Entire Journey Research Articles

Using Discrete-Event Simulation to Balance Staff Allocation and Patient Flow between Clinic and Surgery

We consider the problem of system-level balanced scheduling in a pediatric hospital setting. A hospital clinic has a queue for patients needing care. After being seen in clinic, many require follow-up surgery, for which they also wait in a queue. The rate-limiting factor is physician availability for both clinic visits and surgical cases. Although much existing work has been done to optimize clinic appointments, as well as to optimize surgical appointments, this novel approach models the entire patient journey at the system level, through both clinic and surgery, to optimize the total patient experience. A discrete-event simulation model of the system was built based on historic patient encounter data and validated. The system model was then optimized to determine the best allocation of physician resources across the system to minimize total patient wait time using machine learning. The results were then compared to baseline.

Micro Housing Finance Corporation

This case describes the evolution of MHFC, a player in the Indian informal housing sector. As a new entrant offering micro home loans to the financially excluded lower income families of urban India in 2008, MHFC had grown to an annual number of 18,000 loans worth INR 8 billion with an average ticket size of INR 0.43 million (USD 6,000). With a 53.5% purchasable equity stake in MHFC, Chopra and his team were left with certain decisions to make. Should the company on-board a new social investor? Or should it bring on the more readily available and capital-rich private equity investors interested in the lucrative prospects of the microfinance housing sector? The case discusses two key objectives: (1) to understand the entire entrepreneurial journey of a group of entrepreneurs and how they plan to exit the venture, and (2) to enable classroom discussion on how to develop a business model from scratch, get it funded, achieve scale and then exit.

Analysis of the Breast Cancer Journey in Namibia

Breast cancer (BC) is the leading cancer among women in Namibia. Examining the BC journey in this multiracial country where inequalities remain large is needed to inform effective interventions to reduce BC mortality. To describe the entire BC journey of Namibian women by race, utilizing the World Health Organization Global Breast Cancer Initiative (GBCI) framework. This cohort study used the Namibian subset of the African Breast Cancer-Disparities in Outcomes prospective cohort. Participants were all Namibian residents with confirmed incident BC who presented at the main national public oncology center of the Windhoek Central Hospital (WCH). Follow-up started from recruitment (September 8, 2014, to October 5, 2016) and ended up to 3 years after diagnosis (December 13, 2014, to September 27, 2019). Data analysis was conducted from June 2022 to August 2023. Participants' self-reported ethnicities were aggregated into 3 population groups: Black, mixed ancestry, and White. Three-year overall survival (OS) was examined using Cox models, and summary statistics were used to describe women's BC journey, including GBCI pillar key performance indicators: (1) early stage (TNM I or II) diagnosis (population benchmark ≥60%), (2) prompt diagnosis, ie, 60 days or less to first health care practitioner visit (population benchmark 100%), and (3) completion of recommended multimodal treatment (MT, ie, surgery plus chemotherapy) (population benchmark ≥80%). Of 405 women, there were 300 (74%) Black (mean [SD] age, 53 [15] years), 49 (12%) mixed ancestry (mean [SD] age, 53 [7] years), and 56 (14%) White (mean [SD] age, 59 [12] years) patients. Three-year OS was lowest in Black women (60% [95% CI, 54%-66%]; mixed ancestry: 80% [95% CI, 65%-89%]; White: 89% [95% CI, 77%-95%]), who had lower prevalence of early stage diagnosis (Black: 37% [95% CI, 31%-42%]; mixed ancestry and White: 75% [95% CI, 66%-83%]) and timely diagnosis (Black: 60% [95% CI, 54%-66%]; mixed ancestry and White: 77% [95% CI, 69%-85%]), while MT completion (Black: 53% [95% CI, 46%-59%]; mixed ancestry and White: 63% [95% CI, 50%-73%]) was low in all women. In this cohort study of 405 Namibian residents with BC, marked racial disparities in survival were paralleled by inequities all along the BC journey. To improve BC survival, interventions are needed to promote earlier diagnosis in Black Namibian women and to increase MT initiation and completion in all women.

"It felt like I had an old fashioned telephone ringing in my breasts": An online survey of UK Autistic birthing parents' experiences of infant feeding.

Around 3% of people are Autistic. Autistic people communicate differently from non-Autistic people and experience the sensory world differently. There is limited evidence that Autistic people can face additional barriers to breastfeeding. We are an Autistic-led research team that developed an online survey following consultation with the Autistic community. Autistic people from the UK who had been pregnant were eligible to take part in the survey, which focused on the entire maternity journey. A total of 193 people participated, of whom 152 had experiences of infant feeding (137 breastfeeding, 82 formula feeding). Participants were highly motivated to breastfeed, and almost half of those who breastfed found it positive always or most of the time. However, breastfeeding-and in particular the milk let-down reflex-could result in pain and sensory difficulties, including 'feeling odd'. Expressing breastmilk always or most of the time was reported by 10% of breastfeeding participants. The intensity and unpredictability of both breastand formula feeding were challenging to manage. Parents reported that it was easy to understand how to prepare infant formula, but that it could also be a negative and anxiety-inducing experience. Support for breast and formula feeding was often considered inadequate. When parents did access breastfeeding support, this significantly improved a range of breastfeeding experiences. However, participants recommended more tailored support and continuity of carer. To meet the needs of Autistic birthing parents, those providing infant feeding support should receive training on Autism through a neurodiversity-affirming lens, which should be delivered by Autistic people.

"Care needs to be integrated" Patient and provider perspectives on a cancer shared-care model.

Current early-stage breast and gynecological cancer care models often begin with a referral from a primary care provider (PCP) or gynecologist (OB/Gyn) and end with a patient being transitioned back to the referring provider at the completion of treatment. There is frequently little communication between oncologists and the referring provider during treatment, and this pattern continues after the patient completes their treatment. We convened a diverse Patient Advisory Board (PAB) to identify areas where breast or gynecological cancer patients felt they could benefit from additional support during and after their cancer care. PAB members attended five Zoom meetings and completed four online surveys. Semi-structured interviews were conducted with primary care or OB/Gyn physicians to collect information on current practices. Patients identified multiple areas in which they needed additional support from their PCP. Providers also identified topics on which they could use additional training. However, there was little overlap between patient and provider priority topics. Both patients and providers agreed that there was inadequate communication between the cancer center and PCPs before, during, and after cancer treatment. A shared-care model that emphasizes communication between primary care providers, the oncology care team, and patients is urgently needed. Patients indicated the need for additional support from their PCP on specific topics, and PCPs were interested in continuing their education to better serve their patients with cancer. The importance of consistent communication among all parties during the entire cancer journey was emphasized as a key area for improvement.

Diving into a New Reality: How Immersive Experiences along the Customer Journey Succeed

Abstract Brand communication is entering a new era. Immersive technologies such as augmented reality (AR) ) and virtual reality (VR) enable memorable experiences along the entire customer journey as the combination of real and virtual elements creates innovative forms of consumer-brand interaction. Read in our interview how to implement successful immersive campaigns that people care about and share on social media. Julian Weiss, co-founder and CEO of Hamburg-based agency headraft, expects many more XR (extended reality) applications as “retailing will increasingly become an experience space.” He sees their greatest potential in a symbiosis of real and virtual elements.

Evaluation of opportunity for air traveling of patients with cardiac arrhythmias

The increasing use of air transport by people with cardiovascular diseases, prone to problems associated with air travel, and require more attention during the entire journey. Considerations for preventing the worsening of the condition of patients during air travel based on the available data are summarised, algorithms for preliminary risk assessment and preparation of patients with cardiac arrhythmias are given.

Examining proxemic as an instrument for experiential brand design in physical retail spaces

For luxury coffee shops to create positive and memorable brand experiences for their customers, they must carefully design, manage and maintain their brand image throughout the entire consumer journey. The store environment plays a prominent role because it strongly influences customers’ perceptions of the brand. Factors such as the social atmosphere and employee interactions contribute to defining and representing the brand identity to customers. Therefore, coffee shops must consider customers’ cultural identities to ensure their experiences are relevant to the sociocultural context. By integrating design, branding, anthropometry and proxemics, decision-makers can create personalized experiences that engage customers on physical, emotional, cognitive and cultural levels. This research focuses on using proxemics to design luxury coffee shop experiences in multicultural spaces. We propose an instrument to collect data on task patterns, task distinctions and user preferences in coffee shops. The tool consists of three sections that collect data on proxemic behaviour, proxemic perceptions (cultural) and proxemic reflections. We used a case study to exhibit the relevance of proxemics and proxemic behaviour in improving the interaction between person, object and space. The instrument offers the possibility to document proxemic factors that are imperceptible and intangible in the users’ brand experience and journey in a retail space. It also provides data to increase user engagement with different touchpoints, such as retail space, product design and identity design. Proxemic behaviour is relevant in addressing cultural, behavioural and sociological aspects of interpersonal situations related to spatial distance between individuals. These findings suggest the relevance of proxemics in promoting human-centred design in experiential spaces. Ultimately, the work aims to expand the available instruments and methods for improving user experiences in service-based industries within the experience economy.

Development of Herbal Topical Anesthetic Mucoadhesive Spray for oral Cavity using Customer-Centric Approach

The use of herbal medicines is increasing globally due to consumer perceptions and scientific research. The limited availability of herbal medications and a lack of effective topical anesthetics have driven the development of new products using a customer-centric strategy. This study aimed to present a novel herbal topical anesthetic mucoadhesive spray development using the New Product Development (NPD) process though three steps: the idea concept of the product, prototype development, and consumers’ acceptance evaluation, involving key stakeholders-consumers and healthcare professionals. Multiple research methods were implemented, including qualitative, quantitative, and scientific methods, in each step. The findings showed insights gathered through in-depth interviews about the product needs of stakeholders. Multiple regression analysis showed that price, attitude, and social value significantly positively influenced consumer purchase intentions, while attitude influenced healthcare professionals' prescribing intentions. Consequently, the prototype was developed based on consumer needs. The results of the acceptance evaluation phase indicated high consumer acceptance of the herbal topical anesthetic mucoadhesive spray. The entire journey of the new product development process in this study enhances our understanding of customer-centric approaches in product development and can be applied to generate market-driven innovations that meet the needs of the target market. Doi: 10.28991/HEF-2023-04-03-02 Full Text: PDF

Lorand Gaspar or the Writing of a Complex Existential Path

Abstract The work of Lorand Gaspar, a contemporary author of French expression, born in TarguMures, stands out for a poetic approach to existence, in which the presentation of ideas interferes with body consciousness, culture and nature. The relationships established between them retrace certain poetic, but also ethical and existential principles. The notion of non-belonging is fundamental to Gaspar's poetics. He projected himself as a nomad, subjected to both geographical and spiritual migration, something that became his main source of revitalization and an essential identity component. Besides, poetry remained for Gaspar the only country of belonging, and the road towards it ensured the coherence of the entire journey.

Workforce Crisis in Radiology in the UK and the Strategies to Deal With It: Is Artificial Intelligence the Saviour?

Radiology has seen rapid growth over the last few decades. Technological advances in equipment and computing have resulted in an explosion of new modalities and applications. However, this rapid expansion of capability and capacity has not been matched by a parallel growth in the number of radiologists. This has resulted in global shortages in the workforce, with the UK being one of the most affected countries. The UK National Health Service has been employing several conventional strategies to deal with the workforce situation with mixed success. The emergence of artificial intelligence (AI) tools that have the potential to increase efficiency and efficacy at various stages in radiology has made it possible for radiology departments to use new strategies and workflows that can offset workforce shortages to some extent. This review article discusses the current and projected radiology workforce situation in the UK and the various strategies to deal with it, including applications of AI in radiology. We highlight the benefits of AI tools in improving efficiency and patient safety. AI has a role along the patient's entire journey from the clinician requesting the appropriate radiological investigation, safe image acquisition, alerting the radiologists and clinicians about critical and life-threatening situations, cancer screening follow up, to generating meaningful radiology reports more efficiently. It has great potential in easing the workforce crisis and needs rapid adoption by radiology departments.

Development and Integration of Patient-Reported Measures into E-Health System: Pilot Feasibility Study.

Patient-centered care is recognized as a key element in recent healthcare management strategies. However, the integrated collection of patient feedback capturing the entire journey of patients with complex medical conditions remains understudied. Herein, we aimed to describe the development of an instrument prototype for the collection of PROMs and PREMs that would encompass a whole patient journey at a single time point. We further describe the process of its integration into a hospital's information system (HIS) and the results of a pilot feasibility study in adult patients with kidney and hematological diseases. We developed an instrument consisting of original PREM and generic EQ-5D-5L questionnaires. E-questionnaires were handled with REDCap software (version 12.5.14) and integrated into the HIS. Patients refusing to use e-questionnaires (48%) were offered paper administration and were older (64 vs. 50 years). The overall response rate for e-questionnaires was 57.1% with a median completion time of 2.0 and 3.7 min for PROM and PREM, respectively. Psychological and social services and primary care setting (diagnosis establishment and involvement in continuous care) were identified as most problematic. The majority of PREM dimensions encompassing different levels of care significantly correlated with PROM responses. Our data indicate the feasibility and potential relevance of the proposed approach, although wider-scale studies in diverse settings are needed.

How We Would Treat Our Own Lung Transplantation: A Multidisciplinary and International Perspective

Lung transplantation is the ultimate treatment for end-stage lung disease (ESLD) arising from various etiologies. This manuscript will focus on selected aspects of a theoretical perioperative lung transplantation plan, highlighting data-driven and theoretical techniques the authors would employ if they were the index patient undergoing surgery. Beginning with looking for a transplant center using an Internet search, patient advocacy organizations, and artificial intelligence guidance, the authors lay out a course for multidisciplinary care throughout the entire patient journey, ending with ideal approaches to recovery 6 months posttransplantation. Although the index case will focus on a theoretical patient with pulmonary fibrosis, the general management principles will be applicable across the entire spectrum of patients with ESLD presenting for lung transplantation.

Using a Dynamic Hydrophilization Strategy to Achieve Nanodispersion, Full Wetting, and Precise Delivery of Hydrophobic Pesticide.

Various strategies have been developed to improve the applicability of hydrophobic pesticides for better effectiveness in agriculture. However, existing formulations of hydrophobic pesticides still suffer from complicated processing, abused organic solvents, indispensable surfactants, or inescapable ecotoxicity, which strictly limit their applications. Herein, a dynamic covalent bond tailored pesticide (fipronil) amphiphile is constructed to address the above issues, which accomplishes the nanodispersion, full wetting, and precise delivery without organic solvents, surfactants, and materials simultaneously. By introducing a hydrophilic ligand on the hydrophobic fipronil through an imine bond, the cleavable fipronil amphiphile (FPP) exhibits superior water solubility and can even self-assemble into micelles at higher concentrations, which can be directly applied in powder form without organic solvents. Attributed to the suitable hydrophilic/hydrophobic ratio, FPP achieves full wetting and effective deposition on superhydrophobic rice leaves without surfactants. Moreover, benefiting from the unique dynamic nature of the imine bond, FPP maintains good storage stability while sensitively releasing back to fipronil under the humidity and pH trigger, consequently implementing the precise delivery for nontarget Apis cerana and target Chilo suppressalis without materials. To our knowledge, this dynamic covalent bond tailored amphiphile strategy is the first idea that simultaneously takes the dispersibility, wettability, and responsiveness of hydrophobic pesticides into account, providing a possibility to control the entire journey of field application and even promising to be incorporated into the synthesis process, thus paving the way for modern sustainable agriculture.

Towards an inductive model of customer experience in fitness clubs: a structural topic modeling approach

ABSTRACT Research question A significant advancement in marketing studies has been the use of big data analytics to explore and derive customer experience (CX) insights. With fitness businesses’ pivoting towards managing CX along the entire customer journey, this study aimed to understand CX in the commercial fitness industry. Research methods A textual corpus of three million words was extracted from a total of 24,231 Yelp reviews on 1,045 fitness clubs in the United States. Structural Topic Modeling (STM), content analysis, and topic network analysis were performed to identify CX themes and their inter-relationships. We then inductively identified topics and themes germane to CX in fitness clubs and derived a general CX model. Results and findings Sixty-eight relevant topics were identified through an iterative STM and content analysis process and were subsequently interpreted using the CX paradigm and experience design framework (Funk, 2017; Voss et al., 2008). Our final model integrates experience design elements (i.e. stageware, orgware, customerware), customer journey (i.e. pre-usage, usage, post-usage) and CX (i.e. subjective and internal responses) and shows the interrelationships among them. Implications Our model offers an integrative and coherent theoretical framework to examine CX in commercial fitness clubs. Our model and methodology allow researchers and organizations not only to capture CX and the relative salience of CX topics, but also to track CX trends over time, compare the experience design elements of an organization, measure CX performance against competitors, and link CX topics to other criterion variables (e.g. retention rate, financial performance, business survivability).

Protocol for improving the costs and outcomes of assistive reproductive technology fertility care pathways: a study using cost measurement and process mining

IntroductionValue-based healthcare suggests that care outcomes should be evaluated in relation to the costs of delivering that care from the perspective of the provider. However, few providers achieve this because...

Integrated hydrogen and battery energy systems as emergency backup in electric trains

Moving towards sustainable transport by adopting alternative energy sources to traditional ones is, in these times more than ever, of fundamental importance for humanity. In this paper, the possibility of using fuel cell- and/or battery-based energy systems to replace the Diesel engine of a conventional electric train (the Hitachi Blues), is studied.Four different system configurations are proposed, all satisfying the common characteristic of being perfectly placed in rooms previously occupied by Diesel engines. Their sizing, layout and weight have been thoroughly discussed in the paper.Furthermore, to analyze the application limits of these configurations, their installation on an electric train running along a real railway line in the Calabria region (Italy) was simulated. To size the components and define the layout of the plant, computer-aided design software (CAD 3D) was used, starting from the original construction drawings of the railway carriages. Numerical and dynamic zero-dimensional simulations were implemented to evaluate the performance rating of the systems. Among the tested powertrains, two of the proposed configurations (a full-battery and a hybrid fuel cell-battery systems) have proved to be more than adequate to replace the overhead line, reaching an average driving range of about 100 km. Moreover, two different overhead line malfunction scenarios were assumed to evaluate the train performance. In each case, the innovative powertrains allow the train to travel the entire journey. In detail, the overhead line provides more than half of the energy, while the fuel cell reaches almost 25 % of the overall energy demand, consuming the whole amount of hydrogen stored on board, approximately 24 kg. The battery supplies a maximum of 545 kWh (roughly 40 %), conserving a 45 % State of Charge, and up to 165 kWh (over 10 %) can be recovered through regenerative braking strategies.

AHİ TEŞKİLATININ STANDARDİZASYON ANLAYIŞININ İSLAM HUKUKU AÇISINDAN DEĞERLENDİRİLMESİ

Akhism was a vital system that not only developed the social, cultural, and political but also was one of the most essential mechanisms of the commercial environment of the 13th century. Akhism contributed the social welfare, market stability, and market security.One of the most visible characteristics of Akhisim was seen that it successfully integrated the financial ethic with all types of commercial affairs. In this study, two basics of the standardization policy including quality of product and price stability that the system mostly improved among the financial ethic were examined in the fıqh references. The standardization policy of Akhism controlling the entire journey of any product that includes production, manufacturing, and marketing contributed to the financial development of the thirteenth century. This standardization policy orders that all products must be produced among certain techniques and principles. Quality standards, market conditions, and precautions taken against deceptive and manipulatory affairs, control and product management are the principles that the Islamic Law system underlines. The Akhi organization not only set a certain quality standard for products but also intervened in marketing prices of supplied products so that products have certain price standards. If any affairs to disrupt the marketing conditions and price stabilities occur, the state is supposed to intervene in the system as it has happened since earlier periods. Thus there is a strong relationship between the intervening commercial policies that were fundamental of Akhism and the price policies that have been followed since the early periods of Islam. Keywords: Islamic Law, Akhism, Standardization, Price, Quality.

Sex Differences in Epidemiology, Care, and Outcomes in Patients With Acute Chest Pain

BackgroundDiscrepancies in cardiovascular care for women are well described, but few data assess the entire patient journey for chest pain care. ObjectivesThis study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge. MethodsThis is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses. ResultsIn 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall. ConclusionsSubstantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.

How to use participatory design to develop an eHealth intervention to reduce preprocedural stress and anxiety among children visiting the hospital: The Hospital Hero app multi-study and pilot report.

Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.