Surgeons’ efficiency change is a major determinant of their productivity change

2016 ◽  
Vol 29 (4) ◽  
pp. 417-424 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Major Determinant ◽  
The Other ◽  
University Hospital ◽  
Productivity Change ◽  
Surgical Volume ◽  
Efficiency Change ◽  
Surgical Specialty ◽  
Content Type ◽  
Significant Difference ◽  
Constant Returns To Scale

Purpose – The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year. Design/methodology/approach – The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI. Findings – The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups. Originality/value – EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

scholarly journals Association Between Surgeons’ Technical Efficiency and Hospital Revenue

2019 ◽  
Vol 56 ◽  
pp. 004695801988944
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Technical Efficiency ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Volume ◽  
Surgical Specialty ◽  
Surgical Data

To evaluate surgeons’ performance, health care managers often use the revenues that surgeons make for the hospital. The purpose of this study is to determine the relationship between surgeons’ technical efficiency and their revenues by using multiple regression analysis on surgical data. The authors collected data from all the surgical procedures performed at University Hospital from April 1 through September 30 in 2013-2018. Output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis was employed to calculate each surgeon’s technical efficiency. Seven independent variables were selected; revenue, experience, medical school, surgical volume, sex, academic rank, and surgical specialty. Multiple regression analysis using Tobit model was used for our data. The data from a total of 17 227 surgical cases were obtained in the 36-month study period. The authors performed multiple regression on 222 surgeons. Revenue had significantly positive association with mean efficiency score ( P = .000). Surgical volume had significantly negative association with mean efficiency score ( P = .000). The other coefficients were statistically insignificant. An increase in revenue by 1% was associated with 0.46% to 0.52% increases in efficiency score. We demonstrated that surgeons’ revenue can serve as a proxy variable for their technical efficiency.

Efficiency, productivity and Islamic banks: an application of DEA and Malmquist index

Humanomics ◽  
2015 ◽  
Vol 31 (1) ◽  
pp. 118-131 ◽  
Author(s):  
Muhammad Abbas ◽  
Rayan S Hammad ◽  
Mohamed Fathy Elshahat ◽  
Toseef Azid
Keyword(s):  
Malmquist Index ◽  
Productivity Index ◽  
Scale Efficiency ◽  
Productivity Change ◽  
Islamic Banks ◽  
Efficiency Change ◽  
Lower Growth ◽  
Content Type ◽  
Future Policy ◽  
Conventional Banks

Purpose – This paper aims to compute the Malmquist Index of Islamic and conventional banks to compare their performance in the sample period of 2005-2009. Islamic banks have been showing tremendous growth throughout the world in recent past. Their progress is exceptional in Islamic countries on account of patronization for religious reasons. There existed vacuum in research of their productivity change over the years. Design/methodology/approach – This study tries to apply the Malmquist Index. The Malmquist Total Factor Productivity Index has been further divided into Efficiency Change Index, Technological Change Index, Pure Efficiency Change Index and Scale Efficiency Change Index to obtain an insight about the reasons for the change in productivity. Findings – Results indicate that the productivity of Islamic banks decreased in 2007 but it increased in 2008 to 2009. Islamic banks had higher productivity growth from 2005 to 2006, but they experienced lower growth in subsequent years as compared to their conventional counterparts. Research limitations/implications – Data were not available before 2005 in Pakistan. Practical implications – This study is helpful for the investors and bankers for formulating the future policy. Social implications – This study also provides a guideline for establishing the ethical financial institutions. Originality/value – This is an original attempt.

A study of Vitamin D supplementation to patients with chronic diseases admitted to Ain Shams University Hospital

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Raef Malak Botros ◽  
Ahmed Mohamed Bahaa El Din ◽  
Hany Khairy Mansour ◽  
Mariam Michel Ayad Grace
Keyword(s):  
Vitamin D ◽  
Single Dose ◽  
Chronic Diseases ◽  
Intervention Group ◽  
Vitamin D Supplementation ◽  
The Other ◽  
University Hospital ◽  
Control Group ◽  
P Value ◽  
Significant Difference

Abstract Background Vitamin D deficiency and insufficiency have become a common problem worldwide. Vitamin D has been associated with all causes of mortality in chronic diseases and associated with a longer hospital stay and poor outcome. Aim of the Study to evaluate the role of vitamin D supplementation on the outcome of hospitalization for patients with CLD or CHF admitted to Ain Shams University Hospitals (ASUH) with acute deterioration of their illness. Subjects and methods We conducted prospective case control on 80 patients collected from inpatient ward of endocrinology, divided into 2 groups; 40 patients with chronic liver diseases and 40 patients with heart failure. Serum 25OH-vitamin D and calcium, phosphate and PTH were measured to all participants before intervention. 20 patients of each group (Intervention group) received single dose of vitamin D within 3 days of admission and the other 20 patients of each group (control group) did not receive vitamin D vitamin D. Results no significant difference between patients who received vitamin D supplementation and who did not receive vitamin D supplementation as regards outcome and survival with P value 1.000 in patients with CLD and 0.823 in patients with CHF. On the other hand, we found baseline vitamin D level was an independent predictor of mortality (P value .018). Conclusion We found that a beneficial effect of vitamin D supplementation can't be achieved with single dose vitamin D (200,000 IU) on CHF or CLD hospitalized patients’ mortality. We recommend that vitamin D supplementation should be considered in CLD and CHF outpatients, with exception of hypercalcemic and hyperphosphatemic patients, as baseline vitamin D status affects the disease course and mortality prior to disease deterioration and hospitalization.

Determinants of influence strategies in international strategic alliances

2015 ◽  
Vol 9 (3) ◽  
pp. 273-288 ◽  
Author(s):  
Xiaohua Lin ◽  
Jian Guan
Keyword(s):  
National Culture ◽  
Strategic Alliances ◽  
The Other ◽  
Relative Power ◽  
Influence Strategies ◽  
Content Type ◽  
Significant Difference ◽  
International Strategic Alliances ◽  
Equal Power ◽  
Chinese Managers

Purpose – The purpose of this study is to investigate how relative power and mutual commitment affect partners’ choice of influence strategies and how national culture may moderate these effects in the context of international strategic alliances. Design/methodology/approach – In two experiments involving US and Chinese managers, respectively, the study looks into situations wherein a party’s power is lower, equal or higher, all relative to the other party, and there is high versus low mutual commitment between the two parties. The effects of relative power and mutual commitment on influence strategies are also compared between US and Chinese managers. Findings – There is no significant difference between low and equal power with regard to choice of influence strategies. However, moving from a low/equal power to a high-power position, a party’s use of integrative (non-mediated) communications decreased significantly, whereas the use of coercive (mediated) communications increased significantly. The results also show that the effect of relative power is greater when mutual commitment is low than when mutual commitment is high. Finally, there is evidence that the effect of power is stronger for the Americans, whereas the effect of commitment is stronger for the Chinese. Originality/value – The paper offers a finer account of power relations wherein a party’s power is lower than, equal to or higher than that of the other party and explores the moderating effect role of national culture on the linkages from relative power and relationship commitment to influence strategy use.

Performance of bipolar forceps during coagulation and its dependence on the tip material: a quantitative experimental assay

2004 ◽  
Vol 100 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Takeshi Mikami ◽  
Akira Takahashi ◽  
Kazuo Hashi ◽  
Shinsei Gasa ◽  
Kiyohiro Houkin
Keyword(s):  
Electron Microscopy ◽  
Stainless Steel ◽  
The Other ◽  
Content Type ◽  
Coagulation Performance ◽  
Significant Difference ◽  
Different Types ◽  
Metal Titanium ◽  
Cleaning Cycle ◽  
Fine Print

✓ The aim of this study was to measure objectively the adherence of burned tissue to bipolar forceps to evaluate the coagulation performance of forceps made of different types of metals. Coagulation performance of bipolar forceps made of gold, titanium, and stainless steel was determined by comparing the amount of protein in the adhered coagulum on the tips. The amount of adhered coagulum was significantly less on the gold-plated bipolar forceps than on those made of the other two materials. The ease with which coagulum could be removed was compared using the cleaning cycle of an ultrasonic rinsing device. This ease of removal was also significant with the gold-plated forceps. Electron microscopy observations of the surface of the forceps tips revealed a significant difference in roughness among these materials, and there were also significant differences in wetting tensions. Measuring adherence based on three different types of roughness and wetting tensions of forceps made from the same metal (titanium) also demonstrated a significant difference in the cleaning cycle. Histological examination of an artery coagulated with the gold-plated bipolar forceps showed that the structure had been completely collapsed without destruction of the layers, whereas arteries coagulated with the other materials revealed severely damaged structures. Adherence to bipolar forceps was dependent on both the material in the tips and the roughness of this material. The gold-plated bipolar forceps demonstrated the best performance.

scholarly journals Efficacy of rtsa-byugs vs diclofenac gel in relieving knee pain of patients with osteoarthritis of the knee

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dorji Nidup ◽  
Somboon Kietinun ◽  
Sunyarn Niempoog ◽  
Kusuma Sriyakul
Keyword(s):  
Quality Of Life ◽  
Knee Pain ◽  
Small Sample ◽  
Life Assessment ◽  
University Hospital ◽  
Osteoarthritis Of The Knee ◽  
Content Type ◽  
Significant Difference ◽  
The Mean

PurposeRtsa-byugs, a massage oil from Bhutan, is a traditional herbal formula known for its anti-inflammatory properties and used in osteoarthritis treatment. This study investigates the efficacy of rtsa-byugs vs diclofenacgel in relieving knee pain in osteoarthritis patients.Design/methodology/approachA single-blind, randomized controlled trial was conducted amongst osteoarthritis knee patients at an orthopedic outpatient department of Thammasat University Hospital. Participants were randomly allocated to the rtsa-byugs (N = 31) or the Diclofenac gel (N = 31) group. Primary outcomes were assessed by the knee injury and osteoarthritis outcome scores (KOOS), visual analog scale (VAS) and goniometer at day 0, 1, 3, 7.Findings62 participants completed the study. The result of the KOOS scores demonstrated a significant improvement of symptoms at the end of the study in both treatment groups. Improvement of symptoms, pain, daily life living, sport and recreational score and quality of life assessment showed a significant difference from baseline (p < 0.001) within both groups. The quality of life score for the rtsa-byugs group increased significantly on day 3 and 7. The VAS score in both groups decreased with a significant difference from baseline to day 7. The mean value of extension of angle measurement was decreased in day 7, and the mean of flexion score increased in both groups when compared with the baseline.Research limitations/implicationsThe duration of the study was very limited and included a small sample consisting of men and women.Originality/valueRtsa-byugs is safe and effective in relieving pain from osteoarthritis of the knee and can be used as an alternative treatment for knee osteoarthritis.

Resource utilization in surgery after the revision of surgical fee schedule in Japan

2015 ◽  
Vol 28 (6) ◽  
pp. 635-643 ◽  
Author(s):  
Yoshinori Nakata ◽  
Tatsuya Yoshimura ◽  
Yuichi Watanabe ◽  
Hiroshi Otake ◽  
Giichiro Oiso ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Skin Incision ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Specialty ◽  
Content Type ◽  
Decision Making Unit ◽  
Using Data ◽  
Fee Schedule ◽  
Time Of Operation

Purpose – The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014. Design/methodology/approach – The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis. Findings – The efficiency scores of each surgical specialty were significantly different (p=0.000). Originality/value – This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

scholarly journals Equality of surgical fee schedule in Japan: a retrospective observational study

2021 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Data Envelopment Analysis ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Gini Coefficients ◽  
Decision Making Unit ◽  
Significant Difference ◽  
Fee Schedule

Abstract Background The purpose of this study is to examine how the degree of inequality of Japanese surgical fee schedule changed during the study period by applying Gini coefficients for efficiency scores computed from data envelopment analysis. Methods All the surgeries that were performed in the main operating rooms of Teikyo University Hospital in 2013-18 were candidates used for the analysis of efficiency and equality of fee schedule. The decision making unit was defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee that was charged for reimbursement. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule by the Bootstrap methods. Results The authors analyzed 16,307 surgical procedures during the study period of 2013-18. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules (p > 0.05). Conclusions The authors demonstrated that the degree of inequality of Japanese surgical fee schedule remained constant from 2013 through 2018.

scholarly journals Effect of infertility causes related to gender differences on Women's distress levels among patients utilizing a Turkish university hospital

2020 ◽  
Vol 34 (5) ◽  
pp. 399-407
Author(s):  
Yeter Durgun Ozan ◽  
Mesude Duman
Keyword(s):  
Gender Differences ◽  
Cultural Awareness ◽  
University Hospital ◽  
Care Plan ◽  
Male Factor ◽  
Cross Sectional ◽  
Content Type ◽  
Distress Level ◽  
Significant Difference ◽  
Distress Scale

PurposeThis study aimed to examine the effect of causes of infertility related to gender differences on the distress level of women who were treated for infertility.Design/methodology/approachThis is a cross-sectional, descriptive study. The sample consisted of 314 women who were treated for infertility between September 2016 and June 2017. Data were collected as “Sociodemographic Characteristics Form” and “Infertility Distress Scale.”FindingsA statistically significant difference was found between the mean distress scores of the women for whom the reason for infertility was related to a female factor, and of the women for whom this reason was related to a male factor.Research limitations/implicationsThe situation should be determined with quantitative studies, and the reason for the differences should be determined with qualitative studies.Practical implicationsInfertility nurses should develop a care plan that ensures that couples understand their feelings, and which enhances their mutual respect and partnership.Social implicationsThe study highlights the importance of cultural awareness in the care of infertile couples.Originality/valueThe authors highlight some important aspects about the gender difference on women's distress level.

Comparison of commonly used dietary assessment methods in individuals without obesity

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Busra Baspinar ◽  
Ayşe Özfer Özçelik
Keyword(s):  
Food Consumption ◽  
Dietary Assessment ◽  
Reference Method ◽  
Assessment Methods ◽  
The Other ◽  
Content Type ◽  
Recall Method ◽  
Dietary Assessment Methods ◽  
Significant Difference ◽  
Accurate Reporting

Purpose This study aims to compare commonly used dietary assessment methods in non-obese young adults. Design/methodology/approach This study was carried out on 22 females and 21 males, who were aged between 20 and 25, with no chronic diseases and were not obese or on any diet. The data was collected face to face. In this study, the authors evaluated the consistency of nonconsecutive three-day 24-h recall method (3 × 24HR), which was chosen as a reference for the determination of food consumption, with one-day 24-h recall method (1 × 24HR), three-day food record method (3 × FR) and food frequency questionnaire (FFQ), which has been frequently used in food consumption research. Intraclass correlation coefficients (ICC), Pearson correlation coefficient (PCC) and Bland–Altman graphs were performed in the statistical analyses to determine the association between dietary assessment methods. Findings When the data obtained from the food consumption records were evaluated according to reference method, it was found that the PCC was at moderate and higher level (mean r = 0.513 for 1 × 24HR; r = 0.564 for 3 × FR; and r = 0.452 for FFQ), and the mean ICC was 0.456 for 1 × 24HR, 0.557 for 3 × FR and 0.377 for FFQ. In addition, it was determined that energy and macronutrient values analyzed with Bland–Altman method were consistent with the reference method and that the other methods could also be used instead of the reference method. Under and over reporting was detected in all methods. The method with the highest accurate reporting was 3 × 24HR (72.1%) according to Goldberg standard. In FFQ method, accurate reporting is higher in males (p = 0.01); in other methods, it was determined that there was no significant difference by gender. Originality/value In this study, the consistency of the reference, 3 × 24HR method, with the other three methods was determined to be at a moderate and higher level and that they could replace each other according to characteristics of the participants.

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