||The design of clinical trials is one of the important problems in medical statistics. Its main purpose is to determine the methodology and the sample size required of a testing study to examine the safety and efficacy of drugs. It is also a part of the Food and Drug Administration approval process. In this thesis, we first study the comparison of the efficacy of drugs in clinical trials. We focus on the two-sample comparison of proportions to investigate testing strategies based on two-stage design. The properties and advantages of the procedures from the proposed testing designs are demonstrated by numerical results, where comparison with the classical method is made under the same sample size. A real example discussed in Cardenal et al. (1999) is provided to explain how the methods may be used in practice. Some figures are also presented to illustrate the pattern changes of the power functions of these methods. In addition, the proposed procedure is also compared with the Pocock (1997) and O’Brien and Fleming (1979) tests based on the standardized statistics.|
In the second part of this work, the operating room scheduling problem is considered, which is also important in medical studies. The national health insurance system has been conducted more than ten years in Taiwan. The Bureau of National Health Insurance continues to improve the national health insurance system and try to establish a reasonable fee ratio for people in different income ranges. In accordance to the adjustment of the national health insurance system, hospitals must pay more attention to control the running cost. One of the major hospital's revenues is generated by its surgery center operations. In order to maintain financial balance, effective operating room management is necessary.
For this topic, this study focuses on the model fitting of operating times and operating room scheduling. Log-normal and mixture log-normal distributions are identified to be acceptable statistically in describing these operating times. The procedure is illustrated through analysis of thirteen operations performed in the gynecology department of a major teaching hospital in southern Taiwan. The best fitting distributions are used to evaluate performances of some operating combinations on daily schedule, which occurred in real data. The fitted distributions are selected through certain information criteria and bootstrapping the log-likelihood ratio test. Moreover, we also classify the operations into three different categories as well as three stages for each operation. Then based on the classification, a strategy of efficient scheduling is proposed. The benefits of rescheduling based on the proposed strategy are compared with the original scheduling observed.