COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine.

Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock-extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care.

Estudio de métodos y tiempo en la producción del diagnosticador HeberFast Line Maternitest IIStudy of methods and time in the HeberFast Line Maternitest II diagnostic

La tendencia mundial de incrementar el rendimiento de las producciones biotecnológicas se ha traducido en un interés más amplio acerca del estudio de métodos y tiempo. Uno de los principales productos del Centro de Ingeniería Genética y Biotecnología de Sancti Spíritus es el diagnosticador HeberFast Line Maternitest II, el proceso de etiquetado se realizaba de forma manual desde el 2018 y posteriormente de forma mecanizada con el empleo de la etiquetadora Mecatronic ZIMMER. El presente trabajo tiene como objetivo realizar un estudio de métodos y tiempo en la planta de producción de diagnosticadores en el período comprendido entre el 2018 y 2020. El estudio de métodos demostró que el proceso de etiquetado mecanizado del diagnosticador HeberFast Line Maternitest II presenta una productividad dos veces superior a la manufactura. Se seleccionó la variante de etiquetado D por presentar una productividad de 74,8 paquetes etiquetados y 2,2 % de índice de rechazado por jornada labora(AU)

Open Office Space: The Wave of the Future for Academic Health Centers?

Facing space constraints similar to those experienced by many urban campuses, the University of California, San Francisco (UCSF) looked to innovative office workplace design to curb growing facilities expenditures. Mission Hall, a new office building primarily for desktop and clinical researchers and staff, was designed as an activity-based workplace (ABW), a type of open-space design. ABW was simultaneously being proposed as the template for future UCSF desktop research workspaces. ABWs can be less costly to construct than other designs, and their mix of shared and open workspaces is intended to improve efficiency and interaction. Evaluations of ABWs in corporate settings have yielded mixed results. Examples of ABW buildings for faculty in academic health centers (AHCs) are rare.The Mission Hall experience provided a unique opportunity to understand the impact of an ABW design on faculty satisfaction, work effectiveness, well-being, and engagement. In a 2016 survey of faculty, 1 year after occupancy, respondents reported adverse changes in all 4 areas. The most common complaints involved noise exposure and lack of visual and auditory privacy. In response to these issues, faculty reported working at home or elsewhere more frequently, making collaboration more difficult. In 2018, UCSF retrofitted the building to create some private offices and adjusted its overall program to balance private office and open workspaces in future projects.Lessons drawn from this experience can inform workplace solutions at other AHCs. Most critical are the needs to assess functional requirements of work and align design, change management, and technologies to support those requirements.

Scientific Ethics: A New Approach.

Science is an activity of the human intellect and as such has ethical implications that should be reviewed and taken into account. Although science and ethics have conventionally been considered different, it is herewith proposed that they are essentially similar. The proposal set henceforth is to create a new ethics rooted in science: scientific ethics. Science has firm axiological foundations and searches for truth (as a value, axiology) and knowledge (epistemology). Hence, science cannot be value neutral. Looking at standard scientific principles, it is possible to construct a scientific ethic (that is, an ethical framework based on scientific methods and rules), which can be applied to all sciences. These intellectual standards include the search for truth (honesty and its derivatives), human dignity (and by reflection the dignity of all animals) and respect for life. Through these it is thence achievable to draft a foundation of a ethics based purely on science and applicable beyond the confines of science. A few applications of these will be presented. Scientific ethics can have vast applications in other fields even in non scientific ones.

La pérdida de productividad laboral atribuible al tabaquismo / Occupational productivity lose due to tobacco dependence

Introducción: La Organización Mundial de la Salud (OMS) destaca que una de las consecuencias del tabaquismo para la economía nacional está en la pérdida de la productividad laboral, lo cual trae apareado un círculo vicioso de adicción, falta de productividad y pobreza. La OMS también ha destacado que existe una relación muy estrecha entre desarrollo de las fuerzas productivas y consumo de cigarrillos y tabacos, donde que por lo general, los mayores consumos mundialmente se concentran en los países subdesarrollados, y no precisamente en los de mayor ingreso per cápita o desarrollo económico. De hecho, dada la fuerte dependencia que genera el consumo regular de productos manufacturados de la hoja del tabaco para fumar en sus consumidores, dicho consumo puede ir desplazando poco a poco el consumo de otros bienes y/o servicios de primera necesidad, lo cual acentúa los niveles de pobreza extrema, accesibilidad e iniquidad social. Objetivo: Identificar las características generales y fundamentales del tabaquismo como factor de riesgo en la pérdida de productividad laboral. Método: Se realizó un estudio descriptivo mediante una revisión bibliográfica que permitiera identificar las características generales y fundamentales del tabaquismo como factor de riesgo en la pérdida de productividad laboral. Resultados y discusión: Se desagregaron conceptualmente las distintas manifestaciones de la pérdida de productividad laboral atribuibles al tabaquismo como factor de riesgo. Conclusiones: El tabaquismo como factor de riesgo es un elemento clave en la pérdida de la productividad laboral. Dicha pérdida se manifiesta de diversas maneras e impactan negativamente también sobre la economía individual y social(AU)

The Productivity Dilemma in Workplace Health Promotion.

BACKGROUND: Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing health economics contention that return on investment (ROI) does not merit preventive health investment. METHODS/PROCEDURES: Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value. The issues are presented in the format of 3 conceptual dilemmas. PRINCIPAL FINDINGS: In some occupations such as nursing, the utility of patient survival and staff health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting and eliminating the drag of negative value radically change the CBA value. SIGNIFICANCE: Simple monetization of a work life and calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of productivity and utility.

Documento de posicionamiento sobre la eficiencia de las tecnologías aplicadas al manejo de la diabetes / Position statement on efficiency of technologies for diabetes management

Las cifras del estudio Di@bet.es en España son contundentes: la diabetes afecta al 13,8% de la población española. Pero si los datos estadísticos son alarmantes, el mayor problema lo constituye el ritmo de crecimiento, y las previsiones calculan en poco tiempo proporciones pandémicas de diabetes tipo 2 que pondrán en riesgo el estado de bienestar. Por ello, la diabetes no solo representa un desafío importante para los servicios de salud, sino que pasa a ser un reto para los Ministerios de Sanidad y Economía. La tecnología se ha convertido en una herramienta imprescindible en la atención de calidad del paciente con diabetes, pues facilita los procesos de atención y cuidados para obtener un buen control metabólico y prevenir las complicaciones. Las bombas de insulina, los sensores de glucosa y la automonitorización de la glucemia capilar ya han probado su eficiencia, y la telemedicina está en vías de hacerlo. Los costes indirectos de la diabetes en España son mucho más elevados que los directos, lo cual no deja de ser una paradoja que debemos invertir. La optimización de los recursos dependerá de la habilidad que tengamos los profesionales y la administración para implantar y mantener la innovación tecnológica en todos sus niveles y hacerla eficaz en la ecuación que examina los datos económicos y los beneficios. Los análisis de coste-efectividad y coste-utilidad son necesarios para establecer prioridades y permitir tomar decisiones de gestión sanitaria, que en el caso de enfermedades tan prevalentes como la diabetes tienen repercusiones directas en el gasto sanitario

Di@bet.es study results are impressive, showing that diabetes affects 13.8% of the Spanish population. Not only the statistical facts are alarming, but the increasing incidence of this disease is a major problem, as pandemic proportions of type 2 diabetes are expected. Thus, the study of diabetes represents a challenge not only for health services, but also for the Ministries of Health and Finance. Technology has become an essential tool in the quality care of patients with diabetes, as it helps in the healthcare processes to obtain an optimum metabolic balance and prevent possible complications. Insulin pumps, continuous glucose monitoring and self-monitoring blood glucose have all proved their efficiency, and telemedicine it is making good progress. The indirect costs of diabetes in Spain are much higher than the direct ones, showing the importance of inverting the paradox. The optimization of resources depends not only on the ability of the physicians, but also the administration, to implant and sustain technological innovations in our system, and with that make it effective in terms of benefits. Cost-effectiveness and cost-utility analysis are needed to prioritize and allow health management services to make the correct choices for approaching this prevalent chronic disease

Hacia el pleno desarrollo del transporte pediátrico en España / Towards the full development of paediatric transport in Spain

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Productivity costs in economic evaluations: past, present, future.

Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.

Interfaces between electronic medical record (EMR/EHR) technology and people in American medicine: insight. imagination, and relationships in clinical practice.

This paper explores the contexts and relationships in which EMR/EHR technology is used in healthcare settings. It approaches the EMR/EHR as an issue in clinical ethics. The author recognizes the immense contribution that healthcare informatics makes to coordinating and integrating medical care at the level of individual physician, nurse, and institutions. At the same time the author raises a cautionary note about some unrecognized dimensions of the use and experience of the EMR/EHR. The author argues that the EMR/EHR can consciously and unconsciously become an instrument of assembly line-like physician "productivity" and "production reports" that depersonalize patient and physician alike. Construed this way, the EMR/EHR can narrow the clinician's imagination, relationships, clinical decision-making, and documentation into oversimplified, and potentially distorting, clinical narratives and categories such as fit into CPT, ICD-9, DRG, DSM-IV and other codes, EBM protocols, and clinical algorithms. By contrast, the author uses a vignette and one of his own clinical poems to illustrate the rich weave of relationship and meaning that are foreground rather than background in clinical assessment, decision-making, treatment, outcome, and satisfaction. The author concludes with a call to imaginatively use the EMR/EHR as an instrument of physician-patient communication, and to include in it and make available vital narrative data (evidence) about patient, family, culture, occupation, socioeconomic status, physician, disease, and their relationships.

Enhancement and the ethics of development.

Much of the debate about the ethics of enhancement has proceeded according to two framing assumptions. The first is that although enhancement carries large social risks, the chief benefits of enhancement are to those who are enhanced (or their parents, in the case of enhancing the traits of children). The second is that, because we now understand the wrongs of state-driven eugenics, enhancements, at least in liberal societies, will be personal goods, chosen or not chosen in a market for enhancement services. This article argues that both framing assumptions must be rejected, once it is understood that some enhancements--especially those that are most likely to garner resources and become widespread--will increase human productivity. Once one appreciates the productivity-increasing potential of enhancements, one can begin to see that enhancement need not be primarily a zero sum affair, that the social costs of forgoing enhancements may be great, and that the state may well take an interest in facilitating biomedical enhancements, just as it does in facilitating education and other productivity-increasing traditional enhancements. Appreciating the productivity-increasing potential of enhancements also makes it possible to view the enhancement debate in a new light, through the lens of the ethics of development.

Evaluación económica y toma de decisiones en salud. El papel de la evaluación económica en la adopción y la difusión de tecnologías sanitarias. Informe SESPAS 2008 / Economic evaluation and decision-making in health. The role of economic evaluation in the adoption and spread of health technologies. 2008 SESPAS Report

La evaluación económica de tecnologías sanitarias (EETS)se ha convertido en una herramienta básica para ayudar enla toma de decisiones en materia de salud. El continuo desarrollode aspectos metodológicos y su posible aplicación directaa la realidad de cada país la han situado como elementoimportante en la agenda de los responsables sanitarios. Esteartículo introduce los objetivos generales de la EETS y describela experiencia de varios países europeos donde se empleandichas técnicas para decidir si se implementa una tecnologíasanitaria. A continuación se evalúa la situación deEspaña y el papel que ejerce la EETS en estos momentos.Finalmente, se identifican tareas pendientes y se mencionanalgunas recomendaciones para consolidar la EETS como herramientafundamental en la toma de decisiones sanitarias(AU)

Economic evaluation of health care technologies (EEHT) hasbecome a basic tool in the decision-making process in health.The continuous development of methods and their direct applicationto reality have placed EEHT as a key item on the agendaof health policy makers across countries. The present articleintroduces the aims of EEHT and describes the experienceof several European countries where economic evaluation studiesare currently used to select the health technologies to beimplemented. The role played by EEHT in Spain at the presenttime is then discussed. Finally, pressing tasks are identifiedand recommendations are made for the consolidation ofEEHT as a basic element in the decision-making process ofhealth care technologies(AU)

Race and productivity outcome after traumatic brain injury: influence of confounding factors.

OBJECTIVE: Investigate the impact of race on productivity outcome after traumatic brain injury (TBI) and evaluate the influence of confounding factors on this relationship. DESIGN: Inception cohort of 1083 adults with TBI for whom 1-year productivity follow-up data were available. RESULTS: Univariable logistic regression indicated that race was a significant predictor of productivity outcome after TBI. African Americans were 2.76 times more likely to be nonproductive than whites and other racial minorities were 1.92 times more likely to be nonproductive than whites. Multivariable logistic regression analyses revealed that the effect of race on employability was influenced by confounds with preinjury productivity, education level, and cause of injury. After adjustment for other predictors, African Americans were 2.00 times more likely to be nonproductive than whites and other racial minorities were 2.08 times more likely to be nonproductive than whites. The multivariable logistic regression model with all predictors except race accounted for 39% of the variability in productivity outcome (R2-Nagelkerke=0.39), whereas the full logistic regression model including race accounted for 41% of the variability in productivity outcome (R2-Nagelkerke=0.41); a difference of only 2%. CONCLUSION: Any effect of race on productivity is significantly influenced by confounding with preinjury productivity, education level, and cause of injury.