Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos

Silveira , E. J. D. et al. Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos. J. Bras. Patol. Med. Lab., v. 45, n. 3, p. 233-238, jun 2009. ISBN 1676-2444.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações

Modelo institucional do processo de estruturação de empresas de desenvolvimento de software: um estudo de múltiplos casos

Some authors have shown the need of understanding the technological structuring process in contemporary firms. From this perspective, the software industry is a very important element because it provides products and services directly to many organizations from many fields. In this case, the Brazilian software industry has some peculiarities that distinguish it from other industries located in developed countries, which makes its understanding even more relevant. There is evidence that local firms take different strategies and structural configurations to enter into a market naturally dominated by large multinational firms. Therefore, this study aims to understand not only the structural configurations assumed by domestic firms but also the dynamic and the process that lead to these different configurations. To do so, this PhD dissertation investigates the institutional environment, its entities and the isomorphic movements, by employing an exploratory, descriptive and explanatory multiple cases study. Eight software development companies from the Recife's information technology Cluster were visited. Also, a form was applied and an interview with one of the main firm s professional was conducted. Although the study is predominantly qualitative, part of the data was analyzed through charts and graphs, providing a companies and environment overview that was very useful to analysis done through the interviews interpretation. As a result, it was realized that companies are structured around hybrids business models from two ideal types of software development companies, which are: software factory and technology-based company. Regarding the development process, it was found that there is a balanced distribution between the traditional and agile development paradigm. Among the traditional methodologies, the Rational Unified Process (RUP) is predominant. The Scrum is the most used methodology among the organizations based on the Agile Manifesto's principles. Regarding the structuring process, each institutional entity acts in such way that generates different isomorphic pressure. Emphasis was given to entities such as customers, research agencies, clusters, market-leading businesses, public universities, incubators, software industry organizations, technology vendors, development tool suppliers and manager s school and background because they relate themselves in a close way with the software firms. About this relationship, a dual and bilateral influence was found. Finally, the structuring level of the organizational field has been also identified as low, which gives a chance to organizational actors of acting independently

Os impactos tecnológicos da implantação da nota fiscal eletrônica: um estudo de casos múltiplos

Increasingly, the Information Technology is used in the society, including the private, public and third sector organizational context. Technological tools are created in order to speed, automate, control and monitor processes. These technologies generate impacts on areas that permeate their use and the objective of this study is to investigate the implementation process of the Eletronic Invoice and the impacts arising from this technological tool in companies. For that, case studies have been conducted in three companies that emit and receive Eletronic Invoice, in a Information System consultancy, that provides softwares of Eletronic Invoice, and in a State Tax Department. Data collection was performed with organizations representatives through electronic questionnaires. The study concludes that it is expected, by the investigated organizations, that the tool reaches the benefits offered by the Tax Administration. However, these benefits have not been identified yet and neither have the use of methodologies in order to identify them. Moreover, the main impact found was the need for better training and participant´s technical qualification, followed by reducing printing costs and paper purchase

A influência do processo de terceirização de tecnologia da informação na utilização dos modelos de contratação de serviços: um estudo de casos múltiplos

The change in the economic world and the emergence of Internet as a tool for communication and integration among the markets have forced organizations to adopt a different structure, process-oriented with a focus on information management. Thus, information technology has gained prominence in the organizational context, increasing its complexity and range of services provided by this function. Moreover, outsourcing has become an important model for flexible corporate structure, helping organizations to achieve better results when carrying out their activities and processes and be more competitive. To make the IT outsourcing, it is necessary to follow certain steps that range from strategic assessment to the management of outsourced service. Such steps can influence the form of contracting services, varying the types of service providers and contractors. Thus, the study aimed to identify how this IT outsourcing process influences the use of models for contracting services. For this, a study was conducted in multiple cases study involving two companies in Rio Grande do Norte State, specifically the health sector. Data collection was carried out with the CIOs of the companies surveyed through semi-structured interviews. According to the results obtained, it was found that the outsourcing process more structured influences the use of a more advanced contracting model. However, there are features found in these steps carrying more clearly this influence, as the goals pursued by outsourcing, the criteria used in selecting the supplier, a contract negotiation, how to transition services and the use of methods management, but can vary depending on the level of maturity in the relationship of the companies examined. Moreover, it was found that the use of contracting model may also influence how it is developed the IT outsourcing process, requiring or not its more formalized and organization

Mudança dos processos de negócios e adequação da TI nas empresas em decorrência da implantação do sistema público de escrituração digital SPED: um estudo de casos múltiplos

Companies have always been organized by processes, often imperceptible to its employees. With the advancement of technology, organizational processes currently run an organization through computers, and thus generate immediate information that is available to each sector. With the objective of seeking business information in real time, the government created the SPED - Public System of Digital, which involves three subsystems, which are the Electronic Invoice, Digital Accounting Bookkeeping and Digital Tax Bookkeeping. This system is revolutionizing the business structures when gathering, in an innovative way, all information and interlinked business processes. For the implementation of SPED, a revision in the organizational processes is required, since the information is generated and is sent online to the government, without mistakes. Thus the study aimed to analyze the change brought about by the implementation of the Public System of Digital SPED in the main business processes. In order to do so, we have performed a multiple case study involving three companies in the state of Para, two operate in wholesale and one explores agribusiness. The Data collection was performed by accounting professionals, IT and managers. According to the results obtained, it was found that in two companies, the IT infrastructure was capable of deploying the new system without major problems, while one company had more difficulties to cope with the new system. However, all companies had to examine its processes to make the customizations needed to fit. It was also observed that there is no IT Governance in two companies. Therefore, we recommend the use of an appropriate model, not only for the implementation of SPED, but as a way to manage and extract better results from investment in information technology

Implementação de software livre na administração pública: um estudo de múltiplos casos no Estado do Rio Grande do Norte

New technologies appear each moment and its use can result in countless benefits for that they directly use and for all the society as well. In this direction, the State also can use the technologies of the information and communication to improve the level of rendering of services to the citizens, to give more quality of life to the society and to optimize the public expense, centering it in the main necessities. For this, it has many research on politics of Electronic Government (e-Gov) and its main effect for the citizen and the society as a whole. This research studies the concept of Electronic Government and wishes to understand the process of implementation of Free Softwares in the agencies of the Direct Administration in the Rio Grande do Norte. Moreover, it deepens the analysis to identify if its implantation results in reduction of cost for the state treasury and intends to identify the Free Software participation in the Administration and the bases of the politics of Electronic Government in this State. Through qualitative interviews with technologies coordinators and managers in 3 State Secretaries it could be raised the ways that come being trod for the Government in order to endow the State with technological capacity. It was perceived that the Rio Grande do Norte still is an immature State in relation to practical of electronic government (e-Gov) and with Free Softwares, where few agencies have factual and viable initiatives in this area. It still lacks of a strategical definition of the paper of Technology and more investments in infrastructure of staff and equipment. One also observed advances as the creation of the normative agency, the CETIC (State Advice of Technology of the Information and Communication), the Managing Plan of Technology that provide a necessary diagnosis with the situation how much Technology in the State and considered diverse goals for the area, the accomplishment of a course of after-graduation for managers of Technology and the training in BrOffice (OppenOffice) for 1120 public servers

Autoavaliação institucional na dimensão do SINAES comunicação com a sociedade : estudo de múltiplos casos em instituições de ensino superior do Rio Grande do Norte

This study is about the institutional self-evaluation in Dimension 4, "Communication with Society", from the National System of Higher Education Evaluation SINAES, mandatory for all universities in Brazil. A multiple cases study was conducted with three institutions from Rio Grande do Norte, and the goal was to know how this evaluation is made, describing the concept for the evaluation of communication proposed by them, identifying controllers or emancipator aspects, categorizing methodological procedures and discussing the difficulties reported in the communication evaluation process. Coordinators of the institutions Evaluating Committees were interviewed and data categorized by means of qualitative content analysis. It was noted characteristics of the current controller, emancipator and hybrid designs in the three institutions for evaluation of communication, revealing the lack of a theoretical corpus that transits in accordance with the systemic perspective and epistemology of complexity from SINAES. It was found that the most frequently reported difficulties in the evaluation processes of communication are in the preparation stage, especially in the definition of indicators and tools and awareness work. The weakness in planning makes their own activities in the sector of communication become targets of assessment, forming goals poorly related with broader organizational goals. It was also concluded that the technical evaluation cannot override the issues associated with the broader issue of the complexity surrounding the assessment paradigm proposed by SINAES because contradictions and imperfections are part of the evaluation process and several references are current in the literature to support this view. Finally, it is said that objectives such as transparency and behavioral changes can rely on methodologies and techniques for research on the question of the construction of meaning

Analise das melhores práticas em business process management: estudo de casos em organizações hospitalares de Natal/RN

O gerenciamento dos processos organizacionais vem sendo estudado pela ciência administrativa como forma de romper com o paradigma da estrutura organizacional funcional através da Gestão por Processos. O Business Process Management ( BPM alinhado às estratégias organizacionais e suportado cada vez mais pela Tecnologia da Informação (TI), proporciona clareza nas diversas pontas do processo colaborando para sua melhoria contínua com o objetivo de gerar valor agregado ao cliente. As organizações de saúde estão entre as empresas prestadoras de serviço pouco estudadas em relação ao gerenciamento por processos. Assim, este estudo analisou por meio de um estudo empírico de natureza qualitativa, como estão sendo conduzidos os processos organizacionais hospitalares à luz das melhores práticas em BPM. A pesquisa foi realizada através do estudo de casos múltiplos realizados em duas organizações hospitalares na cidade de Natal/RN. A literatura de referência apresentou diversos fatores para um desempenho otimizado em BPM, tratados nesta pesquisa como as melhores práticas em BPM. A partir da revisão da literatura foi elaborada uma síntese das melhores práticas de BPM que serviu de base para elaboração do modelo da pesquisa utilizado para coleta e análise dos dados. Este modelo indicou onze categorias que foram utilizadas para elaboração do roteiro de estrevistas semi-estruturadas, através da técnica de análise de conteúdo, com categorização de grade fechada. As categorias foram agrupadas em duas dimensões: Elementos relacionados à gestão ( governança ; liderança , alinhamento estratégico , cultura e conhecimento ) e elementos relacionados aos processos ( desenho , responsável , executores , tecnologia da informação e indicadores ), e ainda foi identificada uma terceira categoria: escritório de processos . Para seleção dos sujeitos desta pesquisa foi adotada a estratégia em cadeia ou bola de neve . Foi possível identificar que todas as categorias apontadas no modelo de pesquisa emergem entre os fatores buscados pelas organizações hospitalares para o gerenciamento por processos com destaque para categorias: cultura ; conhecimento ; desenho ; tecnologia da informação e indicadores . Em complemento às categorias de análise, foram identificadas dificuldades relacionadas à comunicação e integração dos diversos elos do processo. Além disso, constatou-se que nos hospitais investigados há um desvio do conceito de BPM no que diz respeito a seu objetivo final: agregar valor ao cliente. A pesquisa concluiu que o gerenciamento por processos nas organizações hospitalares investigadas encontra-se em fase inicial ou em desenvolvimento, sendo necessário superar as barreiras da comunicação e edificar uma cultura organizacional orientada às necessidades dos clientes para aplicação das melhores práticas de BPM, desta forma pesquisas futuras sobre este tema em outras organizações hospitalares, podem facilitar um estudo comparativo e ampliar o conhecimento no assunto

Saída compulsória do estrangeiro do território nacional à luz dos direitos humanos: análise de casos

This paper aims to review traditional concepts inherent to the general theory of the state and human rights, relating to the legal situation of foreign, understood as the subject of rights, especially when the is case of compulsory legal imposition of exit from national territory. After the serious violations during the Second World War and the importance acquired by the International Law of Human Rights, values as dignity, justice and equality are enshrined in the legal system and its respect required beyond the boundaries of any country. The creation of an international community, which is governed by rules that its members are subordinated, without distinction, as well as state - based on volunteerism, become inspired by one principled nature of these new concepts required of Global Society, as well as the adoption, influenced by neoconstitutionalism, to the model of State Constitutional rule of law, are opposed to the idea of state sovereignty connected to a superiority, absolute and unlimited power which recognizes no other above it, not even the basic principles or axioms that must govern the relationships internally. So looks for a concept of state that includes all the requirements of a democratic society, that have the people as the power holder, understanding that state element has undergone a relativization, because had to adapt to the contemporary values applicable to the individual, inserting in its concept, the indispensable obligation to protect the inalienable rights of citizens, regardless of with whom he have legal and political bond of nationality. It happens that, to consecrate these privileges to individuals, which, because they contain reference to values with supranational characteristics, are very abstract and are in constant collision course with internal rules, making it difficult to reconcile, it will use hermeneutics of human rights, due mainly to international courts, correlated with constitutional exegesis, in particular, legal principiologia, using, among others, the principles of reasonableness and proportionality, the systematic interpretation of the Constitution and international legal standards. Thus, it seek to enshrine the common foundation of all law , the link between the systems, namely, the dignity of human beings. Finally, it will see if Brazilian jurisdiction, through case studies, is tuned in line with these new paradigms, and in line with the International Bill of Human Rights, the Federal Constitution, the values and principles she hired

Educação inclusiva e formação continuada: contribuições dos casos de ensino para os processos de aprendizagem e desenvolvimento profissional de professores

This study focuses on processes of learning and professional development experienced by elementary school teachers who have students with special educational needs in their classrooms. Cases and case methods can be used as methodological resource to articulate the continued training of teachers in an inclusive perspective. This research-intervention adopted a constructive-collaborative model for continued teachers formation. The main objective was to investigate the possible contributions of teaching cases, while investigative and formative strategies, for the processes of learning and professional development of teachers who work in the regular school. The data were collected by means of analytical activities, drafting collective discussion and teaching cases, having eight teachers as participants in a regular public school, located in the municipality of Natal/RN, Brasil. The theoretical reference covers the inclusive education, teaching learning, teachers professional development, the knowledge base for teaching and teaching cases as a resource for continued teachers formation in an inclusive perspective. The results indicated that teaching cases allowed description and analysis of educational practices developed by regular education teachers and adoption of reflective processes about situations reported and on their own pedagogical actuation, achieving indications of changes. It also indicates the contribution of cases for the clarification, systematization and extension of professional knowledge about inclusive education process as well as for involvement by the teachers of the study in a pedagogical thinking process. The lessons learned are related mainly to own role as teachers of regular education, to the role of professional support and specialized institutions faced to school inclusion. The analyses showed the methodological option was suitable to develop a schoolcentric training process, allowing teachers to seek in their actual environment alternatives for construction of a new logic of teaching that encloses diversity. The conclusion is that the cases, while bringing educational situations closer to the reality experienced by teachers in their daily professional role, causes relevant improvement on teachers education, because it offers training in conjunction with the experience and knowledge that teachers already have

Educação inclusiva e formação continuada: contribuições dos casos de ensino para os processos de aprendizagem e desenvolvimento profissional de professores

This study focuses on processes of learning and professional development experienced by elementary school teachers who have students with special educational needs in their classrooms. Cases and case methods can be used as methodological resource to articulate the continued training of teachers in an inclusive perspective. This research-intervention adopted a constructive-collaborative model for continued teachers formation. The main objective was to investigate the possible contributions of teaching cases, while investigative and formative strategies, for the processes of learning and professional development of teachers who work in the regular school. The data were collected by means of analytical activities, drafting collective discussion and teaching cases, having eight teachers as participants in a regular public school, located in the municipality of Natal/RN, Brasil. The theoretical reference covers the inclusive education, teaching learning, teachers professional development, the knowledge base for teaching and teaching cases as a resource for continued teachers formation in an inclusive perspective. The results indicated that teaching cases allowed description and analysis of educational practices developed by regular education teachers and adoption of reflective processes about situations reported and on their own pedagogical actuation, achieving indications of changes. It also indicates the contribution of cases for the clarification, systematization and extension of professional knowledge about inclusive education process as well as for involvement by the teachers of the study in a pedagogical thinking process. The lessons learned are related mainly to own role as teachers of regular education, to the role of professional support and specialized institutions faced to school inclusion. The analyses showed the methodological option was suitable to develop a schoolcentric training process, allowing teachers to seek in their actual environment alternatives for construction of a new logic of teaching that encloses diversity. The conclusion is that the cases, while bringing educational situations closer to the reality experienced by teachers in their daily professional role, causes relevant improvement on teachers education, because it offers training in conjunction with the experience and knowledge that teachers already have

A Produção mais Limpa como ferramenta em busca da sustentabilidade empresarial: um estudo de múltiplos casos em empresas do Estado do Rio Grande do Norte

This study aimed to assess the Cleaner Production CP as corporate sustainable tool, through the multiple case studies within companies from Rio Grande do Norte State. In order to achieve this goal a research methodology approach was set. The initial stage of the research methodology was based on a literature review on which it was observed that the CP can be linked with corporate sustainable once it prevents pollution and reduces the operational risks among employees, community and environment. In addition, CP can useful for companies position within competitive position as well as being applied to process, products and services. In order to observe these factors, CP was used within food industry (Company 1), textile industry (Company 2) and in a car dealer (Company 3). Regarding the results, Company 1 changed its raw material as well as implementing housekeeping (control use of water, energy and condensed milk). In Company 2, it was observed the three levels of CP. In other words, housekeeping (e.g. cutting process and manipulation of chemical products), changing technology (high pressure washing machine) and internal and external recycling. In addition, Company 3 considered only level 3 external recycling. As consequence, it was observed that can be applied either within industry as well as service sector. Unfortunately, it was not possible to observe any social gains on a monetary basis. This is due to limitations of the CP methodology and study complexity. Therefore, it was observed improvements regarding to social, environmental and economic areas. Nevertheless, it is necessary more commitment from top level management in order to consider CP like effective sustainable tool

Terceirização em tecnologia da informação sob os aspectos de estratégia, tomada de decisão e análise de investimentos :estudo de múltiplos casos em três organizações franqueadas da Coca-Cola do Brasil

Desde a criação da tecnologia e do seu uso pelas empresas, a relação custo e benefício nem sempre foi bem elucidada tanto para os responsáveis pela área de tecnologia quanto para a alta direção. Mas, apesar disto, cada vez mais as organizações investem maciçamente em tecnologia, esperando que esta seja a solução para diversos problemas. Por isto, esta questão tem se tornado crucial para o processo de tomada de decisões, visto que investimentos nesta área costumam ser dispendiosos e, na atual conjuntura, estas análises precisam ser extremamente criteriosas para que se miniminizem as possibilidades de insucesso dos projetos, principalmente numa economia estabilizada e de concorrência acirrada. Uma das alternativas que as empresas têm buscado para atingir o sucesso e correr menos riscos é a terceirização da área de TI. Partindo desta visão, a presente dissertação tem por objetivo realizar uma investigação sobre a terceirização dos serviços de TI em todos os seus aspectos, isto é, desde a sua motivação, serviços efetivamente terceirizados, vantagens, desvantagens e possíveis obstáculos, a visão do alinhamento estratégico da TI, os processos de gestão de contratos e formas de controle e, por fim, tendências futuras. Trata-se de uma pesquisa de múltiplos casos, envolvendo franquias do Sistema Coca-Cola no Brasil. O estudo apresenta uma pesquisa bibliográfica sobre o processo de tomada de decisão empresarial, a análise de investimentos, a gestão e a terceirização da TI, o que permitem definir as dimensões de análise da pesquisa. Na pesquisa de campo foram entrevistados os gerentes da área de TI, nas cidades de Brasília-DF, Goiânia-GO e Ribeirão Preto-SP. A pesquisa de campo permitiu identificar como as mesmas avaliam seus investimentos em TI, como esta área é gerenciada, o que as levou a optar pela terceirização e como os processos terceirizados afetam a organização. Por se tratar de uma pesquisa qualitativa, optou-se por analisar comparativamente as três organizações. Com a realização deste estudo, obtiveram-se, como principais resultados, que as organizações estão utilizando a terceirização em TI para focar no negócio principal e, mesmo encontrando diversas desvantagens, inclusive com relação a custos, acreditam que os benefícios justificam. Ainda identificaram-se alguns obstáculos internos para a terceirização, principalmente quanto ao receio de se perder a inteligência do negócio. O acompanhamento dessas atividades terceirizadas é realizado pela equipe interna e por critérios estruturados, onde se verificam os níveis de serviço