Cost-effectiveness analysis of a hospital electronic medication management system

OBJECTIVE: To conduct a cost-effectiveness analysis of a hospital electronic medication management system (eMMS). METHODS: We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. RESULTS: The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63-66 (US$56-59) per admission (A$97 740-$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. CONCLUSION: The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost-effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.

Decision Support Systems And Promoting Socially Just Environmental Management

The Mauri Model DMF is unique in its approach to the management of water resources as the framework offers a transparent and inclusive approach to considering the environmental, economic, social and cultural aspects of the decisions being contemplated. The Mauri Model DMF is unique because it is capable of including multiple-worldviews and adopts mauri (intrinsic value or well-being) in the place of the more common monetised assessments of pseudo sustainability using Cost Benefit Analysis. The Mauri Model DMF uses a two stage process that first identifies participants’ worldviews and inherent bias regarding water resource management, and then facilitates transparent assessment of selected sustainability performance indicators. The assessment can then be contemplated as the separate environmental, economic, social and cultural dimensions of the decision, and collectively as an overall result; or the priorities associated with different worldviews can be applied to determine the sensitivity of the result to different cultural contexts or worldviews.

Understanding e-government technology transfer: evidence from the transfer of a patent management system from EPO to INPI

Drawing upon Brazilian experience, this research explores some of the key issues to be addressed in using e-government technical cooperation designed to enhance service provision of Patent Offices in developing countries. While the development of software applications is often seen merely as a technical engineering exercise, localization and adaptation are context bounded matters that are characterized by many entanglements of human and non-humans. In this work, technical, legal and policy implications of technical cooperation are also discussed in a complex and dynamic implementation environment characterized by the influence of powerful hidden agendas associated with the arena of intellectual property (IP), which are shaped by recent technological, economic and social developments in our current knowledge-based economy. This research employs two different theoretical lenses to examine the same case, which consists of transfer of a Patent Management System (PMS) from the European Patent Office (EPO) to the Brazilian Patent Office that is locally named ‘Instituto Nacional da Propriedade Industrial’ (INPI). Fundamentally, we have opted for a multi-paper thesis comprising an introduction, three scientific articles and a concluding chapter that discusses and compares the insights obtained from each article. The first article is dedicated to present an extensive literature review on e-government and technology transfer. This review allowed the proposition on an integrative meta-model of e-government technology transfer, which is named E-government Transfer Model (ETM). Subsequently, in the second article, we present Actor-Network Theory (ANT) as a framework for understanding the processes of transferring e-government technologies from Patent Offices in developed countries to Patent Offices in developing countries. Overall, ANT is seen as having a potentially wide area of application and being a promising theoretical vehicle in IS research to carry out a social analysis of messy and heterogeneous processes that drive technical change. Drawing particularly on the works of Bruno Latour, Michel Callon and John Law, this work applies this theory to a longitudinal study of the management information systems supporting the Brazilian Patent Office restructuration plan that involved the implementation of a European Patent Management System in Brazil. Based upon the ANT elements, we follow the actors to identify and understand patterns of group formation associated with the technical cooperation between the Brazilian Patent Office (INPI) and the European Patent Office (EPO). Therefore, this research explores the intricate relationships and interactions between human and non-human actors in their attempts to construct various network alliances, thereby demonstrating that technologies embodies compromise. Finally, the third article applies ETM model as a heuristic frame to examine the same case previously studied from an ANT perspective. We have found evidence that ETM has strong heuristic qualities that can guide practitioners who are engaged in the transfer of e-government systems from developed to developing countries. The successful implementation of e-government projects in developing countries is important to stimulate economic growth and, as a result, we need to understand the processes through which such projects are being implemented and succeed. Here, we attempt to improve understanding on the development and stabilization of a complex social-technical system in the arena of intellectual property. Our preliminary findings suggest that e-government technology transfer is an inherently political process and that successful outcomes require continuous incremental actions and improvisations to address the ongoing issues as they emerge.

Environmental management in ethanol and sugarcane plants in Brazil

There has been much discussion on the importance of Brazilian ethanol in promoting a more sustainable society. However, there is a lack of analysis of whether sugarcane plants/factories that produce this ethanol are environmentally suitable. Thus, the objective of this study was to analyse stages of environmental management at four Brazilian ethanol-producing plants, examining the management practices adopted and the factors behind this adoption. The results indicate that (1) only one of the four plants is in the environmentally proactive stage; (2) all plants are adopting operational and organisational environmental management practices; (3) all plants have problems in communicating environmental management practices; and (4) the plant with the most advanced environmental management makes intense use of communication practices and is strongly oriented towards a more environmentally aware international market. This paper is an attempt to explain the complex relationship between the evolution of environmental management, environmental practices and motivation using a framework. The implications for society, plant directors and scholars are described, as well as the study's limitations.

Environmental management in Brazil: is it a completely competitive priority?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A QUALITY MANAGEMENT SYSTEM FOR POSITIONING WITH GNSS TECHNOLOGY

This paper presents a proposal for a Quality Management System for a generic GNSS Surveying Company as an alternative for management and service quality improvements. As a result of the increased demand for GNSS measurements, a large number of new or restructured companies were established to operate in that market. Considering that GNSS surveying is a new process, some changes must be performed in order to accommodate the old surveying techniques and the old fashioned management to the new reality. This requires a new management model that must be based on a well-described procedure sequence aiming at the Total Management Quality for the company. The proposed Quality Management System was based on the requirements of the Quality System ISO 9000:2000, applied to the whole company, focusing on the productive process of GNSS surveying work.

Automatic dimming multi-lamp fluorescent management system with active input power factor corrector stage

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Barriers to environmental management in clusters of small businesses in Brazil and Japan: from a lack of knowledge to a decline in traditional knowledge

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Integration of the dispersed generators in the distribution management system

Since the 80s huge efforts have been made to utilize renewable energy sources to generate electric power. An important issue about using renewable energy sources is a Distribution Management System (DMS) in presence of dispersed generators. This paper reports some aspects of integration of the dispersed generators in the DMS. Besides, an investigation of impact of the dispersed generators on the overall performances of the distribution systems in steady state is performed. In order to observe losses in the distribution networks with dispersed generators, several loss allocation methods are applied. Results obtained from case study using IEEE test network, are presented and discussed. © 2003 IEEE.

Software architecture for web-based project management system

This article presents software architecture for a web-based system to aid project managing, conceptually founded on guidelines of the Project Management Body of Knowledge (PMBoK) and on ISO/IEC 9126, as well as on the result of an empiric study done in Brazil. Based on these guidelines, this study focused on two different points of view about project management: the view of those who develop software systems to aid management and the view of those who use these systems. The designed software architecture is capable of guiding an incremental development of a quality system that will satisfy today's marketing necessities, principally those of small and medium size enterprises.

Challenges of teaching corporate environmental management in Brazil

This paper sheds light on the main challenges of teaching Corporate Environmental Management (CEM) in Brazil. Thus, we analysed the main challenges for CEM in Brazil from the viewpoint of teachers. The objective of the research is achieved by means of interviews performed with five renowned professors responsible for teaching CEM in undergraduate courses. Results indicate five types of barriers for teaching CEM: weak integration of other teachers in the teaching of CEM; low level of acceptance of CEM as a subject by the peers teachers; a lack of focus on business while teaching CEM; a scarcity of CEM teaching materials appropriate for the realities of Brazil; and a relative lack of interest among some students in CEM. Teaching CEM is fundamental for the education of more responsible students, but little is known about teaching CEM in Brazil.. Copyright © 2013 Inderscience Enterprises Ltd.

Environmental management and operational performance in automotive companies in Brazil: The role of human resource management and lean manufacturing

The main objective of this study is to verify the influence of Environmental Management (EM) on Operational Performance (OP) in Brazilian automotive companies, analyzing whether Lean Manufacturing (LM) and Human Resources (HR) interfere in the greening of these companies. Therefore, a conceptual framework listing these concepts was proposed, and three research hypotheses were presented. A questionnaire was elaborated based on this theoretical background and sent to respondents occupying the highest positions in the production/operations areas of Brazilian automotive companies. The data, collected from 75 companies, were analyzed using structural equation modeling. The main results are as follows: (a) the model tested revealed an adequate goodness of fit, showing that overall, the relations proposed between EM and OP and between HR, LM and EM tend to be statistically valid; (b) EM tends to influence OP in a positive and statistically weak manner; (c) LM has a greater influence on EM when compared to the influence HR has over EM; (d) HR has a positive relationship over EM, but the statistical significance of this relationship is less than that of the other evaluated relationships. The originality of this paper lies in its gathering the concepts of EM, LM, HR and OP in a single study, as they generally tend not to be treated jointly. This paper also provided valid empirical evidence for a littlestudied context: the Brazilian automotive sector. © 2012 Elsevier Ltd. All rights reserved.

Green teams: Understanding their roles in the environmental management of companies located in Brazil

Green teams are frequently considered in the state-of-the-art literature as an essential factor for companies aiming to implement and improve environmental management approaches and practices. However, most of the available literature on green teams is conceptual and theoretical by nature. Therefore, the main purpose of this article is to evaluate the main characteristics of green teams in Brazilian companies and to analyse the relationships between green teams and the maturity level of environmental management in those companies. Based on a conceptual background on corporate environmental management and green teams, a research was done in two complementary phases: a survey of 94 companies with ISO 14001 certification; and a multiple case study of four industrial companies. Survey results suggest that 82% of the studied companies have cross-functional green teams, i.e. involving various companies' departments; and 65% have functional green teams, i.e. individual department teams. The results of the case study suggest that the use of green teams is an instrument to the greening of companies with ISO 14001 in Brazil. The company with the most proactive and advanced environmental management is the same company which uses green teams more intensely. Green teams are especially necessary for implementing more technical environmental management practices, e.g. Life Cycle Assessment. Since this is one of the first studies analysing green teams, the results presented can be useful for companies and public policies aiming to implementation of environmental initiatives. © 2012 Elsevier Ltd. All rights reserved.

Guidelines for the integration of certifiable management systems in industrial companies

Organizations often operate in turbulent environments characterized by intense competitiveness, constant technological progress, new market requirements, and scarce natural resources. This scenario imposes the constant need for change in the operation and companies' management. The integration of certifiable management systems is an effective alternative in this sense. The objective of the present study is to propose guidelines for the integration of the ISO 9001 Quality Management System (QMS), ISO 14001 Environmental Management System (EMS) and OHSAS 18001 Occupational Health and Safety Management System (OHSMS) in industrial companies. These guidelines were developed based on a theoretical framework and on the results from fourteen case studies performed in Brazilian industrial companies. The proposed guidelines were divided into three phases: A) integration planning, b) integration development, and c) integration control and improvement.

Informe del Seminario sobre las Evaluaciones del Impacto Ambiental como Instrumento de Gestión del Medio Ambiente: Situación y Perspectivas en América Latina y el Caribe = Report of the Seminar on Environmental Impact Assessments as an Instrument of Environmental Management: Situation and Prospects in Latin America and the Caribbean

Contiene asistencia, organización de los trabajos y resumen de los debates de la reunión que tuvo como principal objetivo analizar aspectos de la cooperación internacional en materia de evaluaciones del impacto ambiental.