Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

Because the normal process capability indices (PCIs) C p , C pu , C pl , and C pk represent the times that the process standard deviation is within the specification limits; then, based on and by using the direct relations among the parameters of the Weibull, Gumbel (minimum extreme value type I) and lognormal distributions, the Weibull and lognormal PCIs are derived in this paper. On the other hand, because the proposed PCIs P p , P pu , P pl , and P pk were derived as a function of the mean and standard deviation of the analyzed process, they have the same practical meaning with those of the normal distribution. Results show that the proposed PCIs could be used as the standard C p , C pu , C pl , and C pk if a short-term variance is analyzed. An application to a set of simulated data is presented.

No abstract

No abstract

This study shows the effects of maltodextrins and gum arabic as microencapsulation agents on the stability of sugarcane bagasse extracts and the potential use of the extracts as antimicrobial agents. The bioactive compounds in sugarcane bagasse (SCB) were extracted using 90% methanol and an orbital shaker at a fixed temperature of 50 °C, thereby obtaining a yield of the total phenolic content of 5.91 mg GAE/g. The bioactive compounds identified in the by-product were flavonoids, alkaloids, and lignan (-) Podophyllotoxin. The total phenolic content (TPC), antioxidant activity, and shelf-life stability of fresh and microencapsulated TPC were analyzed. This experiment’s optimal microencapsulation can be obtained with a ratio of 0.6% maltodextrin (MD)/9.423% gum arabic (GA). Sugarcane bagasse showed high antioxidant activities, which remained stable after 30 days of storage and antimicrobial properties against E. coli, B. cereus, S. aureus, and the modified yeast SGS1. The TPC of the microencapsulated SCB extracts was not affected (p > 0.05) by time or storage temperature due to the combination of MD and GA as encapsulating agents. The antioxidant and antimicrobial capacities of sugarcane bagasse extracts showed their potential use as a source of bioactive compounds for further use as a food additive or nutraceutical. The results are a first step in encapsulating phenolic compounds from SCB as a promising source of antioxidant agents and ultimately a novel resource for functional foods.