Optimization of online patient scheduling with urgencies and preferences

We consider the online problem of scheduling patients with urgencies and preferences on hospital resources with limited capacity. To solve this complex scheduling problem effectively we have to address the following sub problems: determining the allocation of capacity to patient groups, setting dynamic rules for exceptions to the allocation, ordering timeslots based on scheduling efficiency, and incorporating patient preferences over appointment times in the scheduling process. We present a scheduling approach with optimized parameter values that solves these issues simultaneously. In our experiments, we show how our approach outperforms standard scheduling benchmarks for a wide range of scenarios, and how we can efficiently trade-off scheduling performance and fulfilling patient preferences

Adaptive resource allocation for efficient patient scheduling

Objective Efficient scheduling of patient appointments on expensive resources is a complex and dynamic task. A resource is typically used by several patient groups. To service these groups, resource capacity is often allocated per group, explicitly or implicitly. Importantly, due to fluctuations in demand, for the most efficient use of resources this allocation must be flexible. Methods We present an adaptive approach to automatic optimization of resource calendars. In our approach, the allocation of capacity to different patient groups is flexible and adaptive to the current and expected future situation. We additionally present an approach to determine optimal resource openings hours on a larger time frame. Our model and its parameter values are based on extensive case analysis at the Academic Medical Hospital Amsterdam. Results and conclusion We have implemented a comprehensive computer simulation of the application case. Simulation experiments show that our approach of adaptive capacity allocation improves the performance of scheduling patients groups with different attributes and makes efficient use of resource capacity

Improving patient activity schedules by multi-agent Pareto appointment exchanging

We present a dynamic and distributed approach to the hospital patient scheduling problem: the multi-agent Pareto-improvement appointment exchanging algorithm, MPAEX. It respects the decentralization of scheduling authorities and is capable of continuously adjusting the different patient schedules in response to the dynamic environment. We present models of the hospital patient scheduling problem in terms of th

Myalgic encephalomyelitis/chronic fatigue Syndrome (ME/CFS) : Investigating care practices pointed out to disparities in diagnosis and treatment across European Union

ME/CFS is a chronic, complex, multisystem disease that often limits the health and functioning of the affected patients. Diagnosing patients with ME/CFS is a challenge, and many different case definitions exist and are used in clinical practice and research. Even after diagnosis, medical treatment is very challenging. Symptom relief and coping may affect how patients live with their disease and their quality of life. There is no consensus on which diagnostic criteria should be used and which treatment strategies can be recommended for patients. The purpose of the current project was to map the landscape of the Euromene countries in respect of national guidelines and recommendations for case definition, diagnosis and clinical approaches for ME/CFS patients. A 23 items questionnaire was sent out by email to the members of Euromene. The form contained questions on existing guidelines for case definitions, treatment/management of the disease, tests and questionnaires applied, and the prioritization of information for data sampling in research. We obtained information from 17 countries. Five countries reported having national guidelines for diagnosis, and five countries reported having guidelines for clinical approaches. For diagnostic purposes, the Fukuda criteria were most often recommended, and also the Canadian Consensus criteria, the International Consensus Criteria and the Oxford criteria were used. A mix of diagnostic criteria was applied within those countries having no guidelines. Many different questionnaires and tests were used for symptom registration and diagnostic investigation. For symptom relief, pain and anti-depressive medication were most often recommended. Cognitive Behavioral Therapy and Graded Exercise treatment were often recommended as disease management and rehabilitative/palliative strategies. The lack of consistency in recommendations across European countries urges the development of regulations, guidance and standards. The results of this study will contribute to the harmonization of diagnostic criteria and treatment for ME/CFS in Europe

The Influence of Age and Sex on Genetic Associations with Adult Body Size and Shape : A Large-Scale Genome-Wide Interaction Study

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for age-and/or sex-specific effects of genetic variants on BMI and WHRadjBMI, we performed meta-analyses of 114 studies (up to 320,485 individuals of European descent) with genome-wide chip and/or Metabochip data by the Genetic Investigation of Anthropometric Traits (GIANT) Consortium. Each study tested the association of up to similar to 2.8M SNPs with BMI and WHRadjBMI in four strata (men 50y, women 50y) and summary statistics were combined in stratum-specific meta-analyses. We then screened for variants that showed age-specific effects (G x AGE), sex-specific effects (G x SEX) or age-specific effects that differed between men and women (G x AGE x SEX). For BMI, we identified 15 loci (11 previously established for main effects, four novel) that showed significant (FDR= 50y). No sex-dependent effects were identified for BMI. For WHRadjBMI, we identified 44 loci (27 previously established for main effects, 17 novel) with sex-specific effects, of which 28 showed larger effects in women than in men, five showed larger effects in men than in women, and 11 showed opposite effects between sexes. No age-dependent effects were identified for WHRadjBMI. This is the first genome-wide interaction meta-analysis to report convincing evidence of age-dependent genetic effects on BMI. In addition, we confirm the sex-specificity of genetic effects on WHRadjBMI. These results may providefurther insights into the biology that underlies weight change with age or the sexually dimorphism of body shape.Peer reviewe

Dynamische Optimalisatie van Patiëntenplanning

In dit hoofdstuk bespreken wij het optimaliseren van de afsprakenplanning voor pati{\"e}nten bij centrale diagnostische faciliteiten. Automatische optimalisatie in het planningsproces is nodig omdat het in de praktijk vaak veel tijd en moeite kost om de agenda effici{\"e}nt te gebruiken. Door middel van een systeem dat het gebruik van de agenda kan monitoren en de beste aanpassingen kan berekenen, kan de agenda zo goed mogelijk worden gebruikt. Naast effici{\"e}ntie, is de service die aan de pati{\"e}nten wordt verleend van belang. We presenteren een methode om rekening te houden met pati{\"e}ntvoorkeuren in het planningsproces. Voor het maken van combinatieafspraken zal er bovendien co{\"o}rdinatie tussen afdelingen moeten plaatsvinden