Operating Room Scheduling by Using Hybrid Genetic Algorithm

Hospitals are among the most important institutions of today. For hospitals, efficient use of operating rooms is of great importance. Efficient use of operating rooms is a problem that needs to be solved. The operating room scheduling problem is a very complex problem with large number of constraints. This type of problem called as NP-Hard type problem. NP-Hard type problems do not consist of polynomial values. Therefore, the solution of these problems is very complex and difficult. Solutions consisting of polynomial values can be solved effectively with existing mathematical methods. However, more effective algorithms were needed to solve NP-hard type problems. As a result of the studies, many heuristic, meta-heuristic algorithms such as Genetic Algorithm, Particle Swarm Optimization, Simulated Annealing, Taboo Search Algorithm have been developed to solve the complexity of NP-Hard problems. In this article, the operating room scheduling problem solved with a hybrid genetic algorithm. In this solution, it shows how the algorithm affects the solution area in the changes in the number of surgeons, operating rooms and operating room reservations, which are among the operating room parameters. In the developed software, C# programming language has been preferred in order to provide comfortable use of the end user

Integrated Planning in Hospitals: A Review

Efficient planning of scarce resources in hospitals is a challenging task for which a large variety of Operations Research and Management Science approaches have been developed since the 1950s. While efficient planning of single resources such as operating rooms, beds, or specific types of staff can already lead to enormous efficiency gains, integrated planning of several resources has been shown to hold even greater potential, and a large number of integrated planning approaches have been presented in the literature over the past decades. This paper provides the first literature review that focuses specifically on the Operations Research and Management Science literature related to integrated planning of different resources in hospitals. We collect the relevant literature and analyze it regarding different aspects such as uncertainty modeling and the use of real-life data. Several cross comparisons reveal interesting insights concerning, e.g., relations between the modeling and solution methods used and the practical implementation of the approaches developed. Moreover, we provide a high-level taxonomy for classifying different resource-focused integration approaches and point out gaps in the literature as well as promising directions for future research

Effectiveness on stroke health care: a comparison between Brazil and France

Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. To measure the effectiveness of the Brazilian healthcare system, a comparison with another country is desirable. The French healthcare system is considered to be one of the best in the world, the following hypothesis has been developed: Is the French health system more effective in terms of results than the Brazilian in terms of strategies and care in stroke? The general objective was to compare the effectiveness of the Brazilian and French healthcare systems related to stroke care. It was sought to identify the commonalities and discrepancies between both national health policies related to stroke care through the specific objectives that sought to describe health strategies and clinical practice for stroke care in both healthcare systems; to research and to describe the number of acute hospitalizations, the average length of stay in the hospital, hospital mortality rate, deaths and the cost of in-hospital stroke treatment. Methods: Comparison and description of the similarities, differences, or relationships between the data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017. The data were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies. As a result, about acute stroke hospitalizations, the in-hospital mortality rate in Brazil was 163 per 1.000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old the rate did not show any significant growth or decrease and it can be considered stable; from 40-59 years it was increasing in both countries; from 60-79 and 80+ years this average rate has been increasing in France and decreasing in Brazil. Regarding the acute stroke hospitalizations costs from 2010 to 2017, Brazil had an average expenditure of Power Purchasing Parity $79.579.810.78 per year. France had$446.919.476.40. So, after this result, two hypotheses have been put forward to explain these differences: 1) The cost is lower in Brazil because of the economies of scale? This hypothesis is refuted because even if economies of scale are achieved thanks to larger purchases linked to technologies and materials for health services and the optimization of institutional and professional spaces, this hypothesis is not sufficient to explain the difference observed in-hospital costs between Brazil and France. 2) Can the different ways of allocating and managing costs interfere with the final cost? This hypothesis is plausible but would require further investigation. It would be interesting to calculate the costs of hospitalizations for stroke in France using the absorption method and, in turn, in Brazil calculate then using the Diagnoses Related Group method. In this way, it would be possible to know the difference between both countries. This second hypothesis could neither be refuted nor affirmed. Thus, a third hypothesis has been raised - the exchange difference between Brazil (Real) and France (Euros) would lead to the illusion that Brazil is spending less on hospitalizations for stroke? As the Brazilian currency fluctuates in the international forex market, it devalues over time due to the international economic scenario. Although this is a probable hypothesis, it is outside the scope of this thesis, and, for this reason, it was not be tested. The hypotheses discussed are not sufficient to explain the difference in acute hospitalization costs by stroke between Brazil and France. In conclusion, the initial hypothesis seems refuted. Compared to the French healthcare system, the Brazilian healthcare system is more efficient, and it is more effective in terms of in-hospital average stay and in-hospital mortality rate. To conclude, both healthcare systems are constantly changing to meet new needs and obtain sufficient financial resources to provide a quality service to their population. No major differences were found about the health care policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care and the moments after hospital care, such as secondary prevention and palliative care.Les systèmes de santé brésilien et français ont été structurés comme d’accès universel et une prise en charge globale, hiérarchisés par le niveau de soins, décentralisés politiquement et administrativement. Comme le système de santé français est considéré comme l'un des meilleurs au monde l'hypothèse suivante a été élaborée : Est-ce-que le système de santé français est-il plus efficace en résultats que le brésilien en matière de stratégies et soins de santé en cas d’accident vasculaire cérébral ? L'objectif général était de comparer l'efficacité de résultats entre les systèmes de santé brésilien et français liés aux soins de l'Accident Vasculaire Cérébral. L’étude a cherché à identifier les points communs et les divergences entre les deux politiques nationales de santé liées aux soins de l'accident vasculaire cérébral à travers les objectifs spécifiques qui visaient à décrire : les politiques de santé et la pratique clinique pour les soins de l'accident vasculaire cérébral dans les deux systèmes de santé ; de rechercher et de décrire le nombre d'hospitalisations aiguës ; la durée moyenne de séjour à l'hôpital ; le taux de mortalité hospitalière ; les décès et le coût du traitement des accidents vasculaires cérébraux à l'hôpital. Méthodes : Comparaison et description des similitudes, des différences ou des relations entre les données concernant les politiques, les facteurs de risque et les indicateurs de santé concernant les soins de l'accident vasculaire cérébral, de 2010 à 2017. Comme résultats, les données ont été obtenues des deux pays auprès des Ministères de la Santé ou des agences internationales respectifs. Les résultats ont montré que les données directement liées à la période d'hospitalisation entre 2010 et 2017 différaient considérablement d'un pays à l'autre. Par rapport aux hospitalisations dues à un AVC aigu, le taux de mortalité hospitalière au Brésil est de 163 pour 1.000 hospitalisés contre 263 en France. La durée moyenne de séjour des hospitalisations aiguës était de 7.6 jours au Brésil contre 12.6 en France. La prévalence des accident vasculaire cérébraux par tranche d'âge entre 2010 et 2017 montre que pour les 0 à 39 ans le taux n'a pas montré aucune croissance ou diminution importante et peut être considérée comme stable ; des 40-59 ans, il a augmenté dans les deux pays et que de 60-79 ans et 80+ ans, le taux était en augmentation en France alors qu’en baisse au Brésil. Concernant les coûts d'hospitalisation pour AVC aigu de 2010 à 2017, le Brésil avait une dépense moyenne de Parité de Pouvoir d’Achat $79.579.810.78 par an et la France avait$446.919.476.40. Deux hypothèses ont été posées pour expliquer ces différences : 1) le coût est plus faible au Brésil à cause des économies d’échelle ? Cette hypothèse est réfutée car même si des économies d'échelle sont réalisées grâce à des achats plus importants liés aux technologies et aux matériels pour les services de santé ainsi qu’à l'optimisation des espaces institutionnels et professionnels, cette hypothèse ne suffit pas à expliquer la différence constatée entre les coûts d'hospitalisation pour accident vasculaire cérébral au Brésil et en France. 2) La manière différente de répartir et de gérer les coûts peut interférer avec le coût final ? Cette hypothèse est plausible mais nécessiterait une enquête plus approfondie. Il serait intéressant de calculer les coûts des hospitalisations pour accident vasculaire cérébral en France en utilisant la méthode d'absorption et, à son tour, au Brésil, de faire le calcul via le système Diagnoses Related Group. De cette façon, il serait possible de connaître la différence exacte entre les coûts de chaque pays. Comme cette seconde hypothèse ne pouvait être ni réfutée ni affirmée, une troisième hypothèse a été soulevée : la différence de change entre le Brésil (Real) et la France (Euros) conduirait à l'illusion que le Brésil dépense moins en hospitalisations pour accident vasculaire cérébral ? Au fur et à mesure que la monnaie brésilienne fluctue sur le marché des changes international, elle se dévalue avec le temps à cause du scénario économique international. Bien qu'il s'agisse d'une hypothèse probable, elle sort du cadre de cette thèse et, pour cette raison, elle ne fera pas l'objet de recherches. Les hypothèses discutées ne sont pas suffisantes pour expliquer la différence des coûts d'hospitalisation aiguë pour cause d’AVC entre le Brésil et la France. En conclusion, l'hypothèse initiale semble réfutée. Le système de santé brésilien par rapport au système de santé français est plus efficient et il est plus efficace en résultats en ce qui concerne le séjour moyen à l'hôpital et pour le taux de mortalité hospitalière. Les deux systèmes de santé sont en constante évolution pour répondre aux nouveaux besoins et obtenir des ressources financières suffisantes pour fournir un service de qualité à leur population. Aucune différence majeure n'a été trouvée concernant les politiques de santé et les plans nationaux de santé liés à l'AVC. Des études ultérieures peuvent être mises en oeuvre pour identifier les facteurs explicatifs, notamment parmi les facteurs de risque et les actions en soins primaires, et la prise en charge après les soins hospitaliers aigus en termes de prévention secondaire, de réhabilitation, voire en soins palliatifs

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

Association between number of medications and mortality in geriatric inpatients : a Danish nationwide register-based cohort study

Purpose: To explore the association between the number of medications and mortality in geriatric inpatients taking activities of daily living and comorbidities into account. Methods: A nationwide population-based cohort study was performed including all patients aged C65 years admitted to geriatric departments in Denmark during 2005-2014. The outcome of interest was mortality. Activities of daily living using Barthel-Index (BI) were measured at admission. National health registers were used to link data on an individual level extracting data on medications, and hospital diseases. Patients were followed to the end of study (31.12.2015), death, or emigration, which ever occurred first. Kaplan-Meier survival curves were used to estimate crude survival proportions. Univariable and multivariable analyses were performed using Cox regression. The multivariable analysis adjusted for age, marital status, period of hospital admission, BMI, and BI (model 1), and further adding either number of diseases (model 2) or Charlson comorbidity index (model 3). Results: We included 74603 patients (62.8% women), with a median age of 83 (interquartile range [IQR] 77-88) years. Patients used a median of 6 (IQR 4-9) medications. Increasing number of medications was associated with increased overall, 30-days, and 1-year mortality in all 3 multivariable models for both men and women. For each extra medication the mortality increased by 3% in women and 4% in men in the fully adjusted model. Conclusion: Increasing number of medications was associated with mortality in this nationwide cohort of geriatric inpatients. Our findings highlight the importance of polypharmacy in older patients with comorbidities

Physical activity and exercise in dementia : an umbrella review of intervention and observational studies

Background: Dementia is a common condition in older people. Among the potential risk factors, increasing attention has been focused on sedentary behaviour. However, synthesizing literature exploring whether physical activity/exercise can affect health outcomes in people with dementia or with mild cognitive impairment (MCI) is still limited. Therefore, the aim of this umbrella review, promoted by the European Geriatric Medicine Society (EuGMS), is to understand the importance of physical activity/exercise for improving cognitive and non-cognitive outcomes in people with dementia/MCI. Methods: Umbrella review of systematic reviews (SR) (with or without meta-analyses) of randomized controlled trials (RCTs) and observational (prospective and case-control in people with MCI) studies based on a systematic literature search in several databases. The certainty of evidence of statistically significant outcomes attributable to physical activity/exercise interventions was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Among 1,160 articles initially evaluated, 27 systematic reviews (4 without meta-analysis) for a total of 28,205 participants with dementia/MCI were included. No observational study on physical activity/exercise in MCI for preventing dementia was included. In SRs with MAs, physical activity/exercise was effective in improving global cognition in Alzheimer’s disease and in all types of dementia (very low/low certainty of evidence). Moreover, physical activity/ exercise significantly improved global cognition, attention, executive function, and memory in MCI, with a certainty of evidence varying from low to moderate. Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls and neuropsychiatric symptoms. SRs, without meta-analysis, corroborated these results. Conclusions: Supported by very low to moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and non-cognitive outcomes in people with dementia and MCI, but RCTs, with low risk of bias/confounding, are still needed to confirm these findings

An institutional perspective of hospital accreditation: A case study in a Portuguese hospital

This thesis investigated the introduction of the new “bureaucratic-quality” logic in the health sector, where already two dominant logics existed: professional logic and business-like logic (since 2002). This new logic was introduced in the health field, in the beginning of 21st century, through hospital accreditation programs, as a result of a major societal movement that affected public administration – New Public Management. A qualitative approach based on a case study was chosen, as the research questions were according to this method. An interpretative perspective based on institutional theory was used to analyse the dynamics between the various levels: societal, field, organizational and individual. Throughout the study two actors were identified and studied regarding the institutional work they attempted in this process. This investigation demonstrated that the introduction of this new logic at the hospital generated minimal or no conflict. This is explained by the fact that (1) this new logic presented compatible, even intrinsic, goals with the two existing logics, (2) the hospital had unique characteristics that increased the compatibility between these logics, and (3) this new logic preserved the identity of physicians as accreditation programs do not interfere with clinical acts. Notwithstanding, the researcher points out that even with compatible logics, if physicians’ identity had not been preserved, there would have been resistance to the introduction of the new logic. By choosing a cross-sectional analysis to study the process of introducing a new logic, the researcher responds to the numerous calls for investigation of cross-sectional analysis in institutional theory.Esta tese investigou a introdução de uma nova lógica “qualidade burocrática” (associada aos programas de acreditação hospitalar) no sector da saúde, que apresentava já duas lógicas dominantes: a lógica profissional e a lógica empresarial. Esta nova lógica foi introduzida no sector da saúde por via dos processos de acreditação hospitalar, como resultado de um movimento societal que afectou a administração pública – New Public Management. Foi escolhida uma abordagem qualitativa realizada através de um estudo de caso, uma vez que as questões de investigação se adequavam a esse método. Foi utilizada uma perspetiva interpretativa com o intuito de analisar as dinâmicas entre os diversos níveis societal, sectorial, organizacional e individual. Ao longo do estudo foram identificados e estudados dois actores tendo por base o trabalho institucional que intentaram neste processo. Esta investigação demonstrou que a introdução da nova lógica no hospital gerou conflito mínimo ou inexistente. Isso deveu-se ao facto de (1) esta nova lógica apresentar objectivos que eram compatíveis, ou mesmo intrínsecos, às duas lógicas existentes, (2) o hospital apresentar características únicas que aumentaram a compatibilidade entre essas lógicas e (3) esta nova lógica preservar a identidade dos médicos uma vez que os programas de acreditação não interferem com actos clínicos. Não obstante, a investigadora salienta que mesmo no caso de lógicas compatíveis, se a identidade dos médicos não tivesse sido preservada teria existido resistência à introdução da nova lógica. Ao escolher estudar este processo de introdução de uma nova lógica através de uma análise transversal, a investigadora responde às inúmeras solicitações de investigação de análises transversais na teoria institucional