Continuous mixed venous oxygen saturation (SVO2) measurements from fiberoptic pulmonary artery catheters, arterial oxygen saturation (SaO2) measurements from pulse oximetry, and minute-by-minute oxygen consumption (VO2) measurements from indirect calorimetry can be used for near-continuous estimation of cardiac output (Qt) and oxygen delivery (DO2) by application of the Fick Principle. Assumptions required for calculation of blood oxygen contents include constant hemoglobin concentration (Hgb) and constant or negligible physically dissolved oxygen. First, the influence of these assumptions on continuous Qt and DO2 determinations was tested. Unmeasured changes in Hgb resulted in substantial error in calculated Qt, whereas calculated DO2 was minimally affected. Both Qt and DO2 were little altered by errors in PaO2 or PVO2. Second, the effects of SVO2, SaO2, and VO2 measurement errors on Qt and DO2 calculations under normal and extreme conditions were quantified. Relative errors in SVO2 were increased by a factor of 4.2 in Qt estimations and by a factor of 3.2 in DO2 measurements under normal conditions. These factors increased with increasing SVO2, and thus, Qt and DO2 became increasingly unreliable as oxygen extraction fell. Third, we compared continuous measurements of Qt and DO2 with intermittent measurements made by thermodilution cardiac output and blood sampling, and found correlation coefficients of 0.85 for Qt and 0.89 for DO2. Fourth, common measurement errors in VO2 and DO2 calculated in this way were found to bias regressions between VO2 and DO2, and this bias could be minimized only if the DO2 range were high and SVO2 were low.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective To highlight clinical and operational issues, identify factors that shape patient responses in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and test the correlations between composite measures and overall hospital ratings. Design Responses to HCAHPS surveys were used in a partial correlation analysis to ascertain those HCAHPS composite measures that most relate to overall hospital ratings. The linear mean scores for the composite measures and individual and global items were analyzed with descriptive analysis and correlation analysis via JMP and SPSS statistical software. Setting HCAHPS is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. The Survey is for adult inpatients, excluding psychiatric patients. Participants 3,382 US hospitals. Intervention None Main Outcome Measure Pearson correlation coefficients for the six composite measures and overall hospital rating. Results The partial correlations for overall hospital rating and three composite measures are positive and moderately strong for care transition (0.445) and nurse communication (0.369) and weak for doctor communication (0.066). Conclusions From a health policy standpoint, it is imperative that hospital administrators stress open and clear communication between providers and patients to avoid problems ranging from misdiagnosis to incorrect treatment. Additional research is needed to determine how COVID-19 pandemic influences patients’ perceptions of quality and willingness to recommend hospitals at a time when nurses and physicians show symptoms of burnout due to heavy workloads and inadequate PPEs.

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The U.S. Navy operates an impressive fleet of nuclear-powered submarines and aircraft carriers and has safely operated its nuclear fleet for more than 60 years, while steaming over 154 million miles. Rigorous training has been key to maintaining such an impressive record. The U.S. Naval Nuclear Propulsion Training Program develops, certifies, and delivers the nuclear-operator qualification training for enlisted and officer personnel operating its nuclear fleet. This training finishes at one of four nuclear-power training units (NPTUs), operates under a complex set of hard and soft constraints, varies depending on the type of student, and requires significant personnel and equipment resources. We developed and implemented a mixed-integer linear program (MILP) that prescribes how many students of each type to allocate to each NPTU at the start of each class (a group of students who train together) and how allocated students complete NPTU training. The use of MILP has improved student allocation by an estimated eight percent and led to significantly improved use of both NPTU personnel and equipment resources. In this paper, we describe this unique optimization application, the MILP formulation, its path to adoption, its user interface, and impacts from its development and use over the past three years.