TY - THES A1 - Blank, Felix T1 - The use of the Hypercube Queueing Model for the location optimization decision of Emergency Medical Service systems T1 - Der Einsatz des Hypercube Queueing Modells zur optimalen Standortentscheidung von medizinischen Notfallsystemen N2 - Die strategische Planung von medizinischen Notfallsystemen steht in einem unmittelbaren Zusammenhang mit der Überlebenswahrscheinlichkeit von betroffenen Patienten. Die Forschung hat zahlreiche Kenngrößen und Evaluationsparameter entwickelt, die zur Bewertung verwendet werden können. Darunter fallen beispielsweise die Reaktionszeit, die Systemauslastung, diverse Wartezeitenparameter sowie der Anteil der Nachfrage, der nicht unmittelbar bedient werden kann. Dabei ist das Hypercube Queueing Modell eines der am häufigsten verwendeten Modelle. Aufgrund seines theoretischen Hintergrundes und der damit verbundenen hohen notwendigen Rechenzeiten wurde das Hypercube Queueing Modell erst in der jüngeren Vergangenheit häufiger zur Optimierung von medizinischen Notfallsystemen verwendet. Gleichermaßen wurden nur wenige Systemparameter mit Hilfe des Modelles berechnet und das volle Potenzial demnach noch nicht ausgeschöpft. Die meisten der bereits vorhandenen Studien im Bereich der Optimierung unter Zuhilfenahme eines Hypercube Queueing Modells nutzen die zu erwartende Reaktionszeit des Systems als Zielparameter. Obwohl die Verwendung von diesem eine zumeist ausgeglichene Systemkonfiguration zur Folge hat, wurden andere Zielparameter identifziert. Die Verwendung des Hypercube Queueing Modells in den Modellen der robusten Optimierung sowie des robusten Goal Programmings haben versucht einen ganzheitlicheren Blick, durch die Verwendung von unterschiedlichen Tageszeiten, zu offerieren. Dabei hat sich gezeigt, dass das Verhalten von medizinischen Notfallsystemen sowie die Parameter stark von diesen abhängen. Daher sollte die Analyse und gegebenenfalls Optimierung dieser Systeme unterschiedliche Verteilungen der Nachfrage, in Abhängigkeit ihrer Menge und räumlichen Verteilung, unbedingt berücksichtigen um eine möglichst ganzheitliche Entscheidungsgrundlage zu garantieren. N2 - The strategic planning of Emergency Medical Service systems is directly related to the probability of surviving of the affected humans. Academic research has contributed to the evaluation of these systems by defining a variety of key performance metrics. The average response time, the workload of the system, several waiting time parameters as well as the fraction of demand that cannot immediately be served are among the most important examples. The Hypercube Queueing Model is one of the most applied models in this field. Due to its theoretical background and the implied high computational times, the Hypercube Queueing Model has only been recently used for the optimization of Emergency Medical Service systems. Likewise, only a few system performance metrics were calculated with the help of the model and the full potential therefore has not yet been reached. Most of the existing studies in the field of optimization with the help of a Hypercube Queueing Model apply the expected response time of the system as their objective function. While it leads to oftentimes balanced system configurations, other influencing factors were identified. The embedding of the Hypercube Queueing Model in the Robust Optimization as well as the Robust Goal Programming intended to offer a more holistic view through the use of different day times. It was shown that the behavior of Emergency Medical Service systems as well as the corresponding parameters are highly subjective to them. The analysis and optimization of such systems should therefore consider the different distributions of the demand, with regard to their quantity and location, in order to derive a holistic basis for the decision-making. KW - Warteschlangentheorie KW - Medizinische Versorgung KW - Standortplanung KW - Emergency Medical Service System KW - Hypercube Queueing Model KW - Location Optimization KW - Metaheuristic KW - Multi-objective optimization KW - Mehrkriterielle Optimierung KW - Metaheuristik KW - Notfallmedizin Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249093 ER - TY - JOUR A1 - Scheer, Monika A1 - Vokuhl, Christian A1 - Blank, Bernd A1 - Hallmen, Erika A1 - von Kalle, Thekla A1 - Münter, Marc A1 - Wessalowski, Rüdiger A1 - Hartwig, Maite A1 - Sparber-Sauer, Monika A1 - Schlegel, Paul-Gerhardt A1 - Kramm, Christof M. A1 - Kontny, Udo A1 - Spriewald, Bernd A1 - Kegel, Thomas A1 - Bauer, Sebastian A1 - Kazanowska, Bernarda A1 - Niggli, Felix A1 - Ladenstein, Ruth A1 - Ljungman, Gustaf A1 - Jahnukainen, Kirsi A1 - Fuchs, Jörg A1 - Bielack, Stefan S. A1 - Klingebiel, Thomas A1 - Koscielniak, Ewa T1 - Desmoplastic small round cell tumors: Multimodality treatment and new risk factors JF - Cancer Medicine N2 - Background To evaluate optimal therapy and potential risk factors. Methods Data of DSRCT patients <40 years treated in prospective CWS trials 1997-2015 were analyzed. Results Median age of 60 patients was 14.5 years. Male:female ratio was 4:1. Tumors were abdominal/retroperitoneal in 56/60 (93%). 6/60 (10%) presented with a localized mass, 16/60 (27%) regionally disseminated nodes, and 38/60 (63%) with extraperitoneal metastases. At diagnosis, 23/60 (38%) patients had effusions, 4/60 (7%) a thrombosis, and 37/54 (69%) elevated CRP. 40/60 (67%) patients underwent tumor resection, 21/60 (35%) macroscopically complete. 37/60 (62%) received chemotherapy according to CEVAIE (ifosfamide, vincristine, actinomycin D, carboplatin, epirubicin, etoposide), 15/60 (25%) VAIA (ifosfamide, vincristine, adriamycin, actinomycin D) and, 5/60 (8%) P6 (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide). Nine received high-dose chemotherapy, 6 received regional hyperthermia, and 20 received radiotherapy. Among 25 patients achieving complete remission, 18 (72%) received metronomic therapies. Three-year event-free (EFS) and overall survival (OS) were 11% (±8 confidence interval [CI] 95%) and 30% (±12 CI 95%), respectively, for all patients and 26.7% (±18.0 CI 95%) and 56.9% (±20.4 CI 95%) for 25 patients achieving remission. Extra-abdominal site, localized disease, no effusion or ascites only, absence of thrombosis, normal CRP, complete tumor resection, and chemotherapy with VAIA correlated with EFS in univariate analysis. In multivariate analysis, significant factors were no thrombosis and chemotherapy with VAIA. In patients achieving complete remission, metronomic therapy with cyclophosphamide/vinblastine correlated with prolonged time to relapse. Conclusion Pleural effusions, venous thrombosis, and CRP elevation were identified as potential risk factors. The VAIA scheme showed best outcome. Maintenance therapy should be investigated further. KW - C-reactive protein KW - desmoplastic small round cell tumor KW - maintenance therapy KW - soft tissue sarcoma KW - Trousseau's syndrome Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228444 VL - 8 IS - 2 ER -