Home About us Contact
|
Home About us Contact | ||
|
|
||
Waiting Times (waiting + time)
Kinds of Waiting Times Selected AbstractsChanging trends in the management of colorectal cancers and its impact on cancer waiting timesCOLORECTAL DISEASE, Issue 2 2006D. Raje Abstract Objective, The aim of this study was to compare the differences in the presentation, management and waiting times for new colorectal cancer (CRC) patients over 5 years in a single metropolitan cancer centre. Methods, A retrospective comparative study of new patients with CRC presenting in the years 1998 and 2003. The groups were compared for referral type, Dukes' stage, site, cancer waiting times and primary treatment. Results, There were 72 new patients in 1998 and 77 in 2003. In 1998 33% were seen urgently and 28% as emergencies whereas in 2003 55% of patients were seen as urgent or target wait patients and 16% as emergencies. The 2-week target for urgent referrals was met in 50% of cases in 1998 and 90% in 2003. In 2003 a higher proportion of patients received adjuvant or neoadjuvant treatment. Stage at diagnosis was similar in both groups, except stage ,D' which was 21% in 1998 and only 12% in 2003. The 31-day Cancer Waiting Time (CWT) target from decision to treat to first treatment would have been met in 81% of cases in 1998 and 79% in 2003. The 62-day overall CWT target from referral to first treatment for urgent GP referrals would have been met in 46% of cases in 1998 and 57% in 2003. Conclusion, More CRC patients were referred urgently in 2003. Most, but not all of these were referred as target waits. The time taken for the patient's journey did not improve between the two cohorts, possibly in part, because more complex treatments are now provided. Further work and perhaps new thinking are needed in order to achieve Cancer Waiting Time targets. [source] Do Private Patients have Shorter Waiting Times for Elective Surgery?ECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 2 2010Evidence from New South Wales Public Hospitals I11; D63 The Productivity Commission (2008) identified waiting times for elective surgery as a measure of governments' success in providing accessible health care. At the 2007 COAG meeting, the Prime Minister identified reduction of elective surgery waiting times in public hospitals as a major policy priority. To date, the analysis of waiting time data has been limited to summary statistics by medical procedure, doctor specialty and state. In this paper, we look behind the summary statistics and analyse the extent to which private patients are prioritised over comparable public patients in public hospitals. Our empirical evidence is based on waiting list and admission data from public hospitals in NSW for 2004,2005. We find that private patients have substantially shorter waiting times, and tend to be admitted ahead of their listing rank, especially for procedures that have low urgency levels. We also explore the benefits and costs of this preferential treatment on waiting times. [source] Triage Presenting Complaint Descriptions Bias Emergency Department Waiting TimesACADEMIC EMERGENCY MEDICINE, Issue 8 2008Martin J. Dutch BMedSci Abstract Objectives:, The authors aimed to determine whether certain emergency department (ED) triage "presenting complaint" descriptions are associated with shorter or longer waiting times, when compared with matched controls. Methods:, This was a retrospective, analytical study in three tertiary referral EDs. Data relating to adult patients with Australasian National Triage Scale (NTS) Category 3,5 complaints, who presented over 1 year, were accessed. A pilot study of 25 emergency physicians (EPs) identified five most liked and five most disliked presenting complaints. For each liked or disliked complaint, "cases" were identified using key words and phrases in the triage presentation description. For each case, the previous presentation at that institution with the same NTS category was used as a "control." Cases and controls were compared for waiting time and proportions seen within the Australasian College for Emergency Medicine (ACEM)-recommended waiting times. Results:, Data on 28,566 case,control pairs were examined. Compared to their controls, three of the five most liked complaints (dislocations, fractures, and palpitations) had significantly shorter waiting times, and significantly more were seen within the recommended waiting times (p < 0.05). In contrast, three of the five most disliked complaints (dizziness, constipation, and back pain) had significantly longer waiting times, and significantly fewer were seen within the recommended waiting times (p < 0.05). Other presenting complaints showed similar, although nonsignificant, trends. Conclusions:, Waiting times for patients with certain presenting complaints are significantly associated with triage presenting complaint descriptions. It is likely that these descriptions allow EPs to selectively seek or avoid patients with liked or disliked complaints, respectively. The impact of this for patients and ED flow needs investigation. [source] Waiting time for rehabilitation services for children with physical disabilitiesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2002D. Ehrmann Feldman Abstract Background Early rehabilitation may minimize disability and complications. However, children often wait a long time to gain admission to rehabilitation centres. Objectives To describe waiting times for paediatric physical and occupational therapy and to determine factors associated with these waiting times. Research Design The study was a prospective cohort design. Patients were followed from 1 January 1999 to 1 March 2000. Subjects All children with physical disabilities, aged 0,18 years, referred in 1999 from the Montreal Children's Hospital to paediatric rehabilitation centres. Measures Data on date of referral, date of first appointment at the rehabilitation centre, age, gender, diagnosis, region and language were obtained from the rehabilitation transfer database. Primary family caregivers of children who were transferred to a rehabilitation facility participated in a telephone interview regarding their perceptions of the transfer process. Results There were 172 children referred to rehabilitation facilities. The mean age of the children was 2.5 years. Average waiting time was 157.4 days (SD 57.1) for occupational therapy and 129.4 days (SD 51.6) for physical therapy. Decreased waiting time was associated with living in the city as opposed to the suburbs (hazard ratio = 1.77; 95% confidence interval = 0.92,3.41) and inversely associated with age (hazard ratio = 0.46; 95% confidence interval = 0.34,0.62). Among the 41 primary family caregivers who participated in the survey, higher empowerment scores were associated with shorter waits for rehabilitation. Conclusion Waiting time for rehabilitation services needs to be reduced. Empowered parents appear to manoeuvre within the system to reduce waiting times for their children. [source] Waiting times for ESL classes and the impact on English learnersNATIONAL CIVIC REVIEW, Issue 1 2007James Thomas Tucker First page of article [source] Equitable access to dental care for an at-risk group: a review of services for Australian refugeesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2007Natasha Davidson Objective: Despite the poor dental health of refugees, few specific services are available. This review maps public dental services for refugees across Australian jurisdictions, identifies gaps in provision, identifies barriers to accessing dental care, and provides recommendations for improving access and oral health promotion for this group. Methods: Data were sought from the State and Territory services for: a) the survivors of torture; b) oral health care units; and c) auditors-general reports of dental services. Eligibility criteria and estimated waiting times for general dental services, criteria for access to emergency care and availability of interpreter services were reviewed. Results: Marked variation exists across Australian jurisdictions in available dental services and criteria for access to public dental care for refugees. There is limited priority access to general dental services for refugees. Waiting times for public dental treatment in most, if not all, jurisdictions are unacceptably long (range 13,58 months). Few interpreter services exist for refugees seeking to access dental services. Conclusions: Access to dental services for refugees across Australia remains fragmented and limited, particularly in rural and regional areas. Refugees are not using services because of several barriers, including long waiting times, variation in assessment criteria, different eligibility criteria and limited interpreter services. Consequently, their pattern of service use does not accurately reflect their needs. Implications: Australia needs better co-ordinated, more extensive dental services that are easily accessible for this very high risk group. Identification of refugees as a special needs group and provision of targeted interventions addressing barriers to care are needed to establish adequate dental care. [source] The Impact of Governmental Guidance on the Time Taken to Receive a Prescription for Medication for ADHD in EnglandCHILD AND ADOLESCENT MENTAL HEALTH, Issue 1 2010David M. Foreman The National Health Service in England has deployed guidance from the National Institute of Clinical Excellence (NICE) to assist practitioners in the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) but, though the number of prescriptions has risen since its introduction, the impact of the guidance on prescribing practice has not been studied. Clinic records of all open ADHD cases (296) in three English Child and Adolescent Mental Health Services were examined. The time from referral to either prescription or data collection was extracted for a survival analysis. It was hypothesised that NICE guidance, clinic, patient and referral characteristics would all influence the speed and likelihood of prescription. Following the introduction of NICE guidance, the median time to start prescribing medication fell from 1262 to 526 days: the minimum realistic time to complete a routine assessment was approximately 70 days. Overall, 70% were prescribed medication. Most of the wait was after face-to-face appointments at the clinic had been initiated. Waiting times differed between clinics and shorter waits were likely for older children and those referred from an educational source. While the introduction of NICE guidance has increased the rate of prescription, the time taken before prescription suggests that the tendency in England is still to postpone treatment by medication. The reasons for this require further research. [source] Effective page refresh policyCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 3 2007Kai Gao Abstract Web pages are created or updated randomly. As for a search engine, keeping up with the evolving Web is necessary. But previous studies have shown the crawler's refresh ability is limited because it is not easy to detect the change instantly, especially when the resources are limited. This article concerns modeling on an effective Web page refresh policy and finding the refresh interval with minimum total waiting time. The major concern is how to model the change and which part should be updated more often. Toward this goal, the Poisson process is used to model the process. Further, the relevance is also used to adjust the process, and the probability on some sites is higher than others so these sites will be given more opportunities to be updated. It is essential when the bandwidth is not wide enough or the resource is limited. The experimental results validate the feasibility of the approach. On the basis of the above works, an educational search engine has been developed. © 2007 Wiley Periodicals, Inc. Comput Appl Eng Educ 14: 240,247, 2007; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20155 [source] Network-aware selective job checkpoint and migration to enhance co-allocation in multi-cluster systems,CONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 13 2009William M. Jones Abstract Multi-site parallel job schedulers can improve average job turn-around time by making use of fragmented node resources available throughout the grid. By mapping jobs across potentially many clusters, jobs that would otherwise wait in the queue for local resources can begin execution much earlier; thereby improving system utilization and reducing average queue waiting time. Recent research in this area of scheduling leverages user-provided estimates of job communication characteristics to more effectively partition the job across system resources. In this paper, we address the impact of inaccuracies in these estimates on system performance and show that multi-site scheduling techniques benefit from these estimates, even in the presence of considerable inaccuracy. While these results are encouraging, there are instances where these errors result in poor job scheduling decisions that cause network over-subscription. This situation can lead to significantly degraded application performance and turnaround time. Consequently, we explore the use of job checkpointing, termination, migration, and restart (CTMR) to selectively stop offending jobs to alleviate network congestion and subsequently restart them when (and where) sufficient network resources are available. We then characterize the conditions and the extent to which the process of CTMR improves overall performance. We demonstrate that this technique is beneficial even when the overhead of doing so is costly. Copyright © 2009 John Wiley & Sons, Ltd. [source] Efficient and fair scheduling for two-level information broadcasting systemsCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 18 2008Byoung-Hoon Lee Abstract In a ubiquitous environment, there are many applications where a server disseminates information of common interest to pervasive clients and devices. For an example, an advertisement server sends information from a broadcast server to display devices. We propose an efficient information scheduling scheme for information broadcast systems to reduce average waiting time for information access while maintaining fairness between information items. Our scheme allocates information items adaptively according to relative popularity for each local server. Simulation results show that our scheme can reduce the waiting time up to 30% compared with the round robin scheme while maintaining cost-effective fairness. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Use of Scripting at Triage and Its Impact on ElopementsACADEMIC EMERGENCY MEDICINE, Issue 5 2010Daniel A. Handel MD Abstract Objectives:, The objective of this study was to measure the effect of scripting language at triage on the likelihood of elopements, controlling for patient volume and other potential confounding variables. Methods:, This was a pre- and postintervention cohort study using the same 5-month period (November 2007,March 2008 and November 2008,March 2009, respectively) that included in the analysis all patients 21 years of age and older, who presented to the triage window in the emergency department (ED) waiting room (not by ambulance). As part of the scripting, triage nurses informed patients of the longest waiting time (at that point in time) for any patients still waiting to be brought back from the waiting room into the ED. Rates of elopement were compared between patients who did and did not receive the scripting, controlling for individual and daily ED variables. Results:, A total of 24,390 ED visits were included in this analysis. The elopement rate was 4.4% among ED patients in the prescripting period, compared to 2.3% in the postscripting period. In a multivariate logistic regression model, the use of scripting was significantly associated with decreased odds of elopement, compared to the nonscripting group (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.46 to 0.80). Conclusions:, The use of triage scripting was found to significantly reduce elopement rates in patients placed in the ED waiting room, even after controlling for other confounding variables. Scripting is a simple and underutilized technique that can have a positive effect for patients and the ED. ACADEMIC EMERGENCY MEDICINE 2010; 17:495,500 © 2010 by the Society for Academic Emergency Medicine [source] Fast track: Has it changed patient care in the emergency department?EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2008Paul Kwa Abstract Objective: To determine whether the introduction of a designated fast-track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED. Methods: Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast-track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did-not-waits. Results: During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS 1 was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels. Conclusions: Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients. [source] Performance analysis of a cellular mobile network with retrials and guard channels using waiting and first passage time measuresEUROPEAN TRANSACTIONS ON TELECOMMUNICATIONS, Issue 4 2009A. Economou Most studies of modern cellular mobile networks concern performance measures directly computable from the stationary state probabilities such as the blocking probability and the mean traffic rates of the various kinds of calls. In this paper, we consider a cellular mobile system with retrials and guard channels for the handover calls, but we concentrate on performance measures related to the waiting and first passage times of the system. More concretely, we first build a Markovian model representing a station of the network and then we study the waiting time of a customer, the idle times of the guard channels and the time between successive lost calls. These measures shed light on the behaviour of the system and quantify the quality of service from both points of view of the customer and the administrator. Several numerical results illustrate the effect of the system parameters in its performance. Copyright © 2008 John Wiley & Sons, Ltd. [source] SONG LEARNING ACCELERATES ALLOPATRIC SPECIATIONEVOLUTION, Issue 9 2004R. F. Lachlan Abstract The songs of many birds are unusual in that they serve a role in identifying conspecific mates, yet they are also culturally transmitted. Noting the apparently high rate of diversity in one avian taxon, the songbirds, in which song learning appears ubiquitous, it has often been speculated that cultural transmission may increase the rate of speciation. Here we examine the possibility that song learning affects the rate of allopatric speciation. We construct a population-genetic model of allopatric divergence that explores the evolution of genes that underlie learning preferences (predispositions to learn some songs over others). We compare this with a model in which mating signals are inherited only genetically. Models are constructed for the cases where songs and preferences are affected by the same or different loci, and we analyze them using analytical local stability analysis combined with simulations of drift and directional sexual selection. Under nearly all conditions examined, song divergence occurs more readily in the learning model than in the nonlearning model. This is a result of reduced frequency-dependent selection in the learning models. Cultural evolution causes males with unusual genotypes to tend to learn from the majority of males around them, and thus develop songs compatible with the majority of the females in the population. Unusual genotypes can therefore be masked by learning. Over a wide range of conditions, learning therefore reduces the waiting time for speciation to occur and can be predicted to accelerate the rate of speciation. [source] PERSPECTIVE: MODELS OF SPECIATION: WHAT HAVE WE LEARNED IN 40 YEARS?EVOLUTION, Issue 10 2003Sergey Gavrilets Abstract Theoretical studies of speciation have been dominated by numerical simulations aiming to demonstrate that speciation in a certain scenario may occur. What is needed now is a shift in focus to identifying more general rules and patterns in the dynamics of speciation. The crucial step in achieving this goal is the development of simple and general dynamical models that can be studied not only numerically but analytically as well. I review some of the existing analytical results on speciation. I first show why the classical theories of speciation by peak shifts across adaptive valleys driven by random genetic drift run into trouble (and into what kind of trouble). Then I describe the Bateson-Dobzhansky-Muller (BDM) model of speciation that does not require overcoming selection. I describe exactly how the probability of speciation, the average waiting time to speciation, and the average duration of speciation depend on the mutation and migration rates, population size, and selection for local adaptation. The BDM model postulates a rather specific genetic architecture of reproductive isolation. I then show exactly why the genetic architecture required by the BDM model should be common in general. Next I consider the multilocus generalizations of the BDM model again concentrating on the qualitative characteristics of speciation such as the average waiting time to speciation and the average duration of speciation. Finally, I consider two models of sympatric speciation in which the conditions for sympatric speciation were found analytically. A number of important conclusions have emerged from analytical studies. Unless the population size is small and the adaptive valley is shallow, the waiting time to a stochastic transition between the adaptive peaks is extremely long. However, if transition does happen, it is very quick. Speciation can occur by mutation and random drift alone with no contribution from selection as different populations accumulate incompatible genes. The importance of mutations and drift in speciation is augmented by the general structure of adaptive landscapes. Speciation can be understood as the divergence along nearly neutral networks and holey adaptive landscapes (driven by mutation, drift, and selection for adaptation to a local biotic and/or abiotic environment) accompanied by the accumulation of reproductive isolation as a by-product. The waiting time to speciation driven by mutation and drift is typically very long. Selection for local adaptation (either acting directly on the loci underlying reproductive isolation via their pleiotropic effects or acting indirectly via establishing a genetic barrier to gene flow) can significantly decrease the waiting time to speciation. In the parapatric case the average actual duration of speciation is much shorter than the average waiting time to speciation. Speciation is expected to be triggered by changes in the environment. Once genetic changes underlying speciation start, they go to completion very rapidly. Sympatric speciation is possible if disruptive selection and/or assortativeness in mating are strong enough. Sympatric speciation is promoted if costs of being choosy are small (or absent) and if linkage between the loci experiencing disruptive selection and those controlling assortative mating is strong. [source] Does more choice reduce waiting times?HEALTH ECONOMICS, Issue 1 2005Luigi Siciliani Abstract This paper develops a model of the supply of elective treatments within a duopolistic market structure where patients can be referred to the hospital with the lowest waiting times. We investigate the effect of a higher degree of substitutability among the two hospitals on equilibrium supply, waiting time and the size of the waiting list. The degree of substitutability is interpreted as the degree of choice or the extent to which patients can switch from one hospital to the other. We show that the greater the degree of substitutability among hospitals, the lower is the supply and the higher the waiting time. The effect on waiting list size is ambiguous. This result holds either when the hospital is remunerated with a fixed budget or with activity-based funding. However, the reduction in supply and the increase in waiting time generated by higher substitutability are higher when hospitals are remunerated with fixed budgets. The main implication of the model is that, under certain assumptions, policies aimed at increasing provider choice may fail to reduce waiting times. Copyright © 2004 John Wiley & Sons, Ltd. [source] A bird can't fly on one wing: patient views on waiting for hip and knee replacement surgeryHEALTH EXPECTATIONS, Issue 2 2007Barbara L. Conner-Spady PhD Abstract Objectives, To obtain patients' perspectives on acceptable waiting times for hip or knee replacement surgery. Methods, A questionnaire with both open- and close-ended items was mailed to 432 consecutive patients who had hip or knee replacement surgery 3,12 months previously in Saskatchewan, Canada. A content analysis was used to analyse the text data from the open-ended questions. Results, The sample of 303 (response rate 70%) was 59% female with a mean age of 70 years (SD 11). The median waiting time from the decision date to surgery was 17 weeks. Individuals who rated their waiting time very acceptable (48%) had a median waiting time of 13 weeks compared with a median waiting time of 22 weeks for those who rated it unacceptable (23%). The two most common determinants of acceptability were patient expectations and pain and its impact on patient quality of life. The median maximum acceptable waiting time was 13 weeks and median ideal waiting time, 8.6 weeks. Seventy-nine per cent felt that those in greater need (higher severity) should go before them on the waiting list. Patient ratings of maximum acceptable waiting time were based on: pain and loss of mobility, time needed to prepare for surgery, and severity at the time of seeing the surgeon. In consideration of changing their surgeon to one with a shorter waiting list, 68% would not. Conclusions, Patient views on waiting times are not only related to quality of life issues, but also to prior expectations and notions of fairness and priority. Understanding patient views on waiting for surgery has implications for better management of waiting times and experiences for joint replacement. [source] Combined fair packet scheduling policy and multi-class adaptive CAC scheme for QoS provisioning in multimedia cellular networksINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 2 2006Tarek Bejaoui Abstract In this paper, we propose a combined multi-class adaptive connection admission control algorithm and a new fair packet scheduling policy, based on an enhanced weighted fair queuing algorithm. It takes into account a realistic behaviour of traffic while considering the spatial variation of the system characterizing both the user mobility and the signal propagation impairments due to the surrounding effects. The proposed allocation scheme provides enhanced traffic performance in heterogeneous environments and achieves a good level of capacity gain. The new adaptive quality of service (QoS) oriented connection admission control (CAC) function is proposed to meet the rapidly increasing demand for providing multimedia services with diversified quality requirements. It decides whether the connection request is to be admitted into the system, on the basis of the generated interference level and the waiting time before access. This CAC scheme, based on service class differentiation, aims at maximizing the use of available radio resource and meeting the QoS requirement of higher priority users as much as possible while maintaining the minimum requirements of lower priority users, especially when the system suffers from congestion. The results indicate that significantly increased traffic performance can be achieved in comparison with other conventional investigated policies. Copyright © 2006 John Wiley & Sons, Ltd. [source] Class-based weighted fair queueing: validation and comparison by trace-driven simulationINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 10 2005Rachid El Abdouni Khayari Abstract World-wide web as well as proxy servers rely for their scheduling on services provided by the underlying operating system. In practice, this means that some form of first-come-first-served (FCFS) scheduling is utilized. Although FCFS is a reasonable scheduling strategy for job sequences that do not show much variance, for the world-wide web it has been shown that the requested-object sizes do exhibit heavy tails. Under these circumstances, job scheduling on the basis of shortest-job first (SJF) or shortest remaining processing time (SRPT) has been shown to minimize the total average waiting time. However, these methods have the disadvantage of potential job starvation. In order to avoid the problems of both FCFS and SJF we present in this paper a new scheduling approach called class-based interleaving weighted fair queueing (CI-WFQ). This scheduling approach exploits the specific characteristics of the job stream being served, that is, the distribution of the sizes of the objects being requested, to set its parameters such that good mean response times are obtained and starvation does not occur. In that sense, the new scheduling strategy can be made adaptive to the characteristics of the job stream being served. In this paper we compare the new scheduling approach (using trace-driven simulations) to FCFS, SJF and the recently introduced ,-scheduling, and show that CI-WFQ combines very good performance (as far as mean and variance of response time and blocking probability are concerned) with a scheduling complexity almost as low as for FCFS (and hence, lower than for SJF and ,-scheduling). The use of trace-driven simulation is essential, since the special properties of the arrival process makes analytical solutions very difficult to achieve. Copyright © 2005 John Wiley & Sons, Ltd. [source] Consumer service and loyalty in Spanish grocery store retailing: an empirical studyINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 4 2009Arturo Molina Abstract The purpose of this paper is to investigate the effects of consumer service on loyalty in retail establishments. Based on a theoretical discussion regarding the relationship between waiting time, product quality, store atmosphere and loyalty, an empirical research was conducted to test the proposed relationships. Multiple-item indicators from previous studies were used to measure the constructs. Results from the study provide empirical support, suggesting that consumer service through three dimensions influences loyalty. Research results suggest that consumer service in retail establishments can be viewed as a threshold factor in order to maintain satisfied and loyal customers. Additionally, managers should consider that loyalty depends on waiting time, product quality and store atmosphere. The present study provides useful information on the relationship between consumer service and loyalty in retailing. [source] Intervention program to reduce waiting time of a dermatological visit: Managed overbooking and service centralization as effective management toolsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2007Yuval Bibi MD Background, Long waiting times are an impediment of dermatological patient care world-wide, resulting in significant disruption of clinical care and frustration among carers and patients. Objective, To reduce waiting times for dermatological appointments. Methods, A focus group including dermatologists and management personnel reviewed the scheduling process, mapped potential problems and proposed a comprehensive intervention program. The two major approaches taken in the intervention program were revision of the scheduling process by managed overbooking of patient appointments and centralization of the dermatological service into a centralized dermatological clinic. Results, Following the intervention program, the average waiting time for dermatological appointments decreased from 29.3 to 6.8 days. The number of scheduled appointments per 6 months rose from 17,007 to 20,433. Non-attendance proportion (no-show) decreased from 33% to 28%. Dermatologist work-hours were without significant change. Conclusions, Waiting lists for dermatological consultations were substantially shortened by managed overbooking of patient appointments and centralization of the service. [source] Vasectomy within the public health services in Campinas, São Paulo, BrazilINTERNATIONAL NURSING REVIEW, Issue 2 2010N.M. Marchi rn MARCHI N.M., DE ALVARENGA A.T., OSIS M.J.D., DE AGUIAR GODOY H.M., SIMÕES E SILVA DOMENI M.F. & BAHAMONDES L. (2010) Vasectomy within the public health services in Campinas, São Paulo, Brazil. International Nursing Review57, 254,259 Objective:, To describe some of the characteristics of men who underwent a vasectomy in the public health network of Campinas, São Paulo, Brazil. Methods:, A descriptive study including 202 men randomly selected from a list of all the men vasectomized between 1998 and 2004 in the public health network. Results:, Most of the men were 30 years of age or older when vasectomized, had completed elementary school and had two or more children of both sexes. Most of the men came from the lowest income segment of the population: 47.6% in 1998,1999 and 61.3% in 2003,2004. Although the men knew various contraceptive methods, 51.2% reported that their partners were using combined oral contraceptives at the time of surgery. Most men initially sought information on vasectomy at health-care clinics where care was provided by a multidisciplinary team; most received counselling, however, 47.9% of the men waited more than 4 months for the vasectomy. Conclusions:, The profile of the vasectomized men in this study appears to indicate that the low-income population from Campinas, São Paulo, Brazil has access to vasectomy; however, the waiting time for vasectomy reveals that difficulties exist in obtaining this contraceptive method in the public health service. [source] Analysing stability and investments in railway networks using advanced evolutionary algorithmsINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 4 2004O. Engelhardt-Funke Abstract We consider a network of periodically running railway lines. Investments are possible to increase the speed and to improve the synchronisation of trains. The model also includes random delays of trains and the propagation of delays across the network. We derive a cost-benefit analysis of investments, where the benefit is measured in reduced waiting time for passengers changing lines. We also estimate the actual mean waiting time simulating the train delays. This allows us to analyse the impact that an increasing synchronisation of the timetable has on its stability. Simulation is based on an analytical model obtained from queueing theory. We use sophisticated adaptive evolutionary algorithms, which send off avant-garde solutions from time to time to speed up the optimisation process. As there is a high correlation between scheduled and estimated waiting times for badly synchronised timetables, we are even able to include the time consuming simulation into our optimisation runs. [source] An equity-based passenger flow control model with application to Hong Kong-Shenzhen border-crossingJOURNAL OF ADVANCED TRANSPORTATION, Issue 2 2002Hai Yang Cross-border passengers from Hong Kong to Shenzhen by the east Kowloon-Canton Railway (KCR) through the Lo Wu customs exceed nearly 200 thousand on a special day such as a day during the Chinese Spring Festival. Such heavy passenger demand often exceeds the processing and holding capacity of the Lo Wu customs for many hours a day. Thus, passengers must be metered off at all entrance stations along the KCR line through ticket rationing to restrain the number of passengers waiting at Lo Wu within its safe holding capacity. This paper proposes an optimal control strategy and model to deal with this passenger crowding and control problem. Because the maximum passenger checkout rate at Lo Wu is fixed, total passenger waiting time is not affected by the control strategy for given time-dependent arriving rates at each station. An equity-based control strategy is thus proposed to equalize the waiting times of passengers arriving at all stations at the same time. This equity is achieved through optimal allocation of the total quota of tickets to all entrance stations for each train service. The total ticket quota for each train service is determined such that the capacity constraint of the passenger queue at Lo Wu is satisfied. The control problem is formulated as a successive linear programming problem and demonstrated for the KCR system with partially simulated data. [source] Application of genetic algorithm for scheduling and schedule coordination problemsJOURNAL OF ADVANCED TRANSPORTATION, Issue 1 2002Prabhat Shrivastava The problems on scheduling and schedule co-ordination usually have conflicting objectives related to user's cost and operator's cost. Users want to spend less time to wait, transfer and travel by public buses. Operators are interested in profit making by lesser vehicle operating cost and having a minimum number of buses. As far as level of service is concerned users are interested in lesser crowing while operators are concerned with maximizing profit and thus to have higher load factors. In schedule co-ordination problems transfer time plays an important role. Users are interested in coordinating services with in acceptable waiting time whereas operators prefer to have lesser services and want to meet higher demands, which invariably increases waiting time. These problems have multiple conflicting objectives and constraints. It is difficult to determine optimum solution for such problems with the help of conventional approaches. It is found that Genetic Algorithm performs well for such multi objective problems. [source] Long-Term Results of Heart Transplantation for End-Stage Valvular Heart DiseaseJOURNAL OF CARDIAC SURGERY, Issue 5 2009D.Sc., F.I.C.S., M.P.H., M.Sc., Ph.D., Yanto Sandy Tjang M.D. However, the outcomes of heart transplantation for patients with end-stage valvular heart disease are less well reported. This is a substantial group of patients, many of whom have had previous cardiac surgery. They therefore may be considered a subgroup with a poor prognosis. This study reports on the outcomes of heart transplantation for patients with end-stage valvular heart disease. Patients and methods: From March 1989 to December 2004, 75 consecutive adult heart transplantations were performed for end-stage valvular heart disease. Clinical characteristics were retrieved from a computerized database. Results: The early mortality risk in heart transplantation for end-stage valvular heart disease was 13%, compared to 8% for other indications (p = 0.12). The main causes of early death were rejection (20%) and right ventricular failure (20%). The total follow-up time was 415 patient-years. During the follow-up, another 23 patients died (55/1000 patient-years of late mortality rate), mostly due to infection (43%) and multiorgan failure (22%). Multivariable analysis demonstrated that increased waiting time to heart transplantation correlated with increased survival (HR = 0.998, p = 0.04). The survival at 1, 5, 10, and 15 years was 70%, 64%, 56%, and 46% compared to 78%, 68%, 53%, and 41% for other indications, respectively (p = 0.5). Conclusion: The outcomes of heart transplantation for patients with end-stage valvular heart disease are similar to those for other patients. Apparently, the longer the waiting time to heart transplantation the better the outcome becomes. [source] The influence of patient acuity on satisfaction with emergency care: perspectives of family, friends and carersJOURNAL OF CLINICAL NURSING, Issue 6 2008Anna Ekwall PhD Aims and objectives., To investigate the factors that influence satisfaction with emergency care among individuals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency. Background., Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective; however, individuals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes. Design and methods., A prospective cross-sectional survey with a consecutive sample (n = 128 response rate 83·7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care. Results., Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients' triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons. Discussion., Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care. Relevance to clinical practice., Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes. [source] Equity and need when waiting for total hip replacement surgeryJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2004Ray Fitzpatrick PhD Abstract Objectives, To explore sociodemographic and health status factors associated with waiting times both for first outpatient appointment and for total hip replacement surgery (THR). Methods, A survey of THR in five former English regions was conducted between September 1996 and October 1997. Every patient listed for THR was asked to fill out a questionnaire preoperatively. This questionnaire included the 12-item Oxford Hip Score (OHS) questionnaire and two questions on the length of time patients waited for an ,outpatient ,appointment ,and ,subsequently ,for ,their operation. Results, From multiple logistic regression analyses, region, private vs. public sector, housing tenure and preoperative OHS were all independently associated with a waiting time for an outpatient appointment for >,3 months. Region, housing tenure and gender were also independently associated with a wait of ,,6 months on the surgical waiting list. Conclusions, A large proportion of patients had long waiting times both for an outpatient appointment and while on a surgical waiting list. There were significant differences in waiting time according to social, geographical and health care system factors. Patients with a worse pain and disability at surgery waited longer for an outpatient appointment. The longer patient waited, the worse was their pain and disability, suggesting that patients were not prioritized by these criteria. Benefits of prioritizing should be tested. [source] Modelling the development of supply-restricted telecommunications marketsJOURNAL OF FORECASTING, Issue 4 2001Towhidul Islam Abstract A large proportion of the world telecommunications market can be characterized as supply restricted. In ITU (1999) official waiting lists numbered about 50 million worldwide with an average waiting time of two years. More than 100 countries had not eliminated the waiting list for telephone connections and hence a supply restricted market prevailed in all of these countries. Only about 25 countries have succeeded in eradicating their waiting list for basic telephone service. In terms of the pattern of diffusion, the subscriber's flow from waiting applicants to adopters is controlled by supply restrictions adding an important dimension that needs to be addressed when modeling and forecasting demand. An empirical analysis of the diffusion of main telephones in 46 supply-restricted countries is presented to demonstrate the usefulness of a three-stage Bass model that has been proposed to capture the dynamics of supply restrictions. We also compare the forecasting ability of different approaches to estimation when panel data are available. Copyright © 2001 John Wiley & Sons, Ltd. [source] False-positive analysis of functional MRI during simulated deep brain stimulation: A phantom studyJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2008Ho-Ling Liu PhD Abstract Purpose To investigate the false-positive activations/deactivations in functional MRI (fMRI) of deep brain stimulation (DBS) using a phantom. Materials and Methods fMRI experiments were performed on a 1.5T scanner using a single-shot gradient-echo echo-planar imaging (GE-EPI) sequence (TR/TE/FA = 6000 msec/60 msec/90°) on an agar-gel phantom inserted with DBS electrodes. During the experimental blocks, two-second stimuli were delivered during the interscan waiting time (ISWT), which was adjusted by changing the number of slices acquired within the TR (3500 msec with 30 slices and 5160 msec with 10 slices). Data were analyzed using SPM2 software, and the false-positive voxels were detected with five different P-value thresholds. Results The number of false-positive voxels in experimental conditions had no significant differences from those in control conditions with either long or short ISWT, which increased with the P-value threshold from zero at P < 0.0001 to approximately 40 at P < 0.05. The pattern of increasing number of false-positive reactions along with P-value was similar between all conditions. Conclusion False-positive findings from fMRI with similar experimental design can be well controlled with a statistical threshold of P < 0.001 or tighter. The short ISWT of 3500 msec did not increase false-positive reactions compared to the long ISWT of 5160 msec. J. Magn. Reson. Imaging 2008;27:1439,1442. © 2008 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||