This century has seen several outbreaks of epidemics caused by a common sub-family of coronaviruses such as the responsible for COVID-19 outbreak. The most ominous variants have developed a peculiar viral mechanisms that allows the virus to directly attack the pulmonary tissues often causing a set of dangerous symptoms. It made quite evident that we need a global response to prepare health systems for future epidemics. Unfortunately, during such kind of diseases' outbreaks a large amount of time is required to the caregivers for sanitization and cleaning operations, therefore tampering with number and duration of visits to patients, especially in oncology wards. Such patients are then left alone for a long time, it follows that their perceived quality of service is greatly diminished, often determining ill-fated consequences also on the psychological side, with significant fallbacks on the recovery possibilities and speed. In this paper we explore an algorithmic approach to automatic communication interfaces that could enhance and enforce the perceived quality of care by the patients in in order to reduce predisposing factors that could potentially tamper with the patient's ability to recover, also preventing the occurrence of precipitating factors that could lead a therapy to complete failure. The proposed interface could be used to connect the patients with a psychological support when it is most needed, and, moreover, to connect them with their physicians and families, and also to the outside world. In particular we aim to provide the psychological support that is actually excluded in pandemics such as the COVID-19 emergency, mainly in order to enforce the healthcare and sanification protocols, due to its potential unsafety related to the introduction of more personnel into the hospital.
matter of weeks. The healthcare system’s capacity to
respond has been under enormous pressure, to the point
This century has seen several outbreaks of epidemics that Intensive care specialists had been considering the
caused by a common sub-family of coronaviruses. The possibility to deny life-saving care to the sickest,
givmost ominous variants have developed a peculiar viral ing priority to patients with better survival chances [
Such a mechanism allows the virus to directly attack dent that we need a global response to prepare health
the pulmonary tissues often causing a set of danger- systems for future epidemics. Oficial numbers of
inous symptoms that can be generalized as Severe Acute fected people during the COVID-19 virus outbreak have
Respiratory Syndromes (SARSs). Therefore such virus- been indicative of the spread of the infection, and of
es are characterized by extreme infectivity, rapid spread, the challenges that have been posed to Italian hospitals
and the concrete risk of developing pulmonary syn- and, in particular, intensive care facilities. The
enordromes that may require intensive care unit admis- mous demand for handling the COVID-19 outbreak
sion [
© 2020 Copyright for this paper by its authors. Use permitted under Creative CPWrEooUrckReshdoinpgs IhStpN:/c1e6u1r3-w-0s.o7r3g CCoEmUmoRns WLiceonrsekAsthtriobuptioPnr4o.0cIneteerdnaitniognasl ((CCC EBYU4R.0)-.WS.org) These afections can also evolve in acute respiratory healthcare and sanification protocols, due to its potensyndromes, with variable or uncertain outcomes, such tial unsafety related to the introduction of more peras severe pneumonia, that commonly require hospital- sonnel into the hospital. ization in intensive care. The paper is organized as follows. After this brief
Unfortunately, during such kind of diseases’ out- introduction, in the following Section 2 we discuss the breaks a large amount of time is required to the care- related works and compare our contribution to the exgivers for sanitization and cleaning operations, there- isting literature. In Section 3 we describe the system, fore tampering with number and duration of visits to its purpose and aim, while we deepen into the algopatients. Such patients are then left alone for a long rithm and topology in Section 4. Finally in Section 5 time, it follows that their perceived quality of service we will report the simulation results and draw our conis greatly diminished, often determining ill-fated con- clusions. sequences also on the psychological side, with significant fallbacks on the recovery possibilities and speed.
Most hospitals could not maintain their routine work 2. Related Works due to the disaster-related new procedures. In facts medical professionals caring for patients with highly infectious diseases such as COVID-19 are at high risk of contracting such infections. All medical personnel involved in the management of potentially infected patients must adhere to airborne precautions, hand hygiene, and donning of personal protective equipment.
All aerosol-generating procedures should be done in an airborne infection isolation room. Double-gloving, as a standard practice at our unit, might provide extra protection and minimize spreading via fomite contamination to the surrounding equipment after intubation. All these necessary safety measures come with an elevated cost, not only on the financial side but also on the amount of time and energy required to enforce such practices, as well as in term of quality of care reduction for the patients, that are often to be left alone for the major part of the day.
In this paper we explore an algorithmic approach to automatic communication interfaces that could enhance and enforce the perceived quality of care by the patients in in order to reduce predisposing factors that could potentially tamper with the patient’s ability to recover, also preventing the occurrence of precipitating factors that could lead a therapy to complete failure. Tumors represent a nefarious event of high importance. In fact, cancer always represents, for the patient and for his family but also for the treatment system, an overwhelming existential test. This test concerns all aspects of life: the relationship with one’s body, the meaning given to sufering, illness, death, as well as family, social and professional relationships.
The proposed interface could be used to connect the
patients with a psychological support when it is most
needed, and, moreover, to connect them with their
physicians and families, and also to the outside world. In
particular we aim to provide the psychological
support that is actually excluded in pandemics such as the
COVID-19 emergency, mainly in order to enforce the
In literature the quality of services of a healthcare
system is defined as consistently delighting the patient by
providing eficacious, efective and eficient healthcare
services according to the latest clinical guidelines and
standards, which meet the patient’s needs and satisfies
providers [
As shown in [
A recent study [
On the other hand [
Moreover, as showin in [
Similarly, other studies have pointed out the
concern that isolation may negatively afect not only the
perceived quality of service but also the patients’
mental health [
Among such measures an extensive application of Moreover trough standardization the caregivers are isolation protocols has been applied in onclology and guided in making decisions regarding the more approradiotherapy units [19].Patients with cancer are known priate therapeutic plan for a specific conditions, while to be at an increased risk for community-acquired res- the medical practices can be rationalized improving, piratory viruses, such as influenza, because of their in the end, the general outcome for the therapy at full frequently observed immunocompromised state [20]. advantage of the patient’s well being. Other fields of
Unfortunately for cancer patients the psychologi- medicine can rely on very efective clinical prediction cal burden of isolation is heavier with respect to iso- rules in order to reduce the uncertainty inherent the lated general medicine patients [21]. As pointed out medical practice by defining how to use clinical findin [22], radiation oncology clinics have always func- ings to make predictions [26]. Finally, it must be said tioned as an interdisciplinary team of support staf, that in certain cases it is uttermost dificult to draw nurses, therapists, dosimetrists, physicists, and physi- methodology-proof clinical practice guidelines due to cians, all aiming to help patients with cancer. Heading the extreme statistical and subjective variability of the into the fight with COVID-19, that team nature and matter at hand [27].
Finally relevant focus should highlight the situation
of patients with cancer may have compromised
immunity due to their malignancy and/or treatment, and
may be at elevated risk of severe COVID-19.
Community transmission of COVID-19 could overwhelm
health care services, compromising delivery of cancer
care. This interim consensus guidance provides advice
for clinicians managing patients with cancer during
the pandemic. [
As it will be shown in the following, the psychological and emotional status of the patients it is paramount to determine the therapeutic outcome, and, often, this is strongly afected by the isolation protocols that deprive the person of human contact and relationships.
Therefore in this work we explore the development of a decision three for oncology patients deployed from the collaboration of diferent figures such as computer scientists, psychologists and radiation oncology physicist. The first responsibility of the radiation oncology physicist is to the patient, trying to assure the best possible treatment given the state of technology and the skills of the other members of the radiation oncology department. A radiation oncology physicist brings a unique perspective to the clinical team in a radiation oncology program: he shows his abilities as a scientist who trained in physics, including radiological physics, same room. and also in clinical, basic medical, and radiobiologi- Even in the waiting room of an oncology departcal sciences. The physicist performs an important role ment, patients are subjected to limitations, in order to working along with the radiation oncologist, the ra- maintain the correct social distancing. Their relatives diotherapy technologist and others, to assure the ac- have to wait upstairs, thus avoiding further gathercurate delivery of all aspects of a treatment prescrip- ings, and sometime they are not admitted in the ward. tion. In radiation oncology, physicists have the pri- The efect of these necessary limitations is to increase mary responsibility for the following for planning the the isolation efect on the oncological patient. resource allocation with radiation oncologists, admin- Therefore, while the patient follows a cure protocol, istrators, and technologists, takes care of the physical he must also be helped, with the same accuracy, by aspects of all radiation sources (radioactive materials means of a parallel protocol that takes care also of the solitude experienced by the person. In the following and radiation producing machines) used in a radiation oncology program, enforce the radiation safety program (possibly shared with an institution’s radiation safety oficer), focuses on the physical aspects of patients’ treatments and interacts with the medical community.
The main objective of the treatment of the cancer patient must be to improve the quality of life and to limit the risk of psychopathological consequences such as to afect the future life of the patient and his family.
Social support therefore represents a constitutive element of the treatment of the cancer patient and falls within the responsibility of each therapeutic figure.
The adaptation to the disease and to the treatments depends largely on the quality of the relational approach of the treating team, which is the author above all through the control of the side efects of the therapies, the control of pain, anxiety and depressive symptoms. This is possible through an individualized care of the patient, through information on the various aspects of the pathology as well as through the evaluation of his needs, his possibilities of choice, his family and social situation.
The psychological and relational dimension represents an element of particular importance in oncology.
In fact, the carers must from time to time be able to tolerate and contain the emotional and afective reactions of patients and their families on a daily basis, developing a particular sensitivity with respect to the perception of signs of discomfort and the inherent limits in the possibility of adaptation of the patient himself to the disease.
Following the dramatic COVID-19 pandemic, the activities of the operators in oncological radiotherapy department have been extensively remodelled, so as to ensure greater safety for the entire staf operating in the facility. First of by applying social distancing, equipping the staf equipped with personal protective equipment, installing sanitizing gel dispensers in every hallway and waiting room, but also determining a maximum limit of two people at the same time in the
Has benign paroxysmal positional vertigo, and vestibular
company neuritis. In [
PRINOORITY mGooboildity In [41] uses fuzzy decision-making rules adapted to classification problems by using the methodology of exploratory analysis followed by unification of particLAST VISIT LAST VISIT ular decision rules into fuzzy groups. On the other < 12 h < 8 h hand clinical decision rule must be based on evidences, when no evidence-based guideline exists, i.e. due to the extreme variability of a disease, then a consensus
NO LOW LOW depression PRIORITY PRIORITY PRIORITY or anxiety based clinical practice guideline is the best option [42].
This latter is often used for psychological treatments planning, sometime also along with more orthodox clinMemory MEDIUM ical decision rules.
Loss PRIORITY It follows that physicians, therapists, psychologists, and caregivers in general could obtain great advantages from specific support systems in order to be inLAS<T4VhISIT PMREIODIRUIMTY formed of the existing decision making rules. When such rules are not available the implementation of decision threes could be of great advantage.
MEDIUM HIGH A decision tree is a decision support tool that uses PRIORITY PRIORITY a tree-like model of decisions and their possible consequences, including chance event outcomes, resource Figure 2: The topology, attributes and nodes of the imple- costs, and utility. It is one way to display an algorithm mented decision tree. that only contains conditional control statements. The decision tree consists of three types of nodes: decisions, chances and endings. we will describe how a decision tree can take respon- Decision trees are commonly used in operations resibility for the latter. search and operations management. One advantage of decision threes is the possibility to linearize them into 4. The implemented decision decision rules. From a decision tree it is possible to extrapolate a chain of decision that are basically driven tree by the comparison of measurements at a constant time.
If such measurements are coming from a set of
obserDecision making rules have been adopted since many vation regarding the psychological state of an isolated
years and with diferent purposes. E. g. in [
There are many works in literature about the extrac- in which variant types of the nodes are connected by
tion and formulation of decision making rules. In [
company Autonomous
pateints Depressed or anxious
Mentally Impaired ∼ 6 h ∼ 3 h −3 h ⃗ = ( ) =1∶ = ( 1, 2, ..., −1, ) in order to feed the training algorithm of our decision stream. Given a set of known samples, the decision three has can be trained with a C4.5 algorithm [47], using the Kullback–Leibler divergence [48] to measure the homogeneity of the target variable within the subsets. In this manner For a value taken by the attribute of the input vector ⃗ ∈ , given a related training set , and the conditional entropy as
(1) ( | ) = ∑ | | ⋅ ( ) (2)
| | the expected information gain is the change in information entropy from a prior state, mediated by the a pirori Shannon entropy ( ), to a state that takes some information, mediated by the conditional entropy.
Therefore it is possible to compute the information gain as
Γ( , ) = ( ) − ( | ) therefore obtaining a good measure for deciding the relevance of each attribute in our recursive partitioning.
(3)
In our approach we used a modified version of the C4.5 algorithm, introducing time and causality, in order to manage the visiting time of the caregivers in an oncology ward. I our simulations (see Table 1) the results has showed an enhanced and improved time distribution and time-consumption eficiency, with a shortened isolation time for the most needful classes of patients. It is possible to state that the patients should then benefit of a positive fallback on their mental status which also improves their remission, therefore reducing hospitalization and relieving also the general burden for the healthcare service, with a positive feedback loop that should exponentially benefit the caregiving system.