PurposeTo investigate the relationship between performance frontier and operations strategy. A two-level conceptual framework is proposed based on performance elements that act as output/input ...variables and delimit the scope of the frontier analysis.Design/methodology/approachThe framework proposition is based on the fourth round of high-performance manufacturing survey data. A representative set of variables for assessing performance based on operations strategy constructs is defined through multivariate data analysis techniques. The main method used is the principal component analysis.FindingsThe proposed first-level conceptual framework formalizes the relationships between performance frontier analysis techniques and operations strategy, delimiting the scope and the structural definitions. The second-level conceptual framework defines the constructs of the input and output dimensions for frontier analysis studies.Originality/valueThe paper contribution is developed in the gap of market-led orientation to study operations strategy performance frontier since most related literature focuses on capabilities development with a main focus on the resource-based view (RBV) approach. A conceptual framework based on the competitive priorities is therefore proposed to represent the operations strategy in the view of the frontier techniques. The value lies in defining performance measures which are not a straightforward task as the growth of organization competitiveness and complexity require multiple performance measures. A deeper understanding of frontier estimation on the operations strategy context is also provided, contributing to positively influence firms to succeed in the current dynamic competitive environments.
This paper aimed to determine arterial partial pressure of carbon dioxide (PaCO2), end-expired CO2 pressure (ETCO2), and the difference between arterial and end-expired CO2 pressure (Pa - ETCO2) in ...prepubescent and adult bitches undergoing videolaparoscopic or conventional ovariohyterectomy (OH). Forty bitches were randomly assigned to four groups: Conventional Adult (CA), Conventional Pediatric (CP), Videolaparoscopic Adult (VA) and Videolaparoscopic Pediatric (VP). Pulse rate (PR), respiratory rate (RR), systolic, mean, and diastolic arterial pressures (SAP, MAP, DAP), ETCO2, peak inspiratory pressure (PIP), pH, arterial partial pressure of oxygen (PaO2), PaCO2, base excess (BE) and HCO3 - were measured. Based on the PaCO2 and ETCO2 values, Pa-ETCO2 was determined. There was no significant difference in PaCO2 between the VA (42.5±5.2 to 53.7±5.2) and VP (48.4±5.4 to55.4±5.7) groups. During the postoperative period, all groups presented with hypertension. However, mild hypertension (SAP 150 to 159mmHg) was observed in the VP group as compared to severe hypertension (SAP>180mmHg) in the CA group, suggesting that both the age range and videolaparoscopic OH are associated with lower levels of hypertension during the postoperative period in dogs.
RESUMO: O objetivo deste estudo foi determinar a pressão parcial de dióxido de carbono (PaCO2), pressão ao final da expiração de CO2 (ETCO2) e diferença artério-alveolar de CO2 (Pa-ETCO2) em cadelas pré-púberes e adultas submetidas à ovário-histerectomia (OH) videolaparoscópica ou convencional. Foram distribuídas 40 cadelas em quatro grupos: Convencional Adulto (CA), Convencional Pediátrico (CP), Videolaparoscópico Adulto (VA) e Videolaparoscópico Pediátrico (VP). Foram mensurados frequência de pulso (FP), frequência respiratória (FR), pressões arteriais sistólica (PAS), média (PAM) e diastólica (PAD), ETCO2, pressão de pico inspiratória (PIP), pH, pressão parcial arterial de oxigênio (PaO2), PaCO2, excesso de bases (EB) e HCO3 -. Com base nos valores de PaCO2 e ETCO2 encontrados, foi determinada a Pa-ETCO2. Não foram encontradas diferenças significativas nos valores de PaCO2 entre os grupos VA (42.5±5.2-53,7±5,2) e VP (48.4±5.4 - 55,4±5,7). Todos os grupos apresentaram hipertensão arterial no período pós-operatório. Entretanto, o grupo VP apresentou hipertensão moderada (PAS 150-159mmHg) em comparação ao grupo CA, que apresentou hipertensão severa (PAS>180 mmHg), sugerindo que tanto a faixa etária, quanto a execução de OH por videolaparoscopia, estão associadas a menores taxas de hipertensão pós-operatória em cadelas.
Background:In the last years the number of exotic company animals has been increased, and the demand for neutering services for these animals has become greater. By the author’s knowledge, there are ...no records of elective ovariectomy in domestic swine (Sus scrofa domesticus). The current paper reports a case of elective laparoscopic ovariectomy in a domestic swine (Sus scrofa domesticus).Case:A 4-month-old domestic swine (Sus scrofa domesticus), weighing 45 kg was referred to elective video-laparoscopic ovariectomy at the Veterinary Clinics Hospital of the Federal University of Rio Grande do Sul (HCV - UFRGS). Physical examination and laboratory tests, including hemogram and biochemistry (alanine aminotransferase - ALT, serum albumin and creatinine), were within normal range for the species. Ketamine hydrochloride (Cetamin®) 10 mg.kg-1, xylazine hydrochloride (Xilazin®) 2 mg.kg-1, and midazolam (Midazolam®) 0.5 mg.kg-1 were administered intramuscularly (IM) as pre-anesthetic medication. The anesthetic induction was performed with intravenous (IV) propofol (Propovan®) and anesthesia was maintained with isoflurane (Isoforine®) diluted in O2 by a universal vaporizer with a partial gas rebreathing anesthetic system. Throughout the procedure, were monitoring constantly the invasive blood pressure (IBP), electrocardiogram (ECG) in lead II, peripheral arterial saturation with O2 (SpO2), end-tidal carbon dioxide concentration (ETCO2), and esophageal temperature. The abdominal cavity was accessed through the insertion of three portals (one of 10 mm of diameter and other two of 5 mm of diameter). The cavity was inflated with medicinal CO2 until the pressure of 10 mmHg was achieved. The uterine body and ovaries were identified. The right ovary was suspended and, by a bipolar clamp, the ovarian vessels were occluded through electrocoagulation in three distinct locations with approximately 0,5 cm between themselves, and cut off. The right ovary was removed from the cavity. An identic maneuver was used for the realization of the surgical steps and removal of the left ovary. By the end, the cavity was deflated and the cannulas were removed. The abdominal wall was sutured with Sultan pattern with 3-0 polyglycolic acid thread, and the skin was sutured with simple interrupted suture with 3-0 nylon monofilament. The post-operative evaluations were subjective and fitting with the patient's behavior. The patient didn't show any clinical signs of pain, discomfort and returned to its usual eating habits on the second day after the procedure. No signs of infection, dehiscence, cicatrization retard or other complications were observed in the surgical wound. The stitches were removed after seven days.Discussion: This case report shows the applicability of the video-laparoscopic ovariectomy technique by three portals in other species than dogs and cats, and serves as bibliographic support to the veterinary endosurgery field. Based on previous studies, it has been concluded that minimally invasive procedures represent the most beneficial sterilization methods to the patient due to its diagnostical and surgical capacity, as well as minor surgical trauma and shorter recovery time. The most common indication for the video-laparoscopic technique in veterinary routine is the elective sterilization. Pyometra, urinary incontinence and weight gain are complications that are not diagnosed more frequently after ovariectomy when compared to ovariohysterectomy. The laparoscopic ovariectomy is a viable technique to be applied to the swine, with the most difficult aspect being the anatomical peculiarities of the animal.
trauma and severe infections cause remarkable metabolic changes in patient with SIRS from an adaptive response aimed to control the underlying disease, repairing damaged tissue, and to synthesize ...substrates. If the attack is intense and sustained and the patient has a compromised nutritional status, can evolve into multiple organ failure and death.
assessment of nutritional proteic status and the involvement of proteins and inflammatory factors in critically ill patients.
multicenter observational analytical study in critical ill patients at the admission in ICU.
patients showed disturbances in clinical nutritional parameters which confirm their hypercatabolic situation, showing malnutrition state at admission, where 42.9% had plasma levels below the reference prealbumin. Amino acid profile was situated below the reference values and 99% of patients had low plasma transferrin. Significant differences were observed in total protein, ferritin and transferrin parameters adjusted by CRP levels, being higher when patients presented high inflammation in the case of ferritin and the opposite for the rest of parameters. Adjusting APACHE and SOFA scores according to low, medium and high severity, results showed significant differences in creatinine, urea, and transferrin, being lower at high severity grade for the last one.
critical illness is characterized by a high degree of stress and accelerated degradation of proteins that cause malnutrition, systemic inflammation and organ dysfunction, with a significant association between albumin, ferritin and transferrin.
O PET-CT com FDG-18F é amplamente empregado no estadiamento inicial e avaliação de resposta terapêutica nas doenças linfoproliferativas, bem como na suspeita de recidiva. No entanto, seus achados não ...são específicos, já que a glicose radiomarcada identifica sítios com aumento da atividade metabólica, observados em diversas neoplasias malignas, bem como em processos inflamatórios ou infecciosos.
Feminino, 73 anos, tratada em 2021 para linfoma linfoplasmacítico indolente, com boa resposta. Evoluiu com sintomas respiratórios recorrentes, atribuídos a processos infecciosos de repetição, apesar da terapêutica antimicrobiana prolongada. Desenvolveu manifestações orotraqueais importantes, cursando com insuficiência respiratória, resultando em traqueostomia. Propedêutica evidenciou amiloidose, sendo instituído tratamento específico, com resposta clínica favorável. Na reavaliação com médico assistente, a paciente apresentava tosse e dispneia, sendo submetida a TC de tórax que evidenciou adenomegalias mediastinais. Diante da suspeita clínica de recidiva do linfoma, solicitou-se PET-CT com FDG-18F para elucidação e definição de conduta, que mostrou aumento volumétrico e hipermetabólico das glândulas salivares maiores, consolidações pulmonares paracardíacas bilaterais acentuadamente hipermetabólicas associadas a redução volumétrica dos lobos médio e inferior esquerdo, além de linfonodos cervicais, axilares e mediastinais discretamente hipermetabólicos. Os achados do PET-CT levaram a suspeita da coexistência de: amiloidose em atividade, sobretudo no parênquima pulmonar e possivelmente nas glândulas salivares; e recidiva do linfoma nas cadeias linfonodais alteradas. Sugeriu-se, então, estudo anatomopatológico das áreas hipermetabólicas que mostrou: 1. deposição amiloide no interstício e paredes dos vasos pulmonares, fibrose estromal e infiltrado linfocítico intersticial e algo nodular de linfócitos pequenos e heterogêneos; ausência de evidências de doença linfoproliferativa; 2. doença linfoproliferativa B de pequenas células, associada a presença de acúmulos de material amiloide no interstício e paredes dos vasos na glândula submandibular esquerda e nos linfonodos cervicais ipsilaterais, consistente com linfoma da zona marginal, com acúmulo secundário amiloide.
O PET-FDG tem papel bem estabelecido nas doenças linfoproliferativas, desde o diagnóstico inicial e avaliação de resposta, bem como na recidiva, podendo definir, em exame único, a extensão da doença, características metabólicas, além de sugerir sítio de biópsia. Na amiloidose este método tem sua importância, demonstrando atividade e extensão da doença. Diante da coexistência das entidades, o PET-FDG pode então definir a conduta terapêutica inicial. Comentários Finais: O caso apresentado demonstra a contribuição do PET-FDG na coexistência de doenças sistêmicas, ao indicar sítios de biópsia, demonstrar a atividade e extensão de cada uma e, assim, guiar a terapêutica inicial, decisão crítica em doenças complexas e potencialmente graves.
Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los ...sujetos hospitalizados, toma entidad propia denominándose "desnutrición hospitalaria". Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos.
While operations strategy is critical in competitiveness, research gaps exist in applying performance frontier methodologies to identify competitive priorities in operations strategy. The concept of ...performance efficiency frontier can identify the competitiveness drivers specifying the maximum performance that can be achieved by a given set of inputs. This paper proposes and tests a process to measure, assess, and address improvements in manufacturing performance by operations strategy. A five-step procedure, based on the super-efficiency data envelopment analysis (DEA), supports the improvement recommendations. Secondary data of the fourth round of the High-Performance Manufacturing (HPM) survey grounds the benchmarking analysis and assessment. The proposed framework is tested using the in-depth case of a company from the Brazilian automotive industry. The results identified the main gaps of the company to become a market leader through the enhancement of its operations strategic positioning. Improvement recommendations are developed based on a gap analysis of the input variables. By integrating the operations strategy definition within the performance frontier analysis, we guided the competitiveness improvement of the case company.
Abstract Objectives: to determine the frequency of stress, anxiety, and depression symptoms in symptomatic patients for COVID-19. To evaluate the associated factors involved in these variants. ...Methods: between May/June of 2020, it was conducted a prospective cross-section study with symptomatic participants for COVID-19 (n=300). It was applied an online questionnaire and the DASS-21 to evaluate the mental health of participants. Results: it was observed that 28.6%, 29.7% and 27% of the participants showed severe/extreme levels symptoms of stress, anxiety, and depression, respectively. The testing for COVID-19 application had constituted a protective factor for the development of psychiatric morbidity, once it had shown significant association in the low frequencies of severe/extreme depression Odds Ratio (OR)= 0.26; p=0.002) and stress (OR=0.39; p=0.01). Conclusion: individuals that are symptomatic for COVID-19 are a vulnerable group that may present high symptomatology for depression, anxiety, and stress. The identification of psychiatric morbidity frequency and its associated factors may contribute for the development of mental health strategies aiming at the prevention and mitigation of psychological impact in COVID-19 symptomatic population during the pandemic.
Resumo Objetivos: determinar a frequência de sintomas de estresse, ansiedade e depressão em pacientes sintomáticos para COVID-19 e avaliar os fatores associados. Métodos: entre maio / junho de 2020, foi realizado um estudo transversal prospectivo com participantes sintomáticos para COVID-19 (n = 300). Foi aplicado um questionário online e o DASS-21 para avaliar a saúde mental dos participantes. Resultados: observou-se que 28,6%, 29,7% e 27% dos participantes apresentaram sintomas graves/extremos para estresse, ansiedade e depressão, respectivamente. A realização do teste para a COVID-19 constituiu-se como fator de proteção para o desenvolvimento de sintomatologia psíquica, uma vez que mostrou associação significativa nas baixas frequências de depressão grave/extrema odds ratio (OR)= 0,26; p=0,002) e de estresse (OR=0,39; p=0,01). Conclusão: os indivíduos sintomáticos para COVID-19 constituem um grupo vulnerável que podem apresentar elevada sintomatologia para depressão, ansiedade e estresse. A identificação da frequência de morbidade psiquiátrica e seus fatores associados podem contribuir para o desenvolvimento de estratégias de saúde mental visando a prevenção e mitigação do impacto psicológico na população sintomática de COVID-19 durante a pandemia.
In hospitalized patients, malnutrition ranges between 30% and 55% and is associated with a higher rate of complications, prolonged hospitalization and increased cost of health services. Despite this, ...there is no awareness of the clinical and economic implications involving hospital malnutrition and its treatment. We analyzed the relationship between hospital malnutrition, average length of stay and early readmissions.
It is a prospective and dynamic cohort study, in which patients were observed from the time of their admission and throughout their hospitalization on a weekly basis. The selection was carried out using a systematic random method. Patients were all older than 18 and admitted to the services with an average stay 5 days. It was decided that a patient had malnutrition when some anthropometric (biceps circumference, tricipital, abdominal and subscapular skinfold thickness) or biochemical (albumin, prealbumin, and transferrin) parameter was below normal values. Early readmission was defined as a patient's return to hospital in a period < 31 days from the last date of discharge. Hospital entries were classified in relation to the average stay (hospital and services) and we analyzed the stays below and the stays above the average expected. Results have been expressed in average and standard deviation (X +/- SD) and frequency (%). Intergroup comparisons by Student's t test and chi(2), remain significant to P < .05. The risk and confidence intervals (CI) were applied to malnourished cohorts, with a significance level of 95%.
The study included 817 patients (50.9 +/- 18.5 years), 62.9% men and 37.1% women. 45.9% (n = 375) of patients were malnourished, and malnutrition was most common in those with digestive diseases (22.5%), neoplasm (20.8%), circulatory (16.5%) and respiratory pathologies (11.6%). The average stay (hospital and services) and the premature readmission rate were higher in patients admitted to hospital with malnutrition.
Nearly half of the patients presented some degree of malnutrition when they were admitted, increasing hospital stay and premature readmission rate. The high prevalence and incidence of malnutrition requires suggestions to develop mechanisms to determine its real scope and programs to solve it.
Resumo: Introdução: Os processos formativos na educação médica possuem fatores estressores e possíveis desencadeadores de transtornos mentais. Objetivo: Este estudo teve como objetivo determinar a ...prevalência e os fatores associados aos sinais e sintomas de ansiedade e depressão nos estudantes de Medicina durante o distanciamento social devido à pandemia pela Covid-19. Método: Realizou-se um estudo de corte transversal entre maio a junho de 2020, com estudantes de Medicina das instituições de ensino superior do estado de Pernambuco, no Brasil. Elaborou-se um questionário on-line por meio do Google Forms contendo características sociodemográficas e clínicas, e a Escala Hospitalar de Ansiedade e Depressão (EHAD). Para análise estatística, realizou-se análise multivariada, e calcularam-se a razão de risco (RR) e o intervalo de confiança de 95% (IC95%), considerando o coeficiente de significância p < 0,05. Resultado: As variáveis associadas ao maior risco de sinais e sintomas de ansiedade foram sexo feminino, diminuir/aumentar o hábito de fumar, aumentar/não alterar o consumo de medicamentos, diminuir/não praticar lazer, não preparação da universidade para o ensino a distância (EAD), ter EAD antes da pandemia e diminuição do rendimento escolar comparado aos períodos anteriores. Quanto à depressão, observaram-se os seguintes fatores: maior risco para aumentar/não alterar o uso de medicamentos, diminuir a prática de lazer, universidade não ter se preparado para o EAD, diminuição do rendimento escolar e cor de pele parda. Conclusão: Identificaram-se diferentes fatores relacionados aos sinais e sintomas de ansiedade e depressão no período de distanciamento social causado pela pandemia da Covid-19.
Abstract: Introduction: Medical training involves stressors and possible triggers of mental disorders. Objective: Our study aims to determine the prevalence and factors associated with signs and symptoms of anxiety and depression in medical students during social distancing measures imposed due to the COVID-19 pandemic. Method: A cross-sectional study was conducted between May and June 2020 among medical students from higher education institutions in Pernambuco state, Brazil. An online questionnaire was created using Google Forms containing sociodemographic and clinical characteristics and the Hospital Anxiety and Depression Scale (EHAD). For statistical analysis, multivariate analysis was performed and the risk ratio (RR) and its 95% confidence interval (95%CI) were calculated, considering the significance coefficient (p) <0.05. Result: The variables associated with a higher risk of anxiety signs and symptoms were female gender, decreasing/increasing smoking habit, increasing/not changing drug consumption, decreasing/not practicing leisure, lack of preparation by the university for distance learning, distance learning in place before the pandemic and decline in academic performance compared to previous periods. As for depression, there was a greater risk of increasing/not changing the use of medications, decreasing leisure time, university not being prepared for distance learning, declining academic performance and brown skin colour. Conclusion: Different factors related to the signs and symptoms of anxiety and depression were identified in the period of social distancing resulting from the COVID-19 pandemic.
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