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1.
Artículo en Inglés | MEDLINE | ID: mdl-33799752

RESUMEN

Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.


Asunto(s)
Prestación de Atención de Salud , Mejoramiento de la Calidad , Eficiencia Organizacional , Instituciones de Salud , Atención Primaria de Salud
3.
Bone Joint J ; 103-B(2): 347-352, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517742

RESUMEN

AIMS: Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines. Operative efficiency is also dependent on high-functioning teams and can offer a proxy for effective communication in highly standardized procedures like primary total hip and knee arthroplasty. We aimed to evaluate how the composition and dynamics of surgical teams impact operative efficiency during arthroplasty. METHODS: We performed a retrospective review of staff characteristics and operating times for 112 surgeries (70 primary total hip arthroplasties (THAs) and 42 primary total knee arthroplasties (TKAs)) conducted by a single surgeon over a one-year period. Each surgery was evaluated in terms of operative duration, presence of surgeon-preferred staff, and turnover of trainees, nurses, and other non-surgical personnel, controlling cases for body mass index, presence of osteoarthritis, and American Society of Anesthesiologists (ASA) score. RESULTS: Turnover among specific types of operating room staff, including the anaesthesiologist (p = 0.011), circulating nurse (p = 0.027), and scrub nurse (p = 0.006), was significantly associated with increased operative duration. Furthermore, the presence of medical students and nursing students were associated with improved intraoperative efficiency in TKA (p = 0.048) and THA (p = 0.015), respectively. The presence of surgical fellows (p > 0.05), vendor representatives (p > 0.05), and physician assistants (p > 0.05) had no effect on intraoperative efficiency. Finally, the presence of the surgeon's 'preferred' staff did not significantly shorten operative duration, except in the case of residents (p = 0.043). CONCLUSION: Our findings suggest that active management of surgical team turnover and composition may provide a means of improving intraoperative efficiency during THA and TKA. Cite this article: Bone Joint J 2021;103-B(2):347-352.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Eficiencia Organizacional , Grupo de Atención al Paciente/organización & administración , Humanos , Relaciones Interprofesionales , Tempo Operativo , Reorganización del Personal , Estudios Retrospectivos
7.
BMC Health Serv Res ; 21(1): 38, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413381

RESUMEN

BACKGROUND: Increasing patient numbers, complexity of patient management, and healthcare resource limitations have resulted in prolonged patient wait times, decreased quality of service, and decreased patient satisfaction in many outpatient services worldwide. This study investigated the impact of Lean Six Sigma, a service improvement methodology originally from manufacturing, in reducing patient wait times and increasing service capacity in a publicly-funded, tertiary referral outpatient ophthalmology clinic. METHODS: This quality improvement study compared results from two five-months audits of operational data pre- and post-implementation of Lean Six Sigma. A baseline audit was conducted to determine duration and variability of patient in-clinic time and number of patients seen per clinic session. Staff interviews and a time-in-motion study were conducted to identify issues reducing clinic service efficiency. Solutions were developed to address these root causes including: clinic schedule amendments, creation of dedicated postoperative clinics, and clear documentation templates. A post-implementation audit was conducted, and the results compared with baseline audit data. Significant differences in patient in-clinic time pre- and post-solution implementation were assessed using Mann-Whitney test. Differences in variability of patient in-clinic times were assessed using Brown-Forsythe test. Differences in numbers of patients seen per clinic session were assessed using Student's t-test. RESULTS: During the baseline audit period, 19.4 patients were seen per 240-minute clinic session. Median patient in-clinic time was 131 minutes with an interquartile range of 133 minutes (84-217 minutes, quartile 1- quartile 3). Targeted low/negligible cost solutions were implemented to reduce in-clinic times. During the post-implementation audit period, the number of patients seen per session increased 9% to 21.1 (p = 0.016). There was significant reduction in duration (p < 0.001) and variability (p < 0.001) of patient in-clinic time (median 107 minutes, interquartile range 91 minutes [71-162 minutes]). CONCLUSIONS: Lean Six Sigma techniques may be used to reduce duration and variability of patient in-clinic time and increase service capacity in outpatient ophthalmology clinics without additional resource input.


Asunto(s)
Oftalmología , Gestión de la Calidad Total , Instituciones de Atención Ambulatoria , Citas y Horarios , Eficiencia Organizacional , Humanos , Oftalmología/normas , Pacientes Ambulatorios
8.
J Nurs Adm ; 51(2): 67-73, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449595

RESUMEN

This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.


Asunto(s)
Centros Comunitarios de Salud/organización & administración , Eficiencia Organizacional , Atención Dirigida al Paciente/organización & administración , Mejoramiento de la Calidad/organización & administración , Niño , Femenino , Humanos , Estudios de Casos Organizacionales , Grupo de Atención al Paciente/organización & administración , Servicios de Salud para Mujeres/organización & administración
9.
J Nurs Adm ; 51(2): 74-80, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449596

RESUMEN

BACKGROUND: Healthcare simulation has expanded dramatically; however, little is known about the scope of simulation in acute care hospitals. METHODS: A descriptive, cross-sectional online survey was used. Participants included nurse executives from acute care hospitals in California. RESULTS: Most organizations (96%) used simulation primarily for education, 37% used simulation for health system integration and systems testing, 30% used it for error investigation, 15% used it for research, and 15% used it for patient/family education. CONCLUSIONS: Organizations have a substantial opportunity to increase the scope of simulation beyond education to include systems integration, clinical systems testing, and other translational simulation activities. This targeted focus on patient safety and quality will allow hospitals to improve financial performance and maximize scarce resources.


Asunto(s)
Eficiencia Organizacional/normas , Maniquíes , Personal de Enfermería en Hospital/educación , Grupo de Atención al Paciente/organización & administración , Simulación de Paciente , California , Competencia Clínica , Simulación por Computador , Estudios Transversales , Humanos
10.
Ann Allergy Asthma Immunol ; 126(3): 235-239, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33309885

RESUMEN

OBJECTIVE: To review evidence-based strategies that have been noted to improve professional fulfillment and reduce burnout by enhancing practice efficiency. DATA SOURCES: A comprehensive literature review was conducted to evaluate the strategies to improve efficiency of practice-a key driver of burnout among physicians. STUDY SELECTIONS: Studies of efficiency-enhancing practices relevant to allergy-immunology were included. RESULTS: Professional burnout is prevalent among physicians and is associated with negative outcomes affecting physicians, patients, and health care organizations. Recent surveys suggest at least 35% of US allergists-immunologists experience burnout. There are multiple drivers of professional burnout, some at the individual level and others at the organizational or practice level. Strategies to improve professional fulfillment may be conceptualized using the Stanford physician wellness framework, in which efforts target the following 3 reciprocal domains: culture, personal resilience, and practice efficiency. Organizational strategies that support physician well-being by creating a more efficient practice environment hold great promise, particularly for allergists-immunologists. The reduction of administrative burden and fostering of team-based care have been found in multiple studies to be cost-effective strategies to improve physician and patient satisfaction. CONCLUSION: To ensure the well-being of the US allergy-immunology workforce and optimize patient outcomes, both private and academic allergy-immunology institutions should prioritize the adoption and iterative evaluation and refinement of these strategies to cocreate an efficient and ideal practice environment.


Asunto(s)
Alergia e Inmunología , Agotamiento Profesional/prevención & control , Eficiencia Organizacional , Cultura Organizacional , Médicos/psicología , Humanos , Satisfacción en el Trabajo , Profesionalismo
11.
Rev. psicol. trab. organ. (1999) ; 36(3): 195-204, dic. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-198239

RESUMEN

Agentic capabilities refer to the basic capabilities of mind that, according to social cognitive theory, allow people to proactively influence their functioning and external context. This study presents a new scale, namely the Work Agentic Capabilities (WAC) questionnaire, that consists of 28 items and measures forethought capability, self-regulation capability, self-reflection capability and vicarious capability in the organizational context. Accordingly, an exploratory (N = 290) and a confirmatory factor analysis (N = 300) demonstrated a four-factor structure. Agentic capabilities were positively correlated with psychological capital and its dimensions i.e., self-efficacy, hope, optimism and resiliency), positive job attitudes (work engagement and job satisfaction), proactive organizational behaviours (job crafting and organizational citizenship behaviours), perceived job performance, and promotion prospects. Finally, we discuss meaningful differences in the mean values of agentic capabilities associated with sociodemographic and organizational variables. Results suggest that the WAC questionnaire can be reliably used to measure agentic capabilities


Las capacidades agénticas aluden a aquellas capacidades de la mente que según la teoría social cognitiva permiten a las personas influir de un modo proactivo en su funcionamiento y en el contexto externo. El presente estudio presenta una nueva escala, el cuestionario de Capacidades Agénticas en el Trabajo (WAC, por sus siglas en inglés), compuesto de 28 ítems que mide la capacidad de previsión, autorregulación, autorreflexión y vicaria en el contexto organizativo. Un estudio con análisis factorial exploratorio (N = 290) y confirmatorio (N = 300) descubrió una estructura de cuatro factores. Las capacidades agénticas correlacionaban positivamente con el capital psicológico y sus dimensiones (es decir, esperanza, optimismo y resiliencia), las actitudes laborales positivas (engagement y satisfacción en el trabajo), la percepción del desempeño laboral y las perspectivas de promoción. Por último abordamos las diferencias significativas de los valores medios de las capacidades agénticas asociadas a las variables sociodemográficas y organizativas. Los resultados indican que el cuestionario WAC puede utilizarse de modo fiable para medir las capacidades agénticas


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Eficiencia Organizacional , Cultura Organizacional , Política Organizacional , Teoría Social
12.
Med J Aust ; 213(11): 516-520, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33314108

RESUMEN

OBJECTIVE: To characterise the working arrangements of medical research scientists and support staff in Australia during the COVID-19 pandemic, and to evaluate factors (in particular: wearing pyjamas) that influence the self-assessed productivity and mental health of medical institute staff working from home. DESIGN: Prospective cohort survey study, 30 April - 18 May 2020. SETTING, PARTICIPANTS: Staff (scientists and non-scientists) and students at five medical research institutes in Sydney, New South Wales. MAIN OUTCOME MEASURES: Self-assessed overall and task-specific productivity, and mental health. RESULTS: The proportions of non-scientists and scientists who wore pyjamas during the day were similar (3% v 11%; P = 0.31). Wearing pyjamas was not associated with differences in self-evaluated productivity, but was significantly associated with more frequent reporting of poorer mental health than non-pyjama wearers while working from home (59% v 26%; P < 0.001). Having children in the home were significantly associated with changes in productivity. Larger proportions of people with toddlers reported reduced overall productivity (63% v 32%; P = 0.008), and reduced productivity in writing manuscripts (50% v 17%; P = 0.023) and data analysis (63% v 23%; P = 0.002). People with primary school children more frequently reported reduced productivity in writing manuscripts (42% v 16%; P = 0.026) and generating new ideas (43% v 19%; P = 0.030). On a positive note, the presence of children in the home was not associated with changes in mental health during the pandemic. In contrast to established researchers, early career researchers frequently reported reduced productivity while working at home. CONCLUSIONS: Our findings are probably applicable to scientists in other countries. They may help improve work-from-home policies by removing the stigma associated with pyjama wearing during work and by providing support for working parents and early career researchers.


Asunto(s)
Eficiencia Organizacional/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Adolescente , Adulto , Australia , Femenino , Personal de Salud/psicología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Lugar de Trabajo , Adulto Joven
13.
BMJ Open ; 10(12): e041422, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310804

RESUMEN

OBJECTIVES: Emergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This study aimed to explore the patient flow process in an ED in Trinidad and Tobago, identifying organisational factors influencing patient flow. METHODS: Multiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyse the data. SETTING: The study was conducted at a major tertiary level ED in Trinidad and Tobago. PARTICIPANTS: Patient and staff journeys in the ED were directly observed. RESULTS: Six broad categories were identified: (1) ED organisational work processes, (2) ED design and layout, (3) material resources, (4) nursing staff levels, roles, skill mix and use, (5) non-clinical ED staff and (6) external clinical and non-clinical departments. Within each category there were individual factors that appeared to either facilitate or hinder patient flow. Organisational processes such as streaming, front loading of investigations and the transfer process were pre-existing strategies in the ED while staff actions to compensate for limitations with flow were more intuitive. A conceptual framework of factors influencing ED patient flow is also presented. CONCLUSION: The knowledge gained may be used to strengthen the emergency care system in the local context. However, the study findings should be validated in other settings.


Asunto(s)
Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Región del Caribe , Comunicación , Eficiencia Organizacional , Humanos , Trinidad y Tobago
14.
PLoS One ; 15(12): e0244444, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33370406

RESUMEN

Efficiency analysis of the Partner Organizations can benefit all the microfinance sector's key stakeholders to benchmark the current scene and formulate optimal policy agenda. This study seeks to measure the partner organizations of the Pakistan Poverty Alleviation Fund's social and financial efficiency and to identify causes and sources of their inefficiencies. A non-parametric technique known as Data Envelopment Analysis is applied to investigate the Partner Organizations' efficiency throughout 2005-2015. The required data was obtained from the database of the Mix-Market and Pakistan Microfinance Network. The social and financial efficiency was estimated assuming Constant Return to Scale, Variable Return to Scale, and with respect to the Operational Scale of the Partner Organizations. Results revealed that the partner organizations are more scale efficient (median = 75%) than pure technically efficient (median = 55%). Further, graphical representations show a decreasing linear trend and negative serial correlation in the percentage of efficient partner organizations. The model fit results show that institutional characteristics that influence partner organizations' efficiencies significantly include their age, Operational Self-Sufficiency, personnel, loan officers, assets and debt. Finally, the diagnostic tests for endogeneity, heteroskedasticity, heterogeneity, and cross-sectional dependence were performed.


Asunto(s)
Países en Desarrollo/economía , Eficiencia Organizacional , Administración Financiera/organización & administración , Pobreza/prevención & control , Administración Financiera/economía , Humanos , Modelos Organizacionales , Pakistán , Políticas , Pobreza/economía
15.
BMJ ; 371: m4571, 2020 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-33376083

RESUMEN

OBJECTIVES: To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. DESIGN: A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. PARTICIPANTS: 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. MAIN OUTCOME MEASURE: A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. RESULTS: 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). CONCLUSION: This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.


Asunto(s)
Enfermedades Cardiovasculares , Calefacción , Hospitalización/estadística & datos numéricos , Vivienda , Enfermedades Respiratorias , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/terapia , Eficiencia Organizacional , Ambiente Controlado , Femenino , Calefacción/métodos , Calefacción/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Desarrollo de Programa , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/prevención & control , Enfermedades Respiratorias/terapia , Estudios Retrospectivos
16.
Nihon Koshu Eisei Zasshi ; 67(10): 734-744, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-33361668

RESUMEN

Objectives This study aimed to examine the effectiveness of a walking point project with incentives for increasing walking time, preventing the decline of physical function and worsening depression among older adults.Methods We used data from the Japan Gerontological Evaluation Study, which included subjects aged ≥65 years who lived in Yokohama City in 2013 and 2016. We obtained information on the subjects' participation in the "Yokohama Walking Point (YWP)," a program launched by Yokohama City in 2014, from the 2016 survey data. We excluded individuals with missing data for sex, age, walking time per day (<30, 30-59, 60-89, or ≥90 min/day), physical function (5 physical function category items on the Kihon Checklist), depression (15-item Geriatric Depression Scale), and participation status in the YWP. We used data from 4,509 eligible respondents. Changes in walking time, physical function, and depression were designated as independent variables, and participation status in the YWP was designated as the dependent variable in the multiple regression analysis with inverse probability of treatment weighting (IPTW), after adjusting for demographic variables, socioeconomic status, health status, and behavior.Results Among the total subjects, 758 (16.8%) participated in the YWP. The IPTW method showed that participants in the YWP had significantly higher walking times (B=3.61, 95% CI: 1.04, 6.17), less decline in physical function, and less depression (B=-0.13, 95% CI: -0.23, -0.03; B=-0.21, 95% CI: -0.42, -0.01) than those who did not participate in the YWP.Conclusions Our findings suggest that the YWP, with incentives, effectively increased walking time and prevented worsening of physical function and depression among older adults. The municipality's health point project, based on the number of steps, is a useful population approach for promoting health among older adults.


Asunto(s)
Depresión/prevención & control , Tolerancia al Ejercicio/fisiología , Promoción de la Salud/métodos , Envejecimiento Saludable/fisiología , Envejecimiento Saludable/psicología , Motivación/fisiología , Rendimiento Físico Funcional , Servicios Preventivos de Salud/métodos , Puntaje de Propensión , Caminata/fisiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Eficiencia Organizacional , Femenino , Humanos , Japón , Masculino
17.
Artículo en Inglés | MEDLINE | ID: mdl-33333979

RESUMEN

In this work, the application of the Lean 6S methodology is exposed, which includes the Safety-Security activity in response to the demands caused by the epidemiological situation due to exposure to SARS-CoV-2, as well as its implementation through a standardized process in n higher education environment in the engineering field. The application of methodologies based on lean principles in the organizational system of an educational institution, causes an impact on the demands of organizational efficiency, where innovation and continuous improvement mark the path to success. The Lean 6S methodology, based on the development of six phases, guarantees, thanks to the impact of all its phases and especially of three of them: cleaning, standardize and safety, the control of the health risk against SARS-CoV-2. This guarantee is achieved through the permanent review of safety in the workplace. The areas of selected implementation to verify the effect have been the essential spaces for the development of the teaching activity: center accesses, learning rooms and practical laboratories. The laboratories are adapted to the security and organization conditions that are required in the regulations required by the Occupational Risk Prevention Services against exposure to SARS-CoV-2, since the appropriate protective equipment for the risk level is reviewed, the ordering of the workstations, the class attendance through the shifts organization and the rearrangement of the common places where the maintenance of a minimum interpersonal safety distance between the teaching staff, auxiliary services and students is guaranteed. The effort of the teaching staff in terms of following the established rules is notably increased. To balance this dedication, it is necessary to increase and rely on auxiliary personnel who guarantee rules compliance control in different spaces than the classroom and the laboratory.


Asunto(s)
Educación Continua , Eficiencia Organizacional , Pandemias , Lugar de Trabajo , Humanos , Laboratorios , Seguridad
18.
Artículo en Inglés | MEDLINE | ID: mdl-33333845

RESUMEN

Many countries are facing the increasing cost of healthcare services and the low efficiency of public hospitals. These issues are also evident in China. This paper offers a comprehensive assessment of the efficiency of public hospitals operating in China's 31 regions. The impact of the third round of reform of the health system in 2009 is assessed based on the three-stage data envelopment analysis procedure. The time period from 2011 to 2018 is covered in this study. Due to different functions performed by the public hospitals and other ones, the number of patients with infectious diseases is incorporated as an output variable reflecting the social function. The outpatient visits and inpatient visits are considered to reflect the outputs related to the private functions. The results imply an increase in the mean efficiency of public hospitals from 0.927 to 0.981 after taking the impact of environmental variables and statistic noise into account. These results indicate that the efficiency of public hospitals is dependent in the operational environment. There are 11 regions whose hospitals operate on the efficiency frontier during the whole period covered. Therefore, the Chinese government should reasonably design and apply the regulatory tools to improve the efficiency of public hospitals.


Asunto(s)
Eficiencia Organizacional , Hospitales Públicos , China , Eficiencia , Humanos
19.
JAMA Netw Open ; 3(12): e2028499, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33351083

RESUMEN

Importance: Engaging adolescent boys and young men in preventing violence against women is a potentially impactful public health strategy. Objective: To evaluate the effectiveness of a community-based, gender-transformative program (ie, Manhood 2.0) on perpetration of gender-based violence by adolescent boys and young men. Design, Setting, and Participants: In this unblinded cluster randomized clinical trial, neighborhoods were designated as the unit of clustering (1:1 allocation). Three-month (ie, time point 2 [T2]) and 9-month (ie, time point 3 [T3]) follow-ups were conducted. The trial took place in 20 Pittsburgh, Pennsylvania, neighborhoods and 1 centrally located site with concentrated disadvantage. Pittsburgh-based adolescent boys and young men (ages 13 to 19 years) were recruited between July 27, 2015, and June 5, 2017, through youth-serving organizations and community-based alternatives to residential placement for juvenile justice-involved youth. Intention-to-treat analysis was conducted from June 2018 to November 2019. Interventions: Manhood 2.0, an international program adapted for adolescent boys and young men in US urban communities, encourages these individuals to challenge gender norms that foster violence against women and unhealthy sexual relationships. Individuals in the control population received job-readiness training. Each program was 18 hours. Main Outcomes and Measures: The primary outcome was change in participant-level perpetration of sexual violence (SV) or adolescent relationship abuse (ARA) at T3. Results: Among 866 participants, 465 individuals (54%) enrolled in 11 intervention clusters and 401 individuals (46%) enrolled in 10 control clusters. In the intervention group, 325 participants (70%) were analyzed at T2 and 334 participants (72%) were analyzed at T3; in the control group, 262 participants (65%) were analyzed at T2 and 301 participants (75%) were analyzed at T3. Mean (SD) age was 15.5 (1.6) years; 609 participants (70%) self-identified as non-Hispanic Black, and 178 (20%) self-identified as Hispanic, multiracial, or other race/ethnicity other than White. Among individuals in the intervention group, 296 participants (64%) reported any SV or ARA perpetration at baseline, and 173 participants (52%) reported any SV or ARA perpetration at T3. Among individuals in the control group, 213 participants (53%) reported any SV or ARA perpetration at baseline, and 124 participants (41%) reported any SV or ARA perpetration at T3). The difference in reduction between groups was not significant. There was no evidence of an intervention effect for the primary outcome (adjusted odds ratio [OR], 1.32; 95% CI, 0.86-2.01; P = .20). Conclusions and Relevance: The findings from this evaluation of a community-based gender-transformative program for adolescent boys and young men did not show a significant intervention effect in reducing SV or ARA perpetration between Manhood 2.0 and a job-readiness control program. Combining gender-transformative approaches with job-readiness programs may be relevant for violence prevention in low-resource urban settings. Attention to improving implementation and strategies to sustain such community-based efforts are needed. Trial Registration: ClinicalTrials.gov Identifier: NCT02427061.


Asunto(s)
Violencia de Pareja , Salud Pública/métodos , Tratamiento Domiciliario/métodos , Delitos Sexuales , Adolescente , Eficiencia Organizacional , Femenino , Humanos , Relaciones Interpersonales , Violencia de Pareja/prevención & control , Violencia de Pareja/psicología , Masculino , Evaluación de Necesidades , Desarrollo de Programa , Delitos Sexuales/prevención & control , Delitos Sexuales/psicología , Conducta Sexual/psicología , Población Urbana , Adulto Joven
20.
Can J Surg ; 63(6): E527-E529, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33180692

RESUMEN

SUMMARY: The cancellation of large numbers of surgical procedures because of the coronavirus disease 2019 (COVID-19) pandemic has drastically extended wait lists and negatively affected patient care and experience. As many facilities resume clinical work owing to the currently low burden of disease in our community, we are faced with operative booking protocols and procedures that are not mathematically designed to optimize efficiency. Using a subset of artificial intelligence called "machine learning," we have shown how the use of operating time can be optimized with a custom Python (a high-level programming language) script and an open source machine-learning algorithm, the ORTools software suite from the Google AI division of Alphabet Inc. This allowed the creation of customized models to optimize the efficiency of operating room booking times, which resulted in a reduction in nursing overtime of 21% - a theoretical cost savings of $469 000 over 3 years.


Asunto(s)
Citas y Horarios , Infecciones por Coronavirus/prevención & control , Eficiencia Organizacional/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Aprendizaje Automático , Quirófanos/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Ontario , Tempo Operativo , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología
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