Optimization of an appointment scheduling problem for healthcare systems based on the quality of fairness service using whale optimization algorithm and NSGA-II

Effective appointment scheduling (EAS) is essential for the quality and patient satisfaction in hospital management. Healthcare schedulers typically refer patients to a suitable period of service before the admission call closes. The appointment date can no longer be adjusted. This research presents the whale optimization algorithm (WOA) based on the Pareto archive and NSGA-II algorithm to solve the appointment scheduling model by considering the simulation approach. Based on these two algorithms, this paper has addressed the multi-criteria method in appointment scheduling. This paper computes WOA and NSGA with various hypotheses to meet the analysis and different factors related to patients in the hospital. In the last part of the model, this paper has analyzed NSGA and WOA with three cases. Fairness policy first come first serve (FCFS) considers the most priority factor to obtain from figure to strategies optimized solution for best satisfaction results. In the proposed NSGA, the FCFS approach and the WOA approach are contrasted. Numerical results indicate that both the FCFS and WOA approaches outperform the strategy optimized by the proposed algorithm.

Gender inequality among medical, pharmaceutical and dental practitioners in French hospitals: Where have we been and where are we now?

Introduction Women are under-represented in senior academic and hospital positions in many countries. The authors aim to assess the place and the evolution of all appointed female and male health practitioners’ working in French public Hospitals. Materials and methods Data of this observational study were collected from the National Management Centre (Centre National de Gestion) from 2015 up to January 1, 2020. First, the authors described demographic characteristics and specialties of all appointed medicine, pharmacy, and dentistry doctors’ working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, they retrospectively reported the annual incidence of new entrance according to gender and professional status from 1999 to 2019 thanks to the appointment date of all practitioners in activity between 2015 and 2020. Results In 2020, 51 401 appointed practitioners (49.7% of female) were in activity in French public hospitals with a large majority being medical doctors (92.4%) compared to pharmacists (6%) and dentists (1.6%). Women represented 52.5% of the Hospital Practitioners, 48.6% of the Associate Professors, and 22.0% of the Full Professors (p < 0.001). There were disparities between the rates of female Full Professors in medicine (20.6%), pharmacy (36.1%), and dentistry (44.3%, p < 0.001). Women were appointed Hospital Practitioners and Associate Professors earlier than men (respectively 37.1 versus 38.8 years, p < 0.001 and 36.1 versus 36.5 years, p = 0.04), and at a later age among Full Professors (43.7 versus 41.9 years, p < 0.001). Compared to men, the annual proportion of appointed women varied significantly between 1999 and 2019 from 47.6% to 60.4% for Hospital Practitioners, from 50.0% to 44.6% for Associate Professors, and from 11.2% to 33.3% for Full Professors (p < 0.001 for trend). Conclusions Although more and more women occupy positions in French hospitals, there is still a gender gap regarding access to Full Professor status in medicine and pharmacy, but not in dentistry. The disparity in numbers makes comparison difficult. Despite a trend towards gender equality during the last twenty years, it has not yet been achieved regarding access to the highest positions.

Survey on IOT Based Medical Box for Elderly People

While the health care society is slow to embrace IOT (Internet of Things) than other sectors, IOT is intended to keep people safe and secure in the field of medicine, where the primary goal is to minimize health care costs in the coming years. A smart IOT-based healthcare system, which includes a sensor-associated intelligence medicine box and a server for routine health monitoring, has been proposed here. This wireless internet access smart medicine box allows patients to get daily health care and to establish easy contact without physically meeting between doctor and patient. The recommended medicinebox allows the patient to take the correct medicine at the right time, along with an email to help the patient take the medicine. A laptop is used as a server where, along with prescription and appointment date, accurate information about the doctor and patient is kept. The doctor and the patient both have IDs and passwords to access the server. In addition, the drug data and patient temperature are kept on the server for the convenience of the doctor. The doctor can if necessary, change the patient's prescription, which will also be notified by email. In addition, in the event of an emergency, the doctor should take immediate action

581 The Effects of the COVID Pandemic on Burn Clinic

Introduction The COVID19 pandemic has led to anxiety and fears for the general public. People were concerned about coming to a medical facility where the virus might be transmitted. Furthermore, stay-at-home orders that were implemented during the pandemic did not apply to clinic visits but contributed to people staying at home even for medical care. We hypothesized that there were delays in burn care due to the pandemic. Methods We queried our clinic data for number of clinic visits and new burn evaluations by month. Patients referred to our clinic from March 15, 2020 to Sept 15, 2020 were reviewed for time of presentation after injury. Days from injury date to clinic referral date and days from clinic referral date to appointment date were calculated. Patients who were referred but did not show and were not seen in our ED were not included because injury date could not be determined. Univariate analysis was performed. Results As seen in Figure 1, our in-person clinic volume decreased in April and May 2020 but rebounded in June 2020 as compared to the number of clinic visits for the same months last year. Similarly, in Figure 2, our new burn evaluations decreased in April and May 2020 compared to our new burn volume from 2019. However, our video telehealth visits increased in March and April then decreased in June-August. Conclusions Our burn clinic remained open to see patients with burn injury throughout the pandemic, however, clinic visits were delayed early in the pandemic. While we had an increase in video telehealth, it does not account for the decrease in clinic visits. This may be due to low enrollment in the electronic medical record encrypted communication platform and/or limited knowledge/access to the technology. Additional care may have been informally given via telephone but not well captured. Furthermore, burn care was delivered in the following months. Additional investigation is necessary to see if the incidence of burn injury decreased.

Conclusion

In the spring of 1968, Shulamith Firestone and Anne Koedt, American feminists representing the New York Radical Women (1967) came to Paris bearing just published copies of their new newspaper Notes from the First Year. Firestone and Koedt wanted to deliver a copy to Beauvoir in person. They went away disappointed. As Firestone wrote her sister from Paris: “Anne and I went to see S de B. on Sat … She wasn’t home & a horrible woman concierge barked at us that we need an appointment date.”...

Tuberculosis among immigrants: risk factors associated with a delayed diagnosis in Portugal

Background A timely diagnosis is a key factor to TB control, since delayed diagnosis increases transmission, severity and mortality rates. However, immigrants have a higher risk of delay due to difficulties in the access to the healthcare services. Hence, the aim of this study is to identify risk factors associated with delays in immigrants and compare the results with the national population. Methods We carried out a retrospective study to analyse all pulmonary TB cases notified in Portugal having a passive case finding, between 2008 and 2017. Global delay was defined as the number of days between symptoms onset and diagnosis date and divided into patient delay (time between symptoms onset and first appointment date) and healthcare services delay (time between first appointment date and diagnosis date). A descriptive analysis was performed, and factors associated with each delay were identified using a Cox regression. Analyses were stratified by country of origin: immigrants (born outside of Portugal) and nationals (Portuguese population). Results Our results were consistent with previous studies and showed that the immigrant population was younger, had a higher proportion of HIV infection and had a smaller proportion of alcoholics, drug addicts, inmates, homeless and individuals living in community residencies compared to nationals. Immigrants had higher patient delay (44 vs. 36 days) compared to nationals. Different risk factors were associated with the delay in immigrants and nationals. Alcohol addiction was the only significant variable in both populations and was associated with lower delay in health services. Conclusions Immigrants have higher global delay, attributable to a higher patient delay. The risk factors related to TB diagnosis delay have an heterogeneous association in immigrant and nationals. Hence, tailored interventions should be implemented to decrease the delay among immigrants. Key messages Different risk factors were identified for the patient and healthcare services delay among immigrants and nationals, which highlight the importance to analyse each component of TB diagnosis delay. Immigrants have higher patient delay compared to nationals, hence tailored interventions should be implemented to facilitate access to healthcare services in this population.

Accessibility and barriers to oncology appointments at 40 NCI-designated cancer centers.

55 Background: Newly diagnosed cancer patients face fear and uncertainty regarding their prognosis and treatment options. As a first step, these patients and their family members may reach out to top-tier, comprehensive cancer centers for evaluation and treatment; however, recent literature reveals barriers to access. To identify these barriers, we evaluated obstacles patients and caregivers face in accessing services at major cancer centers. Methods: We used a ‘mystery shopper’ format to contact 40 NCI-designated, comprehensive cancer centers. We simulated a patient’s family member calling to make an initial consultation appointment using a standardized script. Each center received four calls on separate dates – two calls presented a patient with private insurance; two with Medicaid. Call order and patient name were randomized. We evaluated quantitative and qualitative components of the call, including time to next available appointment and availability of supportive services. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 117 (73%) of calls were first answered by electronic prompts or voicemail, not a live person. Mean call duration was 9.4 minutes, with a range of 1 to 31.9 minutes. On average, callers spent 7.1 minutes speaking to an attendant and spent 2.4 minutes on hold or being transferred. Only a minority of callers (19.3%) were able to obtain an actual date for a next-available appointment without first registering into the cancer center’s records system. 51.3% were given an estimated date for a next-available appointment and 29.4% were told that a date for an appointment could not be estimated unless the patient was registered. When an appointment date was given (estimated or actual), only 27% were within a week. Specifically, only 1.3% of next-available appointments were within 1-2 days, 25.7% were within 3-7 days, 57.5% were within 7-14 days, 15% were not available until > 14 days. At the most extreme, the next-available appointment was not for 37 days. Conclusions: NCI-designated cancer centers often place significant roadblocks in front of patients and caregivers seeking an appointment.

Managing workflow in treatment planning using standard spreadsheet software

Aims: Recent years have seen an expansion of UK radiotherapy treatment capacity with a drive to reduce radiotherapy waiting times. Consequently, the time available for planning patients is decreasing. In this context, management of treatment planning workflow in the Princess Royal Hospital is described and monthly planning times are presented from September 2003 onwards.Materials and Methods: After patients are imaged, patient name, unit number and appointments are available to the planning spreadsheet via a link to the radiotherapy information system. The planning spreadsheet is in descending order of appointment date. Treatment planning staff select the first available task, taking account of individual competencies. At plan completion, the patient record is moved to the completed list.Results: Since September 2003, patient numbers through treatment planning steadily increased from around 90 a month to about 130 currently. Planning times decreased from 11 to 7 workdays.Conclusions: Workflow through treatment planning is indirectly managed and the approach allows for day-to-day staffing fluctuations and competency levels. There is instant information on planning status for all patients throughout the department, building up a record as part of the work process. Bottlenecks and staff training needs can be analysed by reviewing the historic patient workload.