Managing Operational Efficiency And Health Outcomes At Outpatient Clinics Through Effective Scheduling

A variety of studies have documented the substantial deficiencies in the quality of health care delivered across the United States. Attempts to reform the United States health care system in the 1980s and 1990s were inspired by the system\u27s inability to adequately provide access, ensure quality, and restrain costs, but these efforts had limited success. In the era of managed care, access, quality, and costs are still challenges, and medical professionals are increasingly dissatisfied. In recent years, appointment scheduling in outpatient clinics has attracted much attention in health care delivery systems. Increase in demand for health care services as well as health care costs are the most important reasons and motivations for health care decision makers to improve health care systems. The goals of health care systems include patient satisfaction as well as system utilization. Historically, less attention was given to patient satisfaction compared to system utilization and conveniences of care providers. Recently, health care systems have started setting goals regarding patient satisfaction and improving the performance of the health system by providing timely and appropriate health care delivery. In this study we discuss methods for improving patient flow through outpatient clinics considering effective appointment scheduling policies by applying two-stage Stochastic Mixed-Integer Linear Program Model (two-stage SMILP) approaches. Goal is to improve the following patient flow metrics: direct wait time (clinic wait time) and indirect wait time considering patient’s no-show behavior, stochastic server, follow-up surgery appointments, and overbooking. The research seeks to develop two models: 1) a method to optimize the (weekly) scheduling pattern for individual providers that would be updated at regular intervals (e.g., quarterly or annually) based on the type and mix of services rendered and 2) a method for dynamically scheduling patients using the weekly scheduling pattern. Scheduling templates will entertain the possibility of arranging multiple appointments at once. The aim is to increase throughput per session while providing timely care, continuity of care, and overall patient satisfaction as well as equity of resource utilization. First, we use risk-neutral two-stage stochastic programming model where the objective function considers the expected value as a performance criterion in the selection of random variables like total waiting times and next, we expand the model formulation to mean-risk two-stage stochastic programming in which we investigate the effect of considering a risk measure in the model. We apply Conditional-Value-at-Risk (CVaR) as a risk measure for the two-stage stochastic programming model. Results from testing our models using data inspired by real-world OBGYN clinics suggest that the proposed formulations can improve patient satisfaction through reduced direct and indirect waiting times without compromising provider utilization

Digital Diffusion in North Carolina: Appraising the e-NC Initiative

This study appraises the e-NC initiative, an ongoing program in North Carolina to encourage individuals, businesses and public institutions in the state to use information technology, especially the Internet, to improve their economic conditions. The appraisal reviews the premise and the operating strategy of the program, finds both very sound, and suggests issues for future work. Drawing on recent research, the e-NC Authority in future could advise businesses on the most promising information technology packages, and stress the importance of reengineering business processes and workplace practices to reap the full benefits of information technologies. The Authority could also focus its limited advisory and extension resources on those sectors likely to contribute most to productivity growth. And finally, the Authority will need to address the issue of risk management in the face of information technology-related volatility of employment

Louisiana Tech’s Parkinson Resource Center Nursing Student Scholars

The abstract for this presentation can be downloaded by clicking on the blue download button

Female Sexual Dysfunction and its Associated Risk Factors: An Epidemiological Study in the North-East of Iran

Background & aim: Female sexual function (FSD) is a multifactorial phenomenon. Sexual function is influenced by different personal and environmental factors. This study aimed to evaluate FSD and its contributing factors using female sexual function index (FSFI). Methods:This descriptive cross-sectional study was conducted on 264 women referring to 11 health centers of Sabzevar, Iran during October 2012 to January 2013 using a convenience sampling. Data were collected using a validated Persian version of FSFI containing six domains of sexual desire, lubrication, sexual arousal, sexual satisfaction, orgasm and sexual pain as well as demographic questionnaire. A total score of Results: The mean age of women enrolled in this study was 32.2±10.27 years . Considering the cut-off point of sexual dysfunction at 28, 62.1% of the study population had FSD. Highest rate of FSD was estimated at 49.2%, Age was associated with a significant decline in total scores of FSFI (P=0.042). Moreover, a significant correlation was observed between duration of marriage and total scores of FSFI (

National, sub-national, and risk-attributed burden of thyroid cancer in Iran from 1990 to 2019

An updated exploration of the burden of thyroid cancer across a country is always required for making correct decisions. The objective of this study is to present the thyroid cancer burden and attributed burden to the high Body Mass Index (BMI) in Iran at national and sub-national levels from 1990 to 2019. The data was obtained from the GBD 2019 study estimates. To explain the pattern of changes in incidence from 1990 to 2019, decomposition analysis was conducted. Besides, the attribution of high BMI in the thyroid cancer DALYs and deaths were obtained. The age-standardized incidence rate of thyroid cancer was 1.57 (95% UI: 1.33–1.86) in 1990 and increased 131% (53–191) until 2019. The age-standardized prevalence rate of thyroid cancer was 30.19 (18.75–34.55) in 2019 which increased 164% (77–246) from 11.44 (9.38–13.85) in 1990. In 2019, the death rate, and Disability-adjusted life years of thyroid cancer was 0.49 (0.36–0.53), and 13.16 (8.93–14.62), respectively. These numbers also increased since 1990. The DALYs and deaths attributable to high BMI was 1.91 (0.95–3.11) and 0.07 (0.04–0.11), respectively. The thyroid cancer burden and high BMI attributed burden has increased from 1990 to 2019 in Iran. This study and similar studies’ results can be used for accurate resource allocation for efficient management and all potential risks’ modification for thyroid cancer with a cost-conscious view

A review on insights and lessons from COVID-19 to the prevent of monkeypox pandemic

Re-emerging of monkeypox virus (MPXV), a neglected viral zoonotic disease, is a potential global threat. In the current COVID-19 pandemic status, the increasing reporting of positive cases of human MPXV in most countries of the world is a major reason for concern. This paper aims to describe the insights and lessons from COVID-19 pandemic in preventing the impending danger MPXV. In order to prevent further outbreak of disease, identify and control of MPXV transmission routes is necessary. Public health authorities should be vigilant and applied of effective strategies to mitigate the potential spread of MPXV. To address research gaps related to MPX outbreaks, national, regional, and international collaborations are required in time. Finally, the lessons and insights put forward point to the fact that, like the COVID-19 pandemic, people's health by and large depends on the decisions of government officials and people must continue to adhere to health principles. Hence, governments and policymakers must take appropriate precautionary measures to prevent similar crises like COVID-19 in the world

Down syndrome: Neurobiological alterations and therapeutic targets

Down syndrome (DS) is a genetic disease that occurs due to an aneuploidy of human chromosome 21. Trisomy of chromosome 21 is a primary genetic cause of developmental abnormalities leading to cognitive and learning deficits. Impairments in GABAergic transmission, noradrenergic neuronal loss, anomalous glutamatergic transmission and N-methyl-D-aspartate receptor signalling, mitochondrial dysfunction, increased oxidative stress and inflammation, differentially expressed microRNAs, increased expression of crucial chromosome 21 genes, and DNA hyper-methylation and hyperactive homocysteine trans-sulfuration pathway, are common incongruities that have been reported in DS and might contribute to cognitive impairment and intellectual disability. This review provides an update on metabolic and neurobiological alterations in DS. It also provides an overview of the currently available pharmacological therapies that may influence and/or reverse these alterations in DS

Targeting mTORs by omega-3 fatty acids: A possible novel therapeutic strategy for neurodegeneration?

Neurodegenerative diseases (NDs) such as Parkinson's (PD), Alzheimer's (AD), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS) cause significant world-wide morbidity and mortality. To date, there is no drug of cure for these, mostly age-related diseases, although approaches in delaying the pathology and/or giving patients some symptomatic relief have been adopted for the last few decades. Various studies in recent years have shown the beneficial effects of omega-3 poly unsaturated fatty acids (PUFAs) through diverse mechanisms including anti-inflammatory effects. This review now assesses the potential of this class of compounds in NDs therapy through specific action against the mammalian target of rapamycin (mTOR) signaling pathway. The role of mTOR in neurodegenerative diseases and targeted therapies by PUFAs are discussed

New trends in the pharmacological intervention of PPARs in obesity: Role of natural and synthetic compounds_

Obesity is a major health concern for a growing fraction of the population, with the prevalence of obesity and its related metabolic disorders not being fully understood. Over the last decade, many attempts have been undertaken to understand the mechanisms at the basis of this condition, in which the accumulation of fat occurring in adipose tissue, leads to the pathogenesis of obesity related disorders. Among the most recent studies, those on Peroxisome Proliferator Activated Receptors (PPARs) revealed that these nuclear receptor proteins acting as transcription factors, among others, regulate the expression of genes involved in energy, lipid, and glucose metabolisms, and chronic inflammation. The three different isotypes of PPARs, with different tissue expression and ligand binding specificity, exert similar or overlapping functions directly or indirectly linked to obesity. In this study, we reviewed the available scientific reports concerning the PPARs structure and functions, especially in obesity, considering both natural and synthetic ligands and their role in the therapy of obesity and obesity-associated disorders. In the whole, the collected data show that there are both natural and synthetic compounds that show beneficial promising activity as PPAR agonists in chronic diseases related to obesity

Regulation of autophagy by polyphenols: Paving the road for treatment of neurodegeneration

In the present paper, we will discuss on the importance of autophagy in the central nervous system, and outline the relation between autophagic pathways and the pathogenesis of neurodegenerative disorders. The potential therapeutic benefits of naturally occurring phytochemicals as pharmacological modulators of autophagy will also be addressed. Our findings provide renewed insight on the molecular modes of protection by polyphenols, which is likely to be at least in part mediated not only by their potent antioxidant and anti-inflammatory effects, but also through modulation of autophagic processes to remove the aberrant protein aggregates