A flexible and optimal approach for appointment scheduling in healthcare

Appointment scheduling is generally applied in outpatient clinics and other healthcare services. The challenge in scheduling is to find a strategy for dealing with variability and unpredictability in service duration and patient arrivals. The consequences of an ineffective strategy include long waiting times for patients and idle time for the healthcare provider. In turn, these have implications for the perceived quality, cost-efficiency, and capacity of healthcare services. The generation of optimal schedules is a notoriously intractable problem, and earlier attempts at designing effective strategies for appointment scheduling were based on approximation, simulation, or simplification. We propose a novel strategy for scheduling that exploits three tactical ideas to make the problem manageable. We compare the proposed strategy to other approaches, and show that it matches or outperforms competing methods in terms of flexibility, ease of use, and speed. More importantly, it outperforms competing approaches nearly uniformly in approaching the desired balance between waiting and idle times as specified in a chosen objective function. Therefore, the strategy is a good basis for further enrichments

The Netherlands Arrhythmogenic Cardiomyopathy Registry:design and status update

BACKGROUND: Clinical research on arrhythmogenic cardiomyopathy (ACM) is typically limited by small patient numbers, retrospective study designs, and inconsistent definitions. AIM: To create a large national ACM patient cohort with a vast amount of uniformly collected high-quality data that is readily available for future research. METHODS: This is a multicentre, longitudinal, observational cohort study that includes (1) patients with a definite ACM diagnosis, (2) at-risk relatives of ACM patients, and (3) ACM-associated mutation carriers. At baseline and every follow-up visit, a medical history as well information regarding (non-)invasive tests is collected (e. g. electrocardiograms, Holter recordings, imaging and electrophysiological studies, pathology reports, etc.). Outcome data include (non-)sustained ventricular and atrial arrhythmias, heart failure, and (cardiac) death. Data are collected on a research electronic data capture (REDCap) platform in which every participating centre has its own restricted data access group, thus empowering local studies while facilitating data sharing. DISCUSSION: The Netherlands ACM Registry is a national observational cohort study of ACM patients and relatives. Prospective and retrospective data are obtained at multiple time points, enabling both cross-sectional and longitudinal research in a hypothesis-generating approach that extends beyond one specific research question. In so doing, this registry aims to (1) increase the scientific knowledge base on disease mechanisms, genetics, and novel diagnostic and treatment strategies of ACM; and (2) provide education for physicians and patients concerning ACM, e. g. through our website ( www.acmregistry.nl ) and patient conferences

Dysregulated innate and adaptive immune responses discriminate disease severity in COVID-19

The clinical spectrum of COVID-19 varies and the differences in host response characterizing this variation have not been fully elucidated. COVID-19 disease severity correlates with an excessive pro-inflammatory immune response and profound lymphopenia. Inflammatory responses according to disease severity were explored by plasma cytokine measurements and proteomics analysis in 147 COVID-19 patients. Furthermore, peripheral blood mononuclear cell cytokine production assays and whole blood flow cytometry were performed. Results confirm a hyperinflammatory innate immune state, while highlighting hepatocyte growth factor and stem cell factor as potential biomarkers for disease severity. Clustering analysis reveals no specific inflammatory endotypes in COVID-19 patients. Functional assays reveal abrogated adaptive cytokine production (interferon-gamma, interleukin-17 and interleukin-22) and prominent T cell exhaustion in critically ill patients, whereas innate immune responses were intact or hyperresponsive. Collectively, this extensive analysis provides a comprehensive insight into the pathobiology of severe to critical COVID-19 and highlight potential biomarkers of disease severity

Detection and localization of early- and late-stage cancers using platelet RNA

Cancer patients benefit from early tumor detection since treatment outcomes are more favorable for less advanced cancers. Platelets are involved in cancer progression and are considered a promising biosource for cancer detection, as they alter their RNA content upon local and systemic cues. We show that tumor-educated platelet (TEP) RNA-based blood tests enable the detection of 18 cancer types. With 99% specificity in asymptomatic controls, thromboSeq correctly detected the presence of cancer in two-thirds of 1,096 blood samples from stage I–IV cancer patients and in half of 352 stage I–III tumors. Symptomatic controls, including inflammatory and cardiovascular diseases, and benign tumors had increased false-positive test results with an average specificity of 78%. Moreover, thromboSeq determined the tumor site of origin in five different tumor types correctly in over 80% of the cancer patients. These results highlight the potential properties of TEP-derived RNA panels to supplement current approaches for blood-based cancer screening

Industriële statistiek als technologie voor het oplossen van problemen

Hoge kosten en onvoldoende patiëntveiligheid in de zorg, fouten en lange doorlooptijden in de dienstverlening, en kwaliteitsproblemen of het ontwerpen van duurzamere producten in de industrie... alle zijn voorbeelden van problemen die professionals in het bedrijfsleven en in de non-profitsector moeten oplossen. Industriële statistiek ondersteunt zulke professionals met methodologische kennis. Methoden en technieken uit de industriële statistiek spelen een belangrijke rol bij het ontwerpen, beheersen en verbeteren van bedrijfsprocessen, en daarnaast in de productontwikkeling. Industriële statistiek wordt in Nederland vaak ingedeeld bij de wiskunde, als toepassing of specialisatie ervan, maar is dat wel terecht? In welke wetenschappelijke traditie kan het vak geplaatst worden? Welke implicaties heeft de aard van het vak voor onderwijs dat erin gegeven wordt