Medical Tourism Research Articles

Exploring the Role of Destination Management Organizations (DMOs) in Leveraging Social Media as a Destination Marketing Tool: Insights from Himachal Pradesh

TOURISM: Tourism is the movement of people to destinations outside their usual environment for various reasons, including leisure, business, or other purposes. These visitors' activities, known as the visitor economy, can have a significant impact on the visited locations economically, socially, and culturally. This can involve enjoying recreational activities, relaxation, and pleasure, often with the help of established businesses offering services and experiences. Tourism is a multifaceted and dynamic industry that has evolved significantly over the years. It encompasses the movement of people to destinations outside their usual environment for personal or recreational purposes, contributing substantially to the global economy and generating employment opportunities and income for millions. The tourism industry can be broadly categorized into two primary types: international tourism, where tourists travel to foreign lands, and domestic tourism, where tourists explore their own country. The most frequently visited countries by international tourists include France, Spain, the United States, China, Italy, Turkey, Mexico, and the United Kingdom. Tourism serves as a crucial industry, providing employment and income to millions of people worldwide and contributing significantly to the economies of various nations. The steady rise in popularity of tourism since the 1950s can be attributed to advancements in technology, the proliferation of the internet, the increasing availability of paid vacations, demographic changes, and media exposure. The tourism life cycle, proposed by Professor Richard Butler, consists of four stages: initial discovery, growth, decline, and regeneration. This model helps us understand the pattern of popularity that tourist destinations follow. Tourism is not limited to leisure activities; it also includes business tourism, cultural travel, environmental effects of aviation, international tourism advertising, medical tourism, and science tourism, among others. The United Nations World Tourism Organization (UNWTO) plays a crucial role in promoting responsible, sustainable, and universally accessible tourism, providing statistics and insights on key indicators for inbound and outbound tourism globally. In conclusion, tourism is a complex and multifaceted industry that has a significant impact on the global economy and local communities. It encompasses various forms, including international and domestic tourism, and serves as a crucial source of employment and income for millions of people worldwide.

Metabolic predictors of COVID-19 mortality and severity: a survival analysis

IntroductionThe global healthcare burden of COVID-19 pandemic has been unprecedented with a high mortality. Metabolomics, a powerful technique, has been increasingly utilized to study the host response to infections and to understand the progression of multi-system disorders such as COVID-19. Analysis of the host metabolites in response to SARS-CoV-2 infection can provide a snapshot of the endogenous metabolic landscape of the host and its role in shaping the interaction with SARS-CoV-2. Disease severity and consequently the clinical outcomes may be associated with a metabolic imbalance related to amino acids, lipids, and energy-generating pathways. Hence, the host metabolome can help predict potential clinical risks and outcomes.MethodsIn this prospective study, using a targeted metabolomics approach, we studied the metabolic signature in 154 COVID-19 patients (males=138, age range 48-69 yrs) and related it to disease severity and mortality. Blood plasma concentrations of metabolites were quantified through LC-MS using MxP Quant 500 kit, which has a coverage of 630 metabolites from 26 biochemical classes including distinct classes of lipids and small organic molecules. We then employed Kaplan-Meier survival analysis to investigate the correlation between various metabolic markers, disease severity and patient outcomes.ResultsA comparison of survival outcomes between individuals with high levels of various metabolites (amino acids, tryptophan, kynurenine, serotonin, creatine, SDMA, ADMA, 1-MH and carnitine palmitoyltransferase 1 and 2 enzymes) and those with low levels revealed statistically significant differences in survival outcomes. We further used four key metabolic markers (tryptophan, kynurenine, asymmetric dimethylarginine, and 1-Methylhistidine) to develop a COVID-19 mortality risk model through the application of multiple machine-learning methods.ConclusionsMetabolomics analysis revealed distinct metabolic signatures among different severity groups, reflecting discernible alterations in amino acid levels and perturbations in tryptophan metabolism. Notably, critical patients exhibited higher levels of short chain acylcarnitines, concomitant with higher concentrations of SDMA, ADMA, and 1-MH in severe cases and non-survivors. Conversely, levels of 3-methylhistidine were lower in this context.

Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers.

To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres. Global healthcare sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within healthcare. Three databases were searched (Web of Science, Ovid and PubMed), last check January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis. 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics & Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, USA, UK & Ireland,). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive. This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. Additionally, implementation studies should be carried out to examine whether barriers do change in practice. This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. Additionally, implementation studies should be carried out to examine whether barriers do change in practice.

Notes from the Field: Potential Outbreak of Extrapulmonary Mycobacterium abscessus subspecies massiliense Infections from Stem Cell Treatment Clinics in Mexico - Arizona and Colorado, 2022.

Mycobacterium abscessus is an intrinsically drug-resistant, rapidly growing, nontuberculous mycobacterium; extrapulmonary infections have been reported in association with medical tourism (1). During November-December 2022, two Colorado hospitals (hospitals A and B) treated patient A, a Colorado woman aged 30-39 years, for M. abscessus meningitis. In October 2022, she had received intrathecal donor embryonic stem cell injections in Baja California, Mexico to treat multiple sclerosis and subsequently experienced headaches and fevers, consistent with meningitis. Her cerebrospinal fluid revealed neutrophilic pleocytosis and grew M. abscessus in culture at hospital A. Hospital A's physicians consulted hospital B's infectious diseases (ID) physicians to co-manage this patient (2).

Blockchain for Organ Transplantation: A Survey

As blockchain becomes more widely used, a growing number of application fields are becoming interested in blockchain to benefit from its decentralised nature, invariability, security, transparency, quick transaction capabilities, and cost-effectiveness. Blockchain has a wide range of applications and uses in healthcare. Distributed ledger technology facilitates the secure transfer of patient medical records, manages the medicine supply chain, and creates an efficient, transparent, safe, and effective way of communicating data across global healthcare. The organ transplantation process (OTP) is one of the healthcare areas that benefit from the use of such technology to make its process more secure and transparent. In this article, we put forward a systematic literature review analysis on the application of blockchain to the OTP. Additionally, we address and highlight the barriers and challenges that arise while using blockchain technology for the OTP. We also offer some suggestions for future developments that would enhance blockchain’s implementation in the OTP domain.

Ayurveda is on the Way to Open the Golden Door of Indian Tourism through Panchakarma - A Review

ABSTRACT Over the years, Ayurveda, the science of healing and regeneration, has become increasingly popular throughout the world. Numerous Ayurvedic centres are expanding nowadays, as they are one of the primary tourist attractions in the southern region. India is becoming a popular destination for medical tourism due to a number of draw factors, including easy accessibility, affordable and high-quality medical care, beautiful vacation spots, etc. The best place is in South India, which is also the nation's centre of health. The boundaries and opportunities of Ayurvedic tourism have undoubtedly expanded with the recognition of Ayurvedic healing on a national and worldwide level. With any fortunate, India will be the world's top choice for high-quality medical facilities within the next several years. Ayurveda was supposedly bestowed upon humanity by the gods to enable us to live long, healthy lives free from illness. Nearly every tribe in India swiftly embraced ayurveda, and it soon started to spread to nations like Afghanistan, China, and Iran. Panchakarma can provide a long-lasting or permanent treatment for multi-system disruptions. Panchakarma is becoming a vital component of medical travel. Therefore, the government ought to actively support the growth of Panchakarma travel. This review discusses the many facets of ayurvedic travel to India, including Panchakarma, its development, and current trends. Keywords-Ayurveda, Tourism, Panchakarma, health .

The Prevalence of Antibiotic Resistance Phenotypes and Genotypes in Multidrug-Resistant Bacterial Isolates from the Academic Hospital of Jaén, Spain

The heterogenicity of antimicrobial resistance genes described in clinically significant bacterial isolates and their potential role in reducing the efficacy of classically effective antibiotics pose a major challenge for global healthcare, especially in infections caused by Gram-negative bacteria. We analyzed 112 multidrug-resistant (MDR) isolates from clinical samples in order to detect high resistance profiles, both phenotypically and genotypically, among four Gram-negative genera (Acinetobacter, Escherichia, Klebsiella, and Pseudomonas). We found that 9.8% of the total selected isolates were classified as extensively drug-resistant (XDR) (six isolates identified as A. baumannii and five among P. pneumoniae isolates). All other isolates were classified as MDR. Almost 100% of the isolates showed positive results for blaOXA-23 and blaNDM-1 genes among the A. baumannii samples, one resistance gene (blaCTX-M) among E. coli, and two genetic determinants (blaCTX-M and aac(6′)-Ib) among Klebsiella. In contrast, P. aeruginosa showed just one high-frequency antibiotic resistance gene (dfrA), which was present in 68.42% of the isolates studied. We also describe positive associations between ampicillin and cefotaxime resistance in A. baumannii and the presence of blaVEB and blaGES genes, as well as between the aztreonam resistance phenotype and the presence of blaGES gene in E. coli. These data may be useful in achieving a better control of infection strategies and antibiotic management in clinical scenarios where these multidrug-resistant Gram-negative pathogens cause higher morbidity and mortality.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

AMP-Mimetic Antimicrobial Polymer-Involved Synergic Therapy with Various Coagents for Improved Efficiency.

The misuse of antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Infections caused by MDR bacteria are rapidly evolving into a significant threat to global healthcare due to the lack of effective and safe treatments. Antimicrobial peptides (AMPs) with broad-spectrum antibacterial activity kill bacteria generally through a membrane disruption mechanism; hence, they tend not to induce resistance readily. However, AMPs exhibit disadvantages, such as high cost and susceptibility to proteolytic degradation, which limit their clinical application. AMP-mimetic antimicrobial polymers, with low cost, stability to proteolysis, broad-spectrum antimicrobial activity, negligible antimicrobial resistance, and rapid bactericidal effect, have received extensive attention as a new type of antibacterial drugs. Lately, AMP-mimetic polymer-involved synergic therapy provides a superior alternative to combat MDR bacteria by distinct mechanisms. In this Review, we summarize the AMP-mimetic antimicrobial polymers involved in synergic therapy, particularly focusing on the different combinations between the polymers with commercially available antimicrobials, organic small molecule photosensitizers, inorganic nanomaterials, and nitric oxide.

Visibility of International Rotations on Plastic Surgery Program Websites.

Plastic surgery residency programs are offering increasing opportunities for international rotations, recognizing the importance of early exposure and the need to promote better capacity building in host countries. While a greater number of residency programs are offering international opportunities, it is not clear whether applicants are aware of these opportunities based on program websites. The purpose of this study was to determine the availability and ease of access to international rotation information on plastic surgery residency websites. All 101 integrated and independent program websites were visited and assessed for information on international rotations. Programs were noted for any information about rotations and ease of access was determined based on the location of information on the website (homepage, 1 or 2 clicks from homepage, and greater than 2 clicks). Approximately 33% of programs offered any information on international rotations on their program websites. Thirty-six percent of these program websites displayed information on their homepage ("Easy"); 30% of these programs displayed their information 1 or 2 clicks away from the homepage ("Moderate"); and 33% of these programs displayed their information greater than 2 clicks away from the homepage ("Difficult"). Previous studies have established that international rotations are widely available to plastic surgery residents, but this study revealed that only a minority of residency programs are advertising this opportunity on their websites. These data may serve to galvanize faculty to increase website visibility of available international rotations to better promote their programs and attract prospective residents who seek opportunities in global health care.

Charting the Sustainable Course: Navigating the Saudi Arabia Medical and Wellness Tourism Roadmap with Business Model Canvas (BMC)

Medical and wellness tourism has emerged as a pivotal sector with significant economic implications globally, especially after the COVID-19 pandemic. This study delves into the landscape of Saudi Arabia’s medical and wellness tourism, recognizing its importance as a key player in the tourism industry. The study aims to elevate this sector to new heights on the global stage by employing the Business Model Canvas (BMC) as a strategic tool. BMC allows for a comprehensive analysis of the medical tourism industry in Saudi Arabia, breaking down key elements across its nine blocks: key partners, key activities, key resources, value propositions, customer segments, channels, customer relationships, cost structure, and revenue streams. The results of this study shed light on the unique selling proposition (USP) as a crucial strategic step for Saudi Arabia to distinguish itself and enhance its position in the international medical tourism arena. By identifying and maximizing the unique aspects within each BMC block, the study presents a roadmap for Saudi Arabia, navigating the challenges and capitalizing on the potential of the medical and wellness tourism sector. This research serves as a guide, emphasizing the strategic importance of a well-defined business model to shape the future of medical and wellness tourism in Saudi Arabia and establish a prominent global presence.

ANALISIS KETERKAITAN NETWORK PHAMACOLOGY SENYAWA METABOLIT SEKUNDER Abrus precatorius L. SECARA IN SILICO

Cancer remains a global health challenge, prompting extensive research efforts worldwide. Lung cancer, the second most diagnosed cancer, presents a particularly grim survival rate. In Indonesia, cancer incidence ranks significantly, with millions affected and hundreds of thousands succumbing to the disease annually. Traditional medicine persists as a preferred option among many, perceived as safer and more affordable. Abrus precatorius L., an ancient medicinal plant, holds promise in this regard, with a rich history of use and a diverse range of pharmacological activities, including anti-cancer properties. Employing in silico modeling and network pharmacology, this study explores the interaction between Abrus precatorius L. compounds and various proteins associated with cancer. Through bioinformatics tools and databases, 27 bioactive compounds are identified and their physicochemical properties assessed, ensuring adherence to pharmacological guidelines. The study predicts potential protein targets for Abrus precatorius L. compounds, revealing interactions with 453 proteins, including those implicated in cancer pathways. Further analysis using StringDB and DISEASES database establishes protein-protein interaction networks, highlighting key proteins like EGFR and TERT, pivotal in multiple cancer types. The study validates the compounds' adherence to Lipinski's Rule of Five, indicating their potential for pharmacological activity and oral absorption. False Discovery Rate (FDR) analysis confirms significant associations between Abrus precatorius L. compounds and various cancers, further underscoring their therapeutic potential. In conclusion, Abrus precatorius L. compounds, particularly targeting EGFR and TERT proteins, emerge as promising candidates for cancer treatment. Their diverse pharmacological activities and interactions with key cancer-related proteins pave the way for further exploration and development of these compounds as alternative medicinal agents. In vitro and in vivo studies are warranted to validate their efficacy, particularly in addressing the complexities of different cancer types. Ultimately, this research offers valuable insights into leveraging natural compounds for combating cancer, addressing a critical need in global healthcare.

Language Barriers in Intercultural Communication and Their Translation Strategies

This research paper delves into the significant language barriers that arise in cross-cultural communication, with a particular focus on the indispensable role of translation strategies in mitigating these challenges. It scrutinizes elements such as grammar, vocabulary, pronunciation, and the cultural contexts that shape interactions within various global sectors, including diplomacy, business, healthcare, and law. The paper analyzes linguistic discrepancies, cultural subtleties, and obstacles in non-verbal communication that influence understanding across cultures. It also discusses the incorporation of advanced translation techniques and the use of technology in translation practices. The goal is to enhance the academic understanding of intercultural communication barriers and provide practical solutions to improve effective global interactions.

Statins in chronic liver disease: review of literature and future role.

Chronic liver disease (CLD) is a major contributor to global mortality, morbidity, and healthcare burden. Progress in pharmacotherapeutic for CLD management is lagging given its impact on the global population. While statins are indicated for the management of dyslipidemia and cardiovascular disease, their role in CLD prevention and treatment is emerging. Beyond their lipid lowering effects, their liver-related mechanisms of action are multifactorial and include anti-inflammatory, anti-proliferative, and immune-protective effects. In this review, we highlight what is known about the clinical benefits of statins in viral and non-viral etiologies of CLD and HCC, and explore key mechanisms and pathways targeted by statins. While their benefits may span the spectrum of CLD and potentially HCC treatment, their role in CLD chemoprevention is likely to have the largest impact. As emerging data suggest that genetic variants may impact their benefits, the role of statins in precision hepatology will need to be further explored.

Impact of an innovative bundled payment to TB health care providers in China: an economic simulation analysis

BackgroundTuberculosis is the second most deadly infectious disease after COVID-19 and the 13th leading cause of death worldwide. Among the 30 countries with a high burden of TB, China ranks third in the estimated number of TB cases. China is in the top four of 75 countries with a deficit in funding for TB strategic plans. To reduce costs and improve the effectiveness of TB treatment in China, the NHSA developed an innovative BP method. This study aimed to simulate the effects of this payment approach on different stakeholders, reduce the economic burden on TB patients, improve the quality of medical services, facilitate policy optimization, and offer a model for health care payment reforms that can be referenced by other regions throughout the world.MethodsWe developed a simulation model based on a decision tree analysis to project the expected effects of the payment method on the potential financial impacts on different stakeholders. Our analysis mainly focused on comparing changes in health care costs before and after receiving BPs for TB patients with Medicare in the pilot areas. The data that were used for the analysis included the TB service claim records for 2019–2021 from the health insurance agency, TB prevalence data from the local Centre for Disease Control, and health care facilities’ revenue and expenditure data from the Statistic Yearbook. A Monte Carlo randomized simulation model was used to estimate the results.ResultsAfter adopting the innovative BP method, for each TB patient per year, the total annual expenditure was estimated to decrease from $2,523.28 to $2,088.89, which is a reduction of $434.39 (17.22%). The TB patient out-of-pocket expenditure was expected to decrease from $1,249.02 to $1,034.00, which is a reduction of $215.02 (17.22%). The health care provider’s revenue decreased from $2,523.28 to $2,308.26, but the health care provider/institution’s revenue-expenditure ratio increased from -6.09% to 9.50%.ConclusionsThis study highlights the potential of BPs to improve medical outcomes and control the costs associated with TB treatment. It demonstrates its feasibility and advantages in enhancing the coordination and sustainability of medical services, thus offering valuable insights for global health care payment reform.

Three-Dimensional Culture Modelling Reveals Divergent Mycobacterium tuberculosis Virulence and Antimicrobial Treatment Response

Tuberculosis (TB) remains a persistent epidemic, and the emergence of drug-resistant Mycobacterium tuberculosis (Mtb) presents a global healthcare threat. While some new agents have been successfully introduced, innovative technologies to evaluate emerging anti-TB compounds are required to inform transformative approaches. Mtb is an obligate human pathogen, and consequently utilizing models that are consistent with human disease is likely to be critical. We have developed a human 3-dimensional (3-D) cell culture model that reflects human disease gene expression patterns and causes Mtb to become pyrazinamide sensitive in vitro. Here, we identify key differences in virulence between the standard laboratory strain, Mtb H37Rv, and clinical isolates. We demonstrate that Mtb H37Rv is attenuated in the 3-D system, more susceptible to antibiotics and hyperinflammatory compared to clinical isolates. Prolonged in vitro culture of a clinical strain leads to attenuation. We then characterise antibiotic sensitivity of multi-drug-resistant Mtb within the 3-D model and define relative bactericidal activity. Finally, we demonstrate that verapamil increases efficacy of bedaquiline and delamanid antibiotic therapy. Taken together, our findings suggest that studying virulent clinical strains in an advanced cell culture system is a powerful adjunct to established methodologies to evaluate new interventions for TB.

An enhanced MADM with Lq* q-Rung orthopair multi-fuzzy soft set in healthcare supplier selection

The global healthcare systems have encountered unparalleled difficulties due to the COVID-19 pandemic, underscoring the crucial significance of effective management within healthcare supply chains. This research contributes to the field of healthcare supply chain management by presenting a robust MADM methodology called lattice ordered(Lq*) q-rung orthopair multi-fuzzy soft set(Lq* q-ROMFS-MADM) for supplier evaluation and ranking amidst the challenges posed by the COVID-19 pandemic. Taking inspiration from multi-fuzzy soft set and q-rung orthopair fuzzy set, the present research article proposes a novel framework known as Lq* q-rung orthopair multi-fuzzy soft set (Lq* qROMFSS), which incorporates lattice ordering in q-rung orthopair multi-fuzzy soft set. The effectiveness of the proposed model is confirmed through successful experimentation on various important operations, including union, intersection, complement, restricted union and intersection. Moreover, the verification of De Morgan’s laws for Lq* qROMFSS is carried out specifically for these operations mentioned above. To highlight the significance of the proposed Lq* qROMFSS, a multi-attribute decision-making (MADM) problem is presented, showcasing its application in the domain of healthcare supply chain management. Furthermore, a comparative analysis is conducted to elucidate the advantages of this model in comparison to existing models.

Germicidal lamps using UV-C radiation may pose health safety issues: a biomolecular analysis of their effects on apoptosis and senescence.

The battle against the COVID-19 pandemic has spurred a heightened state of vigilance in global healthcare, leading to the proliferation of diverse sanitization methods. Among these approaches, germicidal lamps utilizing ultraviolet (UV) rays, particularly UV-C (wavelength ranging from 280 to 100 nm), have gained prominence for domestic use. These light-emitting diode (LED) lamps are designed to sanitize the air, objects, and surfaces. However, the prevailing concern is that these UV lamps are often introduced into the market without adequate accompanying information to ensure their safe utilization. Importantly, exposure to absorbed UV light can potentially trigger adverse biological responses, encompassing cell death and senescence. Our research encompassed a series of investigations aimed at comprehending the biological repercussions of UV-C radiation exposure from readily available domestic lamps. Our focus centered on epithelial retinal cells, keratinocytes, and fibroblasts, components of the skin and ocular targets frequently exposed to UV irradiation. Our findings underscore the potential harm associated with even brief exposure to UV, leading to irreversible and detrimental alterations in both skin cells and retinal cells of the eye. Notably, epithelial retinal cells exhibited heightened sensitivity, marked by substantial apoptosis. In contrast, keratinocytes demonstrated resilience to apoptosis even at elevated UV doses, though they were prone to senescence. Meanwhile, fibroblasts displayed a gradual amplification of both senescence and apoptosis as radiation doses escalated. In summary, despite the potential benefits offered by UV-C in deactivating pathogens like SARS-CoV-2, it remains evident that the concurrent risks posed by UV-C to human health cannot be ignored.

Integrating Reinforcement Learning and Metaheuristics for Safe and Sustainable Health Tourist Trip Design Problem

This study aims to address the critical challenge of enhancing safety within the domain of health and wellness tourism through the framework of sustainable travel design. Given the rising demand for secure and sustainable tourism experiences, this investigation explores the integration of safety considerations into the strategic planning and execution of tourist journeys. The central focus of this research revolves around the development and application of the Modified Reinforcement Learning-Artificial Multiple Intelligence System (MRL-AMIS). Operating within a multi-objective framework, the objective of this study is to optimize essential parameters encompassing environmental sustainability, economic viability, tourist preferences, and societal acceptability, with a specific emphasis on safety. The efficacy of the proposed methodology is rigorously evaluated across various tourist group scenarios, providing a comprehensive assessment of its applicability. Our computational analyses unequivocally demonstrate the superiority of the proposed approach in enhancing safety, surpassing existing methods such as genetic algorithms, differential evolution algorithms, particle swarm optimization, etc., by 15%-25%. These findings underscore the effectiveness of the proposed method in seamlessly integrating safety considerations into the realm of sustainable tourism planning. This study highlights the potential of the proposed method as an advanced tool in the strategic planning of sustainable tourism, particularly within the context of health and wellness tourism. It constitutes a significant contribution to the field of sustainable tourism by offering an innovative approach that prioritizes safety while upholding the principles of environmental stewardship, economic viability, and societal sustainability.

A multi-objective scheduling model in medical tourism centers considering multi-task staff training

In the present era, hospitals are actively encouraging their International Patient Departments (IPD) to provide high-quality medical services at a cost-effective rate for international patients. To accomplish this objective, several crucial factors must be taken into account, including capacity constraints, hospital waiting lists, and the presence of a highly skilled workforce. The waiting time experienced by patients is a significant indicator of the quality of hospital services and is often used by patients to evaluate healthcare professionals, sometimes even surpassing their knowledge and expertise. This becomes particularly critical when dealing with international patients as longer waiting times indirectly lead to additional accommodation costs. One potential solution is to schedule international patients on different days within a specific timeframe to minimize patient flow time. However, this can only be realistically achieved if staff productivity is enhanced through in-service training. These challenges, coupled with the uncertainty surrounding treatment duration, create a complex problem for IPDs. This study proposes an optimization approach for scheduling medical tourists who visit destination medical centers with two primary objectives: 1) reducing patient waiting times and 2) decreasing training costs while enhancing the skill level of the staff serving patients. The proposed model is formulated as a bi-objective nonlinear integer programming problem, which is subsequently transformed into a linear model using theoretical techniques. Given that this problem is NP-hard, two efficient meta-heuristic methods are developed to solve it for real-world scenarios of varying sizes. The findings of this study present a comparative analysis between the outcomes generated by the proposed algorithms and an exact method (CPLEX), showcasing their effectiveness and superiority. Additionally, a sensitivity analysis highlights that despite the costs associated with in-service training, enhancing staff skills can substantially reduce patient waiting times, resulting in significant cost savings for medical services while ensuring the delivery of high-quality care. Moreover, the improved staff skills enable IPD managers to gain valuable insights into the financial well-being of the medical center, including its ability to attract medical tourists.