectiveness and efficiency of the ED.
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Affiliation(s)
- Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, Naples, Italy
| | | | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Massimo Majolo
- Department of Public Health, University of Naples “Federico II”, Naples, Italy
| | - Maria Romano
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, Naples, Italy
| | - Francesco Amato
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, Naples, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, Naples, Italy
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Improta G, Majolo M, Raiola E, Russo G, Longo G, Triassi M. A case study to investigate the impact of overcrowding indices in emergency departments. BMC Emerg Med 2022; 22:143. [PMID: 35945503 PMCID: PMC9360659 DOI: 10.1186/s12873-022-00703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Emergency department (ED) overcrowding is widespread in hospitals in many countries, causing severe consequences to patient outcomes, staff work and the system, with an overall increase in costs. Therefore, health managers are constantly looking for new preventive and corrective measures to counter this phenomenon. To do this, however, it is necessary to be able to characterize the problem objectively. For this reason, various indices are used in the literature to assess ED crowding. In this work, we explore the use of two of the most widespread crowding indices in an ED of an Italian national hospital, investigate their relationships and discuss their effectiveness. Methods In this study, two of the most widely used indices in the literature, the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Working Index (EDWIN), were analysed to characterize overcrowding in the ED of A.O.R.N. “A. Cardarelli” of Naples, which included 1678 clinical cases. The measurement was taken every 15 minutes for a period of 7 days. Results The results showed consistency in the use of EDWIN and NEDOCS indices as measures of overcrowding, especially in severe overcrowding conditions. Indeed, in the examined case study, both EDWIN and NEDOCS showed very low rates of occurrence of severe overcrowding (2–3%). In contrast, regarding differences in the estimation of busy to overcrowded ED rates, the EDWIN index proved to be less sensitive in distinguishing these variations in the occupancy of the ED. Furthermore, within the target week considered in the study, the results show that, according to both EDWIN and NEDOCS, higher overcrowding rates occurred during the middle week rather than during the weekend. Finally, a low degree of correlation between the two indices was found. Conclusions The effectiveness of both EDWIN and NEDOCS in measuring ED crowding and overcrowding was investigated, and the main differences and relationships in the use of the indices are highlighted. While both indices are useful ED performance metrics, they are not always interchangeable, and their combined use could provide more details in understanding ED dynamics and possibly predicting future critical conditions, thus enhancing ED management.
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Affiliation(s)
- Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Via Pansini, No. 5 - ZIP, 80131, Naples, Italy. .,Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy.
| | | | | | | | | | - Maria Triassi
- Department of Public Health, University of Naples "Federico II", Via Pansini, No. 5 - ZIP, 80131, Naples, Italy.,Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy
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Genovesi ML, Torres B, Goldoni M, Salvo E, Cesario C, Majolo M, Mazza T, Piscopo C, Bernardini L. Case Report: A Novel Homozygous Missense Variant of FBN3 Supporting It Is a New Candidate Gene Causative of a Bardet–Biedl Syndrome–Like Phenotype. Front Genet 2022; 13:924362. [PMID: 35910214 PMCID: PMC9334770 DOI: 10.3389/fgene.2022.924362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
Fibrillin proteins are extracellular matrix glycoproteins assembling into microfibrils. FBN1, FBN2, and FBN3 encode the human fibrillins and mutations in FBN1 and FBN2 cause connective tissue disorders called fibrillinopathies, affecting cardiovascular, dermal, skeletal, and ocular tissues. Recently, mutations of the less characterized fibrillin family member, FBN3, have been associated in a single family with Bardet–Biedl syndrome (BBS). Here, we report on a patient born from two first cousins and affected by developmental delay, cognitive impairment, obesity, dental and genital anomalies, and brachydactyly/syndactyly. His phenotype was very similar to that reported in the previous FBN3-mutated family and fulfilled BBS clinical diagnostic criteria, although lacking polydactyly, the most recurrent clinical feature, as the previous siblings described. A familial SNP-array and proband’s WES were performed prioritizing candidate variants on the sole patient’s runs of homozygosity. This analysis disclosed a novel homozygous missense variant in FBN3 (NM_032447:c.5434A>G; NP_115823:p.Ile1812Val; rs115948457), inherited from the heterozygous parents. This study further supports that FBN3 is a candidate gene for a BBS-like syndrome characterized by developmental delay, cognitive impairment, obesity, dental, genital, and skeletal anomalies. Anyway, additional studies are necessary to investigate the exact role of the gene and possible interactions between FBN3 and BBS proteins.
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Affiliation(s)
- Maria Luce Genovesi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Barbara Torres
- Medical Genetics Division, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Marina Goldoni
- Medical Genetics Division, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Eliana Salvo
- Medical Genetics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Claudia Cesario
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Massimo Majolo
- Hospital Directorate, National Hospital A.O.R.N. “Antonio Cardarelli”, Naples, Italy
| | - Tommaso Mazza
- Laboratory of Bioinformatics, IRCCs Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Carmelo Piscopo
- Medical and Laboratory Genetics Unit, National Hospital A.O.R.N. “Antonio Cardarelli”, Naples, Italy
| | - Laura Bernardini
- Medical Genetics Division, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, Italy
- *Correspondence: Laura Bernardini,
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Ferrara F, Capone V, Cademartiri F, Vriz O, Cocchia R, Ranieri B, Franzese M, Castaldo R, D’Andrea A, Citro R, Chianese S, Annunziata R, Marullo F, Siniscalchi M, Conte M, Sepe C, Maramaldi R, Rega S, Russo G, Majolo M, Raiola E, Salzano A, Mauro C, Trimarco B, Izzo R, Bossone E. Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age. J Pers Med 2022; 12:jpm12060996. [PMID: 35743780 PMCID: PMC9224845 DOI: 10.3390/jpm12060996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Myocardial mechano-energetic efficiency (MEE) is the capability of the left ventricle (LV) to convert the chemical energy obtained from the cardiac oxidative metabolism into mechanical work. The aim of present study was to establish normal non-invasive MEE and MEEi reference values. METHODS In total, 1168 healthy subjects underwent physical examinations, clinical assessment, and standardized transthoracic echocardiographic (TTE) examination. MEE was obtained by TTE as the ratio between stroke volume (SV) and heart rate (HR): MEE = SV/HR [HR expressed in seconds (HR/60)]. Because MEE is highly related to left ventricular mass (LVM), MEE was then divided by LVM with the purpose of obtaining an estimate of energetic expenditure per unit of myocardial mass (i.e., indexed MEE, MEEi, mL/s/g). RESULTS The mean values of MEE and MEEi in the overall population were 61.09 ± 18.19 mL/s; 0.45 ± 0.14, respectively. In a multivariable analysis, gender, body surface area (BSA), diastolic blood pressure, left atrial volume indexed to BSA, E/e' and tricuspid annular plane systolic excursion (TAPSE) were the independent variables associated with MEE, while age, gender, BSA and TAPSE were the independent variables associated with MEEi. CONCLUSIONS The knowledge of age- and gender-based MEE and MEEi normal values may improve the global assessment of LV cardiac mechanics and serve as a reference to identify phenotypes at high risk of cardiovascular events.
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Affiliation(s)
- Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy;
| | - Valentina Capone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Olga Vriz
- Echocardiography Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
| | - Rosangela Cocchia
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Brigida Ranieri
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Monica Franzese
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Rossana Castaldo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Salvatore Chianese
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Roberto Annunziata
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Flavio Marullo
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Mario Siniscalchi
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Marianna Conte
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Chiara Sepe
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Renato Maramaldi
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Salvatore Rega
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
| | - Giuseppe Russo
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Massimo Majolo
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Eliana Raiola
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Andrea Salzano
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Ciro Mauro
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Eduardo Bossone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
- Correspondence:
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Scalise M, Bossone E, Mannelli MP, Ranieri B, Franzese M, Castaldo R, Fidecicchi A, Esposito M, Cocchia R, Lodato S, Majolo M, Russo G, Longo G, Mauro C. STEMI-PCI incidence rates and outcomes during COVID-19 pandemic: insights from Cardarelli Hospital, Naples, Southern Italy. Eur J Prev Cardiol 2021; 29:e216-e219. [PMID: 34626179 DOI: 10.1093/eurjpc/zwab165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Martina Scalise
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Eduardo Bossone
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Maria Pia Mannelli
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | | | | | | | - Andrea Fidecicchi
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Mafalda Esposito
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Rosangela Cocchia
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Sergio Lodato
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Massimo Majolo
- Health Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Giuseppe Russo
- Health Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Giuseppe Longo
- CEO, General Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9 - 80131 Naples, Italy
| | - Ciro Mauro
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
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Cocchia R, Iannelli G, Capone V, Chianese S, Langella G, Ranieri B, Majolo M, Russo G, Pilato E, Mauro C, Bossone E. Successful surgical repair of left ventricular pseudoaneurysm in a patient with subacute ST-elevation myocardial infarction. Monaldi Arch Chest Dis 2021; 92. [PMID: 34579519 DOI: 10.4081/monaldi.2021.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
We report a successful surgical repair of left ventricular pseudoaneurysm in a patient with subacute ST-elevation myocardial infarction (STEMI). In the case of expansion of the infarct related ventricular wall, early (within 24 hours) or late (3-5 days after STEMI) cardiac rupture should be always borne in mind in order to proceed to life saving prompt surgical repair.
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Affiliation(s)
- Rosangela Cocchia
- Cardiology Unit, Internal Medicine Department, Antonio Cardarelli Hospital, Naples.
| | - Gabriele Iannelli
- Division of Cardiac Surgery, Department of Advanced Medical Sciences, University of Naples "Federico II", Naples.
| | - Valentina Capone
- Cardiology Unit, Internal Medicine Department, Antonio Cardarelli Hospital, Naples.
| | - Salvatore Chianese
- Cardiology Unit, Internal Medicine Department, Antonio Cardarelli Hospital, Naples.
| | - Giuseppina Langella
- Division of Cardiac Surgery, Department of Advanced Medical Sciences, University of Naples "Federico II", Naples.
| | | | - Massimo Majolo
- Health Management Office, Department of Strategic Services in the Medical Area, Antonio Cardarelli Hospital, Naples.
| | - Giuseppe Russo
- Health Management Office, Department of Strategic Services in the Medical Area, Antonio Cardarelli Hospital, Naples.
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Medical Sciences, University of Naples "Federico II", Naples.
| | - Ciro Mauro
- Cardiology Unit, Internal Medicine Department, Antonio Cardarelli Hospital, Naples.
| | - Eduardo Bossone
- Cardiology Unit, Internal Medicine Department, Antonio Cardarelli Hospital, Naples.
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