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Sample records for reduce waiting time

  1. Enhancing outpatient clinics management software by reducing patients’ waiting time

    Directory of Open Access Journals (Sweden)

    Iman Almomani

    2016-11-01

    Full Text Available Summary: The Kingdom of Saudi Arabia (KSA gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients—which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient’s satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients’ distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients’ waiting time will consequently affect patients’ satisfaction and improve

  2. Quality Improvement Cycles that Reduced Waiting Times at ...

    African Journals Online (AJOL)

    It was decided to undertake quality improvement (QI) cycles to analyse and improve the situation, using waiting time as a measure of improvement. Methods: A QI team was chosen to conduct two QI cycles. The allocated time for QI cycle 1 was from May to August 2006 and for QI cycle 2 from September to December 2006.

  3. Reducing wait time in a hospital pharmacy to promote customer service.

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E; Dickinson, Alyce M

    2008-01-01

    The purpose of this study was to compare the effects of 2 different interventions on wait times at a hospital outpatient pharmacy: (1) giving feedback to employees about customer satisfaction with wait times and (2) giving a combined intervention package that included giving more specific feedback about actual wait times and goal setting for wait time reduction in addition to the customer satisfaction feedback. The relationship between customer satisfaction ratings and wait times was examined to determine whether wait times affected customer service satisfaction. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCBA' within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction; and A' was a follow-up condition that was similar to the original baseline condition. Wait times were reduced by approximately 20%, and there was concomitant increased shift in levels of customer satisfaction, as indicated by the correlation between these variables (r = -0.57 and P customer's wait time. Data from this study may provide useful preliminary benchmarking data for standard pharmacy wait times.

  4. Wait times in Canada.

    Science.gov (United States)

    MacKinnon, Janice Christine

    2017-07-01

    A significant barrier to accessing healthcare in Canada is long waiting lists, which can be linked to the way that Medicare was structured. After significant pressure, provincial governments began to address wait times. An example of a successful strategy to reduce wait times for elective surgery is the Saskatchewan Surgical Initiative, which saw wait times in the province change from being among the longest in Canada to the shortest.

  5. Models of emergency departments for reducing patient waiting times.

    Directory of Open Access Journals (Sweden)

    Marek Laskowski

    Full Text Available In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial-topographical and social inputs (staffing, patient care models, etc.. Real data obtained through proximity location and tracking system technologies is one example discussed.

  6. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department.

    Science.gov (United States)

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  7. [Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

    Science.gov (United States)

    Kim, Yu Kyung; Song, Kyung Eun; Lee, Won Kil

    2009-04-01

    One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

  8. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Directory of Open Access Journals (Sweden)

    Hourvash Akbari Haghighinejad

    2016-01-01

    Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  9. Practical Solutions for Reducing Container Ships’ Waiting Times at Ports Using Simulation Model

    Institute of Scientific and Technical Information of China (English)

    Abdorreza Sheikholeslami; Gholamreza Ilati; Yones Eftekhari Yeganeh

    2013-01-01

    The main challenge for container ports is the planning required for berthing container ships while docked in port. Growth of containerization is creating problems for ports and container terminals as they reach their capacity limits of various resources which increasingly leads to traffic and port congestion. Good planning and management of container terminal operations reduces waiting time for liner ships. Reducing the waiting time improves the terminal’s productivity and decreases the port difficulties. Two important keys to reducing waiting time with berth allocation are determining suitable access channel depths and increasing the number of berths which in this paper are studied and analyzed as practical solutions. Simulation based analysis is the only way to understand how various resources interact with each other and how they are affected in the berthing time of ships. We used the Enterprise Dynamics software to produce simulation models due to the complexity and nature of the problems. We further present case study for berth allocation simulation of the biggest container terminal in Iran and the optimum access channel depth and the number of berths are obtained from simulation results. The results show a significant reduction in the waiting time for container ships and can be useful for major functions in operations and development of container ship terminals.

  10. Reducing pharmacy wait time to promote customer service: a follow-up study.

    Science.gov (United States)

    Slowiak, Julie M; Huitema, Bradley E

    2015-01-01

    The present study had 3 objectives: (1) to evaluate the effects of 2 different interventions (feedback regarding customer satisfaction with wait time and combined feedback and goal setting) on wait time in a hospital outpatient pharmacy; (2) to assess the extent to which the previously applied interventions maintained their effects; and (3) to evaluate the differences between the effects of the original study and those of the present follow-up study. Participants were 10 employees (4 pharmacists and 6 technicians) of an outpatient pharmacy. Wait times and customer satisfaction ratings were collected for "waiting customers." An ABCB within-subjects design was used to assess the effects of the interventions on both wait time and customer satisfaction, where A was the baseline (no feedback and no goal setting); B was the customer satisfaction feedback; and C was the customer satisfaction feedback, the wait time feedback, and the goal setting for wait time reduction. Wait time decreased after baseline when the combined intervention was introduced, and wait time increased with the reintroduction of satisfaction feedback (alone). The results of the replication study confirm the pattern of the results of the original study and demonstrate high sensitivity of levels of customer satisfaction with wait time. The most impressive result of the replication is the nearly 2-year maintenance of lower wait time between the end of the original study and the beginning (baseline) of the replication.

  11. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study

    Directory of Open Access Journals (Sweden)

    Jing Sun

    2017-08-01

    Full Text Available Abstract Background It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients’ satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. Methods We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. Results The monthly average length of waiting time decreased 3.49 min (P = 0.003 for consultations and 8.70 min (P = 0.02 for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003. There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = −0.71, P = 0.004. Conclusions The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives

  12. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

    Science.gov (United States)

    Sun, Jing; Lin, Qian; Zhao, Pengyu; Zhang, Qiongyao; Xu, Kai; Chen, Huiying; Hu, Cecile Jia; Stuntz, Mark; Li, Hong; Liu, Yuanli

    2017-08-22

    It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This

  13. The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.

    Science.gov (United States)

    Schachter, Michael E; Romann, Alexandra; Djurdev, Ognjenka; Levin, Adeera; Beaulieu, Monica

    2013-08-29

    Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

  14. Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Johann Daniels

    2017-09-01

    Full Text Available A waiting time survey (WTS conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT. A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77- 30.23, a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40 more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28- 4.19 more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.

  15. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    OpenAIRE

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emerg...

  16. Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

    Science.gov (United States)

    Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

    2010-01-01

    In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

  17. A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars

    2014-01-01

    and Neck Surgery during three comparable time intervals 2006-2007, 2007-2008, and 2011-2012 (groups 1-3) were investigated. We recorded the time from patient referral, to first consultation and final diagnosis. The first interval was before initiation of the "package solution", the second just after......In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... procedures. The purpose of this study is to present a model for fast track handling of patients suspicious of cancer in the head and neck region and to evaluate the effect of implementation on the diagnostic work up time. Patients with suspicion of HNC referred to the same university department of ENT Head...

  18. Bell inequalities and waiting times

    Energy Technology Data Exchange (ETDEWEB)

    Poeltl, Christina; Governale, Michele [School of Chemical and Physical Sciences and MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University of Wellington, PO Box 600, Wellington 6140 (New Zealand)

    2015-07-01

    We propose a Bell test based on waiting time distributions for spin entangled electron pairs, which are generated and split in mesoscopic Coulomb blockade structures, denoted as entanglers. These systems have the advantage that quantum point contacts enable a time resolved observation of the electrons occupying the system, which gives access to quantities such as full counting statistics and waiting time distributions. We use the partial waiting times to define a CHSH-Bell test, which is a purely electronic analogue of the test used in quantum optics. After the introduction of the Bell inequality we discuss the findings on the two examples of a double quantum dot and a triple quantum dot. This Bell test allows the exclusion of irrelevant tunnel processes from the statistics normally used for the Bell correlations. This can improve the parameter range for which a violation of the Bell inequality can be measured significantly.

  19. Using business process redesign to reduce wait times at a university hospital in the Netherlands.

    Science.gov (United States)

    Elkhuizen, Sylvia G; Burger, Matthe P M; Jonkers, Rene E; Limburg, Martien; Klazinga, Niek; Bakker, Piet J M

    2007-06-01

    Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in Amsterdam. The BPR consisted of process analysis, identification of bottlenecks and goals for redesign, selection of interventions, and evaluation of effects. After identifying and selecting interventions with the greatest expected benefits, changes were implemented and effects were evaluated. For gynecologic oncology patients, access time (from telephone call to first visit) was reduced from 14 days to changes in communication and planning were sufficient to eliminate bottlenecks in the gynecologic oncology project, the dyspnea project required a radical redesign of processes. Experience since these projects suggests that process redesign may have only marginal impact when the greatest bottleneck occurs, as was the case for the two BPR projects, at the point of access to central diagnostic facilities.

  20. 46 CFR 9.10 - Waiting time.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Waiting time. 9.10 Section 9.10 Shipping COAST GUARD... § 9.10 Waiting time. The same construction should be given the act when charging for waiting time as... for duty the waiting time amounts to at least one hour. ...

  1. Reducing emergency department waiting times by adjusting work shifts considering patient visits to multiple care providers

    NARCIS (Netherlands)

    Sinreich, D.; Jabali, O.; Dellaert, N.P.

    2012-01-01

    Reducing Emergency Department (ED) overcrowding in the hope of improving the ED's operational efficiency and health care delivery ranks high on every health care decision maker's wish list. The current study concentrates on developing efficient work shift schedules that make the best use of current

  2. Waiting time guarantee - an update

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael

    2008-01-01

    The rule of extended free choice of hospital, in force since 2002, provides patients with an option to choose a private hospital if the public system is unable to provide a treatment within the guaranteed waiting time of one month. In June 2008 the Government declared in their yearly budget agree...

  3. Handgun waiting periods reduce gun deaths.

    Science.gov (United States)

    Luca, Michael; Malhotra, Deepak; Poliquin, Christopher

    2017-11-14

    Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a "cooling off" period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states. Copyright © 2017 the Author(s). Published by PNAS.

  4. Outpatient waiting time in Jos University Teaching Hospital ...

    African Journals Online (AJOL)

    Problem Long waiting time for services has been identified as a reason people avoid presenting to for care in African countries. Design Examination of causes for long outpatient waiting time and the effect of measures to reduce waiting time. Setting Outpatient department of the Jos University Teaching Hospital.

  5. Advertising Emergency Department Wait Times

    OpenAIRE

    Weiner, Scott G

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...

  6. The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

    Science.gov (United States)

    2013-01-01

    Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable. PMID:23988113

  7. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

  8. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  9. Advertising Emergency Department Wait Times

    Directory of Open Access Journals (Sweden)

    Scott G. Weiner

    2013-03-01

    Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised

  10. Two Effective Ways to Implement Wait Time. A Symposium on Wait Time.

    Science.gov (United States)

    Swift, J. Nathan; And Others

    The effects of instructional guides and a wait time feedback device (called a "Wait Timer") on the classroom interaction of middle school science teachers are examined. The Wait Timer, an unobtrusive indicator of wait time, is an automatic device that activates a light when a person speaks. The duration of the light at the end of a…

  11. The Effects of Immigration on NHS Waiting Times

    OpenAIRE

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2015-01-01

    This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

  12. Queues with waiting time dependent service

    DEFF Research Database (Denmark)

    Bekker, R.; Koole, G. M.; Nielsen, Bo Friis

    2011-01-01

    Motivated by service levels in terms of the waiting-time distribution seen, for instance, in call centers, we consider two models for systems with a service discipline that depends on the waiting time. The first model deals with a single server that continuously adapts its service rate based...... derive steady-state waiting-time distributions for both models. The results are illustrated with numerical examples....... on the waiting time of the first customer in line. In the second model, one queue is served by a primary server which is supplemented by a secondary server when the waiting of the first customer in line exceeds a threshold. Using level crossings for the waiting-time process of the first customer in line, we...

  13. Can We Predict Patient Wait Time?

    Science.gov (United States)

    Pianykh, Oleg S; Rosenthal, Daniel I

    2015-10-01

    The importance of patient wait-time management and predictability can hardly be overestimated: For most hospitals, it is the patient queues that drive and define every bit of clinical workflow. The objective of this work was to study the predictability of patient wait time and identify its most influential predictors. To solve this problem, we developed a comprehensive list of 25 wait-related parameters, suggested in earlier work and observed in our own experiments. All parameters were chosen as derivable from a typical Hospital Information System dataset. The parameters were fed into several time-predicting models, and the best parameter subsets, discovered through exhaustive model search, were applied to a large sample of actual patient wait data. We were able to discover the most efficient wait-time prediction factors and models, such as the line-size models introduced in this work. Moreover, these models proved to be equally accurate and computationally efficient. Finally, the selected models were implemented in our patient waiting areas, displaying predicted wait times on the monitors located at the front desks. The limitations of these models are also discussed. Optimal regression models based on wait-line sizes can provide accurate and efficient predictions for patient wait time. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Improving Patient Satisfaction with Waiting Time

    Science.gov (United States)

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  15. Factors of Perceived Waiting Time and Implications on Passengers’ Satisfaction with Waiting Time

    Directory of Open Access Journals (Sweden)

    Shumin Feng

    2016-04-01

    Full Text Available In order to explore the influence factors on perceived waiting time, a multiple linear regression model has been used to quantitatively describe the relationship between perceived waiting time and various factors. The model is established with 234 data, which is surveyed with questionnaire at three stops in Harbin, China. The results show that several certain factors (“trip purpose - where to”, “presence of a companion - whether one has a companion or not”, “having a timing device - whether one has a timing device or not”, “riding frequency - how many times one takes one line per week” and “waiting behaviour - what one does while waiting for a bus” have significant influence on perceived waiting time, which confirms previous findings and supports transferability of results. The significance of “waiting mood - howabout the mood while waiting for a bus” and “reserved waiting time - how long one will wait” are confirmed for the first time in this study. In contrast to previous studies, “waiting time interval - for how long in one day” is a negative variable and socioeconomic variables are non-significant. And it is found that the relationship between perceived waiting time and passengers’ satisfaction with the waiting time follows a decreasing exponential distribution. With this model, the variation trend of the section, where passenger satisfaction value is larger than 0 is obviously steeper than the section smaller than 0. Such result proves that passenger mood with short waiting time is more sensitive than with longer waiting time. And the borderline perceived waiting time, distinguishing satisfied from dissatisfied passengers is proven to be 7.87 minutes when assignment interval of satisfaction is (-25.25], when satisfaction is positive (larger than 0, the accuracy being 70.30%, while the accuracy is 82.71% fornegative satisfaction (less than 0.

  16. Stochastic nature of series of waiting times

    Science.gov (United States)

    Anvari, Mehrnaz; Aghamohammadi, Cina; Dashti-Naserabadi, H.; Salehi, E.; Behjat, E.; Qorbani, M.; Khazaei Nezhad, M.; Zirak, M.; Hadjihosseini, Ali; Peinke, Joachim; Tabar, M. Reza Rahimi

    2013-06-01

    Although fluctuations in the waiting time series have been studied for a long time, some important issues such as its long-range memory and its stochastic features in the presence of nonstationarity have so far remained unstudied. Here we find that the “waiting times” series for a given increment level have long-range correlations with Hurst exponents belonging to the interval 1/2waiting time distribution. We find that the logarithmic difference of waiting times series has a short-range correlation, and then we study its stochastic nature using the Markovian method and determine the corresponding Kramers-Moyal coefficients. As an example, we analyze the velocity fluctuations in high Reynolds number turbulence and determine the level dependence of Markov time scales, as well as the drift and diffusion coefficients. We show that the waiting time distributions exhibit power law tails, and we were able to model the distribution with a continuous time random walk.

  17. The effects of immigration on NHS waiting times.

    Science.gov (United States)

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2018-03-01

    This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years). Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  18. WAITING TIME IN THE WAITING ROOM IN FAMILY PRACTICE AND PATIENT SATISFACTION

    Directory of Open Access Journals (Sweden)

    Janko Kersnik

    2001-05-01

    Full Text Available Background: Appointment system shortens the waiting time in the waiting room for the patient and allows better use of time for the doctor. We wanted to examine how long patients are willing to wait in the waiting room, how long they waited at the last visit, patient satisfaction with the last visit, the satisfaction with the length of waiting in the past 12 months and the overall patient satisfaction score for the last 12 months. Appointment system proved to be effective means of organising practice time. Waiting time in the waiting room with appointment system was considerably shorter (mean 18.5 minutes as compared to the waiting time in the practices without appointment system (mean 55.4 minutes, the fact which is reflected also in higher satisfaction with waiting in the waiting room in the past 12 months. Three quarters of patients in practices with appointment system waited standard 20 minutes or less, as opposed to the other practices where only one quarter of patients waited 20 minutes or less.Conclusions: The overall satisfaction with the doctor with the appointment system does not differ in both types of practices. The patients from practices with appointment system evaluated better possibility to get an appointment to suit the patients, but worse help of the doctors’ staff, possibility to get through to the office by phone, the length of time during the consultation and the doctors’ thoroughness.

  19. Longer wait times affect future use of VHA primary care.

    Science.gov (United States)

    Wong, Edwin S; Liu, Chuan-Fen; Hernandez, Susan E; Augustine, Matthew R; Nelson, Karin; Fihn, Stephan D; Hebert, Paul L

    2017-07-29

    Improving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. This observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP). Primary care use was defined as the number of face-to-face visits from VHA and Medicare in the 12 months following SHEP completion. VHA reliance was defined as the number of VHA visits divided by total visits (VHA+Medicare). Wait times were derived from SHEP responses measuring the usual number of days to a VHA appointment with patients' primary care provider for those seeking immediate care. We defined appointment wait times categorically: 0 days, 1day, 2-3 days, 4-7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. Mean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0day waits. Compared with these patients, reliance over the subsequent year was 1.4 (p = 0.041), 2.8 (p = 0.001) and 1.6 (p = 0.014) percentage points lower for patients waiting 2-3 days, 4-7 days and >7 days, respectively. Patients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. Longer wait times may reduce care continuity and impact cost shifting across two federal health programs. Copyright © 2017. Published by Elsevier Inc.

  20. Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

    Directory of Open Access Journals (Sweden)

    Anderson Geoff

    2009-06-01

    Full Text Available Abstract Background Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED waiting times in Ontario, Canada. Methods Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition. Results An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal. Conclusion We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.

  1. Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments.

    Science.gov (United States)

    Leaver, Chad Andrew; Guttmann, Astrid; Zwarenstein, Merrick; Rowe, Brian H; Anderson, Geoff; Stukel, Therese; Golden, Brian; Bell, Robert; Morra, Dante; Abrams, Howard; Schull, Michael J

    2009-06-08

    Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED) waiting times in Ontario, Canada. Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management) panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition. An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal. We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.

  2. Worth the wait? How restaurant waiting time influences customer behavior and revenue

    NARCIS (Netherlands)

    de Vries, J.; Roy, Debjit; De Koster, Rene

    2018-01-01

    In many service industries, customers have to wait for service. When customers have a choice, this waiting may influence their service experience, sojourn time, and ultimately spending, reneging, and return behavior. Not much is known however, about the system-wide impact of waiting on customer

  3. Time while waiting: patients' experiences of scheduled surgery.

    Science.gov (United States)

    Carr, Tracey; Teucher, Ulrich C; Casson, Alan G

    2014-12-01

    Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.

  4. Heart Surgery Waiting Time: Assessing the Effectiveness of an Action.

    Science.gov (United States)

    Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

    2015-08-01

    Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient's problems. The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients' emotionally readiness.

  5. Sustainability: orthopaedic surgery wait time management strategies.

    Science.gov (United States)

    Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2015-01-01

    The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

  6. Waiting time distribution in M/D/1 queueing systems

    DEFF Research Database (Denmark)

    Iversen, Villy Bæk; Staalhagen, Lars

    1999-01-01

    The well-known formula for the waiting time distribution of M/D/1 queueing systems is numerically unsuitable when the load is close to 1.0 and/or the results for a large waiting time are required. An algorithm for any load and waiting time is presented, based on the state probabilities of M/D/1...

  7. G-quadruplex and G-rich sequence stimulate Pif1p-catalyzed downstream duplex DNA unwinding through reducing waiting time at ss/dsDNA junction

    Science.gov (United States)

    Zhang, Bo; Wu, Wen-Qiang; Liu, Na-Nv; Duan, Xiao-Lei; Li, Ming; Dou, Shuo-Xing; Hou, Xi-Miao; Xi, Xu-Guang

    2016-01-01

    Alternative DNA structures that deviate from B-form double-stranded DNA such as G-quadruplex (G4) DNA can be formed by G-rich sequences that are widely distributed throughout the human genome. We have previously shown that Pif1p not only unfolds G4, but also unwinds the downstream duplex DNA in a G4-stimulated manner. In the present study, we further characterized the G4-stimulated duplex DNA unwinding phenomenon by means of single-molecule fluorescence resonance energy transfer. It was found that Pif1p did not unwind the partial duplex DNA immediately after unfolding the upstream G4 structure, but rather, it would dwell at the ss/dsDNA junction with a ‘waiting time’. Further studies revealed that the waiting time was in fact related to a protein dimerization process that was sensitive to ssDNA sequence and would become rapid if the sequence is G-rich. Furthermore, we identified that the G-rich sequence, as the G4 structure, equally stimulates duplex DNA unwinding. The present work sheds new light on the molecular mechanism by which G4-unwinding helicase Pif1p resolves physiological G4/duplex DNA structures in cells. PMID:27471032

  8. Estimating bus passenger waiting times from incomplete bus arrivals data

    OpenAIRE

    McLeod, F.N.

    2007-01-01

    This paper considers the problem of estimating bus passenger waiting times at bus stops using incomplete bus arrivals data. This is of importance to bus operators and regulators as passenger waiting time is a key performance measure. Average waiting times are usually estimated from bus headways, that is, time gaps between buses. It is both time-consuming and expensive to measure bus arrival times manually so methods using automatic vehicle location systems are attractive; however, these syste...

  9. Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2009-08-01

    In many public healthcare systems treatments are rationed by waiting time. We examine the optimal allocation of a fixed supply of a given treatment between different groups of patients. Even in the absence of any distributional aims, welfare is increased by third degree waiting time discrimination: setting different waiting times for different groups waiting for the same treatment. Because waiting time imposes dead weight losses on patients, lower waiting times should be offered to groups with higher marginal waiting time costs and with less elastic demand for the treatment.

  10. The effect of waiting times on demand and supply for elective surgery: Evidence from Italy.

    Science.gov (United States)

    Riganti, Andrea; Siciliani, Luigi; Fiorio, Carlo V

    2017-09-01

    Waiting times are a major policy concern in publicly funded health systems across OECD countries. Economists have argued that, in the presence of excess demand, waiting times act as nonmonetary prices to bring demand for and supply of health care in equilibrium. Using administrative data disaggregated by region and surgical procedure over 2010-2014 in Italy, we estimate demand and supply elasticities with respect to waiting times. We employ linear regression models with first differences and instrumental variables to deal with endogeneity of waiting times. We find that demand is inelastic to waiting times while supply is more elastic. Estimates of demand elasticity are between -0.15 to -0.24. Our results have implications on the effectiveness of policies aimed at increasing supply and their ability to reduce waiting times. Copyright © 2017 John Wiley & Sons, Ltd.

  11. TSA Security Checkpoint Wait Times – API (PMIS)

    Data.gov (United States)

    Department of Homeland Security — TSA operational data including: Airport wait time (hourly) data Airport throughput (hourly) data Prohibited item (hourly) data Monthly Objectives Report (MOR) data...

  12. Should I stay or should I go? Hospital emergency department waiting times and demand.

    Science.gov (United States)

    Sivey, Peter

    2018-03-01

    In the absence of the price mechanism, hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper estimates by how much the number of treatments demanded is reduced by a higher waiting time. I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately -0.25 and is highest for the lowest-urgency patients. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

    Science.gov (United States)

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

  14. Electron Waiting Times of a Cooper Pair Splitter

    Science.gov (United States)

    Walldorf, Nicklas; Padurariu, Ciprian; Jauho, Antti-Pekka; Flindt, Christian

    2018-02-01

    Electron waiting times are an important concept in the analysis of quantum transport in nanoscale conductors. Here we show that the statistics of electron waiting times can be used to characterize Cooper pair splitters that create spatially separated spin-entangled electrons. A short waiting time between electrons tunneling into different leads is associated with the fast emission of a split Cooper pair, while long waiting times are governed by the slow injection of Cooper pairs from a superconductor. Experimentally, the waiting time distributions can be measured using real-time single-electron detectors in the regime of slow tunneling, where conventional current measurements are demanding. Our work is important for understanding the fundamental transport processes in Cooper pair splitters and the predictions may be verified using current technology.

  15. Electron Waiting Times of a Cooper Pair Splitter

    DEFF Research Database (Denmark)

    Walldorf, Nicklas; Padurariu, Ciprian; Jauho, Antti-Pekka

    2018-01-01

    Electron waiting times are an important concept in the analysis of quantum transport in nanoscale conductors. Here we show that the statistics of electron waiting times can be used to characterize Cooper pair splitters that create spatially separated spin-entangled electrons. A short waiting time...... between electrons tunneling into different leads is associated with the fast emission of a split Cooper pair, while long waiting times are governed by the slow injection of Cooper pairs from a superconductor. Experimentally, the waiting time distributions can be measured using real-time single......-electron detectors in the regime of slow tunneling, where conventional current measurements are demanding. Our work is important for understanding the fundamental transport processes in Cooper pair splitters and the predictions may be verified using current technology....

  16. Moderate alcohol consumption and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Andersen, Anne-Marie Nybo; Grønbaek, Morten

    2001-01-01

    BACKGROUND: Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations. METHODS: Self-reported data on alcohol intake and waiting time to pregna...

  17. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

    Directory of Open Access Journals (Sweden)

    Knol Dirk L

    2007-02-01

    Full Text Available Abstract Background Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients. Methods A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones, 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones. Results Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p Conclusion The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice. Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients.

  18. Parental satisfaction with paediatric care, triage and waiting times.

    Science.gov (United States)

    Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

    2014-04-01

    The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. [Influence of waiting time on patient and companion satisfaction].

    Science.gov (United States)

    Fontova-Almató, A; Juvinyà-Canal, D; Suñer-Soler, R

    2015-01-01

    To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Prospective, observational study. Hospital de Figueres Emergency Department (Girona, Spain). sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n=257) was 54.6years (SD=18.3). The mean overall satisfaction (n=273) was 7.6 (SD=2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ)=-0.242, P<.001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ=-0.304; P<.001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P=.001). Perceived waiting time and the information about estimated waiting time determined overall satisfaction. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  20. A RFID-based JIT Application for Least Waiting Time for Dynamic Smart Diet Customers

    Directory of Open Access Journals (Sweden)

    Chen Long-Fei

    2017-01-01

    Full Text Available Waiting in queue is part of everyone’s life. A day may include several different waiting in queue. Waiting in line is always a bit of phenomena for a prosperous restaurant at dinner time. How to manage the queues and keep their feet into customers is the operating challenge facing everyone manager. In addition, rising energy costs and growing demand for protection of the environment call for a shorter waiting queue. Thus, we devise a dynamic smart diet App manager to reduce customer waiting time through radio frequency identification (RFID and just in time (JIT principle to reduce inventory of restaurant food materials, thereby increasing customer satisfaction and loyalty, and improving revenue and social responsibility.

  1. Approaching stationarity: competition between long jumps and long waiting times

    International Nuclear Information System (INIS)

    Dybiec, Bartłomiej

    2010-01-01

    Within the continuous-time random walk (CTRW) scenarios, properties of the overall motion are determined by the waiting time and the jump length distributions. In the decoupled case, with power-law distributed waiting times and jump lengths, the CTRW scenario is asymptotically described by the double (space and time) fractional Fokker–Planck equation. Properties of a system described by such an equation are determined by the subdiffusion parameter and the jump length exponent. Nevertheless, the stationary state is determined solely by the jump length distribution and the potential. The waiting time distribution determines only the rate of convergence to the stationary state. Here, we inspect the competition between long waiting times and long jumps and how this competition is reflected in the way in which a stationary state is reached. In particular, we show that the distance between a time-dependent and a stationary solution changes in time as a double power law

  2. Wait times for gastroenterology consultation in Canada: The patients’ perspective

    Science.gov (United States)

    Paterson, WG; Barkun, AN; Hopman, WM; Leddin, DJ; Paré, P; Petrunia, DM; Sewitch, MJ; Switzer, C; van Zanten, S Veldhuyzen

    2010-01-01

    Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms. PMID:20186353

  3. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002

    DEFF Research Database (Denmark)

    Lyhne, N M; Christensen, A; Alanin, M C

    2013-01-01

    BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the pot......BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time...... and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. METHODS: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed...

  4. Moderate alcohol consumption and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Andersen, Anne-Marie Nybo; Grønbæk, Morten

    2001-01-01

    BACKGROUND: Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations. METHODS: Self-reported data on alcohol intake and waiting time...... to pregnancy (0-2, 3-5, 6-12 and >12 months) was used for 39 612 pregnant women, recruited to the Danish National Birth Cohort within the first 24 weeks of pregnancy from 1997 to 2000. Main outcome measures were odds ratios (OR) for a prolonged waiting time to pregnancy according to alcohol intake. RESULTS......: In nulliparous women neither moderate nor high alcohol intake was related with longer waiting time to pregnancy compared with a low intake. In parous women, a modest association was seen only among those with an intake of >14 drinks per week (subfecundity OR 1.3; 95% confidence interval 1.0-1.7). Women who...

  5. Mean Waiting Time and Patients' Satisfaction in GOPD, Federal ...

    African Journals Online (AJOL)

    Mean Waiting Time and Patients' Satisfaction in GOPD, Federal Medical Centre, Owerri. ... Journal Home > Vol 4, No 2 (2013) > ... dis-satisfaction as noted from this study should be addressed by the staff and management of the hospital.

  6. Heart Surgery Waiting Time: Assessing the Effectiveness of an Action

    OpenAIRE

    Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

    2015-01-01

    Background: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient’s problems. Objectives: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for r...

  7. [Waiting time for the first colposcopic examination in women with abnormal Papanicolaou test].

    Science.gov (United States)

    Nascimento, Maria Isabel do; Rabelo, Irene Machado Moraes Alvarenga; Cardoso, Fabrício Seabra Polidoro; Musse, Ricardo Neif Vieira

    2015-08-01

    To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears. Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance. A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively. A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.

  8. Analysing passenger arrivals rates and waiting time at bus stops

    OpenAIRE

    Kaparias, I.; Rossetti, C.; Trozzi, V.

    2015-01-01

    The present study investigates the rather under-explored topic of passenger waiting times at public transport facilities. Using data collected from part of London’s bus network by means of physical counts, measurements and observations, and complemented by on-site passenger interviews, the waiting behaviour is analysed for a number of bus stops served by different numbers of lines. The analysis employs a wide range of statistical methods and tools, and concentrates on three aspects: passenger...

  9. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  10. What Are We Waiting For Customer Wait Time, Fill Rate, And Marine Corps Equipment Operational Availability

    Science.gov (United States)

    2016-12-01

    directed the use of Customer Wait Time (CWT) as a measure of supply chain performance (Department of Defense [DOD], 2000). CWT is defined as “the total...time elapsed between issuance of a customer order and satisfaction of the order” (United States Marine Corps [USMC], 2014, pp. 2–29). In theory...rate is a widely used metric for setting inventory levels and is also a useful measure of customer satisfaction . In general, high fill-rates can be

  11. Effect of emergency physician burnout on patient waiting times.

    Science.gov (United States)

    De Stefano, Carla; Philippon, Anne-Laure; Krastinova, Evguenia; Hausfater, Pierre; Riou, Bruno; Adnet, Frederic; Freund, Yonathan

    2018-04-01

    Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

  12. Public views on a wait time management initiative: a matter of communication.

    Science.gov (United States)

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2010-08-05

    Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative--the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

  13. Public views on a wait time management initiative: a matter of communication

    Directory of Open Access Journals (Sweden)

    Laupacis Andreas

    2010-08-01

    Full Text Available Abstract Background Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS (Canada. Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Methods Two qualitative studies: 1 an analysis of all emails sent by the public to the (OWTS email address; and 2 in-depth interviews with members of the Ontario public. Results Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Conclusions Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.

  14. Adjusting patients streaming initiated by a wait time threshold in emergency department for minimizing opportunity cost.

    Science.gov (United States)

    Kim, Byungjoon B J; Delbridge, Theodore R; Kendrick, Dawn B

    2017-07-10

    Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients. Findings The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients' opportunity costs by reducing the total LOS in the ED. Research limitations/implications The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern. Practical implications When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED. Originality/value A new streaming scheme of patients' flow may improve the performance of fast track system.

  15. Waiting for Art: The Experience of Real Time in Sculpture

    Directory of Open Access Journals (Sweden)

    Elizabeth Buhe

    2011-05-01

    Full Text Available Why and how does some contemporary art make us wait, and why does the beholder choose to stay? This study seeks to answer this question by exploring what happens to the viewer while waiting in front of a “time sculpture,” a term coined here to mean a three-dimensional artwork that is dynamic over a set period of time. Through an analysis of select works by artists Anish Kapoor, Amelia Whitelaw, Michael Sailstorfer, and Roman Signer, the article posits that while in front of these time sculptures, the viewer experiences an anxiety of waiting and temporal confusion that glues him to the spot. Ultimately, by drawing upon Henri Bergson’s concept of duration, the essay suggests that the viewership of time sculpture allows for a heightened state of perception. Normal 0 false false false EN-US X-NONE X-NONE

  16. Waiting Time Dynamics in Two-Dimensional Infrared Spectroscopy

    NARCIS (Netherlands)

    Jansen, Thomas L. C.; Knoester, Jasper

    We review recent work on the waiting time dynamics of coherent two-dimensional infrared (2DIR) spectroscopy. This dynamics can reveal chemical and physical processes that take place on the femto- and picosecond time scale, which is faster than the time scale that may be probed by, for example,

  17. Indication criteria for cataract extraction and gender differences in waiting time.

    Science.gov (United States)

    Smirthwaite, Goldina; Lundström, Mats; Albrecht, Susanne; Swahnberg, Katarina

    2014-08-01

    The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE). Data were collected by The Swedish National Cataract Register (NCR). Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in spss version 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Student's t-test or chi square as appropriate. Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men. It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  18. Waiting Time Policies in the Health Care Sector. What Works?

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Bech, Mickael

    2013-01-01

    times. In addition, a range of other measures may indirectly have affected waiting times, such as a general increase in spending on health care, the general practitioners’ role as gate-keepers, increased use of activity-based hospital reimbursement, increasing use of private heath insurance and private...

  19. The impact of different prioritisation policies on waiting times: case studies of Norway and Scotland.

    Science.gov (United States)

    Januleviciute, Jurgita; Askildsen, Jan Erik; Kaarboe, Oddvar; Holmås, Tor Helge; Sutton, Matt

    2013-11-01

    We investigate the distributional consequences of two different waiting times initiatives, one in Norway, and one in Scotland. The primary focus of Scotland's recent waiting time reforms, introduced in 2003, and modified in 2005 and 2007, has been on reducing maximum waiting times through the imposition of high profile national targets accompanied by increases in resources. In Norway, the focus of the reform introduced in September 2004, has been on assigning patients referred to hospital a maximum waiting time based on disease severity, the expected benefit and the cost-effectiveness of the treatment. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in medical guidelines. The analysis shows that the lowest priority patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland's high priority patients remained unaffected. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. EVALUTION OF THE SINGLE INTERCITY FREIGHT TRANSPORTATION WAITING TIME

    Directory of Open Access Journals (Sweden)

    N. Ponomariova

    2015-07-01

    Full Text Available The example of vechicle operation on the pendulum intercity route during single freightages processing is considered. Two approaches to the definition of the single freightage waiting time by the carrier are proposed. These approaches allow to take into account the probability of the single freightage obtaining by the carrier during the different load level of the transport enterprise capacity.

  1. Potential impact of enhanced practice efficiency on endoscopy waiting times.

    LENUS (Irish Health Repository)

    Harewood, G C

    2009-06-01

    With the growing demand on endoscopy services, optimising practice efficiency has assumed increasing importance. Prior research has identified practice changes, which increase the efficiency in endoscopy. In this study, the potential impact of these practice changes on the current and projected future endoscopy waiting times at our institution was assessed.

  2. Waiting Time Increases Risk of Attrition in Gambling Disorder Treatment

    DEFF Research Database (Denmark)

    Linnet, Jakob; Pedersen, Anders Sune

    2014-01-01

    Attrition is a well known problem in psychotherapeutic treatment. Patients with addiction have high attrition rates, and it is therefore important to identify factors that can improve completion rates in addiction. Here, we investigated the influence of waiting time as a predictor of treatment...

  3. Incorporating waiting time in competitive location models: Formulations and heuristics

    OpenAIRE

    Silva, Francisco; Serra, Daniel

    2008-01-01

    In this paper we propose a metaheuristic to solve a new version of the Maximum Capture Problem. In the original MCP, market capture is obtained by lower traveling distances or lower traveling time, in this new version not only the traveling time but also the waiting time will affect the market share. This problem is hard to solve using standard optimization techniques. Metaheuristics are shown to offer accurate results within acceptable computing times.

  4. Patient Satisfaction Is Associated With Time With Provider But Not Clinic Wait Time Among Orthopedic Patients.

    Science.gov (United States)

    Patterson, Brendan M; Eskildsen, Scott M; Clement, R Carter; Lin, Feng-Chang; Olcott, Christopher W; Del Gaizo, Daniel J; Tennant, Joshua N

    2017-01-01

    Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon. The Consumer Assessment of Healthcare Providers and Systems survey was used to measure patient satisfaction. Factors associated with increased patient satisfaction included patient age and increased time with the surgeon (P=.024 and P=.037, respectively), but not clinic wait time (P=.625). Perceived wait time was subject to a high level of error, and most patients did not accurately report whether they had been waiting longer than 15 minutes to see a provider until they had waited at least 60 minutes (P=.007). If the results of the current study are generalizable, time with the surgeon is associated with patient satisfaction in orthopedic clinics, but wait time is not. Further, the study findings showed that patients in this setting did not have an accurate perception of actual wait time, with many patients underestimating the time they waited to see a provider. Thus, a potential strategy for improving patient satisfaction is to spend more time with each patient, even at the expense of increased wait time. [Orthopedics. 2017; 40(1):43-48.]. Copyright 2016, SLACK Incorporated.

  5. Renewal processes based on generalized Mittag-Leffler waiting times

    Science.gov (United States)

    Cahoy, Dexter O.; Polito, Federico

    2013-03-01

    The fractional Poisson process has recently attracted experts from several fields of study. Its natural generalization of the ordinary Poisson process made the model more appealing for real-world applications. In this paper, we generalized the standard and fractional Poisson processes through the waiting time distribution, and showed their relations to an integral operator with a generalized Mittag-Leffler function in the kernel. The waiting times of the proposed renewal processes have the generalized Mittag-Leffler and stretched-squashed Mittag-Leffler distributions. Note that the generalizations naturally provide greater flexibility in modeling real-life renewal processes. Algorithms to simulate sample paths and to estimate the model parameters are derived. Note also that these procedures are necessary to make these models more usable in practice. State probabilities and other qualitative or quantitative features of the models are also discussed.

  6. An Elementary Derivation of Mean Wait Time in Polling Systems

    OpenAIRE

    Cady, Field

    2012-01-01

    Polling systems are a well-established subject in queueing theory. However, their formal treatments generally rely heavily on relatively sophisticated theoretical tools, such as moment generating functions and Laplace transforms, and solutions often require the solution of large systems of equations. We show that, if you are willing to only have the average waiting of a system time rather than higher moments, it can found through an elementary derivation based only on algebra and some well-kn...

  7. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

    Science.gov (United States)

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2007-11-16

    As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public

  8. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Laupacis Andreas

    2007-11-01

    Full Text Available Abstract Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1 over 25 documents (e.g. strategic planning reports, public updates, and (2 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario

  9. Computation and evaluation of scheduled waiting time for railway networks

    DEFF Research Database (Denmark)

    Landex, Alex

    2010-01-01

    Timetables are affected by scheduled waiting time (SWT) that prolongs the travel times for trains and thereby passengers. SWT occurs when a train hinders another train to run with the wanted speed. The SWT affects both the trains and the passengers in the trains. The passengers may be further...... affected due to longer transfer times to other trains. SWT can be estimated analytically for a given timetable or by simulation of timetables and/or plans of operation. The simulation of SWT has the benefit that it is possible to examine the entire network. This makes it possible to improve the future...

  10. Canadian Consensus on Medically Acceptable Wait Times for Digestive Health Care

    Directory of Open Access Journals (Sweden)

    William G Paterson

    2006-01-01

    Full Text Available BACKGROUND: Delays in access to health care in Canada have been reported, but standardized systems to manage and monitor wait lists and wait times, and benchmarks for appropriate wait times, are lacking. The objective of the present consensus was to develop evidence- and expertise-based recommendations for medically appropriate maximal wait times for consultation and procedures by a digestive disease specialist.

  11. Pooled Open Blocks Shorten Wait Times for Nonelective Surgical Cases.

    Science.gov (United States)

    Zenteno, Ana C; Carnes, Tim; Levi, Retsef; Daily, Bethany J; Price, Devon; Moss, Susan C; Dunn, Peter F

    2015-07-01

    Assess the impact of the implementation of a data-driven scheduling strategy that aimed to improve the access to care of nonelective surgical patients at Massachusetts General Hospital (MGH). Between July 2009 and June 2010, MGH experienced increasing throughput challenges in its perioperative environment: approximately 30% of the nonelective patients were waiting more than the prescribed amount of time to get to surgery, hampering access to care and aggravating the lack of inpatient beds. This work describes the design and implementation of an "open block" strategy: operating room (OR) blocks were reserved for nonelective patients during regular working hours (prime time) and their management centralized. Discrete event simulation showed that 5 rooms would decrease the percentage of delayed patients from 30% to 2%, assuming that OR availability was the only reason for preoperative delay. Implementation began in January 2012. We compare metrics for June through December of 2012 against the same months of 2011. The average preoperative wait time of all nonelective surgical patients decreased by 25.5% (P reason for delay. Rigorous metrics were developed to evaluate its performance. Strong managerial leadership was crucial to enact the new practices and turn them into organizational change.

  12. Determining prescription durations based on the parametric waiting time distribution

    DEFF Research Database (Denmark)

    Støvring, Henrik; Pottegård, Anton; Hallas, Jesper

    2016-01-01

    two-component mixture model for the waiting time distribution (WTD). The distribution component for prevalent users estimates the forward recurrence density (FRD), which is related to the distribution of time between subsequent prescription redemptions, the inter-arrival density (IAD), for users...... in continued treatment. We exploited this to estimate percentiles of the IAD by inversion of the estimated FRD and defined the duration of a prescription as the time within which 80% of current users will have presented themselves again. Statistical properties were examined in simulation studies......-Normal). When the IAD consisted of a mixture of two Log-Normal distributions, but was analyzed with a single Log-Normal distribution, relative bias did not exceed 9%. Using a Log-Normal FRD, we estimated prescription durations of 117, 91, 137, and 118 days for NSAIDs, warfarin, bendroflumethiazide...

  13. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    Science.gov (United States)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

  14. Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform

    OpenAIRE

    Aakvik, Arild; Holmås, Tor Helge; Kjerstad, Egil

    2012-01-01

    A health policy reform aiming to reduce hospital waiting times and sickness absences, the Faster Return to Work (FRW) scheme, is evaluated by creating treatment and control groups to facilitate causal interpretations of the empirical results. We use a unique dataset on individuals where we match hospital data with social security data and socio-economic characteristics. The main idea behind the reform is that long waiting times for hospital treatment lead to unnecessarily long periods of sick...

  15. A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center

    Science.gov (United States)

    1988-06-01

    at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

  16. Success Run Waiting Times and Fuss-Catalan Numbers

    Directory of Open Access Journals (Sweden)

    S. J. Dilworth

    2015-01-01

    Full Text Available We present power series expressions for all the roots of the auxiliary equation of the recurrence relation for the distribution of the waiting time for the first run of k consecutive successes in a sequence of independent Bernoulli trials, that is, the geometric distribution of order k. We show that the series coefficients are Fuss-Catalan numbers and write the roots in terms of the generating function of the Fuss-Catalan numbers. Our main result is a new exact expression for the distribution, which is more concise than previously published formulas. Our work extends the analysis by Feller, who gave asymptotic results. We obtain quantitative improvements of the error estimates obtained by Feller.

  17. Waiting Time Distributions for Pattern Occurrence in a Constrained Sequence

    Directory of Open Access Journals (Sweden)

    Valeri Stefanov

    2007-01-01

    Full Text Available A binary sequence of zeros and ones is called a (d,k-sequence if it does not contain runs of zeros of length either less than d or greater than k, where d and k are arbitrary, but fixed, non-negative integers and d < k. Such sequences find an abundance of applications in communications, in particular for magnetic and optical recording. Occasionally, one requires that (d,k-sequences do not contain a specific pattern w. Therefore, distribution results concerning pattern occurrence in (d,k-sequences are of interest. In this paper we study the distribution of the waiting time until the r th occurrence of a pattern w in a random (d,k-sequence generated by a Markov source. Numerical examples are also provided.

  18. A web-based appointment system to reduce waiting for outpatients: a retrospective study.

    Science.gov (United States)

    Cao, Wenjun; Wan, Yi; Tu, Haibo; Shang, Fujun; Liu, Danhong; Tan, Zhijun; Sun, Caihong; Ye, Qing; Xu, Yongyong

    2011-11-22

    Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8%) completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P0.05). Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (Pweb-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

  19. Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

    Directory of Open Access Journals (Sweden)

    Hayden Robert

    2005-03-01

    Full Text Available Abstract Background In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups. Methods Using records from a population-based registry, we studied the wait-list time before and after supplementary funding became available. We compared the number of weeks from registration to surgery for equal proportions of patients in synthetic cohorts defined by five registration periods in the 1990s. Results Overall, 9,231 patients spent a total of 137,126 person-weeks on the wait lists. The time to surgery increased by the middle of the decade, and decreased toward the end of the decade. Relative to the 1991–92 registration period, the conditional weekly probabilities of undergoing surgery were 30% lower among patients registered on the wait lists in 1995–96, hazard ratio (HR = 0.70 (0.65–0.76, and 23% lower in 1997–98 patients, HR = 0.77 (0.71–0.83, while there were no differences with 1999–2000 patients, HR = 0.94 (0.88–1.02, after adjusting for priority group at registration, comorbidity, age and sex. We found that the effect of registration period was different across priority groups. Conclusion Our results provide evidence that time to CABG shortened after supplementary funding was provided on an annual basis to tertiary care hospitals within a single publicly funded health system. One plausible explanation is that these hospitals had capacity to increase the number of operations. At the same time, the effect was not uniform across

  20. SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning

    International Nuclear Information System (INIS)

    Joseph, A; Herrera, D; Hijal, T; Kildea, J; Hendren, L; Leung, A; Wainberg, J; Sawaf, M; Gorshkov, M; Maglieri, R; Keshavarz, M

    2016-01-01

    Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts of data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes

  1. SU-F-P-20: Predicting Waiting Times in Radiation Oncology Using Machine Learning

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, A; Herrera, D; Hijal, T; Kildea, J [McGill University Health Centre, Montreal, Quebec (Canada); Hendren, L; Leung, A; Wainberg, J; Sawaf, M; Gorshkov, M; Maglieri, R; Keshavarz, M [McGill University, Montreal, Quebec (Canada)

    2016-06-15

    Purpose: Waiting times remain one of the most vexing patient satisfaction challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick or in pain, to worry about when they will receive the care they need. These waiting periods are often difficult for staff to predict and only rough estimates are typically provided based on personal experience. This level of uncertainty leaves most patients unable to plan their calendar, making the waiting experience uncomfortable, even painful. In the present era of electronic health records (EHRs), waiting times need not be so uncertain. Extensive EHRs provide unprecedented amounts of data that can statistically cluster towards representative values when appropriate patient cohorts are selected. Predictive modelling, such as machine learning, is a powerful approach that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The application of a machine learning algorithm to waiting time data has the potential to produce personalized waiting time predictions such that the uncertainty may be removed from the patient’s waiting experience. Methods: In radiation oncology, patients typically experience several types of waiting (eg waiting at home for treatment planning, waiting in the waiting room for oncologist appointments and daily waiting in the waiting room for radiotherapy treatments). A daily treatment wait time model is discussed in this report. To develop a prediction model using our large dataset (with more than 100k sample points) a variety of machine learning algorithms from the Python package sklearn were tested. Results: We found that the Random Forest Regressor model provides the best predictions for daily radiotherapy treatment waiting times. Using this model, we achieved a median residual (actual value minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes

  2. ADAPTATION OF JOHNSON SEQUENCING ALGORITHM FOR JOB SCHEDULING TO MINIMISE THE AVERAGE WAITING TIME IN CLOUD COMPUTING ENVIRONMENT

    Directory of Open Access Journals (Sweden)

    SOUVIK PAL

    2016-09-01

    Full Text Available Cloud computing is an emerging paradigm of Internet-centric business computing where Cloud Service Providers (CSPs are providing services to the customer according to their needs. The key perception behind cloud computing is on-demand sharing of resources available in the resource pool provided by CSP, which implies new emerging business model. The resources are provisioned when jobs arrive. The job scheduling and minimization of waiting time are the challenging issue in cloud computing. When a large number of jobs are requested, they have to wait for getting allocated to the servers which in turn may increase the queue length and also waiting time. This paper includes system design for implementation which is concerned with Johnson Scheduling Algorithm that provides the optimal sequence. With that sequence, service times can be obtained. The waiting time and queue length can be reduced using queuing model with multi-server and finite capacity which improves the job scheduling model.

  3. Effect of self-triage on waiting times at a walk-in sexual health clinic.

    Science.gov (United States)

    Hitchings, Samantha; Barter, Janet

    2009-10-01

    Lengthy waiting times can be a major problem in walk-in sexual health clinics. They are stressful for both patients and staff and may lead to clients with significant health issues leaving the department before being seen by a clinician. A self-triage system may help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits. This paper describes implementation of a self-triage system in two busy sexual and reproductive health clinics. Patients were asked to complete a self-assessment form on registration to determine the reason for attendance. This then enabled patients to be directed to the most appropriate specialist or clinical service. The benefits of this approach were determined by measuring patient waiting times, reduction in unnecessary specialist review together with patient acceptability as tested by a patient satisfaction survey. The ease of comprehension of the triage form was also assessed by an independent readers' panel. A total of 193 patients were recruited over a 4-month period from November 2004 to February 2005. Patients from the November and December clinics were assigned to the 'traditional treatment' arm, with patients at subsequent clinics being assigned to the 'self-triage' system. Waiting times were collected by the receptionist and clinic staff. Ninety six patients followed the traditional route, 97 the new self-triage system. Sixty-nine (35.8%) patients completed the satisfaction survey. The self-triage system significantly reduced waiting time from 40 (22, 60) to 23 (10, 40) minutes [results expressed as median (interquartile range)]. There was a non-significant reduction in the proportion of patients seeing two clinicians from 21% to 13% (p = 0.17). Satisfaction levels were not significantly altered (95% compared to 97% satisfied, p = 0.64). The readers' panel found the triage form both easy to understand and to complete. Self-triage can effectively reduce clinic waiting times and allow better

  4. Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.

    Science.gov (United States)

    Molinié, F; Leux, C; Delafosse, P; Ayrault-Piault, S; Arveux, P; Woronoff, A S; Guizard, A V; Velten, M; Ganry, O; Bara, S; Daubisse-Marliac, L; Tretarre, B

    2013-10-01

    Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Relative entropy and waiting time for continuous-time Markov processes

    NARCIS (Netherlands)

    Chazottes, J.R.; Giardinà, C.; Redig, F.H.J.

    2006-01-01

    For discrete-time stochastic processes, there is a close connection between return (resp. waiting) times and entropy (resp. relative entropy). Such a connection cannot be straightforwardly extended to the continuous-time setting. Contrarily to the discrete-time case one needs a reference measure on

  6. Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time.

    Science.gov (United States)

    Verma, Akash; Lee, Mui Yok; Wang, Chunhong; Hussein, Nurmalah B M; Selvi, Kalai; Tee, Augustine

    2014-04-01

    The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

  7. Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

    Directory of Open Access Journals (Sweden)

    Jurgita Januleviciute Gangstøe

    2016-06-01

    Full Text Available Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i high priority with assigned individual maximum waiting time; (ii low priority without a maximum waiting time; and (iii refusal (not in need for specialized services. We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual

  8. Spatial structure increases the waiting time for cancer

    Science.gov (United States)

    Martens, Erik A.; Kostadinov, Rumen; Maley, Carlo C.; Hallatschek, Oskar

    2011-11-01

    Cancer results from a sequence of genetic and epigenetic changes that lead to a variety of abnormal phenotypes including increased proliferation and survival of somatic cells and thus to a selective advantage of pre-cancerous cells. The notion of cancer progression as an evolutionary process has been attracting increasing interest in recent years. A great deal of effort has been made to better understand and predict the progression to cancer using mathematical models; these mostly consider the evolution of a well-mixed cell population, even though pre-cancerous cells often evolve in highly structured epithelial tissues. In this study, we propose a novel model of cancer progression that considers a spatially structured cell population where clones expand via adaptive waves. This model is used to assess two different paradigms of asexual evolution that have been suggested to delineate the process of cancer progression. The standard scenario of periodic selection assumes that driver mutations are accumulated strictly sequentially over time. However, when the mutation supply is sufficiently high, clones may arise simultaneously on distinct genetic backgrounds, and clonal adaptation waves interfere with each other. We find that in the presence of clonal interference, spatial structure increases the waiting time for cancer, leads to a patchwork structure of non-uniformly sized clones and decreases the survival probability of virtually neutral (passenger) mutations, and that genetic distance begins to increase over a characteristic length scale Lc. These characteristic features of clonal interference may help us to predict the onset of cancers with pronounced spatial structure and to interpret spatially sampled genetic data obtained from biopsies. Our estimates suggest that clonal interference likely occurs in the progression of colon cancer and possibly other cancers where spatial structure matters.

  9. Waiting Endurance Time Estimation of Electric Two-Wheelers at Signalized Intersections

    Directory of Open Access Journals (Sweden)

    Mei Huan

    2014-01-01

    Full Text Available The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders’ waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

  10. Waiting endurance time estimation of electric two-wheelers at signalized intersections.

    Science.gov (United States)

    Huan, Mei; Yang, Xiao-bao

    2014-01-01

    The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

  11. Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer

    NARCIS (Netherlands)

    Visser, E.; Leeftink, Anne Greetje; van Rossum, P.S.N.; Siesling, Sabine; van Hillegersberg, R.; Ruurda, J.P.

    2016-01-01

    Background Waiting time from diagnosis to treatment has emerged as an important quality indicator in cancer care. This study was designed to determine the impact of waiting time on long-term outcome of patients with esophageal cancer who are treated with neoadjuvant therapy followed by surgery or

  12. Client waiting time in an urban primary health care centre in Lagos ...

    African Journals Online (AJOL)

    Background: Primary Health Care is the usual entry point into the health system and has the potential to touch the lives of most people. However one of the reasons for poor uptake of health services at primary health care facilities in Nigeria is long waiting time. This study was carried out to assess client waiting time and ...

  13. Effects of Wait Time When Communicating with Children Who Have Sensory and Additional Disabilities

    Science.gov (United States)

    Johnson, Nicole; Parker, Amy T.

    2013-01-01

    Introduction: This study utilized wait-time procedures to determine if they are effective in helping children with deafblindness or multiple disabilities that include a visual impairment communicate in their home. Methods: A single subject with an alternating treatment design was used for the study. Zero- to one-second wait time was utilized…

  14. Determinants of Patient Waiting Time in the General Outpatient ...

    African Journals Online (AJOL)

    obtaining services and keeping patients waiting unnecessarily can be a cause of stress for both .... Simple random sampling was done for the first two patients to get the starting ... record clerks (12% [9/76]), and jumping of queue by patients.

  15. Research on the waiting time of passengers and escalator energy consumption at the railway station

    Energy Technology Data Exchange (ETDEWEB)

    Ma, Wei-wu; Liu, Xiao-yan; Li, Liqing; Shi, Xiangnan; Zhou, Chenn Q. [School of Energy Science and Engineering, Central South University, Changsha 410083 (China)

    2009-12-15

    Based on the Little Formula and the classical queuing model of multi-channel M vertical stroke D vertical stroke n, the relation of the average queue length, the maximum waiting time and the escalator service intensity were identified and the waiting time simulation model was established. With the passenger delivery data at A railway station in China and the probability distribution model of waiting time, a detailed analysis was made on the escalator allocation, power and energy consumption on holidays, ordinary working days and the largest-passengers-volume days; meanwhile, the fixed and variable energy consumption were compared and studied when the waiting time are 5, 10 and 30 s. The result shows that the waiting time settings affect the allocation and the energy consumption of the escalators and the fixed energy consumption takes 70%. (author)

  16. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    Science.gov (United States)

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  17. Space, place and (waiting) time: reflections on health policy and politics.

    Science.gov (United States)

    Sheard, Sally

    2018-02-19

    Health systems have repeatedly addressed concerns about efficiency and equity by employing trans-national comparisons to draw out the strengths and weaknesses of specific policy initiatives. This paper demonstrates the potential for explicit historical analysis of waiting times for hospital treatment to add value to spatial comparative methodologies. Waiting times and the size of the lists of waiting patients have become key operational indicators. In the United Kingdom, as National Health Service (NHS) financial pressures intensified from the 1970s, waiting times have become a topic for regular public and political debate. Various explanations for waiting times include the following: hospital consultants manipulate NHS waiting lists to maintain their private practice; there is under-investment in the NHS; and available (and adequate) resources are being used inefficiently. Other countries have also experienced ongoing tensions between the public and private delivery of universal health care in which national and trans-national comparisons of waiting times have been regularly used. The paper discusses the development of key UK policies, and provides a limited Canadian comparative perspective, to explore wider issues, including whether 'waiting crises' were consciously used by policymakers, especially those brought into government to implement new economic and managerial strategies, to diminish the autonomy and authority of the medical professional in the hospital environment.

  18. Reduction of admit wait times: the effect of a leadership-based program.

    Science.gov (United States)

    Patel, Pankaj B; Combs, Mary A; Vinson, David R

    2014-03-01

    Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED. This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured. After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p leadership-based program to reduce admit wait times and boarding times was associated with a significant increase in the percentage of patients admitted to the hospital within 60 minutes and a

  19. Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South ...

    African Journals Online (AJOL)

    prostate cancer (an elevated prostate-specific antigen level or abnormal findings on digital rectal examination) wait to have a prostate biopsy. Objectives. To improve the overall efficiency of the prostate biopsy service offered at St Aidan's Regional Hospital, Durban, SA, by quantifying the burden of disease and waiting times ...

  20. Reading of Waiting, Time and Social Change in S. N. A. Agoro's ...

    African Journals Online (AJOL)

    It is against this backdrop that we attempt to explore the depiction and treatment of waiting, time and social change in the dramatic universe of existentialism created by some playwrights who have not been given scholarly attention. The study shall therefore undertake a dialectical consideration of the concept of waiting and ...

  1. General practice cooperatives: long waiting times for home visits due to long distances?

    Science.gov (United States)

    Giesen, Paul; van Lin, Nieke; Mokkink, Henk; van den Bosch, Wil; Grol, Richard

    2007-02-12

    The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minutes decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.

  2. Survey of Access to GastroEnterology in Canada: The SAGE wait times program

    Science.gov (United States)

    Leddin, Desmond; Bridges, Ronald J; Morgan, David G; Fallone, Carlo; Render, Craig; Plourde, Victor; Gray, Jim; Switzer, Connie; McHattie, Jim; Singh, Harminder; Walli, Eric; Murray, Iain; Nestel, Anthony; Sinclair, Paul; Chen, Ying; Irvine, E Jan

    2010-01-01

    BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years. METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005. RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; Pgastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005. PMID:20186352

  3. Setting wait times to achieve targeted left-without-being-seen rates.

    Science.gov (United States)

    Lucas, Jared; Batt, Robert J; Soremekun, Olanrewaju A

    2014-04-01

    Although several studies have demonstrated that wait time is a key factor that drives high leave-without-being-seen (LWBS) rates, limited data on ideal wait times and impact on LWBS rates exist. We studied the LWBS rates by triage class and target wait times required to achieve various LWBS rates. We conducted a 3-year retrospective analysis of patients presenting to an urban, tertiary, academic, adult emergency department (ED). We divided the 3-year study period into 504 discrete periods by year, day of the week, and hour of the day. Patients of same triage level arriving in the same bin were exposed to similar ED conditions. For each bin, we calculate the mean actual wait time and the proportion of patients that abandoned. We performed a regression analysis on the abandonment proportion on the mean wait time using weighted least squares regression. A total of 143,698 patients were included for analysis during the study period. The R(2) value was highest for Emergency Severity Index (ESI) 3 (R(2) = 0.88), suggesting that wait time is the major factor driving LWBS of ESI 3 patients. Assuming that ESI 2 patients wait less than 10 minutes, our sensitivity analysis shows that the target wait times for ESI 3 and ESI 4/5 patients should be less than 45 and 60 minutes, respectively, to achieve an overall LWBS rate of less than 2%. Achieving target LWBS rates requires analysis to understand the abandonment behavior and redesigning operations to achieve the target wait times. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Lung cancer care trajectory at a Canadian centre: an evaluation of how wait times affect clinical outcomes.

    Science.gov (United States)

    Kasymjanova, G; Small, D; Cohen, V; Jagoe, R T; Batist, G; Sateren, W; Ernst, P; Pepe, C; Sakr, L; Agulnik, J

    2017-10-01

    Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400 new cases diagnosed each year. Although timely care can contribute substantially to quality of life for patients, it remains unclear whether it also improves patient outcomes. In this work, we used a set of quality indicators that aim to describe the quality of care in lung cancer patients. We assessed adherence with existing guidelines for timeliness of lung cancer care and concordance with existing standards of treatment, and we examined the association between timeliness of care and lung cancer survival. Patients with lung cancer diagnosed between 2010 and 2015 were identified from the Pulmonary Division Lung Cancer Registry at our centre. We demonstrated that the interdisciplinary pulmonary oncology service successfully treated most of its patients within the recommended wait times. However, there is still work to be done to decrease variation in wait time. Our results demonstrate a significant association between wait time and survival, supporting the need for clinicians to optimize the patient care trajectory. It would be helpful for Canadian clinicians treating patients with lung cancer to have wait time guidelines for all treatment modalities, together with standard definitions for all time intervals. Any reductions in wait times should be balanced against the need for thorough investigation before initiating treatment. We believe that our unique model of care leads to an acceleration of diagnostic steps. Avoiding any delay associated with referral to a medical oncologist for treatment could be an acceptable strategy with respect to reducing wait time.

  5. Shorter Perceived Outpatient MRI Wait Times Associated With Higher Patient Satisfaction.

    Science.gov (United States)

    Holbrook, Anna; Glenn, Harold; Mahmood, Rabia; Cai, Qingpo; Kang, Jian; Duszak, Richard

    2016-05-01

    The aim of this study was to assess differences in perceived versus actual wait times among patients undergoing outpatient MRI examinations and to correlate those times with patient satisfaction. Over 15 weeks, 190 patients presenting for outpatient MR in a radiology department in which "patient experience" is one of the stated strategic priorities were asked to (1) estimate their wait times for various stages in the imaging process and (2) state their satisfaction with their imaging experience. Perceived times were compared with actual electronic time stamps. Perceived and actual times were compared and correlated with standardized satisfaction scores using Kendall τ correlation. The mean actual wait time between patient arrival and examination start was 53.4 ± 33.8 min, whereas patients perceived a mean wait time of 27.8 ± 23.1 min, a statistically significant underestimation of 25.6 min (P perceived wait times at all points during patient encounters were correlated with higher satisfaction scores (P perceived and actual wait times were both correlated with higher satisfaction scores. As satisfaction surveys play a larger role in an environment of metric transparency and value-based payments, better understanding of such factors will be increasingly important. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care.

    Science.gov (United States)

    Becker, Franklin; Douglass, Stephanie

    2008-01-01

    This study examined the relationship between the attractiveness of the physical environment of healthcare facilities and patient perceptions of quality, service, and waiting time through systematic observations and patient satisfaction surveys at 7 outpatient practices at Weill Cornell Medical Center. Findings indicate positive correlations between more attractive environments and higher levels of perceived quality, satisfaction, staff interaction, and reduction of patient anxiety. The comparison of actual observed time and patients' perception of time showed that patients tend to overestimate shorter waiting times and underestimate longer waiting times in both the waiting area and the examination room. Further examinations of the way outpatient-practice environments impact patient and staff perceptions and how those perceptions impact behavior and medical outcomes are suggested.

  7. The waiting time distribution as a graphical approach to epidemiologic measures of drug utilization

    DEFF Research Database (Denmark)

    Hallas, J; Gaist, D; Bjerrum, L

    1997-01-01

    that effectively conveys some essential utilization parameters for a drug. The waiting time distribution for a group of drug users is a charting of their first prescription presentations within a specified time window. For a drug used for chronic treatment, most current users will be captured at the beginning...... of the window. After a few months, the graph will be dominated by new, incident users. As examples, we present waiting time distributions for insulin, ulcer drugs, systemic corticosteroids, antidepressants, and disulfiram. Appropriately analyzed and interpreted, the waiting time distributions can provide...... information about the period prevalence, point prevalence, incidence, duration of use, seasonality, and rate of prescription renewal or relapse for specific drugs. Each of these parameters has a visual correlate. The waiting time distributions may be an informative supplement to conventional drug utilization...

  8. Waiting time for cataract surgery and its influence on patient attitudes.

    Science.gov (United States)

    Chan, Frank Wan-kin; Fan, Alex Hoi; Wong, Fiona Yan-yan; Lam, Philip Tsze-ho; Yeoh, Eng-kiong; Yam, Carrie Ho-kwan; Griffiths, Sian; Lam, Dennis Shun-chiu; Congdon, Nathan

    2009-08-01

    To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong. This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status. Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more. Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

  9. Asymptotic inference for waiting times and patiences in queues with abandonment

    DEFF Research Database (Denmark)

    Gorst-Rasmussen, Anders; Hansen, Martin Bøgsted

    Motivated by applications in call center management, we propose a framework based on empirical process techniques for inference about the waiting time and patience distribution in multiserver queues with abandonment. The framework rigorises heuristics based on survival analysis of independent...

  10. Asymptotic inference for waiting times and patiences in queues with abandonment

    DEFF Research Database (Denmark)

    Gorst-Rasmussen, Anders; Hansen, Martin Bøgsted

    2009-01-01

    Motivated by applications in call center management, we propose a framework based on empirical process techniques for inference about waiting time and patience distributions in multiserver queues with abandonment. The framework rigorises heuristics based on survival analysis of independent...

  11. Waiting room time: An opportunity for parental oral health education.

    Science.gov (United States)

    Soussou, Randa; Aleksejūnienė, Jolanta; Harrison, Rosamund

    2017-09-14

    The UBC Children's Dental Program (CDP) has provided free dental treatments to underserved low-income children, but its preventive component needs to be enhanced. The study aims were: 1) to develop a "waiting-room based" dental education program engaging caregivers of these children, and 2) to assess the program's feasibility, acceptability and effectiveness. In preparation, a situational analysis (SA) included structured interviews with caregivers, and with various stakeholders (e.g., dental students, instructors, health authority) involved in the CDP program. Based on the SA, caregiver-centered education was designed using an interactive power point presentation; after the presentation, each caregiver set personalized goals for modifying his/her child's dental behaviours. Evaluation of the program was done with follow-up telephone calls; the program's effectiveness was assessed by comparing before/after proportions of caregivers brushing their child's teeth, children brushing teeth in the morning and evening, children eating sugar-containing snacks, and children drinking sugar-containing drinks. The program proved to be easy to implement (feasible) and the recruitment rate was 99% (acceptable). The follow-up rate was 81%. The SA identified that the caregivers' knowledge about caries etiology and prevention was limited. All recruited caregivers completed the educational session and set goals for their family. The evaluation demonstrated an increase in caregiver-reported short-term diet and oral self-care behaviours of their children. A dental education program engaging caregivers in the waiting room was a feasible, acceptable and promising strategy for improving short-term dental behaviours of children.

  12. Public reporting on quality, waiting times and patient experience in 11 high-income countries

    OpenAIRE

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew

    2016-01-01

    : This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospi...

  13. Intake of wine, beer and spirits and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo

    2003-01-01

    A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers appear to have...... fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy....

  14. Discrimination in waiting times by insurance type and financial soundness of German acute care hospitals.

    Science.gov (United States)

    Schwierz, Christoph; Wübker, Achim; Wübker, Ansgar; Kuchinke, Björn A

    2011-10-01

    This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further, we find that hospitals offering private insurees shorter waiting times when compared with SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.

  15. Waiting time and the psychosocial consequences of false-positive mammography

    DEFF Research Database (Denmark)

    Heleno, Bruno M.; Siersma, Volkert; Brodersen, John

    2015-01-01

    Background: There is wide variation in the psychosocial response to false-positive mammography. We aimed to assess whether women having to wait longer to exclude cancer had increased psychosocial consequences that persisted after cancer was ruled out. Findings: We selected women with false......-positive mammography (n = 272), screened for breast cancer in Copenhagen and Funen (Denmark) over a 1-year period. We measured psychosocial consequences immediately before women attended their recall visit and 1, 6, 18 and 36 months after women received their final diagnosis. After women were told that cancer had been...... ruled out, adverse psychosocial consequences decreased with time. We found no statistically significant differences between women who had cancer ruled out immediately at the recall visit (waiting time of 0) and women who had to wait longer before cancer was ruled out (waiting times 1-30, 30...

  16. Waiting time distribution revealing the internal spin dynamics in a double quantum dot

    Science.gov (United States)

    Ptaszyński, Krzysztof

    2017-07-01

    Waiting time distribution and the zero-frequency full counting statistics of unidirectional electron transport through a double quantum dot molecule attached to spin-polarized leads are analyzed using the quantum master equation. The waiting time distribution exhibits a nontrivial dependence on the value of the exchange coupling between the dots and the gradient of the applied magnetic field, which reveals the oscillations between the spin states of the molecule. The zero-frequency full counting statistics, on the other hand, is independent of the aforementioned quantities, thus giving no insight into the internal dynamics. The fact that the waiting time distribution and the zero-frequency full counting statistics give a nonequivalent information is associated with two factors. Firstly, it can be explained by the sensitivity to different timescales of the dynamics of the system. Secondly, it is associated with the presence of the correlation between subsequent waiting times, which makes the renewal theory, relating the full counting statistics and the waiting time distribution, no longer applicable. The study highlights the particular usefulness of the waiting time distribution for the analysis of the internal dynamics of mesoscopic systems.

  17. Discovering the impact of preceding units' characteristics on the wait time of cardiac surgery unit from statistic data.

    Science.gov (United States)

    Liu, Jiming; Tao, Li; Xiao, Bo

    2011-01-01

    Prior research shows that clinical demand and supplier capacity significantly affect the throughput and the wait time within an isolated unit. However, it is doubtful whether characteristics (i.e., demand, capacity, throughput, and wait time) of one unit would affect the wait time of subsequent units on the patient flow process. Focusing on cardiac care, this paper aims to examine the impact of characteristics of the catheterization unit (CU) on the wait time of cardiac surgery unit (SU). This study integrates published data from several sources on characteristics of the CU and SU units in 11 hospitals in Ontario, Canada between 2005 and 2008. It proposes a two-layer wait time model (with each layer representing one unit) to examine the impact of CU's characteristics on the wait time of SU and test the hypotheses using the Partial Least Squares-based Structural Equation Modeling analysis tool. Results show that: (i) wait time of CU has a direct positive impact on wait time of SU (β = 0.330, p relationships among different characteristics (except for the effect of throughput on wait time in SU). Characteristics of CU have direct and indirect impacts on wait time of SU. Specifically, demand and wait time of preceding unit are good predictors for wait time of subsequent units. This suggests that considering such cross-unit effects is necessary when alleviating wait time in a health care system. Further, different patient risk profiles may affect wait time in different ways (e.g., positive or negative effects) within SU. This implies that the wait time management should carefully consider the relationship between priority triage and risk stratification, especially for cardiac surgery.

  18. Discovering the impact of preceding units' characteristics on the wait time of cardiac surgery unit from statistic data.

    Directory of Open Access Journals (Sweden)

    Jiming Liu

    Full Text Available INTRODUCTION: Prior research shows that clinical demand and supplier capacity significantly affect the throughput and the wait time within an isolated unit. However, it is doubtful whether characteristics (i.e., demand, capacity, throughput, and wait time of one unit would affect the wait time of subsequent units on the patient flow process. Focusing on cardiac care, this paper aims to examine the impact of characteristics of the catheterization unit (CU on the wait time of cardiac surgery unit (SU. METHODS: This study integrates published data from several sources on characteristics of the CU and SU units in 11 hospitals in Ontario, Canada between 2005 and 2008. It proposes a two-layer wait time model (with each layer representing one unit to examine the impact of CU's characteristics on the wait time of SU and test the hypotheses using the Partial Least Squares-based Structural Equation Modeling analysis tool. RESULTS: Results show that: (i wait time of CU has a direct positive impact on wait time of SU (β = 0.330, p < 0.01; (ii capacity of CU has a direct positive impact on demand of SU (β = 0.644, p < 0.01; (iii within each unit, there exist significant relationships among different characteristics (except for the effect of throughput on wait time in SU. CONCLUSION: Characteristics of CU have direct and indirect impacts on wait time of SU. Specifically, demand and wait time of preceding unit are good predictors for wait time of subsequent units. This suggests that considering such cross-unit effects is necessary when alleviating wait time in a health care system. Further, different patient risk profiles may affect wait time in different ways (e.g., positive or negative effects within SU. This implies that the wait time management should carefully consider the relationship between priority triage and risk stratification, especially for cardiac surgery.

  19. Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

    Science.gov (United States)

    Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

    2006-03-01

    The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

  20. Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

    Directory of Open Access Journals (Sweden)

    Upshur Ross EG

    2006-03-01

    Full Text Available Abstract Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p 2Autoreg = 0.85 seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

  1. Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning

    International Nuclear Information System (INIS)

    Joseph, Ackeem; Herrera, David; Hijal, Tarek; Hendren, Laurie; Leung, Alvin; Wainberg, Justin; Sawaf, Marya; Maxim, Gorshkov; Maglieri, Robert; Keshavarz, Mehryar; Kildea, John

    2016-01-01

    We describe a method for predicting waiting times in radiation oncology. Machine learning is a powerful predictive modelling tool that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The patient waiting experience remains one of the most vexing challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick and in pain, to worry about when they will receive the care they need. In radiation oncology, patients typically experience three types of waiting: Waiting at home for their treatment plan to be prepared Waiting in the waiting room for daily radiotherapy Waiting in the waiting room to see a physician in consultation or follow-up These waiting periods are difficult for staff to predict and only rough estimates are typically provided, based on personal experience. In the present era of electronic health records, waiting times need not be so uncertain. At our centre, we have incorporated the electronic treatment records of all previously-treated patients into our machine learning model. We found that the Random Forest Regression model provides the best predictions for daily radiotherapy treatment waiting times (type 2). Using this model, we achieved a median residual (actual minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. The main features that generated the best fit model (from most to least significant) are: Allocated time, median past duration, fraction number and the number of treatment fields.

  2. Sci-Fri AM: Quality, Safety, and Professional Issues 04: Predicting waiting times in Radiation Oncology using machine learning

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, Ackeem; Herrera, David; Hijal, Tarek; Hendren, Laurie; Leung, Alvin; Wainberg, Justin; Sawaf, Marya; Maxim, Gorshkov; Maglieri, Robert; Keshavarz, Mehryar; Kildea, John [McGill University Health Centre (Canada)

    2016-08-15

    We describe a method for predicting waiting times in radiation oncology. Machine learning is a powerful predictive modelling tool that benefits from large, potentially complex, datasets. The essence of machine learning is to predict future outcomes by learning from previous experience. The patient waiting experience remains one of the most vexing challenges facing healthcare. Waiting time uncertainty can cause patients, who are already sick and in pain, to worry about when they will receive the care they need. In radiation oncology, patients typically experience three types of waiting: Waiting at home for their treatment plan to be prepared Waiting in the waiting room for daily radiotherapy Waiting in the waiting room to see a physician in consultation or follow-up These waiting periods are difficult for staff to predict and only rough estimates are typically provided, based on personal experience. In the present era of electronic health records, waiting times need not be so uncertain. At our centre, we have incorporated the electronic treatment records of all previously-treated patients into our machine learning model. We found that the Random Forest Regression model provides the best predictions for daily radiotherapy treatment waiting times (type 2). Using this model, we achieved a median residual (actual minus predicted value) of 0.25 minutes and a standard deviation residual of 6.5 minutes. The main features that generated the best fit model (from most to least significant) are: Allocated time, median past duration, fraction number and the number of treatment fields.

  3. Waiting experience in railway environments

    NARCIS (Netherlands)

    van Hagen, M.; Galetzka, Mirjam; Pruyn, Adriaan T.H.

    2014-01-01

    At railway stations, waiting time is usually an unavoidable aspect of the journey for train passengers. According to the attentional model of time, pleasant surroundings and other forms of distraction reduce perceived waiting time. Not every individual reacts identically in the same surroundings.

  4. Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer

    International Nuclear Information System (INIS)

    Bouche, Gauthier; Ingrand, Isabelle; Mathoulin-Pelissier, Simone; Ingrand, Pierre; Breton-Callu, Christel; Migeot, Virginie

    2010-01-01

    Purpose: To examine psycho-social and geographic determinants of delay in starting radiotherapy in early invasive breast cancer patients. Material and methods: Waiting time was defined as the time elapsed until the beginning of radiotherapy, starting from the date of surgery (in absence of chemotherapy) or from the end of chemotherapy. Results: Eight hundred and ninety six women aged 24-89 took part in the study. Mean waiting times were 52 days (sd = 19) between surgery and radiotherapy and 31 days (sd = 14) between chemotherapy and radiotherapy. Differences between radiotherapy centres (p < 0.0001) accounted for 30% and 12%, respectively, of total variance in waiting times. Using a multivariate mixed analysis that took into account intra-centre correlation, the time between surgery and radiotherapy was shorter for young patients (p = 0.020), those who had sought information about their illness (p = 0.024) and those who had undergone surgery and radiotherapy in the same centre (p = 0.021). On the other hand, no patient characteristic was associated with the time between chemotherapy and radiotherapy. Conclusion: Centre is the major factor that explained longer waiting times in radiotherapy, emphasising the structural hypothesis. It is important to pursue initiatives to improve the organization within radiotherapy centres and then to verify that these initiatives have succeeded in shortening waiting times.

  5. Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study

    Directory of Open Access Journals (Sweden)

    Petrelli Alessio

    2012-08-01

    Full Text Available Abstract Background Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. Methods We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD of the Piedmont Region (4,000,000 inhabitants in the North West of Italy from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG, angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA as a proxy of supply. Results Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. Conclusions The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those

  6. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery.

    Science.gov (United States)

    Neves, José; Pereira, Hélder; Sousa Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José

    2015-11-01

    Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada

    Science.gov (United States)

    Leddin, Desmond; Armstrong, David; Borgaonkar, Mark; Bridges, Ronald J; Fallone, Carlo A; Telford, Jennifer J; Chen, Ying; Colacino, Palma; Sinclair, Paul

    2013-01-01

    BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (Pgastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005. PMID:23472243

  8. Posted wait times an added advantage to multi-facility systems?

    Science.gov (United States)

    2011-04-01

    Methodist Le Bonheur Healthcare in Memphis, TN, is investigating whether posting ED wait times via the internet can positively impact patient flow in the six EDs the health system operates in the Memphis region. The health system began posting wait times in August 2010, resulting in increases in ED volume ranging from 6% to 10%. The health system is monitoring ED arrivals by zip code to assess any impact on load balancing between its busy EDs. One marketing challenge is that a competitor is posting ED wait times as well, but it is posting the time it takes for a patient to be placed in a bed as opposed to the door-to-provider time that Methodist Le Bonheur is posting. The approach has the most impact on lower-acuity patients, but experts worry that in the future, payers may not be reimbursed for ED care for these patients.

  9. Act-and-wait time-delayed feedback control of nonautonomous systems

    Science.gov (United States)

    Pyragas, Viktoras; Pyragas, Kestutis

    2016-07-01

    Act-and-wait modification of a time-delayed feedback control (TDFC) algorithm is proposed to stabilize unstable periodic orbits in nonautonomous dynamical systems. Due to periodical switching on and off the control perturbation, an infinite-dimensional function space of the TDFC system is reduced to the finite-dimensional state space. As a result the number of Floquet exponents defining the stability of the controlled orbit remains the same as for the control-free system. The values of these exponents can be effectively manipulated by the variation of control parameters. We demonstrate the advantages of the modification for the chaotic nonautonomous Duffing oscillator with diagonal and nondiagonal control matrices. In both cases very deep minima of the spectral abscissa of Floquet exponents have been attained. The advantage of the modification is particularly remarkable for the nondiagonal coupling; in this case the conventional TDFC fails, whereas the modified version works.

  10. Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study

    Science.gov (United States)

    Pell, Jill P; Pell, Alastair C H; Norrie, John; Ford, Ian; Cobbe, Stuart M

    2000-01-01

    Objective To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status. Design Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation. Setting NHS waiting lists in Scotland. Participants 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997. Main outcome measures Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list. Results Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories. Conclusions Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority. PMID:10617517

  11. Estimating the waiting time of multi-priority emergency patients with downstream blocking.

    Science.gov (United States)

    Lin, Di; Patrick, Jonathan; Labeau, Fabrice

    2014-03-01

    To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.

  12. Intake of wine, beer and spirits and waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo

    2003-01-01

    BACKGROUND: A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers...... appear to have fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy. METHODS: Self-reported data were used for 29......,844 pregnant women, recruited to the Danish National Birth Cohort in 1997-2000. Main outcome measures were odds ratios for a prolonged waiting time to pregnancy according to consumption of wine, beer and spirits. RESULTS: All levels of wine intake compared with non-wine drinking or with consumption of beer...

  13. Wait times in the emergency department for patients with mental illness

    Science.gov (United States)

    Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

    2012-01-01

    Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052

  14. Patient satisfaction with wait times at an emergency ophthalmology on-call service.

    Science.gov (United States)

    Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

    2018-04-01

    To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  15. Waiting for the right time: how and why young Thai women manage to avoid heterosexual intercourse.

    Science.gov (United States)

    Supametaporn, Pinhatai; Stern, Phyllis Noerager; Rodcumdee, Branom; Chaiyawat, Waraporn

    2010-08-01

    Nineteen young Thai women were purposively selected from networks of nongovernmental organizations involving children and youths in Bangkok. Our grounded theory findings indicated that these young women used the basic social process they called "waiting for the right time" in order to maintain heterosexual abstinence. Waiting for the right time involved one overarching condition, honoring parental love, and included three overlapping properties: learning rules, planning life path, and ways of preserving virginity. The findings provide information that may lead to the development of culturally competent interventions for middle-class Thai youths to remain healthy and avoid pregnancy.

  16. Waiting-time approximations in multi-queue systems with cyclic service

    NARCIS (Netherlands)

    Boxma, O.J.; Meister, B.W.

    1987-01-01

    This study is devoted to mean waiting-time approximations in a single-server multi-queue model with cyclic service and zero switching times of the server between consecutive queues. Two different service disciplines are considered: exhaustive service and (ordinary cyclic) nonexhaustive service. For

  17. Determinants of Patient Waiting Time in the General Outpatient ...

    African Journals Online (AJOL)

    The Institute of Medicine (IOM) recommends that, at least 90% of patients should be seen within 30 min of their scheduled appointment time.[5] This is, however, not the case in most developing countries, as several studies have shown that patients spend 2‑4 h in the outpatient departments before seeing the doctor.[6‑8] A ...

  18. The determinants of patient waiting time in the general outpatient department of Debre Markos and Felege Hiwot hospitals in Amhara regional state, North West, Ethiopia

    Directory of Open Access Journals (Sweden)

    Melesse Belayneh

    2017-01-01

    registration time 59(25.4%,76(32.5 in Feleg hiwot and debre markos referral hospitals respectively. the satisfaction status in waiting time greater than 60 minutes in Felege hiwot referral hospital were statically significance with p value 0.0001(95% CI:1.7786,1.8766 with dissatisfaction whereas p= 0.0001 (95% CI;1.7690,1.8689 in debre markos referral hospital. Conclusion There is the need for health care facilities and hospital administrators to address gaps in human resources, infrastructures and other internal procedures and institutional systems aimed at reducing waiting time and thus ensuring an effective health care

  19. WAITING TIME DISTRIBUTION OF SOLAR ENERGETIC PARTICLE EVENTS MODELED WITH A NON-STATIONARY POISSON PROCESS

    International Nuclear Information System (INIS)

    Li, C.; Su, W.; Fang, C.; Zhong, S. J.; Wang, L.

    2014-01-01

    We present a study of the waiting time distributions (WTDs) of solar energetic particle (SEP) events observed with the spacecraft WIND and GOES. The WTDs of both solar electron events (SEEs) and solar proton events (SPEs) display a power-law tail of ∼Δt –γ . The SEEs display a broken power-law WTD. The power-law index is γ 1 = 0.99 for the short waiting times (<70 hr) and γ 2 = 1.92 for large waiting times (>100 hr). The break of the WTD of SEEs is probably due to the modulation of the corotating interaction regions. The power-law index, γ ∼ 1.82, is derived for the WTD of the SPEs which is consistent with the WTD of type II radio bursts, indicating a close relationship between the shock wave and the production of energetic protons. The WTDs of SEP events can be modeled with a non-stationary Poisson process, which was proposed to understand the waiting time statistics of solar flares. We generalize the method and find that, if the SEP event rate λ = 1/Δt varies as the time distribution of event rate f(λ) = Aλ –α exp (– βλ), the time-dependent Poisson distribution can produce a power-law tail WTD of ∼Δt α –3 , where 0 ≤ α < 2

  20. Burst wait time simulation of CALIBAN reactor at delayed super-critical state

    International Nuclear Information System (INIS)

    Humbert, P.; Authier, N.; Richard, B.; Grivot, P.; Casoli, P.

    2012-01-01

    In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present the point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)

  1. Burst wait time simulation of CALIBAN reactor at delayed super-critical state

    Energy Technology Data Exchange (ETDEWEB)

    Humbert, P. [Commissariat a l' Energie Atomique CEA, Centre de Bruyeres-le-Chatel, 91297 Arpajon (France); Authier, N.; Richard, B.; Grivot, P.; Casoli, P. [Commissariat a l' Energie Atomique CEA, Centre de Valduc, 21120 Is-sur-Tille (France)

    2012-07-01

    In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present the point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)

  2. Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets

    Science.gov (United States)

    Leddin, Desmond; Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Paterson, William G

    2008-01-01

    BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. RESULTS: Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]). DISCUSSION: Total wait times for the seven indications exceeded the

  3. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    Science.gov (United States)

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

  4. A study on the impact of prioritising emergency department arrivals on the patient waiting time.

    Science.gov (United States)

    Van Bockstal, Ellen; Maenhout, Broos

    2018-05-03

    In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

  5. Dynamic call center routing policies using call waiting and agent idle times

    NARCIS (Netherlands)

    Chan, W.; Koole, G.M.; L'Ecuyer, P.

    2014-01-01

    We study call routing policies for call centers with multiple call types and multiple agent groups. We introduce new weight-based routing policies where each pair (call type, agent group) is given a matching priority defined as an affine combination of the longest waiting time for that call type and

  6. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    Science.gov (United States)

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  7. The unethical focus on access: a study of medical ethics and the waiting-time guarantee.

    Science.gov (United States)

    Karlberg, H I; Brinkmo, B-M

    2009-03-01

    All civilized societies favour ethical principles of equity. In healthcare, these principles generally focus on needs for medical care. Methods for establishing priorities among such needs are instrumental in this process. In this study, we analysed whether rules on access to healthcare, waiting-time guarantees, conflict with ethical principles of distributive justice. We interviewed directors, managers and other decision-makers of various healthcare providers of hospitals, primary care organizations and purchasing offices. We also conducted focus group interviews with professionals from a number of distinct medical areas. Our informants and their co-workers were reasonably familiar with the ethical platforms for priority-setting established by the Swedish parliament, giving the sickest patients complete priority. However, to satisfy the waiting-time guarantees, the informants often had to make priority decisions contrary to the ethical principles by favouring access before needs to keep waiting times within certain limits. The common opinion was that the waiting-time guarantee leads to crowding-out effects, overruling the ethical principles based on needs. For more than a decade, the interpretation in Sweden of the equitable principle based on medical needs has been distorted through political decisions, leading to healthcare providers giving priority to access rather than needs for care.

  8. Intake of wine, beer and spirits and waiting time to pregnancy.

    Science.gov (United States)

    Juhl, Mette; Olsen, Jørn; Andersen, Anne-Marie Nybo; Grønbaek, Morten

    2003-09-01

    A high intake of alcohol may prolong waiting time to pregnancy, whereas a moderate intake may have no or perhaps even a positive effect on fecundity. In previous studies on fecundity, different types of beverages have not been taken into consideration, although moderate wine drinkers appear to have fewer strokes, lung and digestive tract cancers, and overall mortality than both abstainers and moderate drinkers of beer or spirits. We examined the association between different types of alcoholic beverages and waiting time to pregnancy. Self-reported data were used for 29,844 pregnant women, recruited to the Danish National Birth Cohort in 1997-2000. Main outcome measures were odds ratios for a prolonged waiting time to pregnancy according to consumption of wine, beer and spirits. All levels of wine intake compared with non-wine drinking or with consumption of beer or spirits had subfecundity odds ratios between 0.7 and 0.9. No association was seen regarding beer drinking, while the association with spirits was J-shaped. Our findings suggest that wine drinkers have slightly shorter waiting times to pregnancy than both non-wine drinkers and consumers of other alcoholic beverages. Whether this is an effect of wine itself or the characteristics of the wine drinker is not known.

  9. Assessing and controlling the impact of hospital capacity planning on the waiting time

    NARCIS (Netherlands)

    Dellaert, N.; Çayiroglu, E.; Jeunet, J.

    2015-01-01

    In the literature, tactical plans of elective patients aim at increasing hospital efficiency through a better resource utilisation, although hospitals claim that patient satisfaction, usually measured by the waiting time, is also important. In this regard, the purpose of this paper is to show how

  10. Patients\\' response to waiting time in an out-patient pharmacy in ...

    African Journals Online (AJOL)

    Purpose: To identify the dispensing procedure at a pharmacy, investigate the possible operational problems that may lead to excessive patient waiting times as prescriptions are filled and to examine patient disposition to perceived delays at the pharmacy. Methods: The study was carried out in a 574-bed university teaching ...

  11. Change of tumor target volume during waiting time for intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Chen Bo; Yi Junlin; Gao Li; Xu Guozhen; Huang Xiaodong; Zhang Zhong; Luo Jingwei; Li Suyan

    2007-01-01

    Objective: To determine the influence of change in tumor target volume of nasopharyngeal carcinoma (NPC) while waiting for intensity modulated radiation therapy (IMRT). Methods: From March 2005 to December 2005, 31 patients with nasopharyngeal carcinoma received IMRT as the initial treatment at the Cancer Hospital of Chinese Academic of Medical Sciences. The original simulation CT scan was acquired before IMRT planning. A second CT scan was acquired before the start of radiotherapy. Wait- ing time was defined as the duration between CT simulation and start of radiotherapy. CT-CT fusion was used to minimize the error of delineation between the first tumor target volume (GTV) and the second tumor target volume (sGTV). Tumor target volume was calculated by treatment planning system. T test was carried out to analyse the difference between GTV and sGTV. Pearson correlation and multivariate linear regression was used to analyse the influence factor of the change betweent GTV and sGTV. Results: Median waiting time was 18 days (range, 9-27 days). There were significant differences between GTV and sGTV of both primary tumor (P=0.009) and metastatic lymphoma (P=0.005 ). Both Pearson correlation and multivariate linear regression showed that the change of primary tumor target volume had significant correlation with the first tumor target volume but had no significant correlation with the waiting time, sex, age, T stage and N stage (1992 Chinese Fuzhou Staging Classification). Conclusions: Within the range of the waiting time ob- served in our study, large volume primary tumor would have had a significant increase in volume, but whether the therapeutic effect would be influenced or not would need to be proved by study of large number of cases. Patients with large volume tumor should be considered to reduce the influence of waiting time by enlarging gross target volume and clinical targe volume and by neoadjuveant chemotherapy. For avoiding the unnecessary high-dose to normal

  12. Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

    Science.gov (United States)

    Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2017-09-07

    In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and

  13. Improvement in Obstructive Sleep Apnea Diagnosis and Management Wait Times: A Retrospective Analysis of a Home Management Pathway for Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Samuel Alan Stewart

    2015-01-01

    Full Text Available Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001. Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.

  14. Experience of being a low priority patient during waiting time at an emergency department.

    Science.gov (United States)

    Dahlen, Ingrid; Westin, Lars; Adolfsson, Annsofie

    2012-01-01

    Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department. A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care. The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem. The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.

  15. Modeling the impact of integrating HIV and outpatient health services on patient waiting times in an urban health clinic in Zambia.

    Directory of Open Access Journals (Sweden)

    Sarang Deo

    Full Text Available Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run.A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times.Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p<0.01. Using simulation modeling, we found that a large portion of this increase could be explained by changes in operational conditions before and after integration such as reduced staff availability (p<0.01 and longer breaks between consecutive patients (p<0.05. Controlling for these differences, integration of services, per se, would have resulted in a significant decrease in waiting times for OPD and a moderate decrease for HIV services.Integrating health services has the potential of reducing waiting times due to more efficient use of resources. However, one needs to ensure that other operational factors such as staff availability are not adversely affected due to integration.

  16. Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR.

    Science.gov (United States)

    Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon; Song, Yong Uk

    2017-01-01

    This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

  17. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

    Science.gov (United States)

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

    2013-06-06

    Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied

  18. Experience of being a low priority patient during waiting time at an emergency department

    Directory of Open Access Journals (Sweden)

    Adolfsson A

    2012-01-01

    Full Text Available Ingrid Dahlen1,2, Lars Westin1, Annsofie Adolfsson11School of Life Sciences, University of Skövde, Skövde, Sweden; 2Emergency Department, Skaraborg Hospital, Skövde, SwedenBackground: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department.Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem.Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.Keywords: emergency department, patients, waiting times, nursing staff

  19. Quality improvement cycles that reduced waiting times at Tshwane ...

    African Journals Online (AJOL)

    improvement. QI in medical practices is a method for continuously finding better ways to provide better care and service.11 The QI cycle is a recognised tool for analysing and improving the efficiency and quality of healthcare services.12 QI is a team effort, requiring knowledge, skills, experience and perspective of each team ...

  20. Decreasing laboratory turnaround time and patient wait time by implementing process improvement methodologies in an outpatient oncology infusion unit.

    Science.gov (United States)

    Gjolaj, Lauren N; Gari, Gloria A; Olier-Pino, Angela I; Garcia, Juan D; Fernandez, Gustavo L

    2014-11-01

    Prolonged patient wait times in the outpatient oncology infusion unit indicated a need to streamline phlebotomy processes by using existing resources to decrease laboratory turnaround time and improve patient wait time. Using the DMAIC (define, measure, analyze, improve, control) method, a project to streamline phlebotomy processes within the outpatient oncology infusion unit in an academic Comprehensive Cancer Center known as the Comprehensive Treatment Unit (CTU) was completed. Laboratory turnaround time for patients who needed same-day lab and CTU services and wait time for all CTU patients was tracked for 9 weeks. During the pilot, the wait time from arrival to CTU to sitting in treatment area decreased by 17% for all patients treated in the CTU during the pilot. A total of 528 patients were seen at the CTU phlebotomy location, representing 16% of the total patients who received treatment in the CTU, with a mean turnaround time of 24 minutes compared with a baseline turnaround time of 51 minutes. Streamlining workflows and placing a phlebotomy station inside of the CTU decreased laboratory turnaround times by 53% for patients requiring same day lab and CTU services. The success of the pilot project prompted the team to make the station a permanent fixture. Copyright © 2014 by American Society of Clinical Oncology.

  1. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    International Nuclear Information System (INIS)

    Zhang Hong; Li Guo-Hua

    2016-01-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier–Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. (paper)

  2. Anomalous transport in fluid field with random waiting time depending on the preceding jump length

    Science.gov (United States)

    Zhang, Hong; Li, Guo-Hua

    2016-11-01

    Anomalous (or non-Fickian) transport behaviors of particles have been widely observed in complex porous media. To capture the energy-dependent characteristics of non-Fickian transport of a particle in flow fields, in the present paper a generalized continuous time random walk model whose waiting time probability distribution depends on the preceding jump length is introduced, and the corresponding master equation in Fourier-Laplace space for the distribution of particles is derived. As examples, two generalized advection-dispersion equations for Gaussian distribution and lévy flight with the probability density function of waiting time being quadratic dependent on the preceding jump length are obtained by applying the derived master equation. Project supported by the Foundation for Young Key Teachers of Chengdu University of Technology, China (Grant No. KYGG201414) and the Opening Foundation of Geomathematics Key Laboratory of Sichuan Province, China (Grant No. scsxdz2013009).

  3. Prescription duration and treatment episodes in oral glucocorticoid users: application of the parametric waiting time distribution

    DEFF Research Database (Denmark)

    Laugesen, Kristina; Støvring, Henrik; Hallas, Jesper

    2017-01-01

    for oral glucocorticoids and to describe continuous treatment episodes using the parametric waiting time distribution. Methods: We used Danish nationwide registries to identify all prescriptions for oral glucocorticoids during 1996-2014. We applied the parametric waiting time distribution to estimate...... duration of individual prescriptions each year by estimating the 80th, 90th, 95th and 99th percentiles for the interarrival distribution. These corresponded to the time since last prescription during which 80%, 90%, 95% and 99% of users presented a new prescription for redemption. We used the Kaplan...... of the interarrival distribution to apply as prescription duration has an impact on the level of misclassification. Use of the 80th percentile provides a measure of drug exposure that is specific, while the 99th percentile provides a sensitive measure....

  4. Continuous time random walk model with asymptotical probability density of waiting times via inverse Mittag-Leffler function

    Science.gov (United States)

    Liang, Yingjie; Chen, Wen

    2018-04-01

    The mean squared displacement (MSD) of the traditional ultraslow diffusion is a logarithmic function of time. Recently, the continuous time random walk model is employed to characterize this ultraslow diffusion dynamics by connecting the heavy-tailed logarithmic function and its variation as the asymptotical waiting time density. In this study we investigate the limiting waiting time density of a general ultraslow diffusion model via the inverse Mittag-Leffler function, whose special case includes the traditional logarithmic ultraslow diffusion model. The MSD of the general ultraslow diffusion model is analytically derived as an inverse Mittag-Leffler function, and is observed to increase even more slowly than that of the logarithmic function model. The occurrence of very long waiting time in the case of the inverse Mittag-Leffler function has the largest probability compared with the power law model and the logarithmic function model. The Monte Carlo simulations of one dimensional sample path of a single particle are also performed. The results show that the inverse Mittag-Leffler waiting time density is effective in depicting the general ultraslow random motion.

  5. A modelling framework for mitigating customers' waiting time at a vehicle inspection centre

    Science.gov (United States)

    Ahmad, Norazura; Abidin, Norhaslinda Zainal; Ilyas, Khibtiyah; Abduljabbar, Waleed Khalid

    2017-11-01

    In Malaysia, an agency that is entrusted by the Government to perform mandatory vehicle inspection for public, commercial and private vehicles, receive many customers daily. Often complaints of problems received from the customers are associated with waiting time that leads to lost of business and dissatisfied customers. To address this issue, we propose a framework for modelling a vehicle inspection system using an integration of simulation and optimization approaches. The strengths of simulation and optimization are reviewed briefly that is hoped to reveal the synergy between the established methods in determining an appropriate customer's waiting time for inspection at a vehicle inspection centre. Relevant concepts and preliminary results are also presented and discussed in this paper.

  6. [Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne].

    Science.gov (United States)

    Debreuve-Theresette, A; Jovenin, N; Stona, A C; Kraïem-Leleu, M; Burde, F; Parent, D; Hettler, D; Rey, J B

    2015-12-01

    Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Waiting-time distributions of magnetic discontinuities: Clustering or Poisson process?

    International Nuclear Information System (INIS)

    Greco, A.; Matthaeus, W. H.; Servidio, S.; Dmitruk, P.

    2009-01-01

    Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

  8. Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

    Science.gov (United States)

    Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

    2014-09-01

    Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

  9. Passenger arrival and waiting time distributions dependent on train service frequency and station characteristics: A smart card data analysis

    DEFF Research Database (Denmark)

    Ingvardson, Jesper Bláfoss; Nielsen, Otto Anker; Raveau, Sebastián

    2018-01-01

    Waiting time at public transport stops is perceived by passengers to be more onerous than in-vehicle time, hence it strongly influences the attractiveness and use of public transport. Transport models traditionally assume that average waiting times are half the service headway by assuming random...... Copenhagen Area covering metro, suburban, and regional rail stations thereby giving a range of service headways from 2 to 60 min. It was shown that the proposed mixture distribution is superior to other distributions proposed in the literature. This can improve waiting time estimations in public transport...

  10. Transition in the waiting-time distribution of price-change events in a global socioeconomic system

    Science.gov (United States)

    Zhao, Guannan; McDonald, Mark; Fenn, Dan; Williams, Stacy; Johnson, Nicholas; Johnson, Neil F.

    2013-12-01

    The goal of developing a firmer theoretical understanding of inhomogeneous temporal processes-in particular, the waiting times in some collective dynamical system-is attracting significant interest among physicists. Quantifying the deviations between the waiting-time distribution and the distribution generated by a random process may help unravel the feedback mechanisms that drive the underlying dynamics. We analyze the waiting-time distributions of high-frequency foreign exchange data for the best executable bid-ask prices across all major currencies. We find that the lognormal distribution yields a good overall fit for the waiting-time distribution between currency rate changes if both short and long waiting times are included. If we restrict our study to long waiting times, each currency pair’s distribution is consistent with a power-law tail with exponent near to 3.5. However, for short waiting times, the overall distribution resembles one generated by an archetypal complex systems model in which boundedly rational agents compete for limited resources. Our findings suggest that a gradual transition arises in trading behavior between a fast regime in which traders act in a boundedly rational way and a slower one in which traders’ decisions are driven by generic feedback mechanisms across multiple timescales and hence produce similar power-law tails irrespective of currency type.

  11. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

    Directory of Open Access Journals (Sweden)

    Geeta Yadav

    Full Text Available Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services.A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service.Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05. Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR = 0.4-3.4, followed by Urgent care (9.0 weeks; IQR = 2.1-12.9, then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4. Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks.Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  12. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

    Science.gov (United States)

    Yadav, Geeta; Goldberg, Hanna R; Barense, Morgan D; Bell, Chaim M

    2016-01-01

    Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  13. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery.

    Science.gov (United States)

    Conner-Spady, Barbara L; Sanmartin, Claudia; Johnston, Geoffrey H; McGurran, John J; Kehler, Melissa; Noseworthy, Tom W

    2011-08-01

    The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement. We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction. Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62). In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

    Directory of Open Access Journals (Sweden)

    Santori Gregorio

    2009-01-01

    Full Text Available Abstract Background Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs associated with Maximum Time Before Treatment (MTBT, similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery. Methods In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1 urgency assessment into URGs; 2 correspondent assignment of a pre-set MTBT; 3 real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases. From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list and Appropriate Performance Index (API. Results The SWALIS pre-admission model was used for all registrations in the

  15. Waiting Time for Start of Outpatient Cardiac Rehabilitation: Correlations of Non Compliance to Systematic Referral After Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Ali Soroush

    2016-04-01

    Full Text Available Objectives To assess the waiting time, number of delays, and correlations of non-commitment to the systematic referral to the outpatient cardiac rehabilitation (CR among coronary artery bypass surgery (CABG patients. Methods The cross-sectional study data were gathered through evaluations related to 1,187 CABG patients who were referred to the outpatient CR of 1 hospital in western Iran during 2010 to 2014. The instruments included were demographics and actual risk factors checklist, single item of perceived risk factors, and Beck depression inventory (BDI. Data was analyzed via chi-square test, ANOVA, Bonferroni post hoc test, and binary logistic regression analysis. Results Among 1 187 patients (830 male, 27% had delayed referral, and the number of delays decreased from 2010 (49.3% to 2014 (7.6% (P < 0.001. The mean of the waiting time to receive outpatient CR in western Iran was an estimated 59 days. This mean has been reduced from 66 days (2010 to 53 days (2014 (P < 0.001. After adjustment for all demographics, the results indicated that diabetic patients (P = 0.002 and patients with biological (P = 0.002, behavioral (P = 0.003, or psychological (P = 0.002 perceived risk factors have less commitment. In addition, a family history of cardiac increases the possibility of commitment as 2.41 times (P < 0.001. Conclusions Despite the progressive process of patients’ admittance and acceptability of the present waiting time, especially after 2014, it seems that more attention to diabetic patients and patients without a family history of cardiac, and modification of attitudes about multiple risk factors can associate the self-care with more responsibility and it may also be affective in the control of harm consequences through commitment to the systematic referral.

  16. Reduction of client waiting time using task shifting in an antiretroviral clinic at Specialist Hospital Bauchi, Nigeria

    Directory of Open Access Journals (Sweden)

    Nisser A. Umar

    2011-02-01

    Full Text Available Aiming to assess the impact of the intervention in reducing the patients’ waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients’ sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t- test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P

  17. Transport properties of the continuous-time random walk with a long-tailed waiting-time density

    International Nuclear Information System (INIS)

    Weissman, H.; Havlin, S.; Weiss, G.H.

    1989-01-01

    The authors derive asymptotic properties of the propagator p(r, t) of a continuous-time random walk (CTRW) in which the waiting time density has the asymptotic form ψ(t) ∼ T α /t α+1 when t >> T and 0 = ∫ 0 ∞ τψ(τ)dτ is finite. One is that the asymptotic behavior of p(0, t) is demonstrated by the waiting time at the origin rather than by the dimension. The second difference is that in the presence of a field p(r, t) no longer remains symmetric around a moving peak. Rather, it is shown that the peak of this probability always occurs at r = 0, and the effect of the field is to break the symmetry that occurs when < ∞. Finally, they calculate similar properties, although in not such great detail, for the case in which the single-step jump probabilities themselves have an infinite mean

  18. Waiting time distribution for the first conception leading to a live birth

    International Nuclear Information System (INIS)

    Shrestha, G.; Biswas, S.

    1985-01-01

    An attempt has been made in this paper to obtain probability model describing the distribution of the waiting time from marriage to first conception based on the data from marriage to first live birth. The speciality of this present approach lies in assuming the marital exposure to be finite which was assumed to be infinite by most of the earlier investigators for mathematical simplicity. Illustration of the applicability of the model on the data pertaining to first order of conception and monthly probability of conception for women married at different age groups have been illustrated in this paper. (author)

  19. Ethnographies of Waiting

    DEFF Research Database (Denmark)

    Janeja, Manpreet Kaur; Bandak, Andreas

    We all wait – in traffic jams, passport offices, school meal queues, for better weather, an end to fighting, peace. Time spent waiting produces hope, boredom, anxiety, doubt, or uncertainty. Ethnographies of Waiting explores the social phenomenon of waiting and its centrality in human society...... worth the wait?" Waiting thus conceived is intrinsic to the ethnographic method at the heart of the anthropological enterprise. Featuring detailed ethnographies from Japan, Georgia, England, Ghana, Norway, Russia and the United States, a Foreword by Craig Jeffrey and an Afterword by Ghassan Hage...

  20. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

    Science.gov (United States)

    Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

    2016-01-01

    Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

  1. The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients’ Satisfaction, and Outcome in a Large Health Provider System

    Directory of Open Access Journals (Sweden)

    Ahmad Safadi

    2014-01-01

    Full Text Available During 2009, the Haifa district of Clalit Health Services (CHS has switched from in-lab polysomnography (PSG to home studies for the diagnosis of obstructive sleep apnea (OSA. We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients’ satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs and 2010 and 2011 (when most studies were ambulatory. Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P<0.05. 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients’ satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; P=0.11. Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients’ satisfaction remained similarly high. The total direct cost of OSA management was reduced.

  2. Public reporting on quality, waiting times and patient experience in 11 high-income countries.

    Science.gov (United States)

    Rechel, Bernd; McKee, Martin; Haas, Marion; Marchildon, Gregory P; Bousquet, Frederic; Blümel, Miriam; Geissler, Alexander; van Ginneken, Ewout; Ashton, Toni; Saunes, Ingrid Sperre; Anell, Anders; Quentin, Wilm; Saltman, Richard; Culler, Steven; Barnes, Andrew; Palm, Willy; Nolte, Ellen

    2016-04-01

    This article maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, we found that the data most commonly made available to the public are on waiting times for hospital treatment, being reported for major hospitals in seven countries. Information on patient experience at hospital level is also made available in many countries, but it is not generally available in respect of primary care services. Only one of the 11 countries (England) publishes composite measures of overall quality and safety of care that allow the ranking of providers of hospital care. Similarly, the publication of information on outcomes of individual physicians remains rare. We conclude that public reporting of aggregate measures of quality and safety, as well as of outcomes of individual physicians, remain relatively uncommon. This is likely to be due to both unresolved methodological and ethical problems and concerns that public reporting may lead to unintended consequences. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  3. Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

    Science.gov (United States)

    Helbig, Matthias; Helbig, Silke; Kahla-Witzsch, Heike A; May, Angelika

    2009-01-01

    Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity

  4. Predictive event modelling in multicenter clinical trials with waiting time to response.

    Science.gov (United States)

    Anisimov, Vladimir V

    2011-01-01

    A new analytic statistical technique for predictive event modeling in ongoing multicenter clinical trials with waiting time to response is developed. It allows for the predictive mean and predictive bounds for the number of events to be constructed over time, accounting for the newly recruited patients and patients already at risk in the trial, and for different recruitment scenarios. For modeling patient recruitment, an advanced Poisson-gamma model is used, which accounts for the variation in recruitment over time, the variation in recruitment rates between different centers and the opening or closing of some centers in the future. A few models for event appearance allowing for 'recurrence', 'death' and 'lost-to-follow-up' events and using finite Markov chains in continuous time are considered. To predict the number of future events over time for an ongoing trial at some interim time, the parameters of the recruitment and event models are estimated using current data and then the predictive recruitment rates in each center are adjusted using individual data and Bayesian re-estimation. For a typical scenario (continue to recruit during some time interval, then stop recruitment and wait until a particular number of events happens), the closed-form expressions for the predictive mean and predictive bounds of the number of events at any future time point are derived under the assumptions of Markovian behavior of the event progression. The technique is efficiently applied to modeling different scenarios for some ongoing oncology trials. Case studies are considered. Copyright © 2011 John Wiley & Sons, Ltd.

  5. Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

    Science.gov (United States)

    Arnesen, Kjell E; Erikssen, Jan; Stavem, Knut

    2002-12-01

    In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

  6. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    Science.gov (United States)

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  7. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  8. Wait Time Management Strategies for Scheduled Care: What Makes Them Succeed?

    Science.gov (United States)

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; De Coster, Carolyn; Drew, Madeleine

    2010-01-01

    Objectives: To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations. Methods: We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level. Results: The most frequently cited local factor was physicians' participation. Physicians' leadership made the greatest difference in bringing resistant physicians on board. To be effective, however, local leadership had to be supported by senior management. Alignment of financial incentives between the contextual and local levels was also frequently cited, and interviewees stressed the importance of tools used to design, monitor, evaluate and prioritize WTMS. Conclusions: Finding the right balance between supportive resources and tools and an effective management system is a tough challenge. But achieving this balance will help reconcile contradictions between top-down and bottom-up WTMS. PMID:21286269

  9. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    Science.gov (United States)

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

  10. Wait time management strategies for scheduled care: what makes them succeed?

    Science.gov (United States)

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; De Coster, Carolyn; Drew, Madeleine

    2010-02-01

    To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations. We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level. The most frequently cited local factor was physicians' participation. Physicians' leadership made the greatest difference in bringing resistant physicians on board. To be effective, however, local leadership had to be supported by senior management. Alignment of financial incentives between the contextual and local levels was also frequently cited, and interviewees stressed the importance of tools used to design, monitor, evaluate and prioritize WTMS. Finding the right balance between supportive resources and tools and an effective management system is a tough challenge. But achieving this balance will help reconcile contradictions between top-down and bottom-up WTMS.

  11. Exact and Heuristic Solutions to Minimize Total Waiting Time in the Blood Products Distribution Problem

    Directory of Open Access Journals (Sweden)

    Amir Salehipour

    2012-01-01

    Full Text Available This paper presents a novel application of operations research to support decision making in blood distribution management. The rapid and dynamic increasing demand, criticality of the product, storage, handling, and distribution requirements, and the different geographical locations of hospitals and medical centers have made blood distribution a complex and important problem. In this study, a real blood distribution problem containing 24 hospitals was tackled by the authors, and an exact approach was presented. The objective of the problem is to distribute blood and its products among hospitals and medical centers such that the total waiting time of those requiring the product is minimized. Following the exact solution, a hybrid heuristic algorithm is proposed. Computational experiments showed the optimal solutions could be obtained for medium size instances, while for larger instances the proposed hybrid heuristic is very competitive.

  12. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

    Directory of Open Access Journals (Sweden)

    Yogesh Tiwari

    2014-01-01

    Full Text Available Background: Emergency Department (ED of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD. Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc. of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be "9.00-12.00 h" in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients "under observation" (29.6%; "waiting for routine diagnostic tests" (16.4% and "waiting for discharge" (14.6%. Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach.

  13. Splitting Travel Time Based on AFC Data: Estimating Walking, Waiting, Transfer, and In-Vehicle Travel Times in Metro System

    Directory of Open Access Journals (Sweden)

    Yong-Sheng Zhang

    2015-01-01

    Full Text Available The walking, waiting, transfer, and delayed in-vehicle travel times mainly contribute to route’s travel time reliability in the metro system. The automatic fare collection (AFC system provides huge amounts of smart card records which can be used to estimate all these times distributions. A new estimation model based on Bayesian inference formulation is proposed in this paper by integrating the probability measurement of the OD pair with only one effective route, in which all kinds of times follow the truncated normal distributions. Then, Markov Chain Monte Carlo method is designed to estimate all parameters endogenously. Finally, based on AFC data in Guangzhou Metro, the estimations show that all parameters can be estimated endogenously and identifiably. Meanwhile, the truncated property of the travel time is significant and the threshold tested by the surveyed data is reliable. Furthermore, the superiority of the proposed model over the existing model in estimation and forecasting accuracy is also demonstrated.

  14. Waiting time analysis for MX/G/1 priority queues with/without vacations under random order of service discipline

    Directory of Open Access Journals (Sweden)

    Norikazu Kawasaki

    2000-01-01

    Full Text Available We study MX/G/1 nonpreemptive and preemptive-resume priority queues with/without vacations under random order of service (ROS discipline within each class. By considering the conditional waiting times given the states of the system, which an arbitrary message observes upon arrival, we derive the Laplace-Stieltjes transforms of the waiting time distributions and explicitly obtain the first two moments. The relationship for the second moments under ROS and first-come first-served disciplines extends the one found previously by Takacs and Fuhrmann for non-priority single arrival queues.

  15. Prediction problem for target events based on the inter-event waiting time

    Science.gov (United States)

    Shapoval, A.

    2010-11-01

    In this paper we address the problem of forecasting the target events of a time series given the distribution ξ of time gaps between target events. Strong earthquakes and stock market crashes are the two types of such events that we are focusing on. In the series of earthquakes, as McCann et al. show [W.R. Mc Cann, S.P. Nishenko, L.R. Sykes, J. Krause, Seismic gaps and plate tectonics: seismic potential for major boundaries, Pure and Applied Geophysics 117 (1979) 1082-1147], there are well-defined gaps (called seismic gaps) between strong earthquakes. On the other hand, usually there are no regular gaps in the series of stock market crashes [M. Raberto, E. Scalas, F. Mainardi, Waiting-times and returns in high-frequency financial data: an empirical study, Physica A 314 (2002) 749-755]. For the case of seismic gaps, we analytically derive an upper bound of prediction efficiency given the coefficient of variation of the distribution ξ. For the case of stock market crashes, we develop an algorithm that predicts the next crash within a certain time interval after the previous one. We show that this algorithm outperforms random prediction. The efficiency of our algorithm sets up a lower bound of efficiency for effective prediction of stock market crashes.

  16. Cardiac EASE (Ensuring Access and Speedy Evaluation) – the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada

    Science.gov (United States)

    Bungard, Tammy J; Smigorowsky, Marcie J; Lalonde, Lucille D; Hogan, Terry; Doliszny, Katharine M; Gebreyesus, Ghirmay; Garg, Sipi; Archer, Stephen L

    2009-01-01

    BACKGROUND: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-of-entry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists). OBJECTIVES: It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity. METHODS: The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE. RESULTS: A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (± SD) age (60±16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71±45 days to 33±19 days) and time to a definitive diagnosis (from 120±86 days to 51±58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period. CONCLUSIONS: Cardiac EASE reduced

  17. Hospital competition, GP fundholders and waiting times in the UK internal market: the case of elective surgery.

    Science.gov (United States)

    Xavier, Ana

    2003-03-01

    In this paper I model the demand for and supply of elective surgery using a modified Hotelling framework in which time, money, and distance are determinants of the demand for hospital care. Hospitals compete with each other in terms of the waiting time and consequently treat a certain number of patients. The basic model of hospital competition is then extended to incorporate the general practitioner (GP) fundholding scheme whereby the GPs are allocated a budget with which to buy care for their patients. Waiting time increases when production of care becomes more expensive, when the benefit obtained from treatment increases, when the unit cost of distance decreases, and when the importance given to time as a performance indicator decreases. The higher the money price the lower the waiting time. Finally, the money price paid by the GP fundholders is greater than that paid by the Health Authorities and greater than the hospitals marginal cost of production. As a consequence, fundholding patients pay a zero time price while non-fundholding patients experiment a positive waiting time.

  18. Spin-resolved electron waiting times in a quantum-dot spin valve

    Science.gov (United States)

    Tang, Gaomin; Xu, Fuming; Mi, Shuo; Wang, Jian

    2018-04-01

    We study the electronic waiting-time distributions (WTDs) in a noninteracting quantum-dot spin valve by varying spin polarization and the noncollinear angle between the magnetizations of the leads using the scattering matrix approach. Since the quantum-dot spin valve involves two channels (spin up and down) in both the incoming and outgoing channels, we study three different kinds of WTDs, which are two-channel WTD, spin-resolved single-channel WTD, and cross-channel WTD. We analyze the behaviors of WTDs in short times, correlated with the current behaviors for different spin polarizations and noncollinear angles. Cross-channel WTD reflects the correlation between two spin channels and can be used to characterize the spin-transfer torque process. We study the influence of the earlier detection on the subsequent detection from the perspective of cross-channel WTD, and define the influence degree quantity as the cumulative absolute difference between cross-channel WTDs and first-passage time distributions to quantitatively characterize the spin-flip process. We observe that influence degree versus spin-transfer torque for different noncollinear angles as well as different polarizations collapse into a single curve showing universal behaviors. This demonstrates that cross-channel WTDs can be a pathway to characterize spin correlation in spintronics system.

  19. Whole body magnetic resonance in indolent lymphomas under watchful waiting. The time is now

    Energy Technology Data Exchange (ETDEWEB)

    Galia, Massimo; Albano, Domenico; Midiri, Massimo; Lagalla, Roberto [University of Palermo, Department of Radiology, Di.Bi.Med., Palermo (Italy); Tarella, Corrado [European Institute of Oncology, Hemato-Oncology Division, Milan (Italy); Patti, Caterina; Mule, Antonino [Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Department of Hematology I, Palermo (Italy); Sconfienza, Luca Maria [IRCCS Istituto Ortopedico Galeazzi, Unit of Diagnostic and Interventional Radiology, Milano (Italy); Universita degli Studi di Milano, Department of Biomedical Sciences for Health, Milano (Italy); Alongi, Pierpaolo [Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, Department of Radiological Sciences, Nuclear Medicine Unit, Cefalu (Italy)

    2018-03-15

    The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in i-NHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used. In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging. (orig.)

  20. Poisson-process generalization for the trading waiting-time distribution in a double-auction mechanism

    Science.gov (United States)

    Cincotti, Silvano; Ponta, Linda; Raberto, Marco; Scalas, Enrico

    2005-05-01

    In this paper, empirical analyses and computational experiments are presented on high-frequency data for a double-auction (book) market. Main objective of the paper is to generalize the order waiting time process in order to properly model such empirical evidences. The empirical study is performed on the best bid and best ask data of 7 U.S. financial markets, for 30-stock time series. In particular, statistical properties of trading waiting times have been analyzed and quality of fits is evaluated by suitable statistical tests, i.e., comparing empirical distributions with theoretical models. Starting from the statistical studies on real data, attention has been focused on the reproducibility of such results in an artificial market. The computational experiments have been performed within the Genoa Artificial Stock Market. In the market model, heterogeneous agents trade one risky asset in exchange for cash. Agents have zero intelligence and issue random limit or market orders depending on their budget constraints. The price is cleared by means of a limit order book. The order generation is modelled with a renewal process. Based on empirical trading estimation, the distribution of waiting times between two consecutive orders is modelled by a mixture of exponential processes. Results show that the empirical waiting-time distribution can be considered as a generalization of a Poisson process. Moreover, the renewal process can approximate real data and implementation on the artificial stocks market can reproduce the trading activity in a realistic way.

  1. Statistical distributions of avalanche size and waiting times in an inter-sandpile cascade model

    Science.gov (United States)

    Batac, Rene; Longjas, Anthony; Monterola, Christopher

    2012-02-01

    Sandpile-based models have successfully shed light on key features of nonlinear relaxational processes in nature, particularly the occurrence of fat-tailed magnitude distributions and exponential return times, from simple local stress redistributions. In this work, we extend the existing sandpile paradigm into an inter-sandpile cascade, wherein the avalanches emanating from a uniformly-driven sandpile (first layer) is used to trigger the next (second layer), and so on, in a successive fashion. Statistical characterizations reveal that avalanche size distributions evolve from a power-law p(S)≈S-1.3 for the first layer to gamma distributions p(S)≈Sαexp(-S/S0) for layers far away from the uniformly driven sandpile. The resulting avalanche size statistics is found to be associated with the corresponding waiting time distribution, as explained in an accompanying analytic formulation. Interestingly, both the numerical and analytic models show good agreement with actual inventories of non-uniformly driven events in nature.

  2. A simple derivation of the waiting time distributions in a non-preemptive M/M/c queue with priorities

    NARCIS (Netherlands)

    van Vianen, Lars A.; Gabor, Adriana F.; van Ommeren, Jan C.W.

    2014-01-01

    In this article we give a new derivation for the waiting time distributions in an M=M=c queue with multiple priorities and a common service rate by using elementary lattice paths counting. An advantage of the approach is that it does not require inversion of the Laplace-Stieltjes transform.

  3. A simple derivation of the waiting time distributions in a non-preemptive M/M/c queue with priorities

    NARCIS (Netherlands)

    L.A. van Vianen (Lars); A.F. Gabor (Adriana); J.C.W. van Ommeren (Jan-Kees)

    2014-01-01

    textabstractIn this article we give a new derivation for the waiting time distributions in an M/M/c queue with multiple priorities and a common service rate by using elementary lattice paths counting. An advantage of the approach is that it does not require inversion of the Laplace-Stieltjes

  4. Improving Customer Waiting Time at a DMV Center Using Discrete-Event Simulation

    Science.gov (United States)

    Arnaout, Georges M.; Bowling, Shannon

    2010-01-01

    Virginia's Department of Motor Vehicles (DMV) serves a customer base of approximately 5.6 million licensed drivers and ID card holders and 7 million registered vehicle owners. DMV has more daily face-to-face contact with Virginia's citizens than any other state agency [1]. The DMV faces a major difficulty in keeping up with the excessively large customers' arrival rate. The consequences are queues building up, stretching out to the entrance doors (and sometimes even outside) and customers complaining. While the DMV state employees are trying to serve at their fastest pace, the remarkably large queues indicate that there is a serious problem that the DMV faces in its services, which must be dealt with rapidly. Simulation is considered as one of the best tools for evaluating and improving complex systems. In this paper, we use it to model one of the DMV centers located in Norfolk, VA. The simulation model is modeled in Arena 10.0 from Rockwell systems. The data used is collected from experts of the DMV Virginia headquarter located in Richmond. The model created was verified and validated. The intent of this study is to identify key problems causing the delays at the DMV centers and suggest possible solutions to minimize the customers' waiting time. In addition, two tentative hypotheses aiming to improve the model's design are tested and validated.

  5. A prospective study on the impact of waiting times for radiotherapy ...

    African Journals Online (AJOL)

    Background: Radiotherapy plays a vital role in the management of cervical cancer. However, because of high patient load and limited resources, waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active, relatively young women. The impact of treatment delays on society ...

  6. Improved functional outcome after hip fracture is associated with duration of rehabilitation, but not with waiting time for rehabilitation

    DEFF Research Database (Denmark)

    Pedersen, Tonny Jaeger; Bogh, Louise Nicole Bie; Lauritsen, Jens Martin

    2017-01-01

    INTRODUCTION: The aim of this study was to explore the relationship between “waiting time to onset of municipal rehabilitation”, “length of municipal rehabilitation” and the attained level of function four months after the hip fracture. METHODS: Among a consecutive series of 156 patients, the 116...... duration of municipal rehabilitation and outcome, also at four months. No marked differences in these results were found when subgrouped by pre-fracture level of function as assessed with the Barthel-20 index. CONCLUSIONS: Waiting times from hospital discharge to initiation of municipal rehabilitation...... seems not to correlate with functional level four months after the hip fracture. In contrast, the amount of municipal rehabilitation time does correlate with a better functional level four months after the hip fracture. Furthermore, large-sample studies are warranted to clarify this relationship....

  7. Waiting Time for Coronal Preparation and the Influence of Different Cements on Tensile Strength of Metal Posts

    Directory of Open Access Journals (Sweden)

    Ilione Kruschewsky Costa Sousa Oliveira

    2012-01-01

    Full Text Available This study aimed to assess the effect of post-cementation waiting time for core preparation of cemented cast posts and cores had on retention in the root canal, using two different luting materials. Sixty extracted human canines were sectioned 16 mm from the root apex. After cast nickel-chromium metal posts and cores were fabricated and luted with zinc phosphate (ZP cement or resin cement (RC, the specimens were divided into 3 groups (n = 10 according to the waiting time for core preparation: no preparation (control, 15 minutes, or 1 week after the core cementation. At the appropriate time, the specimens were subjected to a tensile load test (0.5 mm/min until failure. Two-way ANOVA (time versus cement and the Tukey tests (P < 0.05 showed significantly higher (P < 0.05 tensile strength values for the ZP cement groups than for the RC groups. Core preparation and post-cementation waiting time for core recontouring did not influence the retention strength. ZP was the best material for intraradicular metal post cementation.

  8. Prototype of a Questionnaire and Quiz System for Supporting Increase of Health Awareness During Wait Time in Dispensing Pharmacy

    Science.gov (United States)

    Toda, Takeshi; Chen, Poa-Min; Ozaki, Shinya; Ideguchi, Naoko; Miyaki, Tomoko; Nanbu, Keiko; Ikeda, Keiko

    For quit-smoking clinic and its campaign, there was a need for pharmacists to investigate pediatric patient's parent consciousness to tobacco harm utilizing wait time in a pediatric dispensing pharmacy. In this research, we developed the questionnaire and quiz total system using the tablet for user interface, in which people can easily answer the questionnaire/quiz and quickly see the total results on the spot in order to enhance their consciousness to the tobacco harm. The system also provides their tobacco dependence level based on the questionnaire results and some advice for their health and dietary habits due to the tobacco dependence level. From a field trial with one hundred four examinees in the pediatric dispensing pharmacy, the user interface was useful compared to conventional questionnaire form. The system could enhance their consciousness to tobacco harm and make their beneficial use of waiting time in dispensing pharmacy. Some interesting suggestions for improvement and new services were also obtained.

  9. Does Weight Gain During the Operation Wait Time Have an Impact on Weight Loss After Laparoscopic Sleeve Gastrectomy?

    Science.gov (United States)

    Cayci, Haci Murat; Erdogdu, Umut Eren; Karaman, Kerem; Budak, Ersin; Taymur, İbrahim; Buyukuysal, Cagatay

    2017-02-01

    The effect of preoperative weight changes on postoperative outcomes after bariatric surgery remains inconclusive. The aim of the present study was to evaluate the effect of preoperative weight gain on postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG). Ninety-two morbidly obese patients undergoing SG from January 2014 to April 2016 were separated into two groups according to whether they gained weight or not during the waiting time prior to surgery. Thirty-nine patients (42.4 %) gained weight during the waiting time and 53 patients (57.6 %) did not. The median body mass index (BMI; kg/m 2 ) at surgery was significantly higher in weight-gained patients (47.8 (min-max, 40-62)) compared to patients who had not gained weight (45.10 (min-max, 41-67)), (P = 0.034). No significant difference was found between the two groups regarding the distribution of age, gender, family history of obesity, existence of comorbidity, smoking, weight gain during childhood or adulthood, preoperative Beck depression and Beck anxiety scores, waiting time period, and body weight at the initial visit (P > 0.05). The ASA I score was higher in weight-gained patients whereas ASA II score was higher in those who did not gain, and the difference was significant (P = 0.046). Postoperative % BMI loss and % weight loss were not significantly different between the two groups at the first, third, sixth months, and the end of the first year (P > 0.05). Weight gain during waiting time has no negative impact on % weight loss and % BMI loss after SG.

  10. The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: An investigation in six European countries.

    Science.gov (United States)

    Konerding, Uwe; Bowen, Tom; Elkhuizen, Sylvia G; Faubel, Raquel; Forte, Paul; Karampli, Eleftheria; Mahdavi, Mahdi; Malmström, Tomi; Pavi, Elpida; Torkki, Paulus

    2017-04-01

    The effects of travel distance and travel time to the primary diabetes care provider and waiting time in the practice on health-related quality of life (HRQoL) of patients with type 2 diabetes are investigated. Survey data of 1313 persons with type 2 diabetes from six regions in England (274), Finland (163), Germany (254), Greece (165), the Netherlands (354), and Spain (103) were analyzed. Various multiple linear regression analyses with four different EQ-5D-3L indices (English, German, Dutch and Spanish index) as target variables, with travel distance, travel time, and waiting time in the practice as focal predictors and with control for study region, patient's gender, patient's age, patient's education, time since diagnosis, thoroughness of provider-patient communication were computed. Interactions of regions with the remaining five control variables and the three focal predictors were also tested. There are no interactions of regions with control variables or focal predictors. The indices decrease with increasing travel time to the provider and increasing waiting time in the provider's practice. HRQoL of patients with type 2 diabetes might be improved by decreasing travel time to the provider and waiting time in the provider's practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature

    International Nuclear Information System (INIS)

    Chen Zheng; King, Will; Pearcey, Robert; Kerba, Marc; Mackillop, William J.

    2008-01-01

    Purpose: To synthesize the direct clinical evidence relating waiting times (WTs) for radiotherapy (RT) to the outcomes of RT. Methods and materials: We did a systematic review of the literature between 1975 and 2005 to identify clinical studies describing the relationship between WTs and outcomes of RT. Only high quality (HQ) studies that had adequately controlled for confounding factors were included in the primary analysis. WTs that had originally been reported as a categorical variable were converted to a continuous variable based on the distribution of WTs in each category. Meta-analyses were done using a fixed-effect model. Results: The systematic review identified 44 relevant studies. Meta-analyses of 20 HQ studies of local control demonstrated a significant increase in the risk of local failure with increasing WT, RR localrecurrence/month = 1.14, 95% Confidence Intervals (CI): 1.09-1.21. For post-operative RT for breast cancer; RR localrecurrence/month = 1.11, 95%CI: 1.04-1.19. For post-operative RT for head and neck cancer, RR localrecurrenc/month = 1.28, 95%CI: 1.08-1.52. For definitive RT for head and neck cancer, RR localrecurrence/month = 1.15, 95%CI: 1.02-1.29. There was little evidence of any association between WTs and the risk of distant metastasis. Meta-analyses of the 6 HQ studies of breast cancer showed RR metastasis/month = 1.04, 95%CI: 0.98-1.09. Meta-analyses of 4 HQ studies of breast cancer showed no significant decrease in survival with increasing WT, RR death/month = 1.06, 95%CI: 0.97-1.16, but there was a marginally significant decrease in survival in 4 HQ studies of head and neck cancer, RR death/month = 1.16, 95%CI: 1.02-1.32. Conclusions: The risk of local recurrence increases with increasing WTs for RT. The increase in local recurrence rate may translate into decreased survival in some clinical situations. WTs for RT should be as short as reasonably achievable

  12. 'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

    Science.gov (United States)

    Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

    2017-05-05

    Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust

  13. Impact of 'Ideal Clinic' implementation on patient waiting time in primary healthcare clinics in KwaZulu-Natal Province, South Africa: A before-and-after evaluation.

    Science.gov (United States)

    Egbujie, B A; Grimwood, A; Mothibi-Wabafor, E C; Fatti, G; Tshabalala, A M E T; Allie, S; Vilakazi, G; Oyebanji, O

    2018-03-28

    Long waiting times are a major source of dissatisfaction for patients attending public healthcare facilities in South Africa (SA). The National Department of Health has identified this as one of six priority areas for improvement. Health system-strengthening (HSS) interventions to improve patient waiting time are being implemented in public health facilities across SA as part of the 'Ideal Clinic' model. The effect of these interventions on patient waiting time needs to be assessed and evidence generated for system improvement. To determine the effect of Ideal Clinic HSS intervention on patient waiting time in public health facilities in Amajuba District, KwaZulu-Natal Province, SA. We implemented 12 months of HSS activity, including facility reorganisation and patient appointment scheduling. The major outcome of interest was the total time spent by patients in a facility during a visit. This was calculated as the median time spent, obtained through a 'before-and-after' intervention survey. Univariate and multivariate factors associated with waiting time were determined. A total of 1 763 patients from nine clinics were surveyed before and after the intervention (n=860 at baseline and n=903 at follow-up). The median overall waiting time after the intervention was 122 minutes (interquartile range (IQR) 81 - 204), compared with 116 minutes (IQR 66 - 168) before (p<0.05). Individual facility results after the intervention were mixed. Two facilities recorded statistically significant reductions in patient waiting time, while three recorded significant increases (p<0.05). Patient load per nurse, type of service received and time of arrival in facilities were all independently associated with waiting time. Patients' arrival patterns, which were determined by appointment scheduling, played a significant role in the results obtained. Implementation of the Ideal Clinic model in the selected facilities led to changes in patient waiting time. Observed changes were

  14. The influence of waiting time satisfaction on customer loyalty towards multi-stage services in a full-service restaurant: evidence from India

    OpenAIRE

    MITTAL A.

    2016-01-01

    Research shows waiting time in services is an important source of service evaluation by the customer. In fact, time is one component of the total 'cost' that the customer bears and cost is a core component of the perceived cost-benefit equation that the customer uses to evaluate her or his sustained patronage of a particular service. In most services, customers consider waiting as a waste of time. However, from the customer perspective, in the case of a full-service restaurant, waiting is exp...

  15. Weighing waiting

    Directory of Open Access Journals (Sweden)

    Samuel M. Duncan

    2007-12-01

    Full Text Available People have been shown to delay decision making to wait for missing noninstrumental attribute information --- information that would not have altered their decision if known at the outset --- with this delay originally attributed to uncertainty obscuring one's true preference (Bastardi and Shafir, 1998. To test this account, relative to an alternative that delay arises from low confidence in one's preference (Tykocinski and Ruffle, 2003, we manipulated information certainty and the magnitude of a penalty for delay, the latter intended to reduce the influence of easily resolved sources of delay and to magnify any influence of uncertainty. Contrary to expectations, the results were largely inconsistent with the uncertainty account in that, under a low penalty, delay did not depend on information certainty; and, under a high penalty, delay rate was actually much lower when information was uncertain. To explain the latter, we propose that people use a strategy for resolving choice under uncertainty that does not require establishing a confident preference for each value of the missing information. These findings are related to others in which choice difficulty has been found to be a major source of delay.

  16. Use of queue modelling in the analysis of elective patient treatment governed by a maximum waiting time policy

    DEFF Research Database (Denmark)

    Kozlowski, Dawid; Worthington, Dave

    2015-01-01

    chain and discrete event simulation models, to provide an insightful analysis of the public hospital performance under the policy rules. The aim of this paper is to support the enhancement of the quality of elective patient care, to be brought about by better understanding of the policy implications...... on the utilization of public hospital resources. This paper illustrates the use of a queue modelling approach in the analysis of elective patient treatment governed by the maximum waiting time policy. Drawing upon the combined strengths of analytic and simulation approaches we develop both continuous-time Markov...

  17. No More Waits and Delays: Streamlining Workflow to Decrease Patient Time of Stay for Image-guided Musculoskeletal Procedures.

    Science.gov (United States)

    Cheung, Yvonne Y; Goodman, Eric M; Osunkoya, Tomiwa O

    2016-01-01

    Long wait times limit our ability to provide the right care at the right time and are commonly products of inefficient workflow. In 2013, the demand for musculoskeletal (MSK) procedures increased beyond our department's ability to provide efficient and timely service. We initiated a quality improvement (QI) project to increase efficiency and decrease patient time of stay. Our project team included three MSK radiologists, one senior resident, one technologist, one administrative assistant/scheduler, and the lead technologist. We adopted and followed the Lean Six Sigma DMAIC (define, measure, analyze, improve, and control) approach. The team used tools such as voice of the customer (VOC), along with affinity and SIPOC (supplier, input, process, output, customer) diagrams, to understand the current process, identify our customers, and develop a project charter in the define stage. During the measure stage, the team collected data, created a detailed process map, and identified wastes with the value stream mapping technique. Within the analyze phase, a fishbone diagram helped the team to identify critical root causes for long wait times. Scatter plots revealed relationships among time variables. Team brainstorming sessions generated improvement ideas, and selected ideas were piloted via plan, do, study, act (PDSA) cycles. The control phase continued to enable the team to monitor progress using box plots and scheduled reviews. Our project successfully decreased patient time of stay. The highly structured and logical Lean Six Sigma approach was easy to follow and provided a clear course of action with positive results. (©)RSNA, 2016.

  18. Waiting when hospitalised

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    on participating observations during a period of one and a half year. The material is analysed with inspiration from Mattingly's ideas of narrative and time. ConclusionsAlthough waiting times is not a clinically serious problem, the satisfaction levels of patients with the care they receive have become...... increasingly important in today's health care environment. The indicative conclusions form this study suggest that nurses play an important role in ensuring that patients are satisfied and receive quality care when waiting....

  19. Waiting list in a public health facility in Santiago, Chile

    Directory of Open Access Journals (Sweden)

    Alejandro Letelier

    2014-07-01

    Full Text Available Introduction Waiting lists are a well-known problem in public healthcare systems worldwide. For instance, England had over one million people in waiting lists for elective surgical procedures in 2000. Spain had over 360 000 patients in surgical waiting lists in 2007. Chile has been trying to manage waiting times through the GES (Explicit Guarantees in Healthcare plan, which was established by the Chilean government in 2005. Waiting lists for the guaranteed-care diseases in the GES plan had 380 000 patients at the beginning of 2010, and that number was reduced to zero in 2011. Internationally, there are some descriptive studies about waiting lists that focus on variables such as waiting times and number of patients in the list. In Chile, however, this type of study is lacking. Purpose This study aims to describe the characteristics of waiting lists for medical specialties between April and October 2011. It also aims to identify the components of management models in public healthcare centers, and to identify and analyze waiting-time frames of patients referred to a secondary or tertiary healthcare public center from a public primary healthcare center. Methods A descriptive cross-sectional study of the waiting list for first-time consultations for medical specialties was carried out. Referred patients were described and grouped using indicators of access to healthcare and waiting time between April and October 2011. Each consultation request or referral of a new patient was included in the waiting list and analyzed. Results There were 15 935 requests for consultations; 5 717 requests were resolved, and 8 544 were not (54% of the total requests for consultation. There was a mean waiting time of 498 days for non-resolved requests for consultation, and a mean of 141 days for resolved requests. The specialties in highest demand were orthopedic surgery and ophthalmology. The main waiting-list management processes were referral and reception of requests

  20. Analysis of bluetooth and wi-fi technology to measure wait times of personal vehicles at Arizona-Mexico ports of entry : [executive summary].

    Science.gov (United States)

    2015-11-01

    The Arizona Department of Transportation (ADOT), Office of P3 Initiatives and International : Affairs selected Lee Engineering to analyze the penetration rate of Anonymous Re-Identification : (ARID) technology to measure wait time of U.S. and Mexico ...

  1. Sustainability of Routine Notification and Request legislation on eye bank tissue supply and corneal transplantation wait times in Canada.

    Science.gov (United States)

    Lee, Kenneth; Boimer, Corey; Hershenfeld, Samantha; Sharpen, Linda; Slomovic, Allan R

    2011-10-01

    To assess whether provinces with Routine Notification and Request (RNR) legislation have sustained increases in corneal tissue supply and decreases in wait times for corneal transplantation surgery. Cross-sectional survey of Canadian corneal transplant (CT) surgeons and eye banks. Canadian CT surgeons and representatives from the 10 Canadian eye banks. Voluntary and anonymous surveys were distributed between July and October 2009. Eligible CT surgeons were defined as ophthalmologists who practice in Canada; currently perform Penetrating keratoplasty (PKP), Deep anterior lamellar keratoplasty (DALK), Deep lamellar endothelial keratoplasty (DLEK), Descemet stripping endothelial keratoplasty (DSEK), or Descemet membrane endothelial keratoplasty (DMEK); and have obtained tissues from a Canadian eye bank. From 2006 to 2009, for provinces with RNR legislation and where data are available, mean wait times from date of diagnosis to date of CT surgery have increased: in Ontario, from 31 ± 34 weeks to 36 ± 27 weeks; in British Columbia, from 39 ± 20 weeks to 42 ± 35 weeks; in Manitoba, from 32 ± 23 weeks to 49 ± 36 weeks. In addition, the amount of corneal tissue in RNR provinces suitable for transplant, with the exception of British Columbia, has declined between 2006 and 2008: in Ontario, 1186 tissues to 999 tissues (16% decline); in Manitoba, 92 tissues to 83 tissues (10% decline); in New Brunswick, 129 tissues to 98 tissues (24% decline). Although initially effective, RNR legislation has not sustained an increase in corneal tissue availability nor has it shortened wait times in most provinces. Incorporation of community hospitals into the RNR catchment, improved enforcement, and continued education of hospital staff regarding the RNR process may be effective in making this legislation more sustainable in the long term. Copyright © 2011 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  2. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

    Science.gov (United States)

    Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

    2016-01-01

    The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

  3. Managing patients' wait time in specialist out-patient clinic using real-time data from existing queue management and ADT systems.

    Science.gov (United States)

    Ju, John Chen; Gan, Soon Ann; Tan Siew Wee, Justine; Huang Yuchi, Peter; Mei Mei, Chan; Wong Mei Mei, Sharon; Fong, Kam Weng

    2013-01-01

    In major cancer centers, heavy patients load and multiple registration stations could cause significant wait time, and can be result in patient complains. Real-time patient journey data and visual display are useful tools in hospital patient queue management. This paper demonstrates how we capture patient queue data without deploying any tracing devices; and how to convert data into useful patient journey information to understand where interventions are likely to be most effective. During our system development, remarkable effort has been spent on resolving data discrepancy and balancing between accuracy and system performances. A web-based dashboard to display real-time information and a framework for data analysis were also developed to facilitate our clinics' operation. Result shows our system could eliminate more than 95% of data capturing errors and has improved patient wait time data accuracy since it was deployed.

  4. Patient perceptions regarding physician reimbursements, wait times, and out-of-pocket payments for anterior cruciate ligament reconstruction in Ontario.

    Science.gov (United States)

    Memon, Muzammil; Ginsberg, Lydia; de Sa, Darren; Nashed, Andrew; Simunovic, Nicole; Phillips, Mark; Denkers, Matthew; Ogilvie, Rick; Peterson, Devin; Ayeni, Olufemi R

    2017-12-01

    Currently, there is a lack of knowledge regarding patient perceptions surrounding physician reimbursements, appropriate wait times, and out-of-pocket payment options for anterior cruciate ligament reconstruction (ACLR). Our objective was to determine the current state of these perceptions in an Ontario setting. A survey was developed and pretested to address patient perceptions about physician reimbursements, appropriate wait times, and out-of-pocket payment options for ACLR using a focus group of experts and by reviewing prior surveys. The survey was administered to patients in a waiting room setting. Two hundred and fifty completed surveys were obtained (79.9% response rate). Participants responded that an appropriate physician reimbursement for ACLR was $1000.00 and that the Ontario Health Insurance Plan (OHIP) reimbursed physicians $700.00 for ACLR. Seventy-four percent of participants responded that the OHIP reimbursement of $615.20 for the procedure was either lower or much lower than what they considered to be an appropriate reimbursement for ACLR. Over 90% of participants responded that an ACLR should occur within 90 days of injury. Thirty-five percent of participants were willing to pay $750.00 out-of-pocket to have an ACLR done sooner, while 16.4% of participants were willing to pay $2500.00 out-of-pocket to travel outside of Canada for expedited surgery. This survey study demonstrates that patients' estimates of both appropriate and actual physician reimbursements were greater than the current reimbursement for ACLR. Further, the majority of individuals report that the surgical fee for ACLR is lower than what they consider to be an appropriate amount of compensation for the procedure. Additionally, nearly all respondents believe that a ruptured ACL should be reconstructed within 90 days of injury. Consequently, a number of patients are willing to pay out-of-pocket for expedited surgery either in Canada or abroad. However, patients' preferences for

  5. Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

    Science.gov (United States)

    Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

    2017-12-01

    As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

  6. THE INFLUENCE OF WAITING TIME SATISFACTION ON CUSTOMER LOYALTY TOWARDS MULTI-STAGE SERVICES IN A FULL-SERVICE RESTAURANT: EVIDENCE FROM INDIA

    Directory of Open Access Journals (Sweden)

    A. Mittal

    2016-06-01

    Full Text Available Research shows waiting time in services is an important source of service evaluation by the customer. In fact, time is one component of the total 'cost' that the customer bears and cost is a core component of the perceived cost-benefit equation that the customer uses to evaluate her or his sustained patronage of a particular service. In most services, customers consider waiting as a waste of time. However, from the customer perspective, in the case of a full-service restaurant, waiting is expected and sometimes desirable also. Prior research, mainly in the west, suggests that when customers think that a wait for service is too long, they become less satisfied with overall service quality. Based on a research setting in a full-scale restaurant in India, this paper seeks answers to two research questions: First, what are the determinants of overall waiting-time satisfaction and second, what is the influence of waiting-time satisfaction on customer loyalty.

  7. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    Science.gov (United States)

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

  8. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

    Directory of Open Access Journals (Sweden)

    Goh Khean-Lee

    2011-07-01

    Full Text Available Abstract Background Risk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems. Methods A prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort. Results Data on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher was available for analysis. Poor bowel preparation was present in 151 patients (30.1%. Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60, colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37 and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55 were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p Conclusions Education levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.

  9. Estimating medication stopping fraction and real-time prevalence of drug use in pharmaco-epidemiologic databases. An application of the reverse waiting time distribution

    DEFF Research Database (Denmark)

    Støvring, Henrik; Pottegård, Anton; Hallas, Jesper

    2017-01-01

    Purpose: To introduce the reverse waiting time distribution (WTD) and show how it can be used to estimate stopping fractions and real-time prevalence of treatment in pharmacoepidemiological studies. Methods: The reverse WTD is the distribution of time from the last dispensed prescription of each......-hoc decision rules for automated implementations, and it yields estimates of real-time prevalence....... patient within a time window to the end of it. It is a mirrored version of the ordinary WTD, which considers the first dispensed prescription of patients within a time window. Based on renewal process theory, the reverse WTD can be analyzed as an ordinary WTD with maximum likelihood estimation. Based...

  10. [Surgery for colorectal cancer since the introduction of the Netherlands national screening programmeInvestigations into changes in number of resections and waiting times for surgery].

    Science.gov (United States)

    de Neree Tot Babberich, M P M; van der Willik, E M; van Groningen, J T; Ledeboer, M; Wiggers, T; Wouters, M W J M

    2017-01-01

    To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Descriptive study. Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 2011-2015 were included. The volume and median waiting times for the years 2011-2015 are described. Waiting times from first tumor positive biopsy until the operation (biopsy-operation) and first preoperative visit to the surgeon until the operation (visit-operation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visit-operation for academic and non-academic hospitals and for screening compared to non-screening patients. In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsy-operation significantly decreased (ß: 0.94, 95%BI) over the years 2014-2015 compared to 2011-2013. In non-academic hospitals, the waiting time visit-operation also decreased significantly (ß: 0.89, 95%BI 0.87-0.90) over the years 2014-2015 compared to 2011-2013. No difference was found in waiting times between patients referred to the surgeon through screening compared to non-screening. There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery.

  11. The influence of deterministic and stochastic waiting time for triggering mortality and colonization events on the coexistence of cooperators and defectors in an evolutionary game model

    Directory of Open Access Journals (Sweden)

    YouHua Chen

    2014-06-01

    Full Text Available In the present report, the coexistence of Prisoners' Dilemma game players (cooperators and defectors were explored in an individual-based framework with the consideration of the impacts of deterministic and stochastic waiting time (WT for triggering mortality and/or colonization events. For the type of deterministic waiting time, the time step for triggering a mortality and/or colonization event is fixed. For the type of stochastic waiting time, whether a mortality and/or colonization event should be triggered for each time step of a simulation is randomly determined by a given acceptance probability (the event takes place when a variate drawn from a uniform distribution [0,1] is smaller than the acceptance probability. The two strategies of modeling waiting time are considered simultaneously and applied to both quantities (mortality: WTm, colonization: WTc. As such, when WT (WTm and/or WTc is an integral >=1, it indicated a deterministically triggering strategy. In contrast, when 1>WT>0, it indicated a stochastically triggering strategy and the WT value itself is used as the acceptance probability. The parameter space between the waiting time for mortality (WTm-[0.1,40] and colonization (WTc-[0.1,40] was traversed to explore the coexistence and non-coexistence regions. The role of defense award was evaluated. My results showed that, one non-coexistence region is identified consistently, located at the area where 1>=WTm>=0.3 and 40>=WTc>=0.1. As a consequence, it was found that the coexistence of cooperators and defectors in the community is largely dependent on the waiting time of mortality events, regardless of the defense or cooperation rewards. When the mortality events happen in terms of stochastic waiting time (1>=WTm>=0.3, extinction of either cooperators or defectors or both could be very likely, leading to the emergence of non-coexistence scenarios. However, when the mortality events occur in forms of relatively long deterministic

  12. Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England.

    Science.gov (United States)

    Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M

    2017-11-02

    The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching. This was a retrospective cohort study of a large type 1 Emergency department at an NHS teaching hospital in Oxford, England. We analysed anonymised individual level patient data for 378,873 emergency department attendances, representing all attendances between April 2008 and April 2013. We examined patient characteristics and emergency department presentation circumstances associated with the highest likelihood of breaching the four-hour wait time target. We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the four-hour wait time target. The main determinants of patients breaching the four-hour wait time target were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of investigations patients receive (p target were older, presented at night, presented on Monday, received multiple types of investigation in the emergency department, and were not self-referred (p target including patient age, ED referral source, the types of investigations patients receive, as well as the hour, day, and month of arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.

  13. The effects of feeding frequency on waiting time, milking frequency, cubicle and feeding fence utilization for cows in an automatic milking system

    NARCIS (Netherlands)

    Oostra, H.H.; Stefanowska, J.; Sallvik, K.

    2005-01-01

    In this trial, the effects of the forage feeding frequency on the waiting time prior to milking and the cowshed facility utilization by cows milked in an automatic milking unit (AMU) were studied. The feeding frequency was increased from two times per day to six times per day. It was found that the

  14. Polling Systems with Two-Phase Gated Service: Heavy Traffic Results for the Waiting Time Distribution

    NARCIS (Netherlands)

    R.D. van der Mei (Rob); J.A.C. Resing

    2008-01-01

    htmlabstractWe study an asymmetric cyclic polling system with Poisson arrivals, general service-time and switch-over time distributions, and with so-called two-phase gated service at each queue, an interleaving scheme that aims to enforce some level of "fairness" among the different customer

  15. A probabilistic model for estimating the waiting time until the simultaneous collapse of two contingencies

    International Nuclear Information System (INIS)

    Barnett, C.S.

    1991-01-01

    The Double Contingency Principle (DCP) is widely applied to criticality safety practice in the United States. Most practitioners base their application of the principle on qualitative, intuitive assessments. The recent trend toward probabilistic safety assessments provides a motive to search for a quantitative, probabilistic foundation for the DCP. A Markov model is tractable and leads to relatively simple results. The model yields estimates of mean time to simultaneous collapse of two contingencies as a function of estimates of mean failure times and mean recovery times of two independent contingencies. The model is a tool that can be used to supplement the qualitative methods now used to assess effectiveness of the DCP. (Author)

  16. Commercial border crossing and wait time measurement at the Pharr-Reynosa International Bridge.

    Science.gov (United States)

    2010-11-01

    The objective of the research described in this report is to install and implement radio frequency : identification (RFID) technology to measure border crossing time and travel delay for : commercial trucks crossing from Mexico into Texas at the Phar...

  17. An explicit solution for a renewal process with waiting time and its variational principle

    International Nuclear Information System (INIS)

    Lewins, J.D.

    2001-01-01

    The forward and backward equations for the conditional probability density are derived for a reliability system consisting of a single component whose repair is subject to a delay time in providing a spare part but whose mean rate of repair is otherwise constant and whose time to failure is exponentially distributed. Exact solutions are quoted. These equations are then shown to be an adjoint pair that provide stationary conditions for a variational principle, in elementary form, from which all properties of the systems can be predicted with an accuracy greater than that implied by the trial functions or approximations used. A second or specific form of variational principle provides specific estimates to questions at hand. The second or adjoint field in the first elementary principle is the backward Kolmogorov solution and the in the specific form is the importance function, as used in nuclear reactor theory. The solutions are given for long-time and in a recurrence relation form valid for all times so that approximate solutions can be checked. Approximations suitable for variational trial functions are given. Two examples give the effect of a change of delay time for a steady state and an initial transient, respectively

  18. A probabilistic model for estimating the waiting time until the simultaneous collapse of two contingencies

    International Nuclear Information System (INIS)

    Barnett, C.S.

    1991-06-01

    The Double Contingency Principle (DCP) is widely applied to criticality safety practice in the United States. Most practitioners base their application of the principle on qualitative, intuitive assessments. The recent trend toward probabilistic safety assessments provides a motive to search for a quantitative, probabilistic foundation for the DCP. A Markov model is tractable and leads to relatively simple results. The model yields estimates of mean time to simultaneous collapse of two contingencies as a function of estimates of mean failure times and mean recovery times of two independent contingencies. The model is a tool that can be used to supplement the qualitative methods now used to assess effectiveness of the DCP. 3 refs., 1 fig

  19. A probabilistic model for estimating the waiting time until the simultaneous collapse of two contingencies

    International Nuclear Information System (INIS)

    Barnett, C.S.

    1992-01-01

    The double contingency principle (DCP) is widely applied to criticality safety practice in the United States. Most practitioners base their application of the principle on qualitative and intuitive assessments. The recent trend toward probabilistic safety assessments provides a motive for a search for a quantitative and probabilistic foundation for the DCP. A Markov model is tractable and leads to relatively simple results. The model yields estimates of mean time to simultaneous collapse of two contingencies, as functions of estimates of mean failure times and mean recovery times of two independent contingencies. The model is a tool that can be used to supplement the qualitative methods now used to assess the effectiveness of the DCP. (Author)

  20. Deficient neural activity subserving decision-making during reward waiting time in intertemporal choice in adult attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Todokoro, Ayako; Tanaka, Saori C; Kawakubo, Yuki; Yahata, Noriaki; Ishii-Takahashi, Ayaka; Nishimura, Yukika; Kano, Yukiko; Ohtake, Fumio; Kasai, Kiyoto

    2018-04-24

    Impulsivity, which significantly affects social adaptation, is an important target behavioral characteristic in interventions for attention-deficit hyperactivity disorder (ADHD). Typically, people are willing to wait longer to acquire greater rewards. Impulsivity in ADHD may be associated with brain dysfunction in decision-making involving waiting behavior under such situations. We tested the hypothesis that brain circuitry during a period of waiting (i.e., prior to the acquisition of reward) is altered in adults with ADHD. The participants included 14 medication-free adults with ADHD and 16 healthy controls matched for age, sex, IQ, and handedness. The behavioral task had participants choose between a delayed, larger monetary reward and an immediate, smaller monetary reward, where the reward waiting time actually occurred during functional magnetic resonance imaging measurement. We tested for group differences in the contrast values of blood-oxygen-level dependent signals associated with the length of waiting time, calculated using the parametric modulation method. While the two groups did not differ in the time discounting rate, the delay-sensitive contrast values were significantly lower in the caudate and visual cortex in individuals with ADHD. The higher impulsivity scores were significantly associated with lower delay-sensitive contrast values in the caudate and visual cortex. These results suggest that deficient neural activity affects decision-making involving reward waiting time during intertemporal choice tasks, and provide an explanation for the basis of impulsivity in adult ADHD. © 2018 The Author. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

  1. The customer waiting time in an (R,s,Q) inventory system

    NARCIS (Netherlands)

    Kiesmüller, G.P.; Kok, de A.G.

    2006-01-01

    In practice of inventory management customer-oriented service measures play an important role. If inventory managers of stockpoints in a supply chain promise specific times of delivery that cannot be met due to a lack of stock, leadtimes at downstream stockpoints increase, causing substantial

  2. Real-Time Wait-Free Queues using Micro-Transactions

    OpenAIRE

    Meawad, Fadi; Iyer, Karthik; Schoeberl, Martin; Vitek, Jan

    2011-01-01

    This paper evaluates the applicability of transactional mem- ory to the implementation of dierent non-blocking data structures in the context of the Real-time Specication for Java. In particular, we argue that hardware support for micro-transaction allows us to implement eciently data structures that are often dicult to realize with the atomic operations provided by stock hardware. Our main imple- mentation platform is the Java Optimized Processor sys- tem. We report on the performance of dat...

  3. Waiting for the Unicorn: Perception of Time and History in Early Chinese Writings

    OpenAIRE

    Gibas, Piotr Pawel

    2009-01-01

    In this dissertation I examine temporality as conceived in early Chinese historiography, through a systematic examination of four key works: the Mozi, the Zuozhuan, the Rishu;, and the Chu Silk Manuscript, all of them written during 4th through 1st century BCE. Each presents from a different perspective ideas about the mechanism of time and history. While only the Zuozhuan is commonly categorized as historical narrative, all four of these texts depend on records of the past to convey their wo...

  4. Real-Time Wait-Free Queues using Micro-Transactions

    DEFF Research Database (Denmark)

    Meawad, Fadi; Iyer, Karthik; Schoeberl, Martin

    2011-01-01

    This paper evaluates the applicability of transactional mem- ory to the implementation of dierent non-blocking data structures in the context of the Real-time Specication for Java. In particular, we argue that hardware support for micro-transaction allows us to implement eciently data structures...... that are often dicult to realize with the atomic operations provided by stock hardware. Our main imple- mentation platform is the Java Optimized Processor sys- tem. We report on the performance of data structures imple- mented with locks, compare and swap and micro-transactions. Our results conrm...

  5. Waiting time to radiotherapy as a prognostic factor for glioblastoma patients in a scenario of medical disparities

    Energy Technology Data Exchange (ETDEWEB)

    Loureiro, Luiz Victor Maia; Callegaro-Filho, Donato; Koch, Ludmila de Oliveira; Weltman, Eduardo; Victor, Elivane da Silva; Malheiros, Suzana Maria Fleury, E-mail: lvmaia@gmail.com [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Santos, Adrialdo Jose; Borges, Lia Raquel Rodrigues; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Escola paulista de Medicina; Pontes, Luciola de Barros [Hospital do Coracao, Sao Paulo, SP (Brazil). Dept. de Oncologia

    2015-02-15

    Objective: to evaluate the effect of waiting time (WT) to radiotherapy (RT) on overall survival (OS) of glioblastoma (GBM) patients as a reliable prognostic variable in Brazil, a scenario of medical disparities. Method: retrospective study of 115 GBM patients from two different health-care institutions (one public and one private) in Brazil who underwent post-operative RT. Results: Median WT to RT was 6 weeks (range,1.3-17.6). The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9) and for WT . 6 weeks was 14.2 months (95%CI, 11.2-17.2) (HR 1.165, 95%CI 0.770-1.762; p = 0.470). In the multivariate analysis, the variables associated with survival were KPS (p , 0.001), extent of resection (p = 0.009) and the adjuvant treatment (p = 0.001). The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002), showing that the benefit of KPS on OS depends on the WT to RT. Conclusion: no prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors. (author)

  6. Protocol to Exploit Waiting Resources for UASNs

    Directory of Open Access Journals (Sweden)

    Li-Ling Hung

    2016-03-01

    Full Text Available The transmission speed of acoustic waves in water is much slower than that of radio waves in terrestrial wireless sensor networks. Thus, the propagation delay in underwater acoustic sensor networks (UASN is much greater. Longer propagation delay leads to complicated communication and collision problems. To solve collision problems, some studies have proposed waiting mechanisms; however, long waiting mechanisms result in low bandwidth utilization. To improve throughput, this study proposes a slotted medium access control protocol to enhance bandwidth utilization in UASNs. The proposed mechanism increases communication by exploiting temporal and spatial resources that are typically idle in order to protect communication against interference. By reducing wait time, network performance and energy consumption can be improved. A performance evaluation demonstrates that when the data packets are large or sensor deployment is dense, the energy consumption of proposed protocol is less than that of existing protocols as well as the throughput is higher than that of existing protocols.

  7. Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients – A population-based study in The Netherlands

    NARCIS (Netherlands)

    Visser, E.; van Rossum, P.S.N.; Leeftink, Anne Greetje; Siesling, Sabine; van Hillegersberg, R.; Ruurda, J.P.

    Background The aim of this study was to determine whether the waiting time from diagnosis to treatment with curative intent for esophageal cancer impacts oncologic outcomes. Patients and methods All patients treated by esophagectomy for esophageal carcinoma in 2005–2013 were identified from the

  8. The relationship between waiting times and 'adherence' to the Scottish Intercollegiate Guidelines Network 98 guideline in autism spectrum disorder diagnostic services in Scotland.

    Science.gov (United States)

    McKenzie, Karen; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Rutherford, Marion; Murray, Aja; Irvine, Linda

    2016-05-01

    The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits. © The Author(s) 2015.

  9. Waiting time - an offence?

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    The purpose of the original study: Patient-culture - a qualitative study among hospitalised patients, which is inspired by the work of Album and Isaksen, is to discover, and describe patients' experiences of informal relations and interpret the meaning of having fellow-patients during hospitalisa......The purpose of the original study: Patient-culture - a qualitative study among hospitalised patients, which is inspired by the work of Album and Isaksen, is to discover, and describe patients' experiences of informal relations and interpret the meaning of having fellow-patients during...... fieldwork is set up consisting of participant observation and interviews.   Based on the qualitative analysis completed to date on a data set consisting of field notes from participant observations and informal interviews I explore patients' social interactions in their day-to-day lives on two adult...

  10. Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

    Energy Technology Data Exchange (ETDEWEB)

    Kildea, John; Hijal, Tarek [McGill University Health Center (Canada)

    2016-08-15

    We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

  11. Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

    International Nuclear Information System (INIS)

    Kildea, John; Hijal, Tarek

    2016-01-01

    We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

  12. Using business process redesign to reduce wait times at a university hospital in the Netherlands

    NARCIS (Netherlands)

    Elkhuizen, Sylvia G.; Burger, Matthe P. M.; Jonkers, Rene E.; Limburg, Martien; Klazinga, Niek; Bakker, Piet J. M.

    2007-01-01

    BACKGROUND: Business process redesign (BPR) has been applied to implement more customer-focused and cost-effective care. In 2002, two pilot projects to improve patient care processes for two specific patient groups were conducted at the Academic Medical Center, a 1,000-bed university hospital in

  13. Waiting for surgery: is waiting bad for anyone or everyone?

    Science.gov (United States)

    Sutherland, J M; Liu, G; Crump, R T; Karimuddin, A A

    2017-12-01

    For Canadians, as in many countries, waiting for elective surgery is expected. The duration of the wait raises questions about the maximum amount of time patients should wait for their surgery. The primary objective of this study was to test for a relationship between the length of time patients waited for elective hernia repair surgery and change in patients' self-reported health. This study was based on a prospectively recruited longitudinal cohort of patients waiting for elective hernia repair surgery. Participants completed the PHQ-9, PEG, EQ-5D(3L) generic instruments, and the condition-specific COMI-hernia. Multivariate regression models explored associations between patient-reported outcomes and potential confounders, including age, sex, socio-economic status, and medical comorbidities. There were 118 participants and the modal age group was 61-70 years. The average wait time for participants was 22.5 weeks. There were no relationships between the duration of participants' wait for hernia repair and the change in patients' self-reported health for hernia-specific outcomes or overall health-related quality of life. There are gains in health-related quality of life to be realized by prioritizing symptomatic patients. Participants with greater pre-operative depression, pain, and hernia-related symptoms experienced an improvement in health prior to surgery, though more clarity is needed on the mechanisms that led to improved health. Many countries face problems with wait lists for elective surgery-and few have effective processes for triaging patients. This study shows that duration of time on the wait list was not associated with change in hernia patients' self-reported health.

  14. Evaluation of patients' attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor.

    Science.gov (United States)

    Dimovska, E O F; Sharma, S; Trebble, T M

    2016-06-01

    Knowing what patients think about their care is fundamental to the provision of an effective, quality service, and it can help to direct change and reduce costs. Much of the work in oral and maxillofacial departments concerns the treatment of outpatients, but as little is known about what they think about their care, we aimed to find out which aspects were associated with satisfaction. Consecutive patients (n=244) who attended the oral and maxillofacial outpatient department at Southampton University Hospital NHS Foundation Trust over a 7-day period were given a questionnaire to complete before and after their consultation. It included questions with Likert scale responses on environmental, procedural, and interactive aspects of the visit, and a 16-point scale to rank their priorities. A total of 187 patients (77%) completed the questionnaires. No association was found between expected (p=0.93) or actual (p=0.41) waiting times, and 90% of patients were satisfied with their visit. Seeing the doctor, having confidence in the treatment plan, being listened to, and the ability of the doctor to recognise their personal needs, were ranked as important. Environmental and procedural aspects were considered the least important. These findings may be of value in the development of services to improve patient-centred care. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. ¿Ha llegado la hora de la gestión de las listas de espera? Has the time arrived for the management of waiting lists?

    Directory of Open Access Journals (Sweden)

    E. Bernal

    2002-10-01

    Full Text Available Las personas que ocupan una lista de espera sufren a menudo un riesgo adicional derivado del tiempo que pasa hasta que obtienen tratamiento; sin embargo, en otras ocasiones, las personas en lista no tienen necesidad del tratamiento por el que esperan. Ambos argumentos, contrastables con evidencias empíricas, serían suficientes para afirmar que debe llegar la gestión a las listas de espera dejando a un lado políticas más o menos oportunistas. Por políticas oportunistas se entiende mantener la mala información sobre listas o su "maquillaje", utilizar programas de autoconcertación sin más horizonte que llegar a final de año sin lista de más de seis meses, etcétera. El panorama no es del todo oscuro. Algunas iniciativas de gestión (incluso de Política con mayúscula se van abriendo paso y pueden entrar en la agenda de los próximos años. Así, cabe destacar la aplicación de tiempos de atención garantizada o la priorización de las listas en función de criterios explícitos. En todo caso, conviene recordar que, con la excepción de las colas producidas en las salas de espera de los centros de salud y aquéllas que se producen en las puertas de urgencias, el resto de colas del sistema están mediadas por la decisión de un médico. Así que una estrategia ineludible para gestionar las listas de espera consiste en atenuar los problemas derivados de la incertidumbre (o ignorancia con respecto al diagnóstico o al pronóstico de los pacientes.Individuals on the waiting list frequently suffer an additional risk caused by the mean time until they receive treatment; however, other individuals do not need the treatment for which they are waiting. Both arguments, which can be contrasted with empirical evidence, would be sufficient to affirm that waiting list management should be implemented, leaving aside policies that are more of less opportunistic. Opportunistic policies are understood as those providing misinformation on waiting lists or

  16. Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Grünzig, Sasha-Denise; Baumeister, Harald; Bengel, Jürgen; Ebert, David; Krämer, Lena

    2018-05-22

    Due to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy. In a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants' acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction. This study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment. This trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration

  17. Economic performance of lactating dairy cows submitted for first service timed artificial insemination after a voluntary waiting period of 60 or 88 days.

    Science.gov (United States)

    Stangaferro, M L; Wijma, R; Masello, M; Thomas, Mark J; Giordano, J O

    2018-05-23

    The objective of this study was to evaluate the economic performance of dairy cows managed with a voluntary waiting period (VWP) of 60 or 88 d. A secondary objective was estimating variation in cash flow under different input pricing scenarios through stochastic Monte Carlo simulations. Lactating Holstein cows from 3 commercial farms were blocked by parity group and total milk yield in their previous lactation and then randomly assigned to a VWP of 60 (VWP60; n = 1,352) or 88 d (VWP88; n = 1,359). All cows received timed-artificial insemination (TAI) for first service after synchronization of ovulation with the Double-Ovsynch protocol. For second and greater services, cows received artificial insemination (AI) after detection of estrus or the Ovsynch protocol initiated 32 ± 3 d after AI. Two analyses were performed: (1) cash flow per cow for the calving interval of the experimental lactation and (2) cash flow per slot occupied by each cow enrolled in the experiment for an 18-mo period after calving in the experimental lactation. Extending the VWP from 60 to 88 d delayed time to pregnancy during lactation (~20 d) and increased the risk of leaving the herd for multiparous cows (hazard ratio = 1.21). As a result, a smaller proportion of multiparous cows calved again and had a subsequent lactation (-6%). The shift in time to pregnancy combined with the herd exit dynamics resulted in longer lactation length for primiparous (22 d) but not multiparous cows. Longer lactations led to greater milk income over feed cost and a tendency for greater cash flow during the experimental lactation for primiparous but not multiparous cows in the VWP88 group. On the other hand, profitability per slot for the 18-mo period was numerically greater ($68 slot/18 mo) for primiparous cows but numerically reduced (-$85 slot/18 mo) for multiparous cows in the VWP88 treatment. For primiparous cows most of the difference in cash flow was explained by replacement cost, whereas for multiparous

  18. Consumer behaviour in the waiting area.

    Science.gov (United States)

    Mobach, Mark P

    2007-02-01

    To determine consumer behaviour in the pharmacy waiting area. The applied methods for data-collection were direct observations. Three Dutch community pharmacies were selected for the study. The topics in the observation list were based on available services at each waiting area (brochures, books, illuminated new trailer, children's play area, etc.). Per patient each activity was registered, and at each pharmacy the behaviour was studied for 2 weeks. Most patients only waited during the waiting time at the studied pharmacies. Few consumers obtained written information during their wait. The waiting area may have latent possibilities to expand the information function of the pharmacy and combine this with other activities that distract the consumer from the wait. Transdisciplinary research, combining knowledge from pharmacy practice research with consumer research, has been a useful approach to add information on queueing behaviour of consumers.

  19. Learning to wait

    DEFF Research Database (Denmark)

    Dungey, Claire Elisabeth; Meinert, Lotte

    2017-01-01

    enforced through discipline, prepare young people to expect that waiting and enduring hardship will pay off in the end. This expectation makes the status of adulthood particularly vulnerable because the jobs and opportunities that young men learn to wait for often do not come into being by waiting....

  20. Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder.

    Science.gov (United States)

    Gordon-Lipkin, Eliza; Foster, Jessica; Peacock, Georgina

    2016-10-01

    The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Waiting for surgery from the patient perspective

    Directory of Open Access Journals (Sweden)

    Tracey Carr

    2009-10-01

    Full Text Available Tracey Carr1, Ulrich Teucher2, Jackie Mann4, Alan G Casson31Health Sciences, 2Department of Psychology, 3Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 4Acute Care, Saskatoon Health Region, Saskatoon, Saskatchewan, CanadaAbstract: The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.Keywords: wait time, scheduled surgery, patient perspective, literature review

  2. Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times.

    Science.gov (United States)

    Cheng, Ivy; Lee, Jacques; Mittmann, Nicole; Tyberg, Jeffrey; Ramagnano, Sharon; Kiss, Alex; Schull, Michael; Kerr, Fergus; Zwarenstein, Merrick

    2013-11-11

    Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Pragmatic cluster randomized trial. From 131 weekday shifts (8:00-14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. The intervention's median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19-4:38] during comparator shifts. The intervention's median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02-2:14]. The intervention's median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention's left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43-4:16]) and low acuity patients (1:10 95th% CI: 0:58-1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23-0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. The intervention reduced delays

  3. Waiting for a pacemaker

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Elming, Hanne; Jensen, Gunnar

    2012-01-01

    AIMS: To determine waiting period-related morbidity, mortality, and adverse events in acute patients waiting for a permanent pacemaker (PPM).METHODS AND RESULTS: A retrospective chart review of all PPM implantations in Region Zealand, Denmark, in 2009 was conducted. Patients were excluded...... at least one adverse event during the waiting period. The present study indicates that a waiting period is dangerous as it is associated with an increased risk of adverse events. Acute PPMs should be implanted with a 24-h pacemaker implantation service capacity....

  4. Motivational Counseling to Reduce Sitting Time

    DEFF Research Database (Denmark)

    Aadahl, Mette; Linneberg, Allan; Møller, Trine C

    2014-01-01

    counseling intervention aimed at reducing sitting time. DESIGN: A randomized, controlled, observer-blinded, community-based trial with two parallel groups using open-end randomization with 1:1 allocation. SETTING/PARTICIPANTS: A total of 166 sedentary adults were consecutively recruited from the population......-based Health2010 Study. INTERVENTION: Participants were randomized to a control (usual lifestyle) or intervention group with four individual theory-based counseling sessions. MAIN OUTCOME MEASURES: Objectively measured overall sitting time (ActivPAL 3TM, 7 days); secondary measures were breaks in sitting time......, anthropometric measures, and cardiometabolic biomarkers, assessed at baseline and after 6 months. Data were collected in 2010-2012 and analyzed in 2013-2014 using repeated measures multiple regression analyses. RESULTS: Ninety-three participants were randomized to the intervention group and 73 to the control...

  5. Employing innovative techniques to reduce inspection times

    International Nuclear Information System (INIS)

    Heumueller, R.; Guse, G.; Dirauf, F.; Fischer, E.

    1997-01-01

    Shorter inspection periods mean lower revision costs and less tight revision schedules, but must not detract from the quality of inspection findings. This requirement imposes upon the company performing the inspection the need for top achievements both in quality management and in the use of innovative techniques. Flexible equipment systems and inspection techniques adapted to specific purposes are able to reduce inspection times in many inspection jobs. As part of a complete system designed to reduce inspection times, the new Saphir (Siemens Alok Phased Array Integrated Reliable UT-System) inspection equipment system is the core of most of the recent innovations. Being an integrated inspection equipment system, it is able to handle conventional US probes as well as arrays and phased arrays. It is open for further matching to specific inspection and administrative requirements and developments, and it may be incorporated in the network of an integrated system with a database. A technological leap in probe design in the past few years has allowed controllable wave fields to be generated which are in no way inferior to those of conventional probes with fixed angles of incidence. In this way, a number of inspection techniques can be implemented with a single probe. This reduces inspection times, setup and retooling times, and doses. Typical examples already used in practice are the LLT (longitudinal-longitudinal-transverse waves) technique and the integration of inspections for longitudinal and transverse defects in a single run. In the near future, surfaces with complicated curvatures will be inspected by novel modular robot systems consisting of individual modules of linear axes and rotational axes. (orig.) [de

  6. Waiting Online: A Review and Research Agenda.

    Science.gov (United States)

    Ryan, Gerard; Valverde, Mireia

    2003-01-01

    Reviews 21 papers based on 13 separate empirical studies on waiting on the Internet, drawn from the areas of marketing, system response time, and quality of service studies. The article proposes an agenda for future research, including extending the range of research methodologies, broadening the definition of waiting on the Internet, and…

  7. Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi.

    Science.gov (United States)

    McIntosh, Nathalie; Gruits, Patricia; Oppel, Eva; Shao, Amie

    2018-07-01

    To assess satisfaction with maternity waiting home built spaces and features in women who are at risk for underutilizing maternity waiting homes (i.e. residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care). Specifically we wanted to answer the questions: (1) Are built spaces and features associated with maternity waiting home user satisfaction? (2) Can built spaces and features designed to improve hygiene, comfort, privacy and function improve maternity waiting home user satisfaction? And (3) Which built spaces and features are most important for maternity waiting home user satisfaction? A cross-sectional study comparing satisfaction with standard and non-standard maternity waiting home designs. Between December 2016 and February 2017 we surveyed expectant mothers at two maternity waiting homes that differed in their design of built spaces and features. We used bivariate analyses to assess if built spaces and features were associated with satisfaction. We compared ratings of built spaces and features between the two maternity waiting homes using chi-squares and t-tests to assess if design features to improve hygiene, comfort, privacy and function were associated with higher satisfaction. We used exploratory robust regression analysis to examine the relationship between built spaces and features and maternity waiting home satisfaction. Two maternity waiting homes in Malawi, one that incorporated non-standardized design features to improve hygiene, comfort, privacy, and function (Kasungu maternity waiting home) and the other that had a standard maternity waiting home design (Dowa maternity waiting home). 322 expectant mothers at risk for underutilizing maternity waiting homes (i.e. first-time mothers and those with no pregnancy risk factors) who had stayed at the Kasungu or Dowa maternity waiting homes. There were significant differences in ratings of built spaces and features between the

  8. Measuring border delay and crossing times at the US-Mexico border : part II. Guidebook for analysis and dissemination of border crossing time and wait time data.

    Science.gov (United States)

    2012-06-01

    The purpose of this guidebook is to describe to local, regional, and State agencies how to analyze and disseminate data collected by a radio frequency identification (RFID)-based system to measure travel times of commercial vehicles, which is referre...

  9. Commercial border crossing and wait time measurement at Laredo World Trade Bridge and the Colombia-Solidarity Bridge.

    Science.gov (United States)

    2012-03-01

    This research is to establish a baseline and on-going measurement of border crossing times and : delay by measuring travel times for commercial trucks crossing the port of entry (POE) from : Mexico into Texas at the Laredo World Trade Bridge and the ...

  10. A Call to Action to Address Gender Equity Within Our Specialty: Time's Up on Waiting for Change.

    Science.gov (United States)

    Baecher-Lind, Laura; Abbott, Jodi; Atkins, Katharyn Meredith; Nijjar, J Biba; Royce, Celeste; Schiff, Lauren; Ricciotti, Hope A

    2018-06-01

    Although national attention has been focused on sexual harassment and gender inequity in the United States, leaders within the obstetrics and gynecology community have remained relatively silent. Sexual harassment and gender inequity remain pervasive in our specialty. This article serves as a call to action for leadership as well as physicians within obstetrics and gynecology to implement ethical and evidence-based approaches to reduce gender inequity and improve workplace culture within our specialty.

  11. Reducing employee travelling time through smart commuting

    International Nuclear Information System (INIS)

    Rahman, A N N A; Yusoff, Z M; Aziz, I S; Omar, D

    2014-01-01

    Extremely congested roads will definitely delay the arrival time of each trip.This certainly impacted the journey of employees. Tardiness at the workplace has become a perturbing issue for companies where traffic jams are the most common worker excuses. A depressing consequence on daily life and productivity of the employee occurs. The issues of commuting distance between workplace and resident area become the core point of this research. This research will emphasize the use of Geographical Information System (GIS) technique to explore the distance parameter to the employment area and will focus on the accessibility pattern of low-cost housing. The research methodology consists of interview sessions and a questionnaire to residents of low-cost housing areas in Melaka Tengah District in Malaysia. The combination of these processes will show the criteria from the selected parameter for each respondent from their resident area to the employment area. This will further help in the recommendation of several options for a better commute or improvement to the existing routes and public transportations system. Thus enhancing quality of life for employees and helping to reduce stress, decrease lateness, absenteeism and improving productivity in workplace

  12. Reducing employee travelling time through smart commuting

    Science.gov (United States)

    Rahman, A. N. N. A.; Yusoff, Z. M.; Aziz, I. S.; Omar, D.

    2014-02-01

    Extremely congested roads will definitely delay the arrival time of each trip.This certainly impacted the journey of employees. Tardiness at the workplace has become a perturbing issue for companies where traffic jams are the most common worker excuses. A depressing consequence on daily life and productivity of the employee occurs. The issues of commuting distance between workplace and resident area become the core point of this research. This research will emphasize the use of Geographical Information System (GIS) technique to explore the distance parameter to the employment area and will focus on the accessibility pattern of low-cost housing. The research methodology consists of interview sessions and a questionnaire to residents of low-cost housing areas in Melaka Tengah District in Malaysia. The combination of these processes will show the criteria from the selected parameter for each respondent from their resident area to the employment area. This will further help in the recommendation of several options for a better commute or improvement to the existing routes and public transportations system. Thus enhancing quality of life for employees and helping to reduce stress, decrease lateness, absenteeism and improving productivity in workplace.

  13. Strategies to reduce PWR inspection time

    International Nuclear Information System (INIS)

    Guerra, J.; Gonzalez, E.

    2001-01-01

    During last few years, a constant reduction in inspection time was clearly demanded by most nuclear plant owners. This requirement has to be accomplished without any impact in inspection quality that, in general, has also to be improved. All this in a market with increasing competition that forces price reductions. Under these new demands from our customers, Tecnatom reoriented its development efforts to improve his products and services to meet this challenges. Two of our main inspection activities that have clear impact in outage duration are Steam Generator and Vessel inspections. This paper describes the improvements made in these two activities as an example of the reorientation of our development efforts with a focus on the technical improvements made on the software and robotic tools applied as in the data acquisition and analysis systems. In the Steam Generator inspections, new robots with dual guide tubes are commonly used. New eddy current instruments and software were developed to keep up with the data rates produced by the faster acquisition system. Use of automatic analysis software is also helping to improve speed while reducing cost and improving overall job quality. Production rates are close to double from the previous inspection system. (author)

  14. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

    Science.gov (United States)

    Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

    2015-01-01

    To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an

  15. Costly waiting for the future gas energy

    International Nuclear Information System (INIS)

    1999-01-01

    The article discusses solutions while waiting for the pollution free gas power plant and points out that Norway will have to import Danish power from coal and Swedish nuclear energy for a long time yet. Various future scenarios are mentioned

  16. A national analysis of dental waiting lists and point-in-time geographic access to subsidised dental care: can geographic access be improved by offering public dental care through private dental clinics?

    Science.gov (United States)

    Dudko, Yevgeni; Kruger, Estie; Tennant, Marc

    2017-01-01

    Australia is one of the least densely populated countries in the world, with a population concentrated on or around coastal areas. Up to 33% of the Australian population are likely to have untreated dental decay, while people with inadequate dentition (fewer than 21 teeth) account for up to 34% of Australian adults. Historically, inadequate access to public dental care has resulted in long waiting lists, received much media coverage and been the subject of a new federal and state initiative. The objective of this research was to gauge the potential for reducing the national dental waiting list through geographical advantage, which could arise from subcontracting the delivery of subsidised dental care to the existing network of private dental clinics across Australia. Eligible population data were collected from the Australian Bureau of Statistics website. Waiting list data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual state or territory dental health body. Quantum geographic information system software was used to map distribution of the eligible population across Australia by statistical area, and to plot locations of government and private dental clinics. Catchment areas of 5 km for metropolitan clinics and 5 km and 50 km for rural clinics were defined. The number of people on the waiting list and those eligible for subsidised dental care covered by each of the catchment areas was calculated. Percentage of the eligible population and those on the waiting list that could benefit from the potential improvement in geographic access was ascertained for metropolitan and rural residents. Fifty three percent of people on the waiting list resided within metropolitan areas. Rural and remote residents made up 47% of the population waiting to receive care. The utilisation of both government and private dental clinics for the delivery of subsidised dental care to the eligible population

  17. Waiting times for the appearance of cytotoxic T-lymphocyte escape mutants in chronic HIV-1 infection

    International Nuclear Information System (INIS)

    Liu Yi; Mullins, James I.; Mittler, John E.

    2006-01-01

    The failure of HIV-1 to escape at some cytotoxic T-lymphocyte (CTL) epitopes has generally been explained in terms of viral fitness costs or ineffective or attenuated CTL responses. Relatively little attention has been paid to the evolutionary time required for escape mutants to be detected. This time is significantly affected by selection, mutation rates, the presence of other advantageous mutations, and the effective population size of HIV-1 in vivo (typically estimated to be ∼10 3 in chronically infected patients, though one study has estimated it to be ∼10 5 ). Here, we use a forward simulator with experimentally estimated HIV-1 parameters to show that these delays can be substantial. For an effective population size of 10 3 , even highly advantageous mutants (s = 0.5) may not be detected for a couple of years in chronically infected patients, while moderately advantageous escape mutants (s = 0.1) may not be detected for up to 10 years. Even with an effective population size of 10 5 , a moderately advantageous escape mutant (s = 0.1) may not be detected in the population within 2 years if it has to compete with other selectively advantageous mutants. Stochastic evolutionary forces, therefore, in addition to viral fitness costs and ineffective or attenuated CTL responses, must be taken into account when assessing the selection of CTL escape mutations

  18. Has the time to come leave the "watch-and-wait" strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    Science.gov (United States)

    Rueda, Antonio; Casanova, María; Redondo, Maximino; Pérez-Ruiz, Elisabeth; Medina-Pérez, Angeles

    2012-05-31

    Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the

  19. The Wait Calculation: The Broader Consequences of the Minimum Time from Now to Interstellar Destinations and its Significance to the Space Economy

    Science.gov (United States)

    Kennedy, A.

    This paper summarises the wait calculation [1] of interstellar voyagers which finds the minimum time to destination given exponential growth in the rate of travel available to a civilisation. The minimum time obliges stellar system colonisers to consider departure times a significant risk factor in their voyages since a departure then to a destination will beat a departure made at any other time before or after. Generalised conclusions will be drawn about the significant impact that departures to interstellar destinations before, at, or after the minimum time will have on the economic potential of missions and on the inevitability of competition between them. There will be no international law operating in interstellar space and an ability to escape predatory actions en route, or at the destination, can only be done by precise calculations of departure times. Social and economic forces affecting the factors in the growth equation are discussed with reference to the probability of accelerating growth reaching the technological Singularity and strengthening the growth incentive trap. Islamic banking practices are discussed as a credible alternative to compounding interest bearing paper for funding the space economy in the long term and for supporting stakeholder investment in such long term mission development. The paper considers the essential free productivity of the Earth's biosphere and the capital accumulations made possible by land productivity are essential components to a viable long term space economy and that research into re-creating the costless productivity of the biosphere at a destination will determine both the mission's ultimate success and provide means of returns for stakeholders during the long build up. Conclusions of these arguments suggest that the Icarus project should ignore a robotic interstellar mission concept and develop a manned colonising mission from now.

  20. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach

    Directory of Open Access Journals (Sweden)

    Najaf Zare

    2017-08-01

    Full Text Available Background: Time to first pregnancy (TTFP has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. Objective: This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. Materials and Methods: The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran. Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. Results: The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. Conclusion: Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP.

  1. The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

    Science.gov (United States)

    Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

    2015-03-31

    This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

  2. Organ Type and Waiting Time

    Science.gov (United States)

    ... to know FAQ Living donation What is living donation? Organs Types Being a living donor First steps Being ... There are many financial resources for transplants. Living donation increases the existing organ supply. It’s important to get to know your ...

  3. Reactions to waiting online by men and women.

    Science.gov (United States)

    Chebat, Jean-Charles; Salem, Narjes Haj; Poirier, Jean-François; Gélinas-Chebat, Claire

    2010-06-01

    The goal of the present study was to identify factors which may affect the difference between the actual time participants expected to wait for downloading a web page and the perceived waiting time, i.e., the online waiting-time gap. The findings from an experiment in which the music tempo (fast vs. slow) and waiting-duration information (presence vs. absence) were manipulated showed that sex moderated the relation between the manipulated variables and waiting-time gap; emotional response was more important between the manipulated variables and waiting-time gap than was cognitive response. The type of emotional response with an effect on waiting-time gap varied by sex: pleasure for women and arousal for men. For women, pleasure was affected by their cognitive response, while cognitive response played no significant role for men. For both sexes, information on waiting duration increased the perceived waiting time. This study leads to reconsidering the role of emotional response and sex in evaluating waiting time.

  4. The support needs of patients waiting for publicly funded bariatric surgery - implications for health service planners.

    Science.gov (United States)

    Sharman, M J; Venn, A J; Jose, K A; Williams, D; Hensher, M; Palmer, A J; Wilkinson, S; Ezzy, D

    2017-02-01

    The objective of this study was to investigate the experience of waiting for publicly funded bariatric surgery in an Australian tertiary healthcare setting. Focus groups and individual interviews involving people waiting for or who had undergone publicly funded bariatric surgery were audio-recorded, transcribed and analysed thematically. A total of 11 women and 6 men engaged in one of six focus groups in 2014, and an additional 10 women and 9 men were interviewed in 2015. Mean age was 53 years (range 23-66); mean waiting time was 6 years (range 0-12), and mean time since surgery was 4 years (range 0-11). Waiting was commonly reported as emotionally challenging (e.g. frustrating, depressing, stressful) and often associated with weight gain (despite weight-loss attempts) and deteriorating physical health (e.g. development of new or worsening obesity-related comorbidity or decline in mobility) or psychological health (e.g. development of or worsening depression). Peer support, health and mental health counselling, integrated care and better communication about waitlist position and management (e.g. patient prioritization) were identified support needs. Even if wait times cannot be reduced, better peer and health professional supports, together with better communication from health departments, may improve the experience or outcomes of waiting and confer quality-of-life gains irrespective of weight loss. © 2016 World Obesity Federation.

  5. Waiting in the surgery.

    Science.gov (United States)

    Fry, F

    1994-07-01

    The concise Oxford English Dictionary defines 'dilemma' as an argument forcing one to choose one of two alternatives, both of which are unfavourable. This is a situation that frequently confronts the general practitioner. This paper will present one practitioner's view on the subject of patients waiting to see the doctor.

  6. wait and wipe

    African Journals Online (AJOL)

    and wipe strategy” as an alternative to circumcision for HIV prevention. In this paper, we argue that waiting for ten minutes and wiping with a dry cloth does not prevent men from becoming infected by HIV. We ... HIV infected despite having reported no sex or 100% condom .... In a qualitative study conducted in Kenya, men.

  7. Challenging "Waiting for Superman"

    Science.gov (United States)

    Bruhn, Molle

    2014-01-01

    A group of New York City public school teachers, angry about the depiction of public schools in 'Waiting for Superman," decide to make their own film about the realities of the current education reform movement. They persevered even though they had no budget when they started and lacked a background in filmmaking. "The Inconvenient Truth…

  8. Colour Consideration for Waiting areas in hospitals

    Science.gov (United States)

    Zraati, Parisa

    2012-08-01

    Colour is one the most important factors in the nature that can have some affects on human behaviour. Many years ago, it was proven that using colour in public place can have some affect on the users. Depend of the darkness and lightness; it can be vary from positive to negative. The research will mainly focus on the colour and psychological influences and physical factors. The statement of problem in this research is what is impact of colour usually applied to waiting area? The overall aim of the study is to explore the visual environment of hospitals and to manage the colour psychological effect of the hospital users in the waiting area by creating a comfortable, pleasant and cozy environment for users while spend their time in waiting areas. The analysisconcentrate on satisfaction and their interesting regarding applied colour in two private hospital waiting area in Malaysia.

  9. Solving no-wait two-stage flexible flow shop scheduling problem with unrelated parallel machines and rework time by the adjusted discrete Multi Objective Invasive Weed Optimization and fuzzy dominance approach

    Energy Technology Data Exchange (ETDEWEB)

    Jafarzadeh, Hassan; Moradinasab, Nazanin; Gerami, Ali

    2017-07-01

    Adjusted discrete Multi-Objective Invasive Weed Optimization (DMOIWO) algorithm, which uses fuzzy dominant approach for ordering, has been proposed to solve No-wait two-stage flexible flow shop scheduling problem. Design/methodology/approach: No-wait two-stage flexible flow shop scheduling problem by considering sequence-dependent setup times and probable rework in both stations, different ready times for all jobs and rework times for both stations as well as unrelated parallel machines with regards to the simultaneous minimization of maximum job completion time and average latency functions have been investigated in a multi-objective manner. In this study, the parameter setting has been carried out using Taguchi Method based on the quality indicator for beater performance of the algorithm. Findings: The results of this algorithm have been compared with those of conventional, multi-objective algorithms to show the better performance of the proposed algorithm. The results clearly indicated the greater performance of the proposed algorithm. Originality/value: This study provides an efficient method for solving multi objective no-wait two-stage flexible flow shop scheduling problem by considering sequence-dependent setup times, probable rework in both stations, different ready times for all jobs, rework times for both stations and unrelated parallel machines which are the real constraints.

  10. Solving no-wait two-stage flexible flow shop scheduling problem with unrelated parallel machines and rework time by the adjusted discrete Multi Objective Invasive Weed Optimization and fuzzy dominance approach

    International Nuclear Information System (INIS)

    Jafarzadeh, Hassan; Moradinasab, Nazanin; Gerami, Ali

    2017-01-01

    Adjusted discrete Multi-Objective Invasive Weed Optimization (DMOIWO) algorithm, which uses fuzzy dominant approach for ordering, has been proposed to solve No-wait two-stage flexible flow shop scheduling problem. Design/methodology/approach: No-wait two-stage flexible flow shop scheduling problem by considering sequence-dependent setup times and probable rework in both stations, different ready times for all jobs and rework times for both stations as well as unrelated parallel machines with regards to the simultaneous minimization of maximum job completion time and average latency functions have been investigated in a multi-objective manner. In this study, the parameter setting has been carried out using Taguchi Method based on the quality indicator for beater performance of the algorithm. Findings: The results of this algorithm have been compared with those of conventional, multi-objective algorithms to show the better performance of the proposed algorithm. The results clearly indicated the greater performance of the proposed algorithm. Originality/value: This study provides an efficient method for solving multi objective no-wait two-stage flexible flow shop scheduling problem by considering sequence-dependent setup times, probable rework in both stations, different ready times for all jobs, rework times for both stations and unrelated parallel machines which are the real constraints.

  11. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time.

    Science.gov (United States)

    Decaens, Thomas; Roudot-Thoraval, Françoise; Hadni-Bresson, Solange; Meyer, Carole; Gugenheim, Jean; Durand, Francois; Bernard, Pierre-Henri; Boillot, Olivier; Sulpice, Laurent; Calmus, Yvon; Hardwigsen, Jean; Ducerf, Christian; Pageaux, Georges-Philippe; Dharancy, Sebastien; Chazouilleres, Olivier; Cherqui, Daniel; Duvoux, Christophe

    2006-12-01

    Orthotopic liver transplantation (OLT) indication for hepatocellular carcinoma (HCC) is currently based on the Milan criteria. The University of California, San Francisco (UCSF) recently proposed an expansion of the selection criteria according to tumors characteristics on the explanted liver. This study: 1) assessed the validity of these criteria in an independent large series and 2) tested for the usefulness of these criteria when applied to pre-OLT tumor evaluation. Between 1985 and 1998, 479 patients were listed for liver transplantation (LT) for HCC and 467 were transplanted. According to pre-OLT (imaging at date of listing) or post-OLT (explanted liver) tumor characteristics, patients were retrospectively classified according to both the Milan and UCSF criteria. The 5-yr survival statistics were assessed by the Kaplan-Meier method and compared by the log-rank test. Pre-OLT UCSF criteria were analyzed according to an intention-to-treat principle. Based on the pre-OLT evaluation, 279 patients were Milan+, 44 patients were UCSF+ but Milan- (subgroup of patients that might benefit from the expansion), and 145 patients were UCSF- and Milan-. With a short median waiting time of 4 months, 5-yr survival was 60.1 +/- 3.0%, 45.6 +/- 7.8%, and 34.7 +/- 4.0%, respectively (P OLT evaluation, the UCSF criteria are associated with a 5-yr survival below 50%. Their applicability is therefore limited, despite similar survival rates compared to the Milan criteria, when the explanted liver is taken into account.

  12. Chances of late surgery in relation to length of wait lists

    Directory of Open Access Journals (Sweden)

    Levy Adrian R

    2005-09-01

    Full Text Available Abstract Background The proportion of patients who undergo surgery within a clinically safe time is an important performance indicator in health systems that use wait lists to manage access to care. However, little is known about chances of on-time surgery according to variations in existing demand. We sought to determine what proportion of patients have had late coronary bypass surgery after registration on wait lists of different size in a network of hospitals with uniform standards for timing of surgery. Methods Using records from a population-based registry, we studied wait-list times prospectively collected in a cohort of patients registered on wait lists for coronary artery bypass grafting procedures. We compared the number of weeks from registration to surgery against target access times established for three urgency groups. The chances of undergoing surgery within target time have been evaluated in relation to wait-list size at registration and the number of surgeries performed without registration on a wait list. Results In 1991–2001, two in three patients were at risk of late surgery when registered on wait lists for isolated coronary bypass procedures in British Columbia, Canada. Although urgent patients had never seen a wait list with clearance time exceeding one week, the odds of on-time surgery were reduced by 25%, odds ratio [OR] = 0.75 (95% confidence interval [CI] 0.65–0.87 for every additional operation performed without registration on a list. When the wait list at registration required a clearance time of over one month, semi-urgent patients had 51% lower odds of on-time surgery as compared to lists with clearance time less than one week, OR = 0.49 (95%CI 0.41–0.60, after adjustment for age, sex, comorbidity, calendar period, hospital and week on the list. In the non-urgent group, the odds were 69% lower, OR = 0.31 (95%CI 0.20–0.47. Every time an operation in the same hospital was performed without registration on a

  13. Iran - waiting and watching

    International Nuclear Information System (INIS)

    Malhotra, T. C.

    2007-01-01

    Global oil companies are reported to be divided on the issue of possible energy deals in Iran. Some companies may adopt wait and watch policy before singing a fresh deal with Iran, but there are some oil companies, those are still interested to sign a deal with Iran, despite the risks, even as Tehran decided to expand its uranium enrichment programme rather than complying with a UN Security Council ultimatum to freeze it, which clears the path for further harsher sanctions (author) (ml)

  14. A cost sensitive inpatient bed reservation approach to reduce emergency department boarding times.

    Science.gov (United States)

    Qiu, Shanshan; Chinnam, Ratna Babu; Murat, Alper; Batarse, Bassam; Neemuchwala, Hakimuddin; Jordan, Will

    2015-03-01

    Emergency departments (ED) in hospitals are experiencing severe crowding and prolonged patient waiting times. A significant contributing factor is boarding delays where admitted patients are held in ED (occupying critical resources) until an inpatient bed is identified and readied in the admit wards. Recent research has suggested that if the hospital admissions of ED patients can be predicted during triage or soon after, then bed requests and preparations can be triggered early on to reduce patient boarding time. We propose a cost sensitive bed reservation policy that recommends optimal bed reservation times for patients. The policy relies on a classifier that estimates the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after. The policy is cost sensitive in that it accounts for costs associated with patient admission prediction misclassification as well as costs associated with incorrectly selecting the reservation time. Results from testing the proposed bed reservation policy using data from a VA Medical Center are very promising and suggest significant cost saving opportunities and reduced patient boarding times.

  15. Ramsey waits: allocating public health service resources when there is rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2008-09-01

    The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

  16. Methodology for Analysis, Modeling and Simulation of Airport Gate-waiting Delays

    Science.gov (United States)

    Wang, Jianfeng

    This dissertation presents methodologies to estimate gate-waiting delays from historical data, to identify gate-waiting-delay functional causes in major U.S. airports, and to evaluate the impact of gate operation disruptions and mitigation strategies on gate-waiting delay. Airport gates are a resource of congestion in the air transportation system. When an arriving flight cannot pull into its gate, the delay it experiences is called gate-waiting delay. Some possible reasons for gate-waiting delay are: the gate is occupied, gate staff or equipment is unavailable, the weather prevents the use of the gate (e.g. lightning), or the airline has a preferred gate assignment. Gate-waiting delays potentially stay with the aircraft throughout the day (unless they are absorbed), adding costs to passengers and the airlines. As the volume of flights increases, ensuring that airport gates do not become a choke point of the system is critical. The first part of the dissertation presents a methodology for estimating gate-waiting delays based on historical, publicly available sources. Analysis of gate-waiting delays at major U.S. airports in the summer of 2007 identifies the following. (i) Gate-waiting delay is not a significant problem on majority of days; however, the worst delay days (e.g. 4% of the days at LGA) are extreme outliers. (ii) The Atlanta International Airport (ATL), the John F. Kennedy International Airport (JFK), the Dallas/Fort Worth International Airport (DFW) and the Philadelphia International Airport (PHL) experience the highest gate-waiting delays among major U.S. airports. (iii) There is a significant gate-waiting-delay difference between airlines due to a disproportional gate allocation. (iv) Gate-waiting delay is sensitive to time of a day and schedule peaks. According to basic principles of queueing theory, gate-waiting delay can be attributed to over-scheduling, higher-than-scheduled arrival rate, longer-than-scheduled gate-occupancy time, and reduced gate

  17. Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

    Science.gov (United States)

    Sharma, Anurag; Inder, Brett

    2011-08-01

    To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

  18. Using Tic-Tac Software to Reduce Anxiety-Related Behaviour in Adults with Autism and Learning Difficulties during Waiting Periods: A Pilot Study

    Science.gov (United States)

    Campillo, Cristina; Herrera, Gerardo; Remírez de Ganuza, Conchi; Cuesta, José L.; Abellán, Raquel; Campos, Arturo; Navarro, Ignacio; Sevilla, Javier; Pardo, Carlos; Amati, Fabián

    2014-01-01

    Deficits in the perception of time and processing of changes across time are commonly observed in individuals with autism. This pilot study evaluated the efficacy of the use of the software tool Tic-Tac, designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting…

  19. Reducing Attendance Time in LR-EPONs With Differentiated Services

    KAUST Repository

    Elrasad, Amr

    2015-04-09

    This work presents a novel on-the-fly void filling scheme for Long-Reach EPON called Size Controlled Batch Void Filling (SCBVF). SCBVF aims at reducing the time between consecutive bandwidth grants (attendance time) and hence reducing the average delay for delay-sensitive traffic.

  20. Impact of visual art on patient behavior in the emergency department waiting room.

    Science.gov (United States)

    Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

    2012-07-01

    Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Coordinating Transit Transfers in Real Time

    Science.gov (United States)

    2016-05-06

    Transfers are a major source of travel time variability for transit passengers. Coordinating transfers between transit routes in real time can reduce passenger waiting times and travel time variability, but these benefits need to be contrasted with t...

  2. Waiting for the Payday?

    DEFF Research Database (Denmark)

    Arora, Ashish; Fosfuri, Andrea; Rønde, Thomas

    Most technology startups are set up for exit through acquisition by large corporations. In choosing when to sell, startups face a tradeoff. Early acquisitions reduce execution errors but later acquisitions improve the likelihood of finding a better match because there are fewer buyers in the early...... market as early acquisitions require costly absorptive capacity. Moreover, the decision of buyers to invest in absorptive capacity is related to the decision of startups on the timing of the exit sale. In this paper, we build a model to capture this complexity and the related tradeoffs. We find......, when the timing of exit is a tactical choice, i.e., startups can choose to go late after observing the early offers, there are too many early acquisitions and too much investment in absorptive capacity by incumbents....

  3. Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.

    Science.gov (United States)

    Ford, Andria L; Williams, Jennifer A; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko R; Panagos, Peter; Lee, Jin-Moo

    2012-12-01

    Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (PLean process improvement methodology can expedite time-dependent stroke care without compromising safety.

  4. Patients' perceptions of waiting for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Gregory, Deborah M; Temple Newhook, Julia; Twells, Laurie K

    2013-10-18

    In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived

  5. Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands

    NARCIS (Netherlands)

    Meiland, F. J. M.; Danse, J. A. C.; Wendte, J. F.; Gunning-Schepers, L. J.; Klazinga, N. S.

    2002-01-01

    Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article

  6. No-Wait Flexible Flow Shop Scheduling with Due Windows

    Directory of Open Access Journals (Sweden)

    Rong-Hwa Huang

    2015-01-01

    Full Text Available To improve capacity and reduce processing time, the flow shop with multiprocessors (FSMP system is commonly used in glass, steel, and semiconductor production. No-wait FSMP is a modern production system that responds to periods when zero work is required in process production. The production process must be continuous and uninterrupted. Setup time must also be considered. Just-in-time (JIT production is very popular in industry, and timely delivery is important to customer satisfaction. Therefore, it is essential to consider the time window constraint, which is also very complex. This study focuses on a no-wait FSMP problem with time window constraint. An improved ant colony optimization (ACO, known as ant colony optimization with flexible update (ACOFU, is developed to solve the problem. The results demonstrate that ACOFU is more effective and robust than ACO when applied to small-scale problems. ACOFU has superior solution capacity and robustness when applied to large-scale problems. Therefore, this study concludes that the proposed algorithm ACOFU performs excellently when applied to the scheduling problem discussed in this study.

  7. Analysis of emergency department waiting lines

    Directory of Open Access Journals (Sweden)

    Urška Močnik

    2014-10-01

    Full Text Available Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.Results: The research results

  8. No-waiting dentine self-etch concept-Merit or hype.

    Science.gov (United States)

    Huang, Xue-Qing; Pucci, César R; Luo, Tao; Breschi, Lorenzo; Pashley, David H; Niu, Li-Na; Tay, Franklin R

    2017-07-01

    A recently-launched universal adhesive, G-Premio Bond, provides clinicians with the alternative to use the self-etch technique for bonding to dentine without waiting for the adhesive to interact with the bonding substrate (no-waiting self-etch; Japanese brochure), or after leaving the adhesive undisturbed for 10s (10-s self-etch; international brochure). The present study was performed to examine in vitro performance of this new universal adhesive bonded to human coronal dentine using the two alternative self-etch modes. One hundred and ten specimens were bonded using two self-etch application modes and examined with or without thermomechanical cycling (10,000 thermal cycles and 240,000 mechanical cycles) to simulate one year of intraoral functioning. The bonded specimens were sectioned for microtensile bond testing, ultrastructural and nanoleakage examination using transmission electron microscopy. Changes in the composition of mineralised dentine after adhesive application were examined using Fourier transform infrared spectroscopy. Both reduced application time and thermomechanical cycling resulted in significantly lower bond strengths, thinner hybrid layers, and significantly more extensive nanoleakage after thermomechanical cycling. Using the conventional 10-s application time improved bonding performance when compared with the no-waiting self-etch technique. Nevertheless, nanoleakage was generally extensive under all testing parameters employed for examining the adhesive. Although sufficient bond strength to dentine may be achieved using the present universal adhesive in the no-waiting self-etch mode that does not require clinicians to wait prior to polymerisation of the adhesive, this self-etch concept requires further technological refinement before it can be recommended as a clinical technique. Although the surge for cutting application time to increase user friendliness remains the most frequently sought conduit for advancement of dentine bonding

  9. Reducing Design Cycle Time and Cost Through Process Resequencing

    Science.gov (United States)

    Rogers, James L.

    2004-01-01

    In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

  10. REDUCING LEAD TIME USING FUZZY LOGIC AT JOB SHOP

    Directory of Open Access Journals (Sweden)

    EMİN GÜNDOĞAR

    2000-06-01

    Full Text Available One problem encountering at the job shop scheduling is minimum production size of machine is different from each another. This case increases lead time. A new approach was improved to reduce lead time. In this new approach, the parts, which materials are in stock and orders coming very frequently are assigned to machine to reduce lead time. Due the fact that there are a lot of machine and orders, it is possible to become so1ne probletns. In this paper, fuzzy logic is used to cope with this problem. New approach was simulated at the job sop that has owner 15 machinery and 50 orders. Simulation results showed that new approach reduced lead time between 27.89% and 32.36o/o

  11. [Study of the labor market for dentists who recieved Norwegian authorization during 1972-1975. I. Waiting time and alternative employment before the 1st relevant job].

    Science.gov (United States)

    Haugejorden, O

    1977-07-01

    The purpose of the investigation was to monitor changes in the labour market situation for dentists who received authorization to practise dentistry in Norway during the years 1972-1975. Data was collected by postal questionnaire during April/May of the year following authorization, except for the 1972 cohort, which was contacted the second year after authorization. A 92-95 per cent response rate was achieved using one follow-up (Table 1). The percentage of respondents who waited 8 weeks or more to acquire a job in dentistry increased from 15 for those authorized in 1972 to 36 for the 1975 group (Table 3). The proportion of dentists who took paid employment other than dentistry, increased from just over 3 per cent for the 1973 to 14 per cent for the 1975 cohort (Table 4). This development has occured despite a decrease in the number of dentists receiving authorization each year and has resulted in a limited emigration of dentists. It is suggested that the favourable supply of dentists in relation to existing demand for dental services presents an ideal opportunity for attempting to solve dental health problems which have received inadequate attention in the past.

  12. Reducing Recreational Sedentary Screen Time: A Community Guide Systematic Review.

    Science.gov (United States)

    Ramsey Buchanan, Leigh; Rooks-Peck, Cherie R; Finnie, Ramona K C; Wethington, Holly R; Jacob, Verughese; Fulton, Janet E; Johnson, Donna B; Kahwati, Leila C; Pratt, Charlotte A; Ramirez, Gilbert; Mercer, Shawna L; Glanz, Karen

    2016-03-01

    Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school- nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes. For this review, an earlier ("original") review (search period, 1966 through July 2007) was combined with updated evidence (search period, April 2007 through June 2013) to assess effectiveness of behavioral interventions aimed at reducing recreational sedentary screen time. Existing Community Guide systematic review methods were used. Analyses were conducted in 2013-2014. The review included 49 studies. Two types of behavioral interventions were evaluated that either (1) focus on reducing recreational sedentary screen time only (12 studies); or (2) focus equally on reducing recreational sedentary screen time and improving physical activity or diet (37 studies). Most studies targeted children aged ≤13 years. Children's composite screen time (TV viewing plus other forms of recreational sedentary screen time) decreased 26.4 (interquartile interval= -74.4, -12.0) minutes/day and obesity prevalence decreased 2.3 (interquartile interval= -4.5, -1.2) percentage points versus a comparison group. Improvements in physical activity and diet were reported. Three study arms among adults found composite screen time decreased by 130.2 minutes/day. Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet- and weight-related outcomes. More research is needed among adolescents and adults. Published by Elsevier Inc.

  13. Strategy as active waiting.

    Science.gov (United States)

    Sull, Donald N

    2005-09-01

    Successful executives who cut their teeth in stable industries or in developed countries often stumble when they face more volatile markets. They falter, in part, because they assume they can gaze deep into the future and develop a long-term strategy that will confer a sustainable competitive advantage. But visibility into the future of volatile markets is sharply limited because so many different variables are in play. Factors such as technological innovation, customers' evolving needs, government policy, and changes in the capital markets interact with one another to create unexpected outcomes. Over the past six years, Donald Sull, an associate professor at London Business School, has led a research project examining some of the world's most volatile markets, from national markets like China and Brazil to industries like enterprise software, telecommunications, and airlines. One of the most striking findings from this research is the importance of taking action during comparative lulls in the storm. Huge business opportunities are relatively rare; they come along only once or twice in a decade. And, for the most part, companies can't manufacture those opportunities; changes in the external environment converge to make them happen. What managers can do is prepare for these golden opportunities by managing smart during the comparative calm of business as usual. During these periods of active waiting, leaders must probe the future and remain alert to anomalies that signal potential threats or opportunities; exercise restraint to preserve their war chests; and maintain discipline to keep the troops battle ready. When a golden opportunity or"sudden death"threat emerges, managers must have the courage to declare the main effort and concentrate resources to seize the moment.

  14. Reverse time migration by Krylov subspace reduced order modeling

    Science.gov (United States)

    Basir, Hadi Mahdavi; Javaherian, Abdolrahim; Shomali, Zaher Hossein; Firouz-Abadi, Roohollah Dehghani; Gholamy, Shaban Ali

    2018-04-01

    Imaging is a key step in seismic data processing. To date, a myriad of advanced pre-stack depth migration approaches have been developed; however, reverse time migration (RTM) is still considered as the high-end imaging algorithm. The main limitations associated with the performance cost of reverse time migration are the intensive computation of the forward and backward simulations, time consumption, and memory allocation related to imaging condition. Based on the reduced order modeling, we proposed an algorithm, which can be adapted to all the aforementioned factors. Our proposed method benefit from Krylov subspaces method to compute certain mode shapes of the velocity model computed by as an orthogonal base of reduced order modeling. Reverse time migration by reduced order modeling is helpful concerning the highly parallel computation and strongly reduces the memory requirement of reverse time migration. The synthetic model results showed that suggested method can decrease the computational costs of reverse time migration by several orders of magnitudes, compared with reverse time migration by finite element method.

  15. Reducing preoperative fasting time: A trend based on evidence

    OpenAIRE

    de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

    2010-01-01

    Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits re...

  16. How Tolerable is Delay? Consumers' Evaluations of Internet Web Sites After Waiting

    NARCIS (Netherlands)

    Dellaert, B.G.C.; Kahn, B.

    1998-01-01

    How consumers’ waiting times affect their retrospective evaluations of Internet Web Sites is investigated in four computer-based experiments. Results show that waiting can but does not always negatively affect evaluations of Web Sites. Results also show that the potential negative effects of waiting

  17. Implementing the access and waiting time standard for early intervention in psychosis in the United Kingdom: An evaluation of referrals and post-assessment outcomes over the first year of operation.

    Science.gov (United States)

    Adamson, Vidyah; Barrass, Emma; McConville, Stephen; Irikok, Chantelle; Taylor, Kim; Pitt, Steve; Van Duyn, Rob; Bennett, Susan; Jackson, Lisa; Carroll, Jon; Andrews, Mark; Parker, Ann; Wright, Caroline; Greathead, Katie; Price, David

    2018-03-26

    Improving timely access to evidence-based treatment for people aged 14-65 years experiencing a first episode psychosis (FEP) or an at-risk mental state (ARMS) for psychosis is a national priority within the United Kingdom. An early intervention in psychosis (EIP) access and waiting time standard has been set which has extended the age range and acceptance criteria for services. This descriptive evaluation reports upon the referrals and access to treatment times within an EIP service over the first year of operating in line with the access and waiting time standard. Patient pathways and post-assessment status are also described. The service received 406 referrals, of which 88% (n = 357) were assessed. The mean length of time to treatment was 1.5 weeks, with 88% being seen within 2 weeks. Of those who engaged in an assessment, 34% (n = 138) were identified as ARMS cases and 30% (n = 123) were identified as FEP. Over 35 year olds accounted for 22% (n = 80) of the total accepted cases. The findings indicate clinical and operational issues, which will need careful consideration in the future planning of services. The high number of ARMS cases highlights the importance of clear treatment pathways and targeted interventions and may suggest a need to commission distinct ARMS services. The number of people who met the extended age and service acceptance criteria may suggest a need to adapt or redesign clinical services to meet the age-specific needs of over 35 year olds and those with an ARMS. It is unclear how changes to the remit of EIP services will impact upon future clinical outcomes. © 2018 John Wiley & Sons Australia, Ltd.

  18. Reducing preoperative fasting time: A trend based on evidence.

    Science.gov (United States)

    de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

    2010-03-27

    Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time.

  19. Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department

    Science.gov (United States)

    White, Benjamin A.; Yun, Brian J.; Lev, Michael H.; Raja, Ali S.

    2017-01-01

    Introduction Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays and determine the most effective techniques. Methods This prospective, before-and-after analysis of radiology process flow improvements in an academic hospital ED was exempt from institutional review board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely using Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013–3/2016 and requiring plain film imaging were included. We analyzed electronic medical record data using Microsoft Excel and SAS version 9.4, and we used a two-sample t-test to compare data from the pre- and post-intervention periods. Results Following the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.7 ± 4.2 minutes during the three months pre-intervention. It was reduced by 15% in the first three months (4.4 minutes [95% confidence interval [CI] 1.5–7.3]; to 24.3 ± 3.3 min, P=0.021), 19% in the following six months (5.4 minutes, 95% CI [2.7–8.2]; to 23.3 ± 3

  20. Attention Inhibition Training Can Reduce Betel-Nut Chewing Time

    Directory of Open Access Journals (Sweden)

    Ming-Chou Ho

    2011-05-01

    Full Text Available Betel nut (or areca is the fourth most commonly used drug worldwide after tobacco, alcohol, and caffeine. Many chemical ingredients of betel nut are carcinogenic. We examined whether the manipulation of attentional inhibition toward the areca-related stimuli could affect betel-nut chewing time. Three matched groups of habitual chewers were recruited: inhibit-areca, inhibit-non-areca, and control. This study consisted of a Go/No-Go task for inhibition training, followed by a taste test for observing chewing behavior. The Go/No-Go task constituted three phases (pretest, training and posttest. In the taste test, the habitual chewers were asked to rate the flavors of one betel nut and one gum. The purpose (blind to the chewers of this taste test was to observe whether their picking order and chewing time were affected by experimental manipulation. Results from the Go/No-Go task showed successful training. Further, the training groups (the inhibit-areca and inhibit-non-areca groups showed a significant reduction in betel nut chewing time, in comparison to the control group. Since both training groups showed reduced chewing time, the inhibition training may affect general control ability, in regardless of the stimulus (areca or not to be inhibited. Reduced chewing time is important for reducing areca-related diseases.

  1. Waiting narratives of lung transplant candidates.

    Science.gov (United States)

    Yelle, Maria T; Stevens, Patricia E; Lanuza, Dorothy M

    2013-01-01

    Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman's concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients' stories and hear what is most meaningful in their lives.

  2. Waiting Narratives of Lung Transplant Candidates

    Directory of Open Access Journals (Sweden)

    Maria T. Yelle

    2013-01-01

    Full Text Available Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman’s concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients’ stories and hear what is most meaningful in their lives.

  3. Analysis of bluetooth and wi-fi technology to measure wait times of personal vehicles at Arizona-Mexico ports of entry.

    Science.gov (United States)

    2015-11-01

    Robust travel time data collection is possible using Bluetooth or Wi-Fi technology that : matches anonymous MAC addresses from discoverable electronic devices (e.g., smart phones) : to determine travel time along a roadway segment. Several hundred...

  4. Study on the interaction between the food and beverage servicescape and customer waiting experience

    Directory of Open Access Journals (Sweden)

    Yang, Chih-Yun

    2014-11-01

    Full Text Available Past research on the customer waiting experience tended to focus on two primary areas, namely managing the wait and managing the perception of the wait. Very few studies conducted in-depth analysis and discus¬sion of how external environmental factors affect the experience of customer waiting, which it was also viewed as a negative factor that decreases customer satisfaction toward service. However, in reality, the waiting experience can be positive as a result of certain environmental factors, and subsequently increases customer satisfaction toward the service. This study aimed to further examine the potential influencing factors arising from the servicescape during the customer waiting process, and the interaction between the servicescape and customers during their wait time. This paper is based on the causal feedback loop. A system dynamics perspective was applied to construct a conceptual systems model showing the interaction between the servi¬cescape and the customer waiting experience.Estudios previos sobre la experiencia de espera de los clients suelen centrarse sobre todo en dos áreas: la gestión de la espera y la gestión de la experiencia de espera. Existen muy pocos estudios que hayan realizado análisis y discusiones en profundidad sobre cómo los factores ambientales externos afectan a la experiencia de espera de los clientes, que se ha considerado siempre como un factor negativo que reduce la satisfacción del cliente hacia el servicio. Sin embargo, la experiencia de espera puede incrementar en reali¬dad la satisfacción del cliente hacia el servicio. Este estudio pretende profundizar en la influencia potencial de los factores que surgen del “servicescape” durante el proceso de espera del cliente, así como la interacción entre el “servicescape” y los clientes durante el tiempo de espera. Ese artículo se basa en el bucle de retroa¬limentación causal. Desde la perspectiva de la dinámica de sistemas se construye un

  5. Active learning reduces annotation time for clinical concept extraction.

    Science.gov (United States)

    Kholghi, Mahnoosh; Sitbon, Laurianne; Zuccon, Guido; Nguyen, Anthony

    2017-10-01

    To investigate: (1) the annotation time savings by various active learning query strategies compared to supervised learning and a random sampling baseline, and (2) the benefits of active learning-assisted pre-annotations in accelerating the manual annotation process compared to de novo annotation. There are 73 and 120 discharge summary reports provided by Beth Israel institute in the train and test sets of the concept extraction task in the i2b2/VA 2010 challenge, respectively. The 73 reports were used in user study experiments for manual annotation. First, all sequences within the 73 reports were manually annotated from scratch. Next, active learning models were built to generate pre-annotations for the sequences selected by a query strategy. The annotation/reviewing time per sequence was recorded. The 120 test reports were used to measure the effectiveness of the active learning models. When annotating from scratch, active learning reduced the annotation time up to 35% and 28% compared to a fully supervised approach and a random sampling baseline, respectively. Reviewing active learning-assisted pre-annotations resulted in 20% further reduction of the annotation time when compared to de novo annotation. The number of concepts that require manual annotation is a good indicator of the annotation time for various active learning approaches as demonstrated by high correlation between time rate and concept annotation rate. Active learning has a key role in reducing the time required to manually annotate domain concepts from clinical free text, either when annotating from scratch or reviewing active learning-assisted pre-annotations. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Reduced computational cost in the calculation of worst case response time for real time systems

    OpenAIRE

    Urriza, José M.; Schorb, Lucas; Orozco, Javier D.; Cayssials, Ricardo

    2009-01-01

    Modern Real Time Operating Systems require reducing computational costs even though the microprocessors become more powerful each day. It is usual that Real Time Operating Systems for embedded systems have advance features to administrate the resources of the applications that they support. In order to guarantee either the schedulability of the system or the schedulability of a new task in a dynamic Real Time System, it is necessary to know the Worst Case Response Time of the Real Time tasks ...

  7. The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

    Science.gov (United States)

    Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

    2015-01-01

    Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers.

  8. Financial cost to institutions on patients waiting for gall bladder disease surgery.

    Science.gov (United States)

    Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

    2014-01-01

    The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

  9. The influence of ambient scent and music on patients' anxiety in a waiting room of a plastic surgeon.

    Science.gov (United States)

    Fenko, Anna; Loock, Caroline

    2014-01-01

    This study investigates the influence of ambient scent and music, and their combination, on patients' anxiety in a waiting room of a plastic surgeon. Waiting for an appointment with a plastic surgeon can increase a patient's anxiety. It is important to make the waiting time before an appointment with the surgeon more pleasant and to reduce the patient's anxiety. Ambient environmental stimuli can influence people's mood, cognition, and behavior. This experimental study was performed to test whether ambient scent and music can help to reduce patients' anxiety. Two pre-studies (n = 21) were conducted to measure the subjective pleasantness and arousal of various scents and music styles. Scent and music that scored high on pleasantness and low on arousal were selected for the main study. The field experiment (n = 117) was conducted in the waiting room of a German plastic surgeon. The patients' levels of anxiety were measured in four conditions: (1) without scent and music, (2) with lavender scent; (3) with instrumental music; (4) with both scent and music. When used separately, each of the environmental factors, music and scent, significantly reduced the level of patient's anxiety compared to the control condition. However, the combination of scent and music was not effective in reducing anxiety. Our results suggest that ambient scent and music can help to reduce patients' anxiety, but they should be used with caution. Adding more ambient elements to environment could raise patients' level of arousal and thus increase their anxiety. Healing environments, patient, patient-centered care, quality care, satisfaction.

  10. Brazil well worth the wait

    Energy Technology Data Exchange (ETDEWEB)

    Duey, R.

    1999-11-01

    Oil companies weren't the only ones waiting for Brazil to make up its mind about privatizing its oil and gas industry. Seismic firms are flocking to the area in droves to work their spec magic. Exploratory activities in these large offshore blocks are described.

  11. No reason to wait

    International Nuclear Information System (INIS)

    Malloch Brown, M.

    2006-01-01

    Global warming is not the only problem now facing mankind, but it is one of the most serious with which humanity has ever been confronted. Others such as overpopulation - as predicted by Malthus in the 19th century did not occur as forecast. Water shortages, already plaguing many regions of the world, may also probably be tackled successfully. There are however cases where civilizations such as those of Easter Island and some large Mayan Yucatan settlements have perished as a result of overexploiting natural resources. With global warming we are again testing the limits of the carrying capacity of the environment on which we depend, changing the composition of the atmosphere with unknown consequences. The jury is still out on whether civilisation will survive it. The irony is that we know precisely what is causing global warming: the massive injection of gases from human activities into the atmosphere, mainly CO 2 (carbon dioxide) from the burning of fossil fuels. The solution is therefore clear: to reduce such emissions, we must 'decarbonize' the present energy system. This, of course, is more easily said than done, because the extraordinary progress witnessed in the 20th century was based essentially on the large-scale, widespread use of fossil fuels. Coal, oil and gas became essential for mobility, electricity generation, heat production and all kinds of chemical and industrial products

  12. Bystander cells enhance NK cytotoxic efficiency by reducing search time.

    Science.gov (United States)

    Zhou, Xiao; Zhao, Renping; Schwarz, Karsten; Mangeat, Matthieu; Schwarz, Eva C; Hamed, Mohamed; Bogeski, Ivan; Helms, Volkhard; Rieger, Heiko; Qu, Bin

    2017-03-13

    Natural killer (NK) cells play a central role during innate immune responses by eliminating pathogen-infected or tumorigenic cells. In the microenvironment, NK cells encounter not only target cells but also other cell types including non-target bystander cells. The impact of bystander cells on NK killing efficiency is, however, still elusive. In this study we show that the presence of bystander cells, such as P815, monocytes or HUVEC, enhances NK killing efficiency. With bystander cells present, the velocity and persistence of NK cells were increased, whereas the degranulation of lytic granules remained unchanged. Bystander cell-derived H 2 O 2 was found to mediate the acceleration of NK cell migration. Using mathematical diffusion models, we confirm that local acceleration of NK cells in the vicinity of bystander cells reduces their search time to locate target cells. In addition, we found that integrin β chains (β1, β2 and β7) on NK cells are required for bystander-enhanced NK migration persistence. In conclusion, we show that acceleration of NK cell migration in the vicinity of H 2 O 2 -producing bystander cells reduces target cell search time and enhances NK killing efficiency.

  13. Production of pizza dough with reduced fermentation time

    Directory of Open Access Journals (Sweden)

    Simone Limongi

    2012-12-01

    Full Text Available The aim of this study was to reduce the fermentation time of pizza dough by evaluating the development of the dough during fermentation using a Chopin® rheofermentometer and verifying the influence of time and temperature using a 2² factorial design. The focus was to produce characteristic soft pizza dough with bubbles and crispy edges and soft in the center. These attributes were verified by the Quantitative Descriptive Analysis (QDA. The dough was prepared with the usual ingredients, fermented at a temperature range from 27 to 33 ºC for 30 to 42 minutes, enlarged, added with tomato sauce, baked, and frozen. The influence of the variables time and temperature on the release of carbon dioxide (H'm was confirmed with positive and significant effect, using a rheofermentometer, which was not observed for the development or maximum height of the dough (Hm. The same fermentation conditions of the experimental design were used for the production of the pizza dough in the industrial process; it was submitted to Quantitative Descriptive Analysis (QDA, in which the samples were described by nine attributes. The results showed that some samples had the desired characteristics of pizza dough, demonstrated by the principal component analysis (PCA, indicating a 30 % fermentation time reduction when compared to the conventional process.

  14. Reducing dose calculation time for accurate iterative IMRT planning

    International Nuclear Information System (INIS)

    Siebers, Jeffrey V.; Lauterbach, Marc; Tong, Shidong; Wu Qiuwen; Mohan, Radhe

    2002-01-01

    A time-consuming component of IMRT optimization is the dose computation required in each iteration for the evaluation of the objective function. Accurate superposition/convolution (SC) and Monte Carlo (MC) dose calculations are currently considered too time-consuming for iterative IMRT dose calculation. Thus, fast, but less accurate algorithms such as pencil beam (PB) algorithms are typically used in most current IMRT systems. This paper describes two hybrid methods that utilize the speed of fast PB algorithms yet achieve the accuracy of optimizing based upon SC algorithms via the application of dose correction matrices. In one method, the ratio method, an infrequently computed voxel-by-voxel dose ratio matrix (R=D SC /D PB ) is applied for each beam to the dose distributions calculated with the PB method during the optimization. That is, D PB xR is used for the dose calculation during the optimization. The optimization proceeds until both the IMRT beam intensities and the dose correction ratio matrix converge. In the second method, the correction method, a periodically computed voxel-by-voxel correction matrix for each beam, defined to be the difference between the SC and PB dose computations, is used to correct PB dose distributions. To validate the methods, IMRT treatment plans developed with the hybrid methods are compared with those obtained when the SC algorithm is used for all optimization iterations and with those obtained when PB-based optimization is followed by SC-based optimization. In the 12 patient cases studied, no clinically significant differences exist in the final treatment plans developed with each of the dose computation methodologies. However, the number of time-consuming SC iterations is reduced from 6-32 for pure SC optimization to four or less for the ratio matrix method and five or less for the correction method. Because the PB algorithm is faster at computing dose, this reduces the inverse planning optimization time for our implementation

  15. Using probability of drug use as independent variable in a register-based pharmacoepidemiological cause-effect study-An application of the reverse waiting time distribution

    DEFF Research Database (Denmark)

    Hallas, Jesper; Pottegård, Anton; Støvring, Henrik

    2017-01-01

    generated adjusted ORs in the upper range (4.37-4.75) while at the same time having the most narrow confidence intervals (ratio between upper and lower confidence limit, 1.46-1.50). Some ORs generated by conventional measures were higher than the probabilistic ORs, but only when the assumed period of intake......BACKGROUND: In register-based pharmacoepidemiological studies, each day of follow-up is usually categorized either as exposed or unexposed. However, there is an underlying continuous probability of exposure, and by insisting on a dichotomy, researchers unwillingly force a nondifferential...... misclassification into their analyses. We have recently developed a model whereby probability of exposure can be modeled, and we tested this on an empirical case of nonsteroidal anti-inflammatory drug (NSAID)-induced upper gastrointestinal bleeding (UGIB). METHODS: We used a case-controls data set, consisting...

  16. 5S program to reduce change-over time on forming department (case study on CV Piranti Works temanggung)

    Science.gov (United States)

    Rosiana Dewi, Septika; Setiawan, Budi; P, Susatyo Nugroho W.

    2013-06-01

    Productivity is one aspect that determines the success of a company in the competitive world of business. There are seven main types of activities that do not have value-added in manufacturing processes such as overproduction, waiting time, transportation, excess inventory, unnecessary motion and defects. The whole activity is a waste (waste) that can cause harm to the Company. Therefore, in production activities is important to pay attention so that the objectives of production productivity can be achieved. Problems experienced by CV Piranti Works is a production target is not achieved resulting in a lost sale raises the cost of which can cause harm to the Company. From the analysis conducted major known cause of the problem is the length of time required for changeover. This is supported by the high non-value added activity in the changeover activities. Lean Manufacturing is an approach to make system more efficient by reducing waste. This study refers to the book compiled by Takashi Osada (2004) and several other references. In this research used method 5S (Seiri, Seiton, Seiso, Seiketsu, and Shitsuke) for the of forming departement. The purpose of this research is to design a work environment using the 5S method (Seiri, Seiton, Seiso, Seiketsu, and Shitsuke) and make arrangement of equipment and working tool cabinet design with TRIZ methods. From these results, is expected to eliminate or reduce of non-value added activity and improved the changeover time so as to meet production targets completion of the company.

  17. 5S program to reduce change-over time on forming department (case study on CV Piranti Works temanggung)

    International Nuclear Information System (INIS)

    Dewi, Septika Rosiana; Setiawan, Budi; Susatyo Nugroho W P

    2013-01-01

    Productivity is one aspect that determines the success of a company in the competitive world of business. There are seven main types of activities that do not have value-added in manufacturing processes such as overproduction, waiting time, transportation, excess inventory, unnecessary motion and defects. The whole activity is a waste (waste) that can cause harm to the Company. Therefore, in production activities is important to pay attention so that the objectives of production productivity can be achieved. Problems experienced by CV Piranti Works is a production target is not achieved resulting in a lost sale raises the cost of which can cause harm to the Company. From the analysis conducted major known cause of the problem is the length of time required for changeover. This is supported by the high non-value added activity in the changeover activities. Lean Manufacturing is an approach to make system more efficient by reducing waste. This study refers to the book compiled by Takashi Osada (2004) and several other references. In this research used method 5S (Seiri, Seiton, Seiso, Seiketsu, and Shitsuke) for the of forming departement. The purpose of this research is to design a work environment using the 5S method (Seiri, Seiton, Seiso, Seiketsu, and Shitsuke) and make arrangement of equipment and working tool cabinet design with TRIZ methods. From these results, is expected to eliminate or reduce of non-value added activity and improved the changeover time so as to meet production targets completion of the company.

  18. A mathematical model for reducing the composting time

    Directory of Open Access Journals (Sweden)

    Estefanía Larreategui

    2014-06-01

    Full Text Available The environment is still affected by the inappropriate use of organic matter waste, but a culture of recycling and reuse has been promoted in Ecuador to reduce carbon footprint. The composting, a technique to digest organic matter, which traditionally takes 16-24 weeks, is still inefficient to use. Therefore, this paper concerns the optimization of the composting process in both quality and production time. The variables studied were: type of waste (fruits and vegetables and type of bioaccelerator (yeast and indigenous microorganisms. By using a full factorial random design 22, a quality compost was obtained in 7 weeks of processing. Quality factors as temperature, density, moisture content, pH and carbon-nitrogen ratio allowed the best conditions for composting in the San Gabriel del Baba community (Santo Domingo de los Colorados, Ecuador. As a result of this study, a mathematical surface model which explains the relationship between the temperature and the digestion time of organic matter was obtained.

  19. The relationship between health locus of control, depression, and sociodemographic factors and amount of time breast cancer patients wait before seeking diagnosis and treatment.

    Science.gov (United States)

    Marijanović, Inga; Pavleković, Gordana; Buhovac, Teo; Martinac, Marko

    2017-09-01

    In the Federation of Bosnia and Herzegovina, the prevalence and incidence of breast cancer has been increasing, and the national programme of early prevention, administered locally, is sporadic and without quality assurance. While many factors may influence women's decision to adopt prevention-oriented behaviours regarding breast cancer, this study has emphasised the importance of sociodemographic factors, psychological factors and mental wellbeing. Participants in the study were all patients who, during one year, were admitted for the first time for diagnosis and treatment in the biggest Clinical hospitals of the Herzegovina-Neretva region Patients were divided into two groups based on their TNM classification: "early stage" and "late stage". Three instruments were used in this study: an individual questionnaire about demographic and socioeconomic characteristics of the woman, the Multidimensional Health Locus of Control scales, and the Hamilton Depression Rating Scale. The majority of patients diagnosed with advanced disease were admitted to hospital in the late/advanced stages of the disease. Multi-variant analysis showed that the most statistically significant positive predictor for early admittance in hospital is living with family and marital status while religiosity has a negative predictive value. The results indicate that 59.7% of respondents do not have depression, while the remainder do have some degree of depression. There was no statistically significant difference in the degree of depression between women who were diagnosed and treated early and those who were not. The employment status of the respondents was the only significant factor related to degree of depression. Although health locus of control and depression are not statistically significant predictors of early hospital treatment, the recommendation is that further studies focus on the implementation of MHLC and HDRS scales within the community. This could be useful in planning appropriate and

  20. Reducing truck emissions at container terminals in a low carbon economy

    DEFF Research Database (Denmark)

    Chen, Gang; GOVINDAN, Kannan; Golias, Mihalis M.

    2013-01-01

    This study proposes a methodology to optimize truck arrival patterns to reduce emissions from idling truck engines at marine container terminals. A bi-objective model is developed minimizing both truck waiting times and truck arrival pattern change. The truck waiting time is estimated via...... a queueing network. Based on the waiting time, truck idling emissions are estimated. The proposed methodology is evaluated with a case study, where truck arrival rates vary over time. We propose a Genetic Algorithm based heuristic to solve the resulting problem. Result shows that, a small shift of truck...... arrivals can significantly reduce truck emissions, especially at the gate....

  1. The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon

    NARCIS (Netherlands)

    Fenko, Anna; Loock, Caroline

    2014-01-01

    OBJECTIVE: This study investigates the influence of ambient scent and music, and their combination, on patients' anxiety in a waiting room of a plastic surgeon. BACKGROUND: Waiting for an appointment with a plastic surgeon can increase a patient's anxiety. It is important to make the waiting time

  2. Regional differences in waiting time to pregnancy

    DEFF Research Database (Denmark)

    Juul, Svend; Karmaus, W; Olsen, Jørn

    1999-01-01

    of the pregnancies were planned (64%) and approximately 14% were the result of contraceptive failures. The study shows that smoking, body mass index, age and parity did not explain the differences in fecundity found between the centres. Regional differences in fecundity exist and the causes may be genetic or due...

  3. Improving generalized inverted index lock wait times

    Science.gov (United States)

    Borodin, A.; Mirvoda, S.; Porshnev, S.; Ponomareva, O.

    2018-01-01

    Concurrent operations on tree like data structures is a cornerstone of any database system. Concurrent operations intended for improving read\\write performance and usually implemented via some way of locking. Deadlock-free methods of concurrency control are known as tree locking protocols. These protocols provide basic operations(verbs) and algorithm (ways of operation invocations) for applying it to any tree-like data structure. These algorithms operate on data, managed by storage engine which are very different among RDBMS implementations. In this paper, we discuss tree locking protocol implementation for General inverted index (Gin) applied to multiversion concurrency control (MVCC) storage engine inside PostgreSQL RDBMS. After that we introduce improvements to locking protocol and provide usage statistics about evaluation of our improvement in very high load environment in one of the world’s largest IT company.

  4. WAITING FOR GODOT - ABSURD TEATER

    OpenAIRE

    Thorup, Rasmus; Leitthof, Anneliese; Kock, Felizia; Johansson, Lars; Moustgaard, Mie; Rosenkrands, Tobias; Staalhøj, Sarah; Jeppesen, Freja

    2013-01-01

    This project aims to reassess and discuss the different interpretations of Samuel Beckett’s play Waiting for Godot, made by Martin Esslin and Michael Y. Bennett. The analytical tools needed to enable the reassessment is found in the dimensional courses of Philosophy and Scientific theory (Da: Filosofi og Videnskabsteori) and Text-analysis (Da: Tekst og Tegn) and the discussion is based on Esslin’s The Theatre of The Absurd and Bennett’s Reassessing The Theatre of The Absurd. The conclusion is...

  5. Waiting in the queue on Hotelling’s Main Street

    NARCIS (Netherlands)

    Peters, H.J.M.; Schröder, M.J.W.; Vermeulen, A.J.

    2015-01-01

    We consider a variant of Hotelling’s location model that was proposed by Kohlberg (1983): when choosing a firm, consumers take travel time and also (expected) waiting time, which again depends on the number of consumers choosing that firm, into consideration. If we assume that firms are symmetric,

  6. Optimising radiation outcomes, scheduling patient waiting lists for maximum population tumour control

    International Nuclear Information System (INIS)

    Ebert, M.A.; Jennings, L.; Kearvell, R.; Bydder, S.

    2011-01-01

    Full text: Delays in the commencement of radiotherapy, possibly due to resource constraints, are known to impact on control-related outcomes. We sought an objective solution for patient prioritisation based on tumour control probability (TCP). With a utilitarian objective for maximising TCP in a population of M patients, with patient i waiting a time between diagnosis and treatment of Ti and a mean wait time of TMean, the optimisation problem is as shown. A linear-quadratic/Poissonian model for cell survival/TCP was considered including cell doubling during the wait time. Solutions to several distributions of patient population characteristics were examined together with the expected change in TCP for the population and individuals. An analytical solution to the optimisation problem was found which gives the optimal wait time for each patient as a function of the distribution of radiobiological characteristics in the population. This solution does not allow a negativity constraint on an individual's optimised waiting time so a waiting list simulation was developed to enforce that. Optimal wait time distributions were calculated for situations where patients are allocated distinct diagnostic groups (sharing radiobiological parameters) and for a (log-normal) distribution of doubling times in the population. In order to meet the utilitarian objective, the optimal solutions require patients with rapid cell doubling times to be accelerated up the waiting list at the expense of those with slowly proliferating tumours. The net population benefit however is comparable to or greater then the expected benefit from beam intensity modulation or dose escalation.

  7. Minimizing makespan for a no-wait flowshop using genetic algorithm

    Indian Academy of Sciences (India)

    This paper explains minimization of makespan or total completion time .... lead to a natural reduction of the no-wait flow shop problem to the travelling sales- ... FCH can also be applied in real time scheduling and rescheduling for no-wait flow.

  8. An open and shut case of reduced outage times

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    The closure of steam turbine casings, using conventional bolt heaters, has traditionally been a lengthy and laborious task. Hydraulic tensionings can, however, reduce critical path working from several days to a matter of hours. (author)

  9. Development of an Information Model for Kidney Transplant Wait List.

    Science.gov (United States)

    Bircan, Hüseyin Yüce; Özçelik, Ümit; Uysal, Nida; Demirağ, Alp; Haberal, Mehmet

    2015-11-01

    Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.

  10. Reducing Door-to-Needle Times using Toyota’s Lean Manufacturing Principles and Value Stream Analysis

    Science.gov (United States)

    Ford, Andria L.; Williams, Jennifer A.; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko; Panagos, Peter; Lee, Jin-Moo

    2012-01-01

    Background Earlier tPA treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times (DNTs). We utilized lean process improvement methodology to develop a streamlined IV tPA protocol. Methods In early 2011, a multi-disciplinary team analyzed the steps required to treat acute ischemic stroke patients with IV tPA, utilizing value stream analysis (VSA). We directly compared the tPA-treated patients in the “pre-VSA” epoch to the “post-VSA” epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. Results The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to room; serial processing of work flow; and delays in waiting for lab results. On 3/1/2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT prior to patient room, utilizing parallel process work-flow, and implementing point-of-care labs. In the pre-and post-VSA epochs, 132 and 87 patients were treated with IV tPA, respectively. Compared to pre-VSA, DNTs and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 min vs. 39 min (pLean process improvement methodology can expedite time-dependent stroke care, without compromising safety. PMID:23138440

  11. Reducing passengers’ travel time by optimising stopping patterns in a large-scale network: A case-study in the Copenhagen Region

    DEFF Research Database (Denmark)

    Parbo, Jens; Nielsen, Otto Anker; Prato, Carlo Giacomo

    2018-01-01

    Optimising stopping patterns in railway schedules is a cost-effective way to reduce passengers’ generalised travel costs without increasing train operators’ costs. The challenge consists in striking a balance between an increase in waiting time for passengers at skipped stations and a decrease...... in travel time for through-going passengers, with possible consequent changes in the passenger demand and route choices. This study presents the formulation of the skip-stop problem as a bi-level optimisation problem where the lower level is a schedule-based transit assignment model that delivers passengers...... is a mixed-integer problem, whereas the route choice model is a non-linear non-continuous mapping of the timetable. The method was tested on the suburban railway network in the Greater Copenhagen Region (Denmark): the reduction in railway passengers’ in-vehicle travel time was 5.5%, the reduction...

  12. Children's preferences concerning ambiance of dental waiting rooms.

    Science.gov (United States)

    Panda, A; Garg, I; Shah, M

    2015-02-01

    Despite many advances in paediatric dentistry, the greatest challenge for any paediatric dentist is to remove the anxiety related to a dental visit and have a child patient to accept dental treatment readily. Minor changes made in the waiting room design can have a major effect on the way any child perceives the upcoming dental experience. This study was carried out to determine children's preferences regarding the dental waiting area so as to improve their waiting experience and reduce their preoperative anxiety before a dental appointment. This was a cross-sectional descriptive study using survey methodology. A questionnaire designed to evaluate children's preferences regarding the waiting room was distributed to new paediatric patients, aged between 6 and 11 years of age, attending an outpatient dental facility and was completed by 212 children (127 males, 85 females). The analyses were carried out on cross-tables using Phi (for 2×2 tables) or Cramer's V (for larger than 2×2 tables) to assess responses to the questionnaire items across age groups and gender. A majority of children preferred music and the ability to play in a waiting room. They also preferred natural light and walls with pictures. They preferred looking at an aquarium or a television and sitting on beanbags and chairs and also preferred plants and oral hygiene posters Repetious. The results obtained from this study may help the dental team decide on an appropriate design of their paediatric waiting room so as to make children comfortable in the dental environment and improve delivery of health care.

  13. Criterion-based laparoscopic training reduces total training time

    NARCIS (Netherlands)

    Brinkman, W.M.; Buzink, S.N.; Alevizos, L.; De Hingh, I.H.J.T.; Jakimowicz, J.J.

    2011-01-01

    The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency. Methods During four training sessions within 1 week (one session per day) 34 medical interns

  14. Wait too long to talk about kidney disease and you could be waiting for a kidney.

    Science.gov (United States)

    ... Home Current Issue Past Issues Public Service Announcement Kidney Disease Past Issues / Summer 2006 Table of Contents ... Javascript on. Wait too long to talk about kidney disease and you could be waiting for a ...

  15. PROCESS INNOVATION: HOLISTIC SCENARIOS TO REDUCE TOTAL LEAD TIME

    Directory of Open Access Journals (Sweden)

    Alin POSTEUCĂ

    2015-11-01

    Full Text Available The globalization of markets requires continuous development of business holistic scenarios to ensure acceptable flexibility to satisfy customers. Continuous improvement of supply chain supposes continuous improvement of materials and products lead time and flow, material stocks and finished products stocks and increasing the number of suppliers close by as possible. The contribution of our study is to present holistic scenarios of total lead time improvement and innovation by implementing supply chain policy.

  16. Dedicated robotics team reduces pre-surgical preparation time

    Directory of Open Access Journals (Sweden)

    Michael S Lasser

    2012-01-01

    Statistical Analysis Used: Analysis of variance; Two-sample t-test for unequal variances. Results: The first and last 100 cases were found to have similar age (P=0.27, BMI (P=0.11, and ASA (P=0.09. The average preoperative times were 66. 4 and 53.4 min, respectively (P<0.05. The second 100 patients treated were found to have a significantly shorter preoperative time when compared to the first 100 patients (P<0.05. When the first 100 cases were divided into cohorts of 10 cases the mean preoperative time for the first through fourth cohorts were 80.5, 69.3, 78.8, and 64.7 min, respectively. After treatment of our first 30 patients we found a significant drop in preoperative time. This persisted throughout the remainder of our experience. Conclusions: From the time of patient arrival a number of tasks are accomplished by the non-physician operating room staff during RALRP. The use of a consistent staff can decrease preoperative setup times and, therefore, the overall length of surgery.

  17. Why wait? : Organizing integrated processes in cancer care

    NARCIS (Netherlands)

    Leeftink, Anne Greetje

    2017-01-01

    The access to cancer diagnostics and cancer treatment is not the same for all types of cancer patients. Furthermore, the resources involved in these processes are costly and scarce. Long access and waiting times to diagnostics and treatment can cause increased anxiety of patients. The goal of this

  18. The time course of natural scene perception with reduced attention.

    Science.gov (United States)

    Groen, Iris I A; Ghebreab, Sennay; Lamme, Victor A F; Scholte, H Steven

    2016-02-01

    Attention is thought to impose an informational bottleneck on vision by selecting particular information from visual scenes for enhanced processing. Behavioral evidence suggests, however, that some scene information is extracted even when attention is directed elsewhere. Here, we investigated the neural correlates of this ability by examining how attention affects electrophysiological markers of scene perception. In two electro-encephalography (EEG) experiments, human subjects categorized real-world scenes as manmade or natural (full attention condition) or performed tasks on unrelated stimuli in the center or periphery of the scenes (reduced attention conditions). Scene processing was examined in two ways: traditional trial averaging was used to assess the presence of a categorical manmade/natural distinction in event-related potentials, whereas single-trial analyses assessed whether EEG activity was modulated by scene statistics that are diagnostic of naturalness of individual scenes. The results indicated that evoked activity up to 250 ms was unaffected by reduced attention, showing intact categorical differences between manmade and natural scenes and strong modulations of single-trial activity by scene statistics in all conditions. Thus initial processing of both categorical and individual scene information remained intact with reduced attention. Importantly, however, attention did have profound effects on later evoked activity; full attention on the scene resulted in prolonged manmade/natural differences, increased neural sensitivity to scene statistics, and enhanced scene memory. These results show that initial processing of real-world scene information is intact with diminished attention but that the depth of processing of this information does depend on attention. Copyright © 2016 the American Physiological Society.

  19. Workshop: Waiting for the top quark

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The world of elementary particle physics is eagerly waiting for the top quark, probably the final element of the 'periodic table' of elementary particle constituents. This table consists of two families of weakly interacting particles (leptons) - one series carrying electric charge; the other being electrically neutral - together with a family of quarks carrying electric charge 2/3 (up, charm, top) and a family of charge -1/3 quarks (down, strange, beauty). It was then not surprising that the 1990 Theory Workshop at the DESY Laboratory in Hamburg in October, devoted this time to 'top physics', attracted some 200 physicists, substantially more than previous workshops in the series

  20. How tolerable is delay? : Consumers' evaluations of internet web sites after waiting

    NARCIS (Netherlands)

    B.G.C. Dellaert (Benedict); B.E. Kahn

    1998-01-01

    textabstractHow consumer's waiting times affect their retrospective evaluations of Internet Web Sites is investigated in four computer-based experiments. Results show that waiting can but does not always negatively affect evaluations of Web Sites. Results also show that the potential negative

  1. Increased commuting to school time reduces sleep duration in adolescents.

    Science.gov (United States)

    Pereira, Erico Felden; Moreno, Claudia; Louzada, Fernando Mazzilli

    2014-02-01

    Active travel to school has been referred to as one way of increasing the level of daily physical exercise, but the actual impacts on student's general health are not clear. Recently, a possible association between active travel to school and the duration of sleep was suggested. Thus, the aim was of this study to investigate the associations between the type of transportation and travel time to school, the time in bed and sleepiness in the classroom of high school students. Information on sleeping habits and travel to school of 1126 high school students were analyzed, where 55.1% were girls with an average age of 16.24 (1.39) years old, in Santa Maria Municipality, Rio Grande do Sul, Brazil. Multiple linear regression and adjusted prevalence rates analyses were carried out. The frequency of active travel found was 61.8%. Associations between time in bed, sleepiness in the classroom and the type of transportation (active or passive) were not identified. Nevertheless, the time in bed was inversely associated with the travel time (p = 0.036) and with a phase delay. In the adjusted analysis, active travel was more incident for the students of schools in the suburbs (PR: 1.68; CI: 1.40-2.01) in comparison with the students of schools in the center. Therefore, longer trips were associated with a reduction of sleep duration of morning and night groups. Interventions concerning active travel to school must be carried out cautiously in order not to cause a reduction of the sleeping time.

  2. Criterion-based laparoscopic training reduces total training time

    OpenAIRE

    Brinkman, Willem M.; Buzink, Sonja N.; Alevizos, Leonidas; de Hingh, Ignace H. J. T.; Jakimowicz, Jack J.

    2011-01-01

    Introduction The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency. Methods During four training sessions within 1 week (one session per day) 34 medical interns (no laparoscopic experience) practiced on two basic tasks on the Simbionix LAP Mentor virtual-reality (VR) simulator: ‘clipping and grasping’ and ‘cutting’. Group C (criterion-based) (N...

  3. Identifying family television practices to reduce children's television time

    NARCIS (Netherlands)

    Piotrowski, J.; Jordan, A.B.; Bleakley, A.; Hennessy, M.

    2015-01-01

    The family system plays an important role in shaping children’s television use. The American Academy of Pediatrics has recommended that parents limit screen time, given the risks associated with children’s heavy television viewing. Researchers have highlighted family television practices that may be

  4. Prefilled syringes for intravitreal injection reduce preparation time

    DEFF Research Database (Denmark)

    Subhi, Yousif; Kjer, Birgit; Munch, Inger Christine

    2016-01-01

    INTRODUCTION: The demand for intravitreal therapy has increased dramatically with the introduction of vascular endo-thelial growth factor inhibitors. Improved utilisation of existing resources is crucial to meeting the increased future demand. We investigated time spent preparing intravitreal inj...... had no influence on the design of the study, analysis of the data, preparation of the manuscript or the decision to publish. TRIAL REGISTRATION: not relevant.......INTRODUCTION: The demand for intravitreal therapy has increased dramatically with the introduction of vascular endo-thelial growth factor inhibitors. Improved utilisation of existing resources is crucial to meeting the increased future demand. We investigated time spent preparing intravitreal...... injection treatment using either prefilled syringes or vials in routine clinical practice. METHODS: We video-recorded preparations of intravitreal injections (n = 172) for each preparation type (ranibizumab prefilled syringe (n = 56), ranibizumab vial (n = 56) and aflibercept vial (n = 60)) in a multi...

  5. Attention Inhibition Training Can Reduce Betel-Nut Chewing Time

    OpenAIRE

    Ho, Ming-Chou; Li, Ren-Hau; Tang, Tze-Chun

    2011-01-01

    Betel nut (or areca) is the fourth most commonly used drug worldwide after tobacco, alcohol, and caffeine. Many chemical ingredients of betel nut are carcinogenic. We examined whether the manipulation of attentional inhibition toward the areca-related stimuli could affect betel-nut chewing time. Three matched groups of habitual chewers were recruited: inhibit-areca, inhibit-non-areca, and control. This study consisted of a Go/No-Go task for inhibition training, followed by a taste test for ob...

  6. Significantly reducing registration time in IGRT using graphics processing units

    DEFF Research Database (Denmark)

    Noe, Karsten Østergaard; Denis de Senneville, Baudouin; Tanderup, Kari

    2008-01-01

    respiration phases in a free breathing volunteer and 41 anatomical landmark points in each image series. The registration method used is a multi-resolution GPU implementation of the 3D Horn and Schunck algorithm. It is based on the CUDA framework from Nvidia. Results On an Intel Core 2 CPU at 2.4GHz each...... registration took 30 minutes. On an Nvidia Geforce 8800GTX GPU in the same machine this registration took 37 seconds, making the GPU version 48.7 times faster. The nine image series of different respiration phases were registered to the same reference image (full inhale). Accuracy was evaluated on landmark...

  7. Reduced time delay for gravitational waves with dark matter emulators

    International Nuclear Information System (INIS)

    Desai, S.; Kahya, E. O.; Woodard, R. P.

    2008-01-01

    We discuss the implications for gravitational wave detectors of a class of modified gravity theories which dispense with the need for dark matter. These models, which are known as dark matter emulators, have the property that weak gravitational waves couple to the metric that would follow from general relativity without dark matter whereas ordinary particles couple to a combination of the metric and other fields which reproduces the result of general relativity with dark matter. We show that there is an appreciable difference in the Shapiro delays of gravitational waves and photons or neutrinos from the same source, with the gravitational waves always arriving first. We compute the expected time lags for GRB 070201, for SN 1987a and for Sco-X1. We estimate the probable error by taking account of the uncertainty in position, and by using three different dark matter profiles

  8. Measures to reduce construction time of high-rise buildings

    Science.gov (United States)

    Kolchedantsev, Leonid; Adamtsevich, Aleksey; Stupakova, Olga; Drozdov, Alexander

    2018-03-01

    The organizational and technological solutions for high-rise buildings construction efficiency increase are considered, primarily - decrease of typical floor construction time and improvement of bearing structures concrete quality. The essence of offered technology is: a concrete mixing station and a polygon mainly for load-bearing wall panels with starter bars casting are located on the building site; for reinforced concrete components manufacturing and butt joints grouting the warmed-up concrete mixtures are used. The results of researches and elaborations carried out by the SPSUACE in area of a preliminary warming-up of concrete mixtures are presented. The possibility and feasibility of their usage in high-rise buildings and of excess height buildings construction including cast-in-place and precast execution are shown. The essence of heat-vibro treating of concrete mixture is revealed as a kind of prior electroresistive curing, and the achieved results are: accelerated concrete strength gain, power inputs decrease, concrete quality improvement. It is shown that the location of a concrete mixing station on the building site enables to broaden possibilities of the "thermos" method use and to avoid concrete mixtures warming up in medium-mass structures erection (columns, girders) during the high-rise buildings construction. It is experimentally proved that the splice between precast elements encased with warmed-up concrete mixture is equal with conjugated elements in strength.

  9. Reducing the time requirement of k-means algorithm.

    Science.gov (United States)

    Osamor, Victor Chukwudi; Adebiyi, Ezekiel Femi; Oyelade, Jelilli Olarenwaju; Doumbia, Seydou

    2012-01-01

    Traditional k-means and most k-means variants are still computationally expensive for large datasets, such as microarray data, which have large datasets with large dimension size d. In k-means clustering, we are given a set of n data points in d-dimensional space R(d) and an integer k. The problem is to determine a set of k points in R(d), called centers, so as to minimize the mean squared distance from each data point to its nearest center. In this work, we develop a novel k-means algorithm, which is simple but more efficient than the traditional k-means and the recent enhanced k-means. Our new algorithm is based on the recently established relationship between principal component analysis and the k-means clustering. We provided the correctness proof for this algorithm. Results obtained from testing the algorithm on three biological data and six non-biological data (three of these data are real, while the other three are simulated) also indicate that our algorithm is empirically faster than other known k-means algorithms. We assessed the quality of our algorithm clusters against the clusters of a known structure using the Hubert-Arabie Adjusted Rand index (ARI(HA)). We found that when k is close to d, the quality is good (ARI(HA)>0.8) and when k is not close to d, the quality of our new k-means algorithm is excellent (ARI(HA)>0.9). In this paper, emphases are on the reduction of the time requirement of the k-means algorithm and its application to microarray data due to the desire to create a tool for clustering and malaria research. However, the new clustering algorithm can be used for other clustering needs as long as an appropriate measure of distance between the centroids and the members is used. This has been demonstrated in this work on six non-biological data.

  10. Measuring border delay and crossing times at the US-Mexico border : part II. Step-by-step guidelines for implementing a radio frequency identification (RFID) system to measure border crossing and wait times.

    Science.gov (United States)

    2012-06-01

    The purpose of these step-by-step guidelines is to assist in planning, designing, and deploying a system that uses radio frequency identification (RFID) technology to measure the time needed for commercial vehicles to complete the northbound border c...

  11. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  12. Conservative Wait-and-See Therapy Versus Antibiotic Treatment for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

    NARCIS (Netherlands)

    Lindeboom, Jerome A.

    2011-01-01

    Background. In this explorative study, 50 children with microbiologically confirmed nontuberculous mycobacterial cervicofacial lymphadenitis were randomized to either receive antibiotic therapy or follow a conservative wait-and-see approach. Our primary objective was to assess the time for all

  13. Does acupuncture used in nulliparous women reduce time from prelabour rupture of membranes at term to active phase of labour? A randomised controlled trial.

    Science.gov (United States)

    Selmer-Olsen, Tone; Lydersen, Stian; Mørkved, Siv

    2007-01-01

    To assess if acupuncture influences the onset of labour and the need for induction after prelabour rupture of membranes (PROM) in nulliparous women. Further, to investigate a possible effect of acupuncture on the woman's wellbeing. In a randomised controlled trial (RCT), 106 nulliparous women with PROM were allocated to an acupuncture group (AG) or a control group (CG). The outcome measures were time from PROM to onset of active phase of labour, and rate of inductions if labour was absent after 2 days. The women's self-reported wellbeing was registered on a Visual Analogue Scale (VAS). There was no statistically significant difference between the 2 groups regarding time from PROM to active phase (median times in AG versus CG: 15 versus 20.5 h, p=0.34). Additionally, there was no difference between the 2 groups in the need for induction. We found no significant differences in self-reported wellbeing, but the women receiving acupuncture considered their treatment to be more positive than the controls (p=0.003). No adverse effects were reported. Acupuncture treatment used in nulliparas after PROM showed no significant effect in reducing time to active labour or in reducing rate of inductions. There was no change in wellbeing as a result of acupuncture, but it was considered positive to receive this kind of treatment while waiting for labour to begin.

  14. An evaluation on the impact of national cancer wait targets on a (UK) radiotherapy department

    International Nuclear Information System (INIS)

    Roberts, Neill

    2012-01-01

    The radiotherapy department in this evaluation has been working towards full compliance with national cancer wait targets (CWT) since their implementation. 31 and 62 day targets set a maximum time frame for cancer patients to commence treatment. This evaluation explored the impact of these targets on staff and patients within the radiotherapy department and their overall impact on the radiotherapy service. Methods: This evaluation followed a mixed method approach of sequential triangulation. Qualitative data collection and analysis dominate findings but existing quantitative data, available within the department, was used to support the overall findings. Staff and patient interviews were used to establish attitudes to and experiences of the CWT initiative in relation to radiotherapy treatment. Quantitative data was taken from the local Cancer Centre CWT database that tracks patients referred for radiotherapy. Findings and Conclusion: Qualitative data analysis identified four main themes: pressure, appropriateness of target lengths, quality of treatment provided and efficiency of working practices within the department. Responses within these themes were both positive and negative with patients mainly the former and staff the latter. Quantitative evaluation found an increased monitoring and management burden from the CWT initiative, primarily for administrative, clerical and managerial staff. The main impact of the CWT initiative was an increase in pressure on staff due to reduced time to prepare and deliver treatment. Patients felt the initiative had not impacted negatively on their care and experienced a reduction in anxiety due to a reduction in waiting time.

  15. Timely Referral to Outpatient Nephrology Care Slows Progression and Reduces Treatment Costs of Chronic Kidney Diseases

    Directory of Open Access Journals (Sweden)

    Gerhard Lonnemann

    2017-03-01

    Discussion: Timely referral to outpatient nephrology care is associated with slowed disease progression, less hospital admissions, reduced total treatment costs, and improved survival in patients with CKD.

  16. Use of maternity waiting home in rural Zambia.

    Science.gov (United States)

    van Lonkhuijzen, Luc; Stegeman, Margreet; Nyirongo, Rebecca; van Roosmalen, Jos

    2003-04-01

    This study was conducted to assess the results from the use of a maternity waiting home, a health facility to which women with high risk pregnancies are referred during the last weeks of pregnancy in rural Zambia. It compared the risk status and pregnancy outcome in women staying as waiters with those women who give birth in hospital after direct admission (non-waiters). Forty seven per-cent of the non-waiters (n = 292) had no maternal risk factors and 85% had no antenatal risk factors as compared to 17% and 78% among the waiters (n = 218). Eighty six per cent of waiters had spontaneous vaginal vertex delivery as compared to 95% of non-waiters. Although the differences in risk status were statistically significant, no differences were found in birth weight and maternal and perinatal mortality. The similar obstetric outcome among waiters with more high risk pregnancies and non-waiters could be interpreted as a possible outcome of the maternity waiting home. When dependent on a proper functioning referral system, such waiting homes can reduce perinatal mortality.

  17. The Psychosocial Influences of Waiting Periods on Patients Undergoing Endoscopic Submucosal Dissection.

    Science.gov (United States)

    Nagao, Noriko; Tsuchiya, Aya; Ando, Sae; Arita, Mizue; Toyonaga, Takashi; Miyawaki, Ikuko

    This study aimed to clarify psychosocial influences of waiting periods on patients undergoing endoscopic submucosal dissection for cancer at an advanced medical care facility in Japan. Subjects were consenting patients hospitalized from 2009 to 2010. Qualitative and quantitative data were gathered about patients' characteristics, disease and stage, and waiting period. Qualitative content analysis was used to analyze free statements and interview data. Subjects included 154 patients with an average wait period of 46.28 days for admission. Qualitative analysis revealed the following wait period perceptions. For calmness, results indicated (1) no anxiety, (2) relief based on doctors' positive judgment, (3) whatever happens/no choice, and (4) trust in doctor. For uneasiness, perceptions included (1) the sooner, the better/eagerly waiting, (2) anxiety and concern, and (3) emotional instability. Four waiting period coping types were identified: (1) making phone inquiries, (2) busy and forgot about the medical procedure, (3) relief from anxiety, and (4) unable to function well in daily life. Patients need to be educated about cancer progression and provided an estimated wait time. They also require more information about how to manage daily life such as monitoring factors from the nursing domain including physical condition, digestive symptoms, diet, and exercise.

  18. Participatory Workplace Interventions Can Reduce Sedentary Time for Office Workers?A Randomised Controlled Trial

    OpenAIRE

    Parry, Sharon; Straker, Leon; Gilson, Nicholas D.; Smith, Anne J.

    2013-01-01

    BACKGROUND: Occupational sedentary behaviour is an important contributor to overall sedentary risk. There is limited evidence for effective workplace interventions to reduce occupational sedentary time and increase light activity during work hours. The purpose of the study was to determine if participatory workplace interventions could reduce total sedentary time, sustained sedentary time (bouts >30 minutes), increase the frequency of breaks in sedentary time and promote light intensity activ...

  19. Evolutionary Hybrid Particle Swarm Optimization Algorithm for Solving NP-Hard No-Wait Flow Shop Scheduling Problems

    Directory of Open Access Journals (Sweden)

    Laxmi A. Bewoor

    2017-10-01

    Full Text Available The no-wait flow shop is a flowshop in which the scheduling of jobs is continuous and simultaneous through all machines without waiting for any consecutive machines. The scheduling of a no-wait flow shop requires finding an appropriate sequence of jobs for scheduling, which in turn reduces total processing time. The classical brute force method for finding the probabilities of scheduling for improving the utilization of resources may become trapped in local optima, and this problem can hence be observed as a typical NP-hard combinatorial optimization problem that requires finding a near optimal solution with heuristic and metaheuristic techniques. This paper proposes an effective hybrid Particle Swarm Optimization (PSO metaheuristic algorithm for solving no-wait flow shop scheduling problems with the objective of minimizing the total flow time of jobs. This Proposed Hybrid Particle Swarm Optimization (PHPSO algorithm presents a solution by the random key representation rule for converting the continuous position information values of particles to a discrete job permutation. The proposed algorithm initializes population efficiently with the Nawaz-Enscore-Ham (NEH heuristic technique and uses an evolutionary search guided by the mechanism of PSO, as well as simulated annealing based on a local neighborhood search to avoid getting stuck in local optima and to provide the appropriate balance of global exploration and local exploitation. Extensive computational experiments are carried out based on Taillard’s benchmark suite. Computational results and comparisons with existing metaheuristics show that the PHPSO algorithm outperforms the existing methods in terms of quality search and robustness for the problem considered. The improvement in solution quality is confirmed by statistical tests of significance.

  20. Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

    Science.gov (United States)

    Klersy, P C; Arlt, F; Hofer, M; Meixensberger, J

    2018-01-01

    A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

  1. Making Time for Nature: Visual Exposure to Natural Environments Lengthens Subjective Time Perception and Reduces Impulsivity.

    Directory of Open Access Journals (Sweden)

    Meredith S Berry

    Full Text Available Impulsivity in delay discounting is associated with maladaptive behaviors such as overeating and drug and alcohol abuse. Researchers have recently noted that delay discounting, even when measured by a brief laboratory task, may be the best predictor of human health related behaviors (e.g., exercise currently available. Identifying techniques to decrease impulsivity in delay discounting, therefore, could help improve decision-making on a global scale. Visual exposure to natural environments is one recent approach shown to decrease impulsive decision-making in a delay discounting task, although the mechanism driving this result is currently unknown. The present experiment was thus designed to evaluate not only whether visual exposure to natural (mountains, lakes relative to built (buildings, cities environments resulted in less impulsivity, but also whether this exposure influenced time perception. Participants were randomly assigned to either a natural environment condition or a built environment condition. Participants viewed photographs of either natural scenes or built scenes before and during a delay discounting task in which they made choices about receiving immediate or delayed hypothetical monetary outcomes. Participants also completed an interval bisection task in which natural or built stimuli were judged as relatively longer or shorter presentation durations. Following the delay discounting and interval bisection tasks, additional measures of time perception were administered, including how many minutes participants thought had passed during the session and a scale measurement of whether time "flew" or "dragged" during the session. Participants exposed to natural as opposed to built scenes were less impulsive and also reported longer subjective session times, although no differences across groups were revealed with the interval bisection task. These results are the first to suggest that decreased impulsivity from exposure to natural as

  2. Traffic pollutants measured inside vehicles waiting in line at a major US-Mexico Port of Entry.

    Science.gov (United States)

    Quintana, Penelope J E; Khalighi, Mehdi; Castillo Quiñones, Javier Emmanuel; Patel, Zalak; Guerrero Garcia, Jesus; Martinez Vergara, Paulina; Bryden, Megan; Mantz, Antoinette

    2018-05-01

    At US-Mexico border Ports of Entry, vehicles idle for long times waiting to cross northbound into the US. Long wait times at the border have mainly been studied as an economic issue, however, exposures to emissions from idling vehicles can also present an exposure risk. Here we present the first data on in-vehicle exposures to driver and passengers crossing the US-Mexico border at the San Ysidro, California Port of Entry (SYPOE). Participants were recruited who regularly commuted across the border in either direction and told to drive a scripted route between two border universities, one in the US and one in Mexico. Instruments were placed in participants' cars prior to commute to monitor-1-minute average levels of the traffic pollutants ultrafine particles (UFP), black carbon (BC) and carbon monoxide (CO) in the breathing zone of drivers and passengers. Location was determined by a GPS monitor. Results reported here are for 68 northbound participant trips. The highest median levels of in-vehicle UFP were recorded during the wait to cross at the SYPOE (median 29,692particles/cm 3 ) significantly higher than the portion of the commute in the US (median 20,508particles/cm 3 ) though not that portion in Mexico (median 22, 191particles/cm 3 ). In-vehicle BC levels at the border were significantly lower than in other parts of the commute. Our results indicate that waiting in line at the SYPOE contributes a median 62.5% (range 15.5%-86.0%) of a cross-border commuter's exposure to UFP and a median 44.5% (range (10.6-79.7%) of exposure to BC inside the vehicle while traveling in the northbound direction. Reducing border wait time can significantly reduce in-vehicle exposures to toxic air pollutants such as UFP and BC, and these preventable exposures can be considered an environmental justice issue. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Reducing the time until psychotherapy initiation reduces sick leave duration in participants diagnosed with anxiety and mood disorders.

    Science.gov (United States)

    Alonso, Sandra; Marco, José H; Andani, Joaquín

    2018-01-01

    Sick leave in patients with a mental disorder is characterized by having a long duration. Studies suggest that the time until a patient on sick leave for a common mental health disorder initiates evaluation and treatment by a healthcare professional is an important factor in the duration of the sick leave. However, in these studies, the intervention was not performed by a mental health specialist. The aim of this study was to find out whether the length of sick leave was associated with the time before initiating psychotherapy, age, time until returning to work after psychotherapy ends, and duration of psychotherapy. In a further analysis, we examined whether the model composed of age, duration of psychotherapy, and time before initiating psychotherapy predicted the length of sick leave. The sample consisted of 2,423 participants, 64.1% (n = 1,554) women and 35.9% (n = 869) men, who were on sick leave for anxiety disorders or depressive disorder. The total duration of the sick leave of participants diagnosed with depression and anxiety was positively associated with the time before beginning psychotherapy. Time before beginning psychotherapy predicted the length of sick leave when the variables age and duration of psychotherapy were controlled. It is necessary to reduce the time until beginning psychotherapy in people on sick leave for common mental disorders. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Linear Parameter Varying Versus Linear Time Invariant Reduced Order Controller Design of Turboprop Aircraft Dynamics

    Directory of Open Access Journals (Sweden)

    Widowati

    2012-07-01

    Full Text Available The applicability of parameter varying reduced order controllers to aircraft model is proposed. The generalization of the balanced singular perturbation method of linear time invariant (LTI system is used to reduce the order of linear parameter varying (LPV system. Based on the reduced order model the low-order LPV controller is designed by using synthesis technique. The performance of the reduced order controller is examined by applying it to lateral-directional control of aircraft model having 20th order. Furthermore, the time responses of the closed loop system with reduced order LPV controllers and reduced order LTI controller is compared. From the simulation results, the 8th order LPV controller can maintain stability and to provide the same level of closed-loop systems performance as the full-order LPV controller. It is different with the reduced-order LTI controller that cannot maintain stability and performance for all allowable parameter trajectories.

  5. Reducing acquisition times in multidimensional NMR with a time-optimized Fourier encoding algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Zhiyong [Department of Chemical Physics, Weizmann Institute of Science, Rehovot 76100 (Israel); Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, Fujian 361005 (China); Smith, Pieter E. S.; Frydman, Lucio, E-mail: lucio.frydman@weizmann.ac.il [Department of Chemical Physics, Weizmann Institute of Science, Rehovot 76100 (Israel)

    2014-11-21

    Speeding up the acquisition of multidimensional nuclear magnetic resonance (NMR) spectra is an important topic in contemporary NMR, with central roles in high-throughput investigations and analyses of marginally stable samples. A variety of fast NMR techniques have been developed, including methods based on non-uniform sampling and Hadamard encoding, that overcome the long sampling times inherent to schemes based on fast-Fourier-transform (FFT) methods. Here, we explore the potential of an alternative fast acquisition method that leverages a priori knowledge, to tailor polychromatic pulses and customized time delays for an efficient Fourier encoding of the indirect domain of an NMR experiment. By porting the encoding of the indirect-domain to the excitation process, this strategy avoids potential artifacts associated with non-uniform sampling schemes and uses a minimum number of scans equal to the number of resonances present in the indirect dimension. An added convenience is afforded by the fact that a usual 2D FFT can be used to process the generated data. Acquisitions of 2D heteronuclear correlation NMR spectra on quinine and on the anti-inflammatory drug isobutyl propionic phenolic acid illustrate the new method's performance. This method can be readily automated to deal with complex samples such as those occurring in metabolomics, in in-cell as well as in in vivo NMR applications, where speed and temporal stability are often primary concerns.

  6. Reducing acquisition times in multidimensional NMR with a time-optimized Fourier encoding algorithm

    International Nuclear Information System (INIS)

    Zhang, Zhiyong; Smith, Pieter E. S.; Frydman, Lucio

    2014-01-01

    Speeding up the acquisition of multidimensional nuclear magnetic resonance (NMR) spectra is an important topic in contemporary NMR, with central roles in high-throughput investigations and analyses of marginally stable samples. A variety of fast NMR techniques have been developed, including methods based on non-uniform sampling and Hadamard encoding, that overcome the long sampling times inherent to schemes based on fast-Fourier-transform (FFT) methods. Here, we explore the potential of an alternative fast acquisition method that leverages a priori knowledge, to tailor polychromatic pulses and customized time delays for an efficient Fourier encoding of the indirect domain of an NMR experiment. By porting the encoding of the indirect-domain to the excitation process, this strategy avoids potential artifacts associated with non-uniform sampling schemes and uses a minimum number of scans equal to the number of resonances present in the indirect dimension. An added convenience is afforded by the fact that a usual 2D FFT can be used to process the generated data. Acquisitions of 2D heteronuclear correlation NMR spectra on quinine and on the anti-inflammatory drug isobutyl propionic phenolic acid illustrate the new method's performance. This method can be readily automated to deal with complex samples such as those occurring in metabolomics, in in-cell as well as in in vivo NMR applications, where speed and temporal stability are often primary concerns

  7. Consumer behaviour in the waiting area

    NARCIS (Netherlands)

    Mobach, M.P.

    Objective of the study: To determine consumer behaviour in the pharmacy waiting area. Method: The applied methods for data-collection were direct observations. Three Dutch community pharmacies were selected for the study. The topics in the observation list were based on available services at each

  8. Parental strategies for assisting children to wait.

    Science.gov (United States)

    Cuskelly, Monica; Jobling, Anne; Gilmore, Linda; Glenn, Sheila

    2006-09-01

    This study examined parents' behaviours as they waited with their child. Children were presented with an attractively wrapped gift and then asked not to touch it until the experimenter returned from finishing some work in another room. Three parent groups and their children participated in the study - parents of children with Down syndrome, parents of children with intellectual disability from another cause, and parents of children who were developing typically. There were no significant differences between children in how long they were able to wait before touching the gift. The data from the first two groups were combined for all analyses after it was established that there were no significant differences between them. There were few significant differences between parents of a child with intellectual disability and comparison parents. The former group were more likely to be classified as Authoritarian than were comparison parents, however with one exception, parenting style was unrelated to the strategies parents used in the waiting situation. Very few parents in either group used the opportunity to teach or explicitly praise effective waiting strategies in their children.

  9. Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care.

    Science.gov (United States)

    Anthony, Samantha J; Annunziato, Rachel A; Fairey, Elise; Kelly, Vicky L; So, Stephanie; Wray, Jo

    2014-08-01

    The waiting period for an organ transplant has been described as a time of tremendous uncertainty and vulnerability, posing unique challenges and stressors for pediatric transplant candidates and their families. It has been identified as the most stressful stage of the transplant journey, yet little attention has been given to the physical, psychological, or social impact of the waiting period in the literature. In this review, we discuss the physical, nutritional, and psychosocial implications of the waiting period for child and adolescent transplant candidates and the impact on their parents and siblings. We identify areas for future research and provide recommendations for clinical practice to support children, adolescents, and families during the waiting period. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Probability-Based Determination Methods for Service Waiting in Service-Oriented Computing Environments

    Science.gov (United States)

    Zeng, Sen; Huang, Shuangxi; Liu, Yang

    Cooperative business processes (CBP)-based service-oriented enterprise networks (SOEN) are emerging with the significant advances of enterprise integration and service-oriented architecture. The performance prediction and optimization for CBP-based SOEN is very complex. To meet these challenges, one of the key points is to try to reduce an abstract service’s waiting number of its physical services. This paper introduces a probability-based determination method (PBDM) of an abstract service’ waiting number, M l , and time span, τ i , for its physical services. The determination of M i and τ i is according to the physical services’ arriving rule and their overall performance’s distribution functions. In PBDM, the arriving probability of the physical services with the best overall performance value is a pre-defined reliability. PBDM has made use of the information of the physical services’ arriving rule and performance distribution functions thoroughly, which will improve the computational efficiency for the scheme design and performance optimization of the collaborative business processes in service-oriented computing environments.

  11. Tile Drainage Density Reduces Groundwater Travel Times and Compromises Riparian Buffer Effectiveness.

    Science.gov (United States)

    Schilling, Keith E; Wolter, Calvin F; Isenhart, Thomas M; Schultz, Richard C

    2015-11-01

    Strategies to reduce nitrate-nitrogen (nitrate) pollution delivered to streams often seek to increase groundwater residence time to achieve measureable results, yet the effects of tile drainage on residence time have not been well documented. In this study, we used a geographic information system groundwater travel time model to quantify the effects of artificial subsurface drainage on groundwater travel times in the 7443-ha Bear Creek watershed in north-central Iowa. Our objectives were to evaluate how mean groundwater travel times changed with increasing drainage intensity and to assess how tile drainage density reduces groundwater contributions to riparian buffers. Results indicate that mean groundwater travel times are reduced with increasing degrees of tile drainage. Mean groundwater travel times decreased from 5.6 to 1.1 yr, with drainage densities ranging from 0.005 m (7.6 mi) to 0.04 m (62 mi), respectively. Model simulations indicate that mean travel times with tile drainage are more than 150 times faster than those that existed before settlement. With intensive drainage, less than 2% of the groundwater in the basin appears to flow through a perennial stream buffer, thereby reducing the effectiveness of this practice to reduce stream nitrate loads. Hence, strategies, such as reconnecting tile drainage to buffers, are promising because they increase groundwater residence times in tile-drained watersheds. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  12. The design and testing of interactive hospital spaces to meet the needs of waiting children.

    Science.gov (United States)

    Biddiss, Elaine; McPherson, Amy; Shea, Geoffrey; McKeever, Patricia

    2013-01-01

    To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play. In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes. An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay. ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience. ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community. Design process, healing environments, hospital, interdisciplinary, pediatric.

  13. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kok Robin N

    2012-08-01

    Full Text Available Abstract Background Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. Methods/design A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia are randomly allocated (at a 1:1 ratio to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline and at 3, 6, 9 and 12 months after baseline. Discussion Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Trial registration Netherlands Trial Register NTR2233

  14. Beyond AIRSpeed: How Organizational Modeling and Simulation Further Reduced Engine Maintenance Time

    National Research Council Canada - National Science Library

    Hagan, Joel; Slack, William; Zolin, Roxanne; Dillard, John

    2007-01-01

    The Aircraft Intermediate Maintenance Division (AIMD) at Naval Air Station (NAS) Lemoore, CA, has worked aggressively to reduce engine maintenance time using the tools of the NAVAIR Enterprise AiRSpeed (AiRSpeed) program...

  15. Teaching Evaluation: Waiting for Initiatives

    Directory of Open Access Journals (Sweden)

    Alejandro Canales Sánchez

    2008-08-01

    Full Text Available In this text, it is sustained that, despite the fact that the teaching activity is one of the main functions of higher education institutions or even the only one in most of them, it hasn’t been reflected in the leading initiatives that have been set in motion in this area for the last two decades. In particular, it points out that the wide evaluation politics established in the education system during the late eighties, didn’t consider the teaching activity as a concern issue for the mechanisms or rewards in the evaluation system. Even though the implementation of new actions tried to repair the situation, mainly by improving the quality of working time and the qualifications of the personnel performing these activities; teaching, in strict sense, and the design or application of a new evaluation scheme to strengthen it, didn’t get better.

  16. Patient experiences with interventions to reduce surgery cancellations

    DEFF Research Database (Denmark)

    Hovlid, Einar; von Plessen, Christian; Haug, Kjell

    2013-01-01

    The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency......, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied how patients experienced interventions to reduce cancellations....

  17. VHA Support Service Center Electronic Wait List (EWL)

    Data.gov (United States)

    Department of Veterans Affairs — The goal of the Electronic Wait List (EWL) is to provide care to the patient as quickly as possible. To facilitate this goal, patients may be placed on a Wait List...

  18. Reducing lumber thickness variation using real-time statistical process control

    Science.gov (United States)

    Thomas M. Young; Brian H. Bond; Jan Wiedenbeck

    2002-01-01

    A technology feasibility study for reducing lumber thickness variation was conducted from April 2001 until March 2002 at two sawmills located in the southern U.S. A real-time statistical process control (SPC) system was developed that featured Wonderware human machine interface technology (HMI) with distributed real-time control charts for all sawing centers and...

  19. Maternity waiting homes in Rural Health Centers of Ethiop: The ...

    African Journals Online (AJOL)

    Conclusions: It is necessary to prepare guidelines for the establishment and management of waiting homes as well as set up admission and discharge criteria and to initiate quality control mechanisms. Keywords: Maternity waiting homes, waiting homes, prenatal care, intention to stay postpartum, postpartum care, Ethiopia, ...

  20. Mobile Technology Waiting for the 3G Rush

    Institute of Scientific and Technical Information of China (English)

    HAYET SELLAMI

    2006-01-01

    @@ China is potentially the biggest third generation (3G) mobile market in the world, and everyone is eager to grab a piece of the pie. Foreign carriers are still not allowed to apply for licences since China's decision regarding licensing and adoption of 3G mobile services is still pending, but the waiting list is long. Both Chinese officials and industry executives have stated that they want 3G in place in time for the August 2008 Olympic Games held in Beijing. This tight deadline leaves no room for failure.

  1. A new pathway for elective surgery to reduce cancellation rates

    DEFF Research Database (Denmark)

    Hovlid, Einar; Bukve, Oddbjørn; Haug, Kjell

    2012-01-01

    The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients...

  2. Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic.

    Science.gov (United States)

    Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; Christo, Paul J; Hough, Douglas; Aron, Ravi; Ulatowski, John A

    2015-02-01

    This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time. Prospective quality improvement. Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States. Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months. Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session. Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor. The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times. Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians. Wiley Periodicals, Inc.

  3. Reducing the throughput time of the diagnostic track involving CT scanning with computer simulation

    International Nuclear Information System (INIS)

    Lent, Wineke A.M. van; Deetman, Joost W.; Teertstra, H. Jelle; Muller, Sara H.; Hans, Erwin W.; Harten, Wim H. van

    2012-01-01

    Introduction: To examine the use of computer simulation to reduce the time between the CT request and the consult in which the CT report is discussed (diagnostic track) while restricting idle time and overtime. Methods: After a pre implementation analysis in our case study hospital, by computer simulation three scenarios were evaluated on access time, overtime and idle time of the CT; after implementation these same aspects were evaluated again. Effects on throughput time were measured for outpatient short-term and urgent requests only. Conclusion: The pre implementation analysis showed an average CT access time of 9.8 operating days and an average diagnostic track of 14.5 operating days. Based on the outcomes of the simulation, management changed the capacity for the different patient groups to facilitate a diagnostic track of 10 operating days, with a CT access time of 7 days. After the implementation of changes, the average diagnostic track duration was 12.6 days with an average CT access time of 7.3 days. The fraction of patients with a total throughput time within 10 days increased from 29% to 44% while the utilization remained equal with 82%, the idle time increased by 11% and the overtime decreased by 82%. The fraction of patients that completed the diagnostic track within 10 days improved with 52%. Computer simulation proved useful for studying the effects of proposed scenarios in radiology management. Besides the tangible effects, the simulation increased the awareness that optimizing capacity allocation can reduce access times.

  4. Reducing the throughput time of the diagnostic track involving CT scanning with computer simulation

    Energy Technology Data Exchange (ETDEWEB)

    Lent, Wineke A.M. van, E-mail: w.v.lent@nki.nl [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), P.O. Box 90203, 1006 BE Amsterdam (Netherlands); University of Twente, IGS Institute for Innovation and Governance Studies, Department of Health Technology Services Research (HTSR), Enschede (Netherlands); Deetman, Joost W., E-mail: j.deetman@nki.nl [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), P.O. Box 90203, 1006 BE Amsterdam (Netherlands); Teertstra, H. Jelle, E-mail: h.teertstra@nki.nl [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), P.O. Box 90203, 1006 BE Amsterdam (Netherlands); Muller, Sara H., E-mail: s.muller@nki.nl [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), P.O. Box 90203, 1006 BE Amsterdam (Netherlands); Hans, Erwin W., E-mail: e.w.hans@utwente.nl [University of Twente, School of Management and Governance, Dept. of Industrial Engineering and Business Intelligence Systems, Enschede (Netherlands); Harten, Wim H. van, E-mail: w.v.harten@nki.nl [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), P.O. Box 90203, 1006 BE Amsterdam (Netherlands); University of Twente, IGS Institute for Innovation and Governance Studies, Department of Health Technology Services Research (HTSR), Enschede (Netherlands)

    2012-11-15

    Introduction: To examine the use of computer simulation to reduce the time between the CT request and the consult in which the CT report is discussed (diagnostic track) while restricting idle time and overtime. Methods: After a pre implementation analysis in our case study hospital, by computer simulation three scenarios were evaluated on access time, overtime and idle time of the CT; after implementation these same aspects were evaluated again. Effects on throughput time were measured for outpatient short-term and urgent requests only. Conclusion: The pre implementation analysis showed an average CT access time of 9.8 operating days and an average diagnostic track of 14.5 operating days. Based on the outcomes of the simulation, management changed the capacity for the different patient groups to facilitate a diagnostic track of 10 operating days, with a CT access time of 7 days. After the implementation of changes, the average diagnostic track duration was 12.6 days with an average CT access time of 7.3 days. The fraction of patients with a total throughput time within 10 days increased from 29% to 44% while the utilization remained equal with 82%, the idle time increased by 11% and the overtime decreased by 82%. The fraction of patients that completed the diagnostic track within 10 days improved with 52%. Computer simulation proved useful for studying the effects of proposed scenarios in radiology management. Besides the tangible effects, the simulation increased the awareness that optimizing capacity allocation can reduce access times.

  5. Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

    DEFF Research Database (Denmark)

    Hansen, L. K.; Folkestad, L.; Brabrand, M.

    2013-01-01

    BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...... physicians were included. All had prior experience in advanced life support. Chest compressions were shorter interrupted using ALT (mean, 6.7 vs 13.0 seconds). Analyzing data for ventricular tachycardia scenarios only, hands-off time was shorter using ALT (mean, 7.1 vs 18.2 seconds). In ERC 2010 vs ALT, 12...... physicians were included. Two physicians had not prior experience in advanced life support. Hands-off time was reduced using ALT (mean, 3.9 vs 5.6 seconds). Looking solely at ventricular tachycardia scenarios, hands-off time was shortened using ALT (mean, 4.5 vs 7.6 seconds). No significant reduction...

  6. Negative emotional stimuli reduce contextual cueing but not response times in inefficient search

    OpenAIRE

    Kunar, Melina A.; Watson, Derrick G.; Cole, Louise (Researcher in Psychology); Cox, Angeline

    2014-01-01

    In visual search, previous work has shown that negative stimuli narrow the focus of attention and speed reaction times (RTs). This paper investigates these two effects by first asking whether negative emotional stimuli narrow the focus of attention to reduce the learning of a display context in a contextual cueing task and, second, whether exposure to negative stimuli also reduces RTs in inefficient search tasks. In Experiment 1, participants viewed either negative or neutral images (faces or...

  7. A strategy for reducing turnaround time in design optimization using a distributed computer system

    Science.gov (United States)

    Young, Katherine C.; Padula, Sharon L.; Rogers, James L.

    1988-01-01

    There is a need to explore methods for reducing lengthly computer turnaround or clock time associated with engineering design problems. Different strategies can be employed to reduce this turnaround time. One strategy is to run validated analysis software on a network of existing smaller computers so that portions of the computation can be done in parallel. This paper focuses on the implementation of this method using two types of problems. The first type is a traditional structural design optimization problem, which is characterized by a simple data flow and a complicated analysis. The second type of problem uses an existing computer program designed to study multilevel optimization techniques. This problem is characterized by complicated data flow and a simple analysis. The paper shows that distributed computing can be a viable means for reducing computational turnaround time for engineering design problems that lend themselves to decomposition. Parallel computing can be accomplished with a minimal cost in terms of hardware and software.

  8. Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing

    DEFF Research Database (Denmark)

    Skytte, A-B; Gerdes, Anne-Marie Axø; Andersen, M K

    2010-01-01

    from 306 healthy BRCA carriers with no personal history of ovarian or breast cancer. We found a 10-year uptake of 75% for risk-reducing salpingo-oophorectomy and 50% for risk-reducing mastectomy by time to event analysis. Age and childbirth influenced this decision. The uptake rate has not changed......Once female carriers of a BRCA mutation are identified they have to make decisions on risk management. The aim of this study is to outline the uptake of risk-reducing surgery in the Danish population of BRCA mutation positive women and to search for factors affecting this decision. We analysed data...

  9. Audiovisual biofeedback improves image quality and reduces scan time for respiratory-gated 3D MRI

    Science.gov (United States)

    Lee, D.; Greer, P. B.; Arm, J.; Keall, P.; Kim, T.

    2014-03-01

    The purpose of this study was to test the hypothesis that audiovisual (AV) biofeedback can improve image quality and reduce scan time for respiratory-gated 3D thoracic MRI. For five healthy human subjects respiratory motion guidance in MR scans was provided using an AV biofeedback system, utilizing real-time respiratory motion signals. To investigate the improvement of respiratory-gated 3D MR images between free breathing (FB) and AV biofeedback (AV), each subject underwent two imaging sessions. Respiratory-related motion artifacts and imaging time were qualitatively evaluated in addition to the reproducibility of external (abdominal) motion. In the results, 3D MR images in AV biofeedback showed more anatomic information such as a clear distinction of diaphragm, lung lobes and sharper organ boundaries. The scan time was reduced from 401±215 s in FB to 334±94 s in AV (p-value 0.36). The root mean square variation of the displacement and period of the abdominal motion was reduced from 0.4±0.22 cm and 2.8±2.5 s in FB to 0.1±0.15 cm and 0.9±1.3 s in AV (p-value of displacement audiovisual biofeedback improves image quality and reduces scan time for respiratory-gated 3D MRI. These results suggest that AV biofeedback has the potential to be a useful motion management tool in medical imaging and radiation therapy procedures.

  10. RubiShort: Reducing scan time in 82Rb heart scans to minimize movements artifacts

    DEFF Research Database (Denmark)

    Madsen, Jeppe; Vraa, Kaspar J.; Harms, Hans

    .013x, R2=0.98; %Reversible: y=1.008x, R2=0.95; TPD: y=1.000x, R2=0.99). Conclusion:, Scan time of myocardial perfusion scans using 82Rb can be reduced from 7 min. to 5 min. without loss of quantitative accuracy. Since patient motion is frequent in the last minutes of the scans, scan time reduction...

  11. Transforming Nursing Programs to Reduce Time to Completion. Strategies for Transformative Change

    Science.gov (United States)

    Hudson, A.; King, D.; Combs, M.

    2016-01-01

    This brief focuses on the efforts of the nursing programs at Phillips Community College of the University of Arkansas (PCCUA) to reduce time to completion, increase achievement, and enhance student support. To accomplish these goals, PCCUA involved healthcare providers, faculty, students, college curriculum committees, the Accreditation Commission…

  12. Learning to wait: A laboratory investigation

    Science.gov (United States)

    Oprea, R.; Friedman, D.; Anderson, S.T.

    2009-01-01

    Human subjects decide when to sink a fixed cost C to seize an irreversible investment opportunity whose value V is governed by Brownian motion. The optimal policy is to invest when V first crosses a threshold V* = (1 + w*) C, where the wait option premium w* depends on drift, volatility, and expiration hazard parameters. Subjects in the Low w* treatment on average invest at values quite close to optimum. Subjects in the two Medium and the High w* treatments invested at values below optimum, but with the predicted ordering, and values approached the optimum by the last block of 20 periods. ?? 2009 The Review of Economic Studies Limited.

  13. Evaluation of focused ultrasound algorithms: Issues for reducing pre-focal heating and treatment time.

    Science.gov (United States)

    Yiannakou, Marinos; Trimikliniotis, Michael; Yiallouras, Christos; Damianou, Christakis

    2016-02-01

    Due to the heating in the pre-focal field the delay between successive movements in high intensity focused ultrasound (HIFU) are sometimes as long as 60s, resulting to treatment time in the order of 2-3h. Because there is generally a requirement to reduce treatment time, we were motivated to explore alternative transducer motion algorithms in order to reduce pre-focal heating and treatment time. A 1 MHz single element transducer with 4 cm diameter and 10 cm focal length was used. A simulation model was developed that estimates the temperature, thermal dose and lesion development in the pre-focal field. The simulated temperature history that was combined with the motion algorithms produced thermal maps in the pre-focal region. Polyacrylimde gel phantom was used to evaluate the induced pre-focal heating for each motion algorithm used, and also was used to assess the accuracy of the simulation model. Three out of the six algorithms having successive steps close to each other, exhibited severe heating in the pre-focal field. Minimal heating was produced with the algorithms having successive steps apart from each other (square, square spiral and random). The last three algorithms were improved further (with small cost in time), thus eliminating completely the pre-focal heating and reducing substantially the treatment time as compared to traditional algorithms. Out of the six algorithms, 3 were successful in eliminating the pre-focal heating completely. Because these 3 algorithms required no delay between successive movements (except in the last part of the motion), the treatment time was reduced by 93%. Therefore, it will be possible in the future, to achieve treatment time of focused ultrasound therapies shorter than 30 min. The rate of ablated volume achieved with one of the proposed algorithms was 71 cm(3)/h. The intention of this pilot study was to demonstrate that the navigation algorithms play the most important role in reducing pre-focal heating. By evaluating in

  14. Analysis of satisfaction factors at urban transport interchanges: Measuring travelers’ attitudes to information, security and waiting

    Energy Technology Data Exchange (ETDEWEB)

    Lois Garcia, D.; Monzon de Caceres, A.; Hernandez del Olmo, S.

    2016-07-01

    Transport interchanges can be considered as a node, where people transfer from one mode to another, and as a place to stay, using facilities and services as well as waiting areas. Reducing disruption of transfer in multimodal trips is a key element for assuring seamless mobility in big cities. Based on previous research (Hernández & Monzón, 2016) this paper aims to explore the predictive capacity of attitudes towards several service factors on general satisfaction with transport interchange. Complementary, it was analyzing how personal and trip characteristics are related to evaluation of some variables, and examining the influence of waiting time on the perceived quality. To that end, a two steps methodology was conducted (personal and on-line interview) in a representative sample of 740 users (54% female, 55% work purpose trip). We performed path analysis to test the model showing a satisfactory statistical fit. The model developed show good performance for predicting general satisfaction at Moncloa Transport Interchange (Madrid, Spain). The outputs of the model indicate that Information and Safety and Security factors predicted 49% of general satisfaction. Furthermore, the results showed also a strong association between evaluation of Design and Environmental quality, factors that not affect directly general satisfaction but do so through Information and Safety & Security perception, acting the last as mediator variables. Nevertheless, spending time queuing inside the interchange show a negative influence on Information and Safety & Security, while age of participants affect negatively to Information, which mean that elder have some cognitive accessibility problems. Moreover, our data shows gender differences in safety perception, since women feel less safe (particularity the youngest) inside the interchange. The results indicate a number of priority measures to enhance. (Author)

  15. Caffeine Reduces Reaction Time and Improves Performance in Simulated-Contest of Taekwondo

    Science.gov (United States)

    Santos, Victor G. F.; Santos, Vander R. F.; Felippe, Leandro J. C.; Almeida, Jose W.; Bertuzzi, Rômulo; Kiss, Maria A. P. D. M.; Lima-Silva, Adriano E.

    2014-01-01

    The aim of this study was to investigate the effects of caffeine on reaction time during a specific taekwondo task and athletic performance during a simulated taekwondo contest. Ten taekwondo athletes ingested either 5 mg·kg−1 body mass caffeine or placebo and performed two combats (spaced apart by 20 min). The reaction-time test (five kicks “Bandal Tchagui”) was performed immediately prior to the first combat and immediately after the first and second combats. Caffeine improved reaction time (from 0.42 ± 0.05 to 0.37 ± 0.07 s) only prior to the first combat (P = 0.004). During the first combat, break times during the first two rounds were shorter in caffeine ingestion, followed by higher plasma lactate concentrations compared with placebo (P = 0.029 and 0.014, respectively). During the second combat, skipping-time was reduced, and relative attack times and attack/skipping ratio was increased following ingestion of caffeine during the first two rounds (all P Caffeine resulted in no change in combat intensity parameters between the first and second combat (all P > 0.05), but combat intensity was decreased following placebo (all P caffeine reduced reaction time in non-fatigued conditions and delayed fatigue during successive taekwondo combats. PMID:24518826

  16. Reduced order for nuclear reactor model in frequency and time domain

    International Nuclear Information System (INIS)

    Nugroho, D.H.

    1997-01-01

    In control system theory, a model can be represented by frequency or time domain. In frequency domain, the model was represented by transfer function. in time domain, the model was represented by state space. for the sake of simplification in computation, it is necessary to reduce the model order. the main aim of this research is to find the best in nuclear reactor model. Model order reduction in frequency domain can be done utilizing pole-zero cancellation method; while in time domain utilizing balanced aggregation method the balanced aggregation method was developed by moore (1981). In this paper, the two kinds of method were applied to reduce a nuclear reactor model which was constructed by neutron dynamics and heat transfer equations. to validate that the model characteristics were not change when model order reduction applied, the response was utilized for full and reduced order. it was shown that the nuclear reactor order model can be reduced from order 8 to 2 order 2 is the best order for nuclear reactor model

  17. Reducing of Manufacturing Lead Time by Implementation of Lean Manufacturing Principles

    Directory of Open Access Journals (Sweden)

    Hussein Salem Ketan

    2015-08-01

    Full Text Available Many organizations today are interesting to implementing lean manufacturing principles that should enable them to eliminating the wastes to reducing a manufacturing lead time. This paper concentrates on increasing the competitive level of the company in globalization markets and improving of the productivity by reducing the manufacturing lead time. This will be by using the main tool of lean manufacturing which is value stream mapping (VSM to identifying all the activities of manufacturing process (value and non-value added activities to reducing elimination of wastes (non-value added activities by converting a manufacturing system to pull instead of push by applying some of pull system strategies as kanban and first on first out lane (FIFO. ARENA software is used to simulate the current and future state. This work is executed in the state company for electrical industries in Baghdad. The obtained results of the application showed that implementation of lean principles helped on reducing of a manufacturing lead time by 33%.

  18. Solution of large nonlinear time-dependent problems using reduced coordinates

    International Nuclear Information System (INIS)

    Mish, K.D.

    1987-01-01

    This research is concerned with the idea of reducing a large time-dependent problem, such as one obtained from a finite-element discretization, down to a more manageable size while preserving the most-important physical behavior of the solution. This reduction process is motivated by the concept of a projection operator on a Hilbert Space, and leads to the Lanczos Algorithm for generation of approximate eigenvectors of a large symmetric matrix. The Lanczos Algorithm is then used to develop a reduced form of the spatial component of a time-dependent problem. The solution of the remaining temporal part of the problem is considered from the standpoint of numerical-integration schemes in the time domain. All of these theoretical results are combined to motivate the proposed reduced coordinate algorithm. This algorithm is then developed, discussed, and compared to related methods from the mechanics literature. The proposed reduced coordinate method is then applied to the solution of some representative problems in mechanics. The results of these problems are discussed, conclusions are drawn, and suggestions are made for related future research

  19. The control of deliberate waiting strategies in a stop-signal task

    Directory of Open Access Journals (Sweden)

    R.P. Sylwan

    2004-06-01

    Full Text Available To inhibit an ongoing flow of thoughts or actions has been largely considered to be a crucial executive function, and the stop-signal paradigm makes inhibitory control measurable. Stop-signal tasks usually combine two concurrent tasks, i.e., manual responses to a primary task (go-task are occasionally countermanded by a stimulus which signals participants to inhibit their response in that trial (stop-task. Participants are always instructed not to wait for the stop-signal, since waiting strategies cause the response times to be unstable, invalidating the data. The aim of the present study was to experimentally control the strategies of waiting deliberately for the stop-signal in a stop-task by means of an algorithm that measured the variation in the reaction times to go-stimuli on-line, and displayed a warning legend urging participants to be faster when their reaction times were more than two standard deviations of the mean. Thirty-four university students performed a stop-task with go- and stop-stimuli, both of which were delivered in the visual modality and were lateralized within the visual field. The participants were divided into two groups (group A, without the algorithm, vs group B, with the algorithm. Group B exhibited lower variability of reaction times to go-stimuli, whereas no significant between-group differences were found in any of the measures of inhibitory control, showing that the algorithm succeeded in controlling the deliberate waiting strategies. Differences between deliberate and unintentional waiting strategies, and anxiety as a probable factor responsible for individual differences in deliberate waiting behavior, are discussed.

  20. Real-time, high frequency QRS electrocardiograph with reduced amplitude zone detection

    Science.gov (United States)

    Schlegel, Todd T. (Inventor); DePalma, Jude L. (Inventor); Moradi, Saeed (Inventor)

    2009-01-01

    Real time cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed in real time in a useful form on a computer screen or monitor. The monitor displays the high frequency data from the QRS complex in units of microvolts, juxtaposed with a display of conventional ECG data in units of millivolts or microvolts. The high frequency data are analyzed for their root mean square (RMS) voltage values and the discrete RMS values and related parameters are displayed in real time. The high frequency data from the QRS complex are analyzed with imbedded algorithms to determine the presence or absence of reduced amplitude zones, referred to herein as ''RAZs''. RAZs are displayed as ''go, no-go'' signals on the computer monitor. The RMS and related values of the high frequency components are displayed as time varying signals, and the presence or absence of RAZs may be similarly displayed over time.

  1. Participatory workplace interventions can reduce sedentary time for office workers--a randomised controlled trial.

    Science.gov (United States)

    Parry, Sharon; Straker, Leon; Gilson, Nicholas D; Smith, Anne J

    2013-01-01

    Occupational sedentary behaviour is an important contributor to overall sedentary risk. There is limited evidence for effective workplace interventions to reduce occupational sedentary time and increase light activity during work hours. The purpose of the study was to determine if participatory workplace interventions could reduce total sedentary time, sustained sedentary time (bouts >30 minutes), increase the frequency of breaks in sedentary time and promote light intensity activity and moderate/vigorous activity (MVPA) during work hours. A randomised controlled trial (ANZCTR NUMBER: ACTN12612000743864) was conducted using clerical, call centre and data processing workers (n = 62, aged 25-59 years) in 3 large government organisations in Perth, Australia. Three groups developed interventions with a participatory approach: 'Active office' (n = 19), 'Active Workstation' and promotion of incidental office activity; 'Traditional physical activity' (n = 14), pedometer challenge to increase activity between productive work time and 'Office ergonomics' (n = 29), computer workstation design and breaking up computer tasks. Accelerometer (ActiGraph GT3X, 7 days) determined sedentary time, sustained sedentary time, breaks in sedentary time, light intensity activity and MVPA on work days and during work hours were measured before and following a 12 week intervention period. For all participants there was a significant reduction in sedentary time on work days (-1.6%, p = 0.006) and during work hours (-1.7%, p = 0.014) and a significant increase in number of breaks/sedentary hour on work days (0.64, p = 0.005) and during work hours (0.72, p = 0.015); there was a concurrent significant increase in light activity during work hours (1.5%, p = 0.012) and MVPA on work days (0.6%, p = 0.012). This study explored novel ways to modify work practices to reduce occupational sedentary behaviour. Participatory workplace interventions can reduce

  2. Participatory workplace interventions can reduce sedentary time for office workers--a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Sharon Parry

    Full Text Available BACKGROUND: Occupational sedentary behaviour is an important contributor to overall sedentary risk. There is limited evidence for effective workplace interventions to reduce occupational sedentary time and increase light activity during work hours. The purpose of the study was to determine if participatory workplace interventions could reduce total sedentary time, sustained sedentary time (bouts >30 minutes, increase the frequency of breaks in sedentary time and promote light intensity activity and moderate/vigorous activity (MVPA during work hours. METHODS: A randomised controlled trial (ANZCTR NUMBER: ACTN12612000743864 was conducted using clerical, call centre and data processing workers (n = 62, aged 25-59 years in 3 large government organisations in Perth, Australia. Three groups developed interventions with a participatory approach: 'Active office' (n = 19, 'Active Workstation' and promotion of incidental office activity; 'Traditional physical activity' (n = 14, pedometer challenge to increase activity between productive work time and 'Office ergonomics' (n = 29, computer workstation design and breaking up computer tasks. Accelerometer (ActiGraph GT3X, 7 days determined sedentary time, sustained sedentary time, breaks in sedentary time, light intensity activity and MVPA on work days and during work hours were measured before and following a 12 week intervention period. RESULTS: For all participants there was a significant reduction in sedentary time on work days (-1.6%, p = 0.006 and during work hours (-1.7%, p = 0.014 and a significant increase in number of breaks/sedentary hour on work days (0.64, p = 0.005 and during work hours (0.72, p = 0.015; there was a concurrent significant increase in light activity during work hours (1.5%, p = 0.012 and MVPA on work days (0.6%, p = 0.012. CONCLUSIONS: This study explored novel ways to modify work practices to reduce occupational sedentary behaviour

  3. Audiovisual biofeedback improves image quality and reduces scan time for respiratory-gated 3D MRI

    International Nuclear Information System (INIS)

    Lee, D; Keall, P; Kim, T; Greer, P B; Arm, J

    2014-01-01

    The purpose of this study was to test the hypothesis that audiovisual (AV) biofeedback can improve image quality and reduce scan time for respiratory-gated 3D thoracic MRI. For five healthy human subjects respiratory motion guidance in MR scans was provided using an AV biofeedback system, utilizing real-time respiratory motion signals. To investigate the improvement of respiratory-gated 3D MR images between free breathing (FB) and AV biofeedback (AV), each subject underwent two imaging sessions. Respiratory-related motion artifacts and imaging time were qualitatively evaluated in addition to the reproducibility of external (abdominal) motion. In the results, 3D MR images in AV biofeedback showed more anatomic information such as a clear distinction of diaphragm, lung lobes and sharper organ boundaries. The scan time was reduced from 401±215 s in FB to 334±94 s in AV (p-value 0.36). The root mean square variation of the displacement and period of the abdominal motion was reduced from 0.4±0.22 cm and 2.8±2.5 s in FB to 0.1±0.15 cm and 0.9±1.3 s in AV (p-value of displacement <0.01 and p-value of period 0.12). This study demonstrated that audiovisual biofeedback improves image quality and reduces scan time for respiratory-gated 3D MRI. These results suggest that AV biofeedback has the potential to be a useful motion management tool in medical imaging and radiation therapy procedures.

  4. Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward.

    Science.gov (United States)

    Newton, Richard J G; Stuart, Grant M; Willdridge, Daniel J; Thomas, Mark

    2017-08-01

    We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours. Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers. We conducted a QI project from January 2014 until August 2016 at a large tertiary pediatric teaching hospital. Baseline data and the magnitude of the problem were obtained from pilot studies. This allowed us to build a key driver diagram, a process map and conduct a failure mode and effects analysis. Using a framework of Plan-Do-Study-Act cycles our key interventions primarily focused on reducing confusion over procedure start times, giving parents accurate information, empowering staff and reducing variation by allowing children to drink on arrival (up to one hour) before surgery. Prior to this project, using the 6,4,2 fasting rule for solids, breast milk, and clear fluids, respectively, 19% of children were fasted for fluid for less than 4 hours, mean fluid fasting time was 6.3 hours (SD 4.48). At the conclusion 72% of patients received a drink within 4 hours, mean fluid fasting reduced to 3.1 hours (SD 2.33). The secondary measures of aspiration (4.14:10 000) and cancellations have not increased since starting this project. By using established QI methodology we reduced the mean fluid fasting time for day admissions at our hospital to 3.1 hours and increased the proportion of children fasting for less than 4 hours from 19% to 72%. © 2017 John Wiley & Sons Ltd.

  5. Analysis of high-level radioactive slurries as a method to reduce DWPF turnaround times

    International Nuclear Information System (INIS)

    Coleman, C.J.; Bibler, N.E.; Ferrara, D.M.; Hay, M.S.

    1996-01-01

    Analysis of Defense Waste Processing Facility (DWPF) samples as slurries rather than as dried or vitrified samples is an effective way to reduce sample turnaround times. Slurries can be dissolved with a mixture of concentrated acids to yield solutions for elemental analysis by inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Slurry analyses can be performed in eight hours, whereas analyses of vitrified samples require up to 40 hours to complete. Analyses of melter feed samples consisting of the DWPF borosilicate frit and either simulated or actual DWPF radioactive sludge were typically within a range of 3--5% of the predicted value based on the relative amounts of sludge and frit added to the slurry. The results indicate that the slurry analysis approach yields analytical accuracy and precision competitive with those obtained from analyses of vitrified samples. Slurry analyses offer a viable alternative to analyses of solid samples as a simple way to reduce analytical turnaround times

  6. Use of videoconferencing in Wales to reduce carbon dioxide emissions, travel costs and time.

    Science.gov (United States)

    Lewis, Delyth; Tranter, Glynis; Axford, Alan T

    2009-01-01

    In September 2005 a telemedicine service was started to assist multidisciplinary teams in Wales to improve cancer services. In October 2006 and October 2007 users of videoconferencing equipment at one site completed questionnaires. During October 2006 a total of 18,000 km of car travel were avoided, equivalent to 1696 kg of CO(2) emission. During October 2007 a total of 20,800 km of car travel were avoided, equivalent to 2590 kg of CO(2) emission. We estimate that 48 trees would take a year to absorb that quantity of CO(2). The results of the surveys show that exploiting telemedicine makes better use of staff time, reduces the time spent travelling and assists in reducing climate change by limiting the emissions of CO(2).

  7. Effect of hydraulic retention time on metal precipitation in sulfate reducing inverse fluidized bed reactors

    KAUST Repository

    Villa-Gómez, Denys Kristalia

    2014-02-13

    BACKGROUND: Metal sulfide recovery in sulfate reducing bioreactors is a challenge due to the formation of small precipitates with poor settling properties. The size of the metal sulfide precipitates with the change in operational parameters such as pH, sulfide concentration and reactor configuration has been previously studied. The effect of the hydraulic retention time (HRT) on the metal precipitate characteristics such as particle size for settling has not yet been addressed. RESULTS: The change in size of the metal (Cu, Zn, Pb and Cd) sulfide precipitates as a function of the HRT was studied in two sulfate reducing inversed fluidized bed (IFB) reactors operating at different chemical oxygen demand concentrations to produce high and low sulfide concentrations. The decrease of the HRT from 24 to 9h in both IFB reactors affected the contact time of the precipitates formed, thus making differences in aggregation and particle growth regardless of the differences in sulfide concentration. Further HRT decrease to 4.5h affected the sulfate reducing activity for sulfide production and hence, the supersaturation level and solid phase speciation. Metal sulfide precipitates affected the sulfate reducing activity and community in the biofilm, probably because of the stronger local supersaturation causing metal sulfides accumulation in the biofilm. CONCLUSIONS: This study shows that the HRT is an important factor determining the size and thus the settling rate of the metal sulfides formed in bioreactors.

  8. Does Financial Development Reduce CO2 Emissions in Malaysian Economy? A Time Series Analysis

    OpenAIRE

    Shahbaz, Muhammad; Solarin, Sakiru Adebola; Mahmood, Haider

    2012-01-01

    This study deals with the question whether financial development reduces CO2 emissions or not in case of Malaysia. For this purpose, we apply the bounds testing approach to cointegration for long run relations between the variables. The study uses annual time series data over the period 1971-2008. Ng-Perron stationarity test is applied to test the unit root properties of the series. Our results validate the presence of cointegration between CO2 emissions, financial development, energy co...

  9. Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping".

    Science.gov (United States)

    Verma, Jennifer Y; Amar, Claudia

    2015-07-28

    Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs. © 2015 by Kerman University of Medical Sciences.

  10. Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Verma

    2015-11-01

    Full Text Available Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects and containing costs (eg, improving integration of services as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim; and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.

  11. Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ahmed A. EL-Nawawy

    Full Text Available Abstract Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%, with significantly reduced shock reversal time (3.3 vs. 4.5 days. Pediatric intensive care unit stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days. Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%. In the study group, inotropes were used more frequently (89% vs. 67% and initiated earlier (12[0.5-24] vs. 24[6-72] h with lower maximum vasopressor inotrope score (120[30-325] vs. 170[80-395], revealing predominant use of milrinone (62% vs. 22%. Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock.

  12. Interventions to reduce postpartum stress in first-time mothers: a randomized-controlled trial.

    Science.gov (United States)

    Osman, Hibah; Saliba, Matilda; Chaaya, Monique; Naasan, Georges

    2014-10-15

    The postpartum period can be a challenging time particularly for first-time mothers. This study aimed to assess two different interventions designed to reduce stress in the postpartum among first-time mothers. Healthy first-time mothers with healthy newborns were recruited from hospitals in Beirut, Lebanon after delivery. The two interventions were a 20-minute film addressing common stressors in the postpartum period and a 24-hour telephone support hotline. Participants were randomized to one of four study arms to receive either the postpartum support film, the hotline service, both interventions, or a music CD (control). Participants were interviewed at eight to twelve weeks postpartum for assessment of levels of stress as measured by the Cohen Perceived Stress Scale (PSS-10). Of the 632 eligible women, 552 (88%) agreed to participate in the study. Of those, 452 (82%) completed the study. Mean PSS-10 scores of mothers who received the film alone (15.76) or the film with the hotline service (15.86) were significantly lower than that of the control group (18.93) (p-value film and the 24-hour telephone hotline service reduced stress in the postpartum period in first-time mothers. These simple interventions can be easily implemented and could have an important impact on the mental wellbeing of new mothers. The trial was registered with clinicaltrials.gov (identifier # NCT00857051) on March 5, 2009.

  13. An intervention to preschool children for reducing screen time: a randomized controlled trial.

    Science.gov (United States)

    Yilmaz, G; Demirli Caylan, N; Karacan, C D

    2015-05-01

    Screen time, defined as time spent watching television, DVDs, or videos or playing computer or video games, has been related to serious health consequences in children, such as impaired language acquisition, violent behaviour, tobacco smoking and obesity. Our aim was to determine if a simple intervention aimed at preschool-aged children, applied at the health maintenance visits, in the primary care setting, would be effective in reducing screen time. We used a two group randomized controlled trial design. Two- to 6-year-old children and their parents were randomly assigned to receive an intervention to reduce their screen time, BMI and parental report of aggressive behaviour. At the end of the intervention we made home visits at 2, 6 and 9 months and the parents completed questionnaire. Parents in the intervention group reported less screen time and less aggressive behaviour than those in the control group but there were no differences in BMI z scores. This study shows that a preschool-based intervention can lead to reductions in young children's television/video viewing. © 2014 John Wiley & Sons Ltd.

  14. Decay of autoionizing states in time-dependent density functional and reduced density matrix functional theory

    Energy Technology Data Exchange (ETDEWEB)

    Kapoor, Varun; Brics, Martins; Bauer, Dieter [Institut fuer Physik, Universitaet Rostock, 18051 Rostock (Germany)

    2013-07-01

    Autoionizing states are inaccessible to time-dependent density functional theory (TDDFT) using known, adiabatic Kohn-Sham (KS) potentials. We determine the exact KS potential for a numerically exactly solvable model Helium atom interacting with a laser field that is populating an autoionizing state. The exact single-particle density of the population in the autoionizing state corresponds to that of the energetically lowest quasi-stationary state in the exact KS potential. We describe how this exact potential controls the decay by a barrier whose height and width allows for the density to tunnel out and decay with the same rate as in the ab initio time-dependent Schroedinger calculation. However, devising a useful exchange-correlation potential that is capable of governing such a scenario in general and in more complex systems is hopeless. As an improvement over TDDFT, time-dependent reduced density matrix functional theory has been proposed. We are able to obtain for the above described autoionization process the exact time-dependent natural orbitals (i.e., the eigenfunctions of the exact, time-dependent one-body reduced density matrix) and study the potentials that appear in the equations of motion for the natural orbitals and the structure of the two-body density matrix expanded in them.

  15. USING CENTER HOLE HEAT TRANSFER TO REDUCE FORMATION TIMES FOR CERAMIC WASTE FORMS FROM PYROPROCESSING

    International Nuclear Information System (INIS)

    Kenneth J. Bateman; Charles W. Solbrig

    2006-01-01

    The waste produced from processing spent fuel from the EBR II reactor must be processed into a waste form suitable for long term storage in Yucca Mountain. The method chosen produces zeolite granules mixed with glass frit, which must then be converted into a solid. This is accomplished by loading it into a can and heating to 900 C in a furnace regulated at 915 C. During heatup to 900 C, the zeolite and glass frit react and consolidate to produce a sodalite monolith. The resultant ceramic waste form (CWF) is then cooled. The waste is 52 cm in diameter and initially 300 cm long but consolidates to 150 cm long during the heating process. After cooling it is then inserted in a 5-DHLW/DOE SNF Long Canister. Without intervention, the waste takes 82 hours to heat up to 900 C in a furnace designed to geometrically fit the cylindrical waste form. This paper investigates the reduction in heating times possible with four different methods of additional heating through a center hole. The hole size is kept small to maximize the amount of CWF that is processed in a single run. A hole radius of 1.82 cm was selected which removes only 1% of the CWF. A reference computation was done with a specified inner hole surface temperature of 915 C to provide a benchmark for the amount of improvement which can be made. It showed that the heatup time can potentially be reduced to 43 hours with center hole heating. The first method, simply pouring high temperature liquid aluminum into the hole, did not produce any noticeable effect on reducing heat up times. The second method, flowing liquid aluminum through the hole, works well as long as the velocity is high enough (2.5 cm/sec) to prevent solidification of the aluminum during the initial front movement of the aluminum into the center hole. The velocity can be reduced to 1 cm/sec after the initial front has traversed the ceramic. This procedure reduces the formation time to near that of the reference case. The third method, flowing a gas

  16. Controlling spark timing for consecutive cycles to reduce the cyclic variations of SI engines

    International Nuclear Information System (INIS)

    Kaleli, Alirıza; Ceviz, Mehmet Akif; Erenturk, Köksal

    2015-01-01

    Minimization of the cyclic variations is one of the most important design goal for spark-ignited engines. Primary motivation of this study is to reduce the cyclic variations in spark ignition engines by controlling the spark timing for consecutive cycles. A stochastic model was performed between spark timing and in–cylinder maximum pressure by using the system identification techniques. The incylinder maximum pressure of the next cycle was predicted with this model. Minimum variance and generalized minimum variance controllers were designed to regulate the in–cylinder maximum pressure by changing the spark timing for consecutive cycles of the test engine. The produced control algorithms were built in LabView environment and installed to the Field Programmable Gate Arrays (FPGA) chassis. According to the test results, the in–cylinder maximum pressure of the next pressure cycle can be predicted fairly well, and the spark timing can be regulated to keep the in–cylinder maximum pressure in a desired band to reduce the cyclic variations. At fixed spark timing experiments, the COV Pmax and COV imep were 3.764 and 0.677%, whereas they decreased to 3.208 and 0.533% when GMV controller was applied, respectively. - Highlights: • Cycle per cycle spark timing control was carried out. • A stochastic process model was described between P max and the spark timing. • The cyclic variations in P max was decreased by keeping it in a desired band. • Different controllers were used to adjust spark timing signal of the next cycle. • COV Pmax was decreased by about 15% by using GMV controller

  17. Change in hearing during 'wait and scan' management of patients with vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Caye-Thomasen, P.; Tos, M.

    2008-01-01

    : At the time of diagnosis, 334 patients (53 per cent) had good hearing and speech discrimination of better than 70 per cent; at the end of the 10-year observation period, this latter percentage was 31 per cent. In 17 per cent of the patients, speech discrimination at diagnosis was 100 per cent; of these, 88......Aim: To evaluate hearing changes during 'wait and scan' management of patients with vestibular schwannoma. Subjects: Over a 10-year period, 636 patients have prospectively been allocated to 'wait and scan' management, with annual magnetic resonance scanning and audiological examination. Results...... surgery and of radiation therapy with those of 'wait and scan' management, it appears that, in vestibular schwannoma patients with a small tumour and normal speech discrimination, the main indication for active treatment should be established tumour growth Udgivelsesdato: 2008/7...

  18. Reduced Operating Time but Not Blood Loss With Cruciate Retaining Total Knee Arthroplasty

    Science.gov (United States)

    Vermesan, Dinu; Trocan, Ilie; Prejbeanu, Radu; Poenaru, Dan V; Haragus, Horia; Gratian, Damian; Marrelli, Massimo; Inchingolo, Francesco; Caprio, Monica; Cagiano, Raffaele; Tatullo, Marco

    2015-01-01

    Background There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant. Methods For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included. Results Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls. Conclusions In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss. PMID:25584102

  19. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery.

    Science.gov (United States)

    Xu, D; Yin, Y; Hou, L; Dai, W

    2016-05-01

    Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX. SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.

  20. Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions.

    Science.gov (United States)

    Loeb, Stacy; Zhou, Qinlian; Siebert, Uwe; Rochau, Ursula; Jahn, Beate; Mühlberger, Nikolai; Carter, H Ballentine; Lepor, Herbert; Braithwaite, R Scott

    2017-12-01

    An increasing proportion of prostate cancer is being managed conservatively. However, there are no randomized trials or consensus regarding the optimal follow-up strategy. To compare life expectancy and quality of life between watchful waiting (WW) versus different strategies of active surveillance (AS). A Markov model was created for US men starting at age 50, diagnosed with localized prostate cancer who chose conservative management by WW or AS using different testing protocols (prostate-specific antigen every 3-6 mo, biopsy every 1-5 yr, or magnetic resonance imaging based). Transition probabilities and utilities were obtained from the literature. Primary outcomes were life years and quality-adjusted life years (QALYs). Secondary outcomes include radical treatment, metastasis, and prostate cancer death. All AS strategies yielded more life years compared with WW. Lifetime risks of prostate cancer death and metastasis were, respectively, 5.42% and 6.40% with AS versus 8.72% and 10.30% with WW. AS yielded more QALYs than WW except in cohorts age >65 yr at diagnosis, or when treatment-related complications were long term. The preferred follow-up strategy was also sensitive to whether people value short-term over long-term benefits (time preference). Depending on the AS protocol, 30-41% underwent radical treatment within 10 yr. Extending the surveillance biopsy interval from 1 to 5 yr reduced life years slightly, with a 0.26 difference in QALYs. AS extends life more than WW, particularly for men with higher-risk features, but this is partly offset by the decrement in quality of life since many men eventually receive treatment. More intensive active surveillance protocols extend life more than watchful waiting, but this is partly offset by decrements in quality of life from subsequent treatment. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  1. Mass measurement on the rp-process waiting point {sup 72}Kr

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, D. [Gesellschaft fuer Schwerionenforschung mbH, Darmstadt (Germany); Kolhinen, V.S. [Jyvaeskylae Univ. (Finland); Audi, G. [CSNSM-IN2P3-Centre National de la Recherche Scientifique (CNRS), 91 - Orsay (FR)] [and others

    2004-06-01

    The mass of one of the three major waiting points in the astrophysical rp-process {sup 72}Kr was measured for the first time with the Penning trap mass spectrometer ISOLTRAP. The measurement yielded a relative mass uncertainty of {delta}m/m=1.2 x 10{sup -7} ({delta}m=8 keV). Other Kr isotopes, also needed for astrophysical calculations, were measured with more than one order of magnitude improved accuracy. We use the ISOLTRAP masses of{sup 72-74}Kr to reanalyze the role of the {sup 72}Kr waiting point in the rp-process during X-ray bursts. (orig.)

  2. Reducing the ecological consequences of night-time light pollution: options and developments.

    Science.gov (United States)

    Gaston, Kevin J; Davies, Thomas W; Bennie, Jonathan; Hopkins, John

    2012-12-01

    1. Much concern has been expressed about the ecological consequences of night-time light pollution. This concern is most often focused on the encroachment of artificial light into previously unlit areas of the night-time environment, but changes in the spectral composition, duration and spatial pattern of light are also recognized as having ecological effects.2. Here, we examine the potential consequences for organisms of five management options to reduce night-time light pollution. These are to (i) prevent areas from being artificially lit; (ii) limit the duration of lighting; (iii) reduce the 'trespass' of lighting into areas that are not intended to be lit (including the night sky); (iv) change the intensity of lighting; and (v) change the spectral composition of lighting.3. Maintaining and increasing natural unlit areas is likely to be the most effective option for reducing the ecological effects of lighting. However, this will often conflict with other social and economic objectives. Decreasing the duration of lighting will reduce energy costs and carbon emissions, but is unlikely to alleviate many impacts on nocturnal and crepuscular animals, as peak times of demand for lighting frequently coincide with those in the activities of these species. Reducing the trespass of lighting will maintain heterogeneity even in otherwise well-lit areas, providing dark refuges that mobile animals can exploit. Decreasing the intensity of lighting will reduce energy consumption and limit both skyglow and the area impacted by high-intensity direct light. Shifts towards 'whiter' light are likely to increase the potential range of environmental impacts as light is emitted across a broader range of wavelengths.4.Synthesis and applications. The artificial lightscape will change considerably over coming decades with the drive for more cost-effective low-carbon street lighting solutions and growth in the artificially lit area. Developing lighting strategies that minimize adverse

  3. Participants' Perceptions on the Use of Wearable Devices to Reduce Sitting Time: Qualitative Analysis.

    Science.gov (United States)

    Takemoto, Michelle; Lewars, Brittany; Hurst, Samantha; Crist, Katie; Nebeker, Camille; Madanat, Hala; Nichols, Jeanne; Rosenberg, Dori E; Kerr, Jacqueline

    2018-03-31

    Recent epidemiological evidence indicates that, on average, people are sedentary for approximately 7.7 hours per day. There are deleterious effects of prolonged sedentary behavior that are separate from participation in physical activity and include increased risk of weight gain, cancer, metabolic syndrome, diabetes, and heart disease. Previous trials have used wearable devices to increase physical activity in studies; however, additional research is needed to fully understand how this technology can be used to reduce sitting time. The purpose of this study was to explore the potential of wearable devices as an intervention tool in a larger sedentary behavior study through a general inductive and deductive analysis of focus group discussions. We conducted four focus groups with 15 participants to discuss 7 different wearable devices with sedentary behavior capabilities. Participants recruited for the focus groups had previously participated in a pilot intervention targeting sedentary behavior over a 3-week period and were knowledgeable about the challenges of reducing sitting time. During the focus groups, participants commented on the wearability, functionality, and feedback mechanism of each device and then identified their two favorite and two least favorite devices. Finally, participants designed and described their ideal or dream wearable device. Two researchers, who have expertise analyzing qualitative data, coded and analyzed the data from the focus groups. A thematic analysis approach using Dedoose software (SocioCultural Research Consultants, LLC version 7.5.9) guided the organization of themes that reflected participants' perspectives. Analysis resulted in 14 codes that we grouped into themes. Three themes emerged from our data: (1) features of the device, (2) data the device collected, and (3) how data are displayed. Current wearable devices for increasing physical activity are insufficient to intervene on sitting time. This was especially evident when

  4. Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

    Directory of Open Access Journals (Sweden)

    Dionne Clermont E

    2009-05-01

    Full Text Available Abstract Background Recent evidences show that education and rehabilitation while waiting for knee replacement have positive effects on the patients' health status. Identification of factors associated with worse pain, function and health-related quality of life (HRQoL while waiting for surgery could help develop pre-surgery rehabilitation interventions that target specifically these factors and prioritize patients that may benefit the most from them. The objectives of this study were to measure pain, stiffness, function and HRQoL in patients at enrolment on waiting lists for knee replacement and to identify demographic, clinical, socioeconomic and psychosocial characteristics associated with these outcomes. Methods This study is part of a broader study measuring the effects of pre-surgery wait in patients scheduled for knee replacement. From 02/2006 to 09/2007, 197 patients newly scheduled for total knee replacement were recruited from the waiting lists of three university hospitals in Quebec City, Canada. Pain, stiffness and function were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC and HRQoL was measured with the SF-36 Health Survey. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Results The scores of all eight HRQoL physical and mental domains of the SF-36 were significantly lower than aged matched Canadian normative data (p Conclusion Patients waiting for knee replacement have poor function and HRQoL. Characteristics that were found to be associated with these outcomes could help develop pre-surgery rehabilitation program and prioritize patients that may benefit the most from them. Such programs could include interventions to reduce psychological distress, therapeutic exercises targeting both knees and weight loss management.

  5. Optimal testing input sets for reduced diagnosis time of nuclear power plant digital electronic circuits

    International Nuclear Information System (INIS)

    Kim, D.S.; Seong, P.H.

    1994-01-01

    This paper describes the optimal testing input sets required for the fault diagnosis of the nuclear power plant digital electronic circuits. With the complicated systems such as very large scale integration (VLSI), nuclear power plant (NPP), and aircraft, testing is the major factor of the maintenance of the system. Particularly, diagnosis time grows quickly with the complexity of the component. In this research, for reduce diagnosis time the authors derived the optimal testing sets that are the minimal testing sets required for detecting the failure and for locating of the failed component. For reduced diagnosis time, the technique presented by Hayes fits best for the approach to testing sets generation among many conventional methods. However, this method has the following disadvantages: (a) it considers only the simple network (b) it concerns only whether the system is in failed state or not and does not provide the way to locate the failed component. Therefore the authors have derived the optimal testing input sets that resolve these problems by Hayes while preserving its advantages. When they applied the optimal testing sets to the automatic fault diagnosis system (AFDS) which incorporates the advanced fault diagnosis method of artificial intelligence technique, they found that the fault diagnosis using the optimal testing sets makes testing the digital electronic circuits much faster than that using exhaustive testing input sets; when they applied them to test the Universal (UV) Card which is a nuclear power plant digital input/output solid state protection system card, they reduced the testing time up to about 100 times

  6. Reducing the metabolic cost of walking with an ankle exoskeleton: interaction between actuation timing and power.

    Science.gov (United States)

    Galle, Samuel; Malcolm, Philippe; Collins, Steven Hartley; De Clercq, Dirk

    2017-04-27

    Powered ankle-foot exoskeletons can reduce the metabolic cost of human walking to below normal levels, but optimal assistance properties remain unclear. The purpose of this study was to test the effects of different assistance timing and power characteristics in an experiment with a tethered ankle-foot exoskeleton. Ten healthy female subjects walked on a treadmill with bilateral ankle-foot exoskeletons in 10 different assistance conditions. Artificial pneumatic muscles assisted plantarflexion during ankle push-off using one of four actuation onset timings (36, 42, 48 and 54% of the stride) and three power levels (average positive exoskeleton power over a stride, summed for both legs, of 0.2, 0.4 and 0.5 W∙kg -1 ). We compared metabolic rate, kinematics and electromyography (EMG) between conditions. Optimal assistance was achieved with an onset of 42% stride and average power of 0.4 W∙kg -1 , leading to 21% reduction in metabolic cost compared to walking with the exoskeleton deactivated and 12% reduction compared to normal walking without the exoskeleton. With suboptimal timing or power, the exoskeleton still reduced metabolic cost, but substantially less so. The relationship between timing, power and metabolic rate was well-characterized by a two-dimensional quadratic function. The assistive mechanisms leading to these improvements included reducing muscular activity in the ankle plantarflexors and assisting leg swing initiation. These results emphasize the importance of optimizing exoskeleton actuation properties when assisting or augmenting human locomotion. Our optimal assistance onset timing and average power levels could be used for other exoskeletons to improve assistance and resulting benefits.

  7. Primary and secondary effects of real-time feedback to reduce vertical loading rate during running.

    Science.gov (United States)

    Baggaley, M; Willy, R W; Meardon, S A

    2017-05-01

    Gait modifications are often proposed to reduce average loading rate (AVLR) during running. While many modifications may reduce AVLR, little work has investigated secondary gait changes. Thirty-two rearfoot runners [16M, 16F, 24.7 (3.3) years, 22.72 (3.01) kg/m 2 , >16 km/week] ran at a self-selected speed (2.9 ± 0.3 m/s) on an instrumented treadmill, while 3D mechanics were calculated via real-time data acquisition. Real-time visual feedback was provided in a randomized order to cue a forefoot strike (FFS), a minimum 7.5% decrease in step length, or a minimum 15% reduction in AVLR. AVLR was reduced by FFS (mean difference = 26.4 BW/s; 95% CI = 20.1, 32.7; P < 0.001), shortened step length (8.4 BW/s; 95% CI = 2.9, 14.0; P = 0.004), and cues to reduce AVLR (14.9 BW/s; 95% CI = 10.2, 19.6; P < 0.001). FFS, shortened step length, and cues to reduce AVLR all reduced eccentric knee joint work per km [(-48.2 J/kg*m; 95% CI = -58.1, -38.3; P < 0.001), (-35.5 J/kg*m; 95% CI = -42.4, 28.6; P < 0.001), (-23.1 J/kg*m; 95% CI = -33.3, -12.9; P < 0.001)]. However, FFS and cues to reduce AVLR also increased eccentric ankle joint work per km [(54.49 J/kg*m; 95% CI = 45.3, 63.7; P < 0.001), (9.20 J/kg*m; 95% CI = 1.7, 16.7; P = 0.035)]. Potentially injurious secondary effects associated with FFS and cues to reduce AVLR may undermine their clinical utility. Alternatively, a shortened step length resulted in small reductions in AVLR, without any potentially injurious secondary effects. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

    Science.gov (United States)

    Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

    2018-06-01

    Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

  9. Challenges in reducing the computational time of QSTS simulations for distribution system analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Deboever, Jeremiah [Georgia Inst. of Technology, Atlanta, GA (United States); Zhang, Xiaochen [Georgia Inst. of Technology, Atlanta, GA (United States); Reno, Matthew J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Broderick, Robert Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Grijalva, Santiago [Georgia Inst. of Technology, Atlanta, GA (United States); Therrien, Francis [CME International T& D, St. Bruno, QC (Canada)

    2017-06-01

    The rapid increase in penetration of distributed energy resources on the electric power distribution system has created a need for more comprehensive interconnection modelling and impact analysis. Unlike conventional scenario - based studies , quasi - static time - series (QSTS) simulation s can realistically model time - dependent voltage controllers and the diversity of potential impacts that can occur at different times of year . However, to accurately model a distribution system with all its controllable devices, a yearlong simulation at 1 - second resolution is often required , which could take conventional computers a computational time of 10 to 120 hours when an actual unbalanced distribution feeder is modeled . This computational burden is a clear l imitation to the adoption of QSTS simulation s in interconnection studies and for determining optimal control solutions for utility operations . Our ongoing research to improve the speed of QSTS simulation has revealed many unique aspects of distribution system modelling and sequential power flow analysis that make fast QSTS a very difficult problem to solve. In this report , the most relevant challenges in reducing the computational time of QSTS simulations are presented: number of power flows to solve, circuit complexity, time dependence between time steps, multiple valid power flow solutions, controllable element interactions, and extensive accurate simulation analysis.

  10. Learning time-dependent noise to reduce logical errors: real time error rate estimation in quantum error correction

    Science.gov (United States)

    Huo, Ming-Xia; Li, Ying

    2017-12-01

    Quantum error correction is important to quantum information processing, which allows us to reliably process information encoded in quantum error correction codes. Efficient quantum error correction benefits from the knowledge of error rates. We propose a protocol for monitoring error rates in real time without interrupting the quantum error correction. Any adaptation of the quantum error correction code or its implementation circuit is not required. The protocol can be directly applied to the most advanced quantum error correction techniques, e.g. surface code. A Gaussian processes algorithm is used to estimate and predict error rates based on error correction data in the past. We find that using these estimated error rates, the probability of error correction failures can be significantly reduced by a factor increasing with the code distance.

  11. Does Enhancing Work-Time Control and Flexibility Reduce Turnover? A Naturally Occurring Experiment.

    Science.gov (United States)

    Moen, Phyllis; Kelly, Erin L; Hill, Rachelle

    2011-02-01

    We investigate the turnover effects of an organizational innovation (ROWE-Results Only Work Environment) aimed at moving away from standard time practices to focus on results rather than time spent at work. To model rates of turnover, we draw on survey data from a sample of employees at a corporate headquarters (N = 775) and institutional records of turnover over eight months following the ROWE implementation. We find the odds of turnover are indeed lower for employees participating in the ROWE initiative, which offers employees greater work-time control and flexibility, and that this is the case regardless of employees' gender, age, or family life stage. ROWE also moderates the turnover effects of organizational tenure and negative home-to-work spillover, physical symptoms, and job insecurity, with those in ROWE who report these situations generally less likely to leave the organization. Additionally, ROWE reduces turnover intentions among those remaining with the corporation. This research moves the "opting-out" argument from one of private troubles to an issue of greater employee work-time control and flexibility by showing that an organizational policy initiative can reduce turnover.

  12. Use of Six Sigma Methodology to Reduce Appointment Lead-Time in Obstetrics Outpatient Department.

    Science.gov (United States)

    Ortiz Barrios, Miguel A; Felizzola Jiménez, Heriberto

    2016-10-01

    This paper focuses on the issue of longer appointment lead-time in the obstetrics outpatient department of a maternal-child hospital in Colombia. Because of extended appointment lead-time, women with high-risk pregnancy could develop severe complications in their health status and put their babies at risk. This problem was detected through a project selection process explained in this article and to solve it, Six Sigma methodology has been used. First, the process was defined through a SIPOC diagram to identify its input and output variables. Second, six sigma performance indicators were calculated to establish the process baseline. Then, a fishbone diagram was used to determine the possible causes of the problem. These causes were validated with the aid of correlation analysis and other statistical tools. Later, improvement strategies were designed to reduce appointment lead-time in this department. Project results evidenced that average appointment lead-time reduced from 6,89 days to 4,08 days and the deviation standard dropped from 1,57 days to 1,24 days. In this way, the hospital will serve pregnant women faster, which represents a risk reduction of perinatal and maternal mortality.

  13. Reducing children's television-viewing time: a qualitative study of parents and their children.

    Science.gov (United States)

    Jordan, Amy B; Hersey, James C; McDivitt, Judith A; Heitzler, Carrie D

    2006-11-01

    The American Academy of Pediatrics recommends that children over age 2 years spend dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

  14. Waiting for the Barbarians: Conrad, Kafka, Coetzee

    Directory of Open Access Journals (Sweden)

    Simona Micali

    2017-12-01

    Full Text Available The threat of the “Barbarians at the gates”, who bring chaos and death upon civilization, has gradually become one of the thematic obsessions of contemporary imagination. Along the course of the 20th century, the Enemy became less and less the bearer of another culture, and more and more the carrier of a Nonculture or an Anticulture. Such evolution is particularly evident in popular imagination, in all the comics and blockbuster films which stage the final battle between the heros of (white, Western civilization against a dreadful army of barbarian enemies. The article focus on three works – Heart of Darkness by Joseph Conrad, Beim Bau der chinesischen Mauer by Franz Kafka, Waiting for the Barbarians by J.M. Coetzee – which investigate on this mechanism from within, highlighting its ideological implications and its tragic potential.

  15. Can intermittent pneumatic compression (IPC) reduce time to surgery for malleolar fractures?

    DEFF Research Database (Denmark)

    Arndt, K B; Jordy, A; Viberg, Bjarke

    2017-01-01

    BACKGROUND: Surgery of malleolar fractures are often delayed due to oedema of the ankle. The use of intermittent pneumatic compression (IPC) is thought to reduce oedema of the fracture site and thereby time to surgery in patients with malleolar fractures. PURPOSE: To investigate the influence...... of IPC on the time from admission to surgery in adult patients with internal fixated primary malleolar fractures. METHODS: February 1st 2013 IPC was introduced as a standard treatment for all patients admitted with a malleolar fracture. Data was retrieved from the hospital database 2 years prior...... for patients operated after 24h was 21.5 (4.1-57.0) hours for the control group and 18.4 (7.4-32.3) hours in the IPC group (p=0.353). INTERPRETATION: There was no benefit from IPC on time to surgery in patients with acute primary malleolar fracture in a cohort with a mean surgical delay less than 24h....

  16. Intelli-Restore as an Instantaneous Approach for Reduced Data Recovery Time

    Directory of Open Access Journals (Sweden)

    Ismail Lukandu Ateya

    2012-07-01

    Full Text Available Due to the competitive and regulatory pressures and the high demands and dependence placed on data, there is need for higher data availability and a faster means of recovering the data in case it becomes corrupted or lost. Based on results provided on the reasons behind the long / high data recovery times by Kenyan SMEs this paper provides a solution that reduces the data recovery time. In order to solve the problem of high data recovery times, an instantaneous data recovery strategy based on an existing Continuous Data Protection (CDP architecture is introduced as an important component of a well-rounded backup and recovery strategy. CDP is a disk based backup solution which ensures that data is retrieved at a much faster rate during recovery. The solution presented in this paper could help organizations adopt or complement existing data recovery strategies.

  17. Reducing time delays in the management of ischemic stroke patients in Northern Italy.

    Science.gov (United States)

    Vidale, Simone; Arnaboldi, Marco; Bezzi, Giacomo; Bono, Giorgio; Grampa, Giampiero; Guidotti, Mario; Perrone, Patrizia; Salmaggi, Andrea; Zarcone, Davide; Zoli, Alberto; Agostoni, Elio

    2016-07-15

    Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections. Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression. 1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (ptimes were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p<0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study. The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Technical Note: Reducing the spin-up time of integrated surface water–groundwater models

    KAUST Repository

    Ajami, H.

    2014-06-26

    One of the main challenges in catchment scale application of coupled/integrated hydrologic models is specifying a catchment\\'s initial conditions in terms of soil moisture and depth to water table (DTWT) distributions. One approach to reduce uncertainty in model initialization is to run the model recursively using a single or multiple years of forcing data until the system equilibrates with respect to state and diagnostic variables. However, such "spin-up" approaches often require many years of simulations, making them computationally intensive. In this study, a new hybrid approach was developed to reduce the computational burden of spin-up time for an integrated groundwater-surface water-land surface model (ParFlow.CLM) by using a combination of ParFlow.CLM simulations and an empirical DTWT function. The methodology is examined in two catchments located in the temperate and semi-arid regions of Denmark and Australia respectively. Our results illustrate that the hybrid approach reduced the spin-up time required by ParFlow.CLM by up to 50%, and we outline a methodology that is applicable to other coupled/integrated modelling frameworks when initialization from equilibrium state is required.

  19. Computer-aided detection system for chest radiography: reducing report turnaround times of examinations with abnormalities.

    Science.gov (United States)

    Kao, E-Fong; Liu, Gin-Chung; Lee, Lo-Yeh; Tsai, Huei-Yi; Jaw, Twei-Shiun

    2015-06-01

    The ability to give high priority to examinations with pathological findings could be very useful to radiologists with large work lists who wish to first evaluate the most critical studies. A computer-aided detection (CAD) system for identifying chest examinations with abnormalities has therefore been developed. To evaluate the effectiveness of a CAD system on report turnaround times of chest examinations with abnormalities. The CAD system was designed to automatically mark chest examinations with possible abnormalities in the work list of radiologists interpreting chest examinations. The system evaluation was performed in two phases: two radiologists interpreted the chest examinations without CAD in phase 1 and with CAD in phase 2. The time information recorded by the radiology information system was then used to calculate the turnaround times. All chest examinations were reviewed by two other radiologists and were divided into normal and abnormal groups. The turnaround times for the examinations with pathological findings with and without the CAD system assistance were compared. The sensitivity and specificity of the CAD for chest abnormalities were 0.790 and 0.697, respectively, and use of the CAD system decreased the turnaround time for chest examinations with abnormalities by 44%. The turnaround times required for radiologists to identify chest examinations with abnormalities could be reduced by using the CAD system. This system could be useful for radiologists with large work lists who wish to first evaluate the most critical studies. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Psoriatic T cells reduce epidermal turnover time and affect cell proliferation contributed from differential gene expression.

    Science.gov (United States)

    Li, Junqin; Li, Xinhua; Hou, Ruixia; Liu, Ruifeng; Zhao, Xincheng; Dong, Feng; Wang, Chunfang; Yin, Guohua; Zhang, Kaiming

    2015-09-01

    Psoriasis is mediated primarily by T cells, which reduce epidermal turnover time and affect keratinocyte proliferation. We aimed to identify differentially expressed genes (DEG) in T cells from normal, five pairs of monozygotic twins concordant or discordant for psoriasis, to determine whether these DEG may account for the influence to epidermal turnover time and keratinocyte proliferation. The impact of T cells on keratinocyte proliferation and epidermal turnover time were investigated separately by immunohistochemistry and cultured with (3) H-TdR. mRNA expression patterns were investigated by RNA sequencing and verified by real-time reverse transcription polymerase chain reaction. After co-culture with psoriatic T cells, the expression of Ki-67, c-Myc and p53 increased, while expression of Bcl-2 and epidermal turnover time decreased. There were 14 DEG which were found to participate in the regulation of cell proliferation or differentiation. Psoriatic T cells exhibited the ability to decrease epidermal turnover time and affect keratinocyte proliferation because of the differential expression of PPIL1, HSPH1, SENP3, NUP54, FABP5, PLEKHG3, SLC9A9 and CHCHD4. © 2015 Japanese Dermatological Association.

  1. One Improvement Method of Reducing Duration Directly to Solve Time-Cost Tradeoff Problem

    Science.gov (United States)

    Jian-xun, Qi; Dedong, Sun

    Time and cost are two of the most important factors for project plan and schedule management, and specially, time-cost tradeoff problem is one classical problem in project scheduling, which is also a difficult problem. Methods of solving the problem mainly contain method of network flow and method of mending the minimal cost. Thereinto, for the method of mending the minimal cost is intuitionistic, convenient and lesser computation, these advantages make the method being used widely in practice. But disadvantage of the method is that the result of each step is optimal but the terminal result maybe not optimal. In this paper, firstly, method of confirming the maximal effective quantity of reducing duration is designed; secondly, on the basis of above method and the method of mending the minimal cost, the main method of reducing duration directly is designed to solve time-cost tradeoff problem, and by analyzing validity of the method, the method could obtain more optimal result for the problem.

  2. The effect of dentine surface preparation and reduced application time of adhesive on bonding strength.

    Science.gov (United States)

    Saikaew, Pipop; Chowdhury, A F M Almas; Fukuyama, Mai; Kakuda, Shinichi; Carvalho, Ricardo M; Sano, Hidehiko

    2016-04-01

    This study evaluated the effects of surface preparation and the application time of adhesives on the resin-dentine bond strengths with universal adhesives. Sixty molars were cut to exposed mid-coronal dentine and divided into 12 groups (n=5) based on three factors; (1) adhesive: G-Premio Bond (GP, GC Corp., Tokyo, Japan), Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc., Okayama, Japan) and Scotchbond Universal Adhesive (SB, 3M ESPE, St. Paul, MN, USA); (2) smear layer preparation: SiC paper ground dentine or bur-cut dentine; (3) application time: shortened time or as manufacturer's instruction. Fifteen resin-dentine sticks per group were processed for microtensile bond strength test (μTBS) according to non-trimming technique (1mm(2)) after storage in distilled water (37 °C) for 24h. Data were analyzed by three-way ANOVA and Dunnett T3 tests (α=0.05). Fractured surfaces were observed under scanning electron microscope (SEM). Another 12 teeth were prepared and cut into slices for SEM examination of bonded interfaces. μTBS were higher when bonded to SiC-ground dentine according to manufacturer's instruction. Bonding to bur-cut dentine resulted in significantly lower μTBS (padhesive resin interface. This was more pronounced when adhesives were bonded with a reduced application time and on bur cut dentine. The performance of universal adhesives can be compromised on bur cut dentine and when applied with a reduced application time. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Feasibility and acceptability of reducing workplace sitting time: a qualitative study with Australian office workers.

    Science.gov (United States)

    Hadgraft, Nyssa T; Brakenridge, Charlotte L; LaMontagne, Anthony D; Fjeldsoe, Brianna S; Lynch, Brigid M; Dunstan, David W; Owen, Neville; Healy, Genevieve N; Lawler, Sheleigh P

    2016-09-05

    Office workers spend a large proportion of their working hours sitting. This may contribute to an increased risk of chronic disease and premature mortality. While there is growing interest in workplace interventions targeting prolonged sitting, few qualitative studies have explored workers' perceptions of reducing occupational sitting outside of an intervention context. This study explored barriers to reducing office workplace sitting, and the feasibility and acceptability of strategies targeting prolonged sitting in this context. Semi-structured interviews were conducted with a convenience sample of 20 office workers (50 % women), including employees and managers, in Melbourne, Australia. The three organisations (two large, and one small organisation) were from retail, health and IT industries and had not implemented any formalised approaches to sitting reduction. Questions covered barriers to reducing sitting, the feasibility of potential strategies aimed at reducing sitting, and perceived effects on productivity. Interviews were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Participants reported spending most (median: 7.2 h) of their working hours sitting. The nature of computer-based work and exposure to furniture designed for a seated posture were considered to be the main factors influencing sitting time. Low cost strategies, such as standing meetings and in-person communication, were identified as feasible ways to reduce sitting time and were also perceived to have potential productivity benefits. However, social norms around appropriate workplace behaviour and workload pressures were perceived to be barriers to uptake of these strategies. The cost implications of height-adjustable workstations influenced perceptions of feasibility. Managers noted the need for an evidence-based business case supporting action on prolonged sitting, particularly in the context of limited resources and competing workplace health priorities

  4. Feasibility and acceptability of reducing workplace sitting time: a qualitative study with Australian office workers

    Directory of Open Access Journals (Sweden)

    Nyssa T. Hadgraft

    2016-09-01

    Full Text Available Abstract Background Office workers spend a large proportion of their working hours sitting. This may contribute to an increased risk of chronic disease and premature mortality. While there is growing interest in workplace interventions targeting prolonged sitting, few qualitative studies have explored workers’ perceptions of reducing occupational sitting outside of an intervention context. This study explored barriers to reducing office workplace sitting, and the feasibility and acceptability of strategies targeting prolonged sitting in this context. Methods Semi-structured interviews were conducted with a convenience sample of 20 office workers (50 % women, including employees and managers, in Melbourne, Australia. The three organisations (two large, and one small organisation were from retail, health and IT industries and had not implemented any formalised approaches to sitting reduction. Questions covered barriers to reducing sitting, the feasibility of potential strategies aimed at reducing sitting, and perceived effects on productivity. Interviews were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results Participants reported spending most (median: 7.2 h of their working hours sitting. The nature of computer-based work and exposure to furniture designed for a seated posture were considered to be the main factors influencing sitting time. Low cost strategies, such as standing meetings and in-person communication, were identified as feasible ways to reduce sitting time and were also perceived to have potential productivity benefits. However, social norms around appropriate workplace behaviour and workload pressures were perceived to be barriers to uptake of these strategies. The cost implications of height-adjustable workstations influenced perceptions of feasibility. Managers noted the need for an evidence-based business case supporting action on prolonged sitting, particularly in the context of

  5. Wait watchers: the application of a waiting list active management program in ambulatory care.

    Science.gov (United States)

    de Belvis, Antonio Giulio; Marino, Marta; Avolio, Maria; Pelone, Ferruccio; Basso, Danila; Dei Tos, Gian Antonio; Cinquetti, Sandro; Ricciardi, Walter

    2013-04-01

    This study describes and evaluates the application of a waiting list management program in ambulatory care. Waiting list active management survey (telephone call and further contact); before and after controlled trial. Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

  6. Can increasing adult vaccination rates reduce lost time and increase productivity?

    Science.gov (United States)

    Rittle, Chad

    2014-12-01

    This article addresses limited vaccination coverage by providing an overview of the epidemiology of influenza, pertussis, and pneumonia, and the impact these diseases have on work attendance for the worker, the worker's family, and employer profit. Studies focused on the cost of vaccination programs, lost work time, lost employee productivity and acute disease treatment are discussed, as well as strategies for increasing vaccination coverage to reduce overall health care costs for employers. Communicating the benefits of universal vaccination for employees and their families and combating vaccine misinformation among employees are outlined. Copyright 2014, SLACK Incorporated.

  7. The boarding experience from the patient perspective: the wait.

    Science.gov (United States)

    Liu, Shan; Milne, Leslie; Yun, Brian; Walsh, Kathleen

    2015-11-01

    We sought to better understand the experience of being a boarder patient. We conducted a qualitative study between March and August 2012 to examine the experience of boarding in an urban, teaching hospital emergency department (ED). We included boarder patients and selected patients based on a convenience sample. Interviews were semistructured, consisting of eight main open-ended questions. Interviews were transcribed; codes were generated and then organised into categorises and subsequently into one theme. We concluded analysis when we achieved thematic saturation. Our institutional review board approved this study. Our final sample included 18 patients. The average age was 62.3 years. Patients characterised waiting as central to their experience as a boarder patient. One patient stated, "Well if you have to wait for a bed you have to wait for a bed, it's terrible." Three categories exemplified this waiting experience: (1) there was often lack of communication; (2) patients experienced frustration during this waiting period; and yet (3) patients often differentiated the experience of waiting from the care they were receiving. Being a boarder patient was characterised as a waiting experience associated with poor communication and frustration. However, patients may still differentiate their feelings towards the wait from those towards the medical care they are receiving. Our data add more reason to eradicate the practice of ED boarding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Maternity waiting homes in Rural Health Centers of Ethiop: The ...

    African Journals Online (AJOL)

    kim

    1 The Last Ten Kilometers Project, JSI Research & Training Institute, Inc., Addis ... The main aim of this study was to assess the situation of maternity waiting ... experiences and challenges of mothers using waiting homes. ..... education on MWHs were home visits by HEWs ... travel long distances to deliver food, which meant.

  9. It's worth the wait: optimizing questioning methods for effective intraoperative teaching.

    Science.gov (United States)

    Barrett, Meredith; Magas, Christopher P; Gruppen, Larry D; Dedhia, Priya H; Sandhu, Gurjit

    2017-07-01

    The use of questioning to engage learners is critical to furthering resident education intraoperatively. Previous studies have demonstrated that higher level questioning and optimal wait times (>3 s) result in learner responses reflective of higher cognition and retention. Given the importance of intraoperative learning, we investigated question delivery in the operating room. A total of 12 laparoscopic cholecystectomies were observed and recorded. All questions were transcribed and classified using Bloom's Taxonomy, a framework associated with hierarchical levels of learning outcomes. Wait time between question end and response was recorded. Six faculty attendings and seven house officers at our institution were observed. A total of 133 questions were recorded with an average number of questions per case of 11.2. The majority of questions 112 out of 133 (84%) were classified as Bloom's levels 1-3, with only 6% of questions of the highest level. The wait time before the resident answered the question averaged 1.75 s, with attendings interceding after 2.50 s. Question complexity and wait time did not vary based on resident postgraduate year level suggesting limited tailoring of question to learner. Intraoperative questioning is not aligned with higher level thinking. The majority of questions were Bloom's level 3 or below, limiting the complexity of answer formulation. Most responses were given within 2 s, hindering opportunity to pursue higher-order thinking. This suggests including higher level questions and tailoring questions to learner level may improve retention and maximize gains. In addition, with attendings answering 20% of their own questions, increasing their wait time offers another area for teaching development. © 2017 Royal Australasian College of Surgeons.

  10. Waiting for Merlot: anticipatory consumption of experiential and material purchases.

    Science.gov (United States)

    Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas

    2014-10-01

    Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.

  11. Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate.

    Science.gov (United States)

    Kintzel, Polly E; Campbell, Alan D; Yost, Kathleen J; Brinker, Brett T; Arradaza, Nicole V; Frobish, Daniel; Wehr, Alison M; O'Rourke, Timothy J

    2012-06-01

    Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined. Medical records of adult patients receiving HDMTX during the calendar years of 2008-2009 were retrospectively reviewed to determine the time to achieve urine pH > 7. Number of hospital days, bicarbonate dose, ordered hydration rate, urine output, and urine pH were assessed. A survival analysis model was run for time to urine pH > 7 using preadmission oral bicarbonate as a predictor variable and including a frailty term. Observational statistics were performed for other parameters. The analysis included 79 encounters for ten patients. Urine pH > 7 was achieved more rapidly in patients receiving preadmission oral bicarbonate (P = 0.012). The number of patients receiving HDMTX on the same day as admission was greater for those receiving preadmission oral bicarbonate (47%) in comparison to those who did not (2%), and they spent less time in the hospital. A standard regimen for hydration and urinary alkalinization based on this project is reported. The nature and frequency of adverse events were as expected for this treatment. At our institution, the time to achieve urinary alkalinization was reduced for patients receiving preadmission oral bic