Análisis de las barreras para la unificación de una Historia Clínica Electrónica -HCE- en Colombia

Objetivo: Identificar las barreras para la unificación de una Historia Clínica Electrónica –HCE- en Colombia. Materiales y Métodos: Se realizó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a profesionales y expertos de 22 instituciones del sector salud, de Bogotá y de los departamentos de Cundinamarca, Santander, Antioquia, Caldas, Huila, Valle del Cauca. Resultados: Colombia se encuentra en una estructuración para la implementación de la Historia Clínica Electrónica Unificada -HCEU-. Actualmente, se encuentra en unificación en 42 IPSs públicas en el departamento de Cundinamarca, el desarrollo de la HCEU en el país es privado y de desarrollo propio debido a las necesidades particulares de cada IPS. Conclusiones: Se identificaron barreras humanas, financieras, legales, organizacionales, técnicas y profesionales en los departamentos entrevistados. Se identificó que la unificación de la HCE depende del acuerdo de voluntades entre las IPSs del sector público, privado, EPSs, y el Gobierno Nacional.

Instrumentos de apoio à gestão estratégica e ao desempenho organizacional dos fisioterapeutas em unidades privadas de fisioterapia

O sucesso de uma gestão baseada na estratégia reside, no aproveitamento racional e eficiente dos seus recursos humanos, financeiros e organizacionais, bem como na sua capacidade para concretizar objectivos e alcançar resultados. Esta dissertação foi elaborada baseando-se no pressuposto que, a selecção e a aplicação de um Instrumento de Apoio à Gestão em unidades privadas de fisioterapia (UPF’s) permitirão induzir níveis acrescidos de melhoria do desempenho individual e/ou organizacional. Constituiu objectivo geral da mesma contribuir para a sensibilização e a difusão alargada das ferramentas de apoio à gestão que, aplicadas naquelas unidades, poderiam induzir níveis acrescidos de melhoria do desempenho. Definiram-se ainda três objectivos específicos consubstanciando preocupações relacionadas com a reprodução do conhecimento especializado em gestão, com a sua aplicação específica no terreno e com a subjacente criação de valor individual e organizacional. A metodologia utilizada foi a abordagem de Estudo de Caso, inspirada na técnica focus-group, aplicada a três UPF’s, e os resultados obtidos através das análises efectuadas permitiram identificar a ausência da aplicação de instrumentos de apoio à gestão e de avaliação de desempenho, bem como níveis elevados de desempenho, satisfação e autonomia nos profissionais de fisioterapia, constituindo estes a base para justificar a necessidade urgente da elaboração de um plano de implementação de um sistema de avaliação de desempenho nas unidades estudadas. /ABSTRACT: The success of a management based on strategy relies in the rational and efficient use of its human, financial and organizational resources, as well as its ability to achieve objectives and results. This thesis was developed, based on the assumption that the selection and application of a management support instrument in private physiotherapy units would induce higher levels of individual performance and / or organization. It was general objective the contribution to the sensibilization and diffusion of tools to support management, which applied in those units, could induce higher levels of performance. There were defined three specific objectives which concerned whereabouts with the reproduction of specialized knowledge in management, with its specified applicability in the work field and with the underneath creation of individual and organizational value. The applied methodology was a case study, inspired by the focus-group technique applied in three private physiotherapy units, and the results obtained through the analysis allowed the identification of lack of use of any support management tools and performance evaluation, as well as high standard levels of performance, satisfaction and professional autonomy in physical therapists, being this the base for justifying the urgent need for developing an implementation plan of a performance evaluation system applied to these units.

Changes in fish assemblage structure after implementation of Marine Protected Areas in the south western coast of Portugal.

Marine Protected Areas (MPAs) are increasingly being recommended as management tools for biodiversity conservation and fisheries. With the purpose of protecting the region's biodiversity and prevent the over exploitation of marine resources, in February 2011 the no-take MPAs of Ilha do Pessegueiro and Cabo Sard~ao were implemented within the “Parque Natural do Sudoeste Alentejano e Costa Vicentina “(PNSACV) Marine Park, south western coast of Portugal. As such, commercial and recreational fishing became prohibited in these areas. In order to evaluate the effects of these no-take MPAs, the structure of their fish assemblages and of adjacent control areas without fishing restrictions were studied between 2011 (immediately after implementation) and 2013 (two years after implementation). A total of 4 sampling campaigns were conducted (summer 2011, winter 2012, summer 2013 and winter 2013) using trammel nets and bottom trawl. Ichthyofaunal assemblages from the no-take MPAs (treatment) were compared with adjacent areas (controls) and changes evaluated as a function of time since protection. Results revealed significant increase in fish abundance after the implementation of the no-take MPAs. Furthermore, significant differences in the structure of fish assemblages (abundance and fish size) between protected and neighbouring areas were rapidly observed upon the implementation of the no-take MPAs. In addition, specimens of larger size occurred more frequently within Ilha do Pessegueiro no-take MPA in the last year of the study. Overall, despite the young age of these no-take MPAs, changes on the structure of their fish assemblages were already evident after only two years of protection, indicating that management measures such as MPA designation may play an important role to promote fisheries sustainable exploitation as well as to protect species with conservation interest.

Douleurs neuropathiques : quelques pistes pour une évaluation structurée et une prise en charge spécifique et globale [Neuropathic pain: tips and tools for specific and comprehensive pain management]

Les syndromes neuropathiques sont caractérisés par une douleur d'intensité élevée, de longue durée et résistante aux analgésiques classiques. De fait, il existe un risque important de répercussions sur la vie et le bien-être des patients. A travers une vignette clinique, cet article abordera le diagnostic, le traitement spécifique et l'impact de la douleur neuropathique sur la qualité de vie et les conséquences psychologiques associées, comme la dépression et l'anxiété. Nous présenterons des outils validés qui permettent d'objectiver la composante neuropathique aux douleurs et les comorbidités psychiatriques associées. Cette évaluation globale favorise un meilleur dialogue avec les patients ainsi que l'élaboration de stratégies thérapeutiques, notamment par le biais d'antidépresseurs, dont l'efficacité sera discutée en fin d'article. Neuropathic pain syndromes are characterized by intense and long lasting pain that is resistant to usual analgesics. Patients are therefore at high risk of decreased quality of life and impaired well-being. Using a case report, we will consider in this article the diagnosis and treatment of neuropathic pain as well as its impact on the quality of life including psychological consequences such as depression and anxiety. We will present simple and reliable scales that can help the general practitioner evaluate the neuropathic component of the pain syndrome and its related psychiatric co-morbidities. This comprehensive approach to pain management should facilitate communication with the patient and help the practitioner select the most appropriate therapeutic strategy, notably the prescription of antidepressants, the efficacy of which we will discuss at the end of the article.

Allergie aux venins d'hyménopteres: nouveautés diagnostiques et prise en charge [Hymenoptera venom allergy: new diagnostic tools and management].

Anaphylactic reactions to hymenoptera venoms are common and, in our latitudes, mainly concern wasps and bees. Recently, molecular biology techniques have contributed to identifying and to sequencing the major allergens of insect venoms and led to the production of recombinant allergens. Assays for specific IgE directed against these recombinant allergens have recently been made available in clinical practice. They provide considerable assistance in identifying the insect responsible for an anaphylactic reaction, in particular when standard tests are positive for both wasp and bee. This article focuses on these new laboratory tests and also reviews the management of patients experiencing an anaphylactic reaction after hymenoptera sting.

GIS - Based Decision and Outreach Tools for Aggregate Source Management, September 2008

This research project combined various datasets, existing and created for this project, into an Interactive Mapping Service (IMS) for use by Iowa DOT personnel, county planning and zoning departments and the public in order to make more informed decisions regarding aggregate sources and future access to them. Iowa DOT Technical Advisory Committee meetings were held, along with public forum presentations, in order to understand better the social, ecological and economic limitations to extracting aggregate. The information needed by potential users was conveyed and integrated into a single informational source, the Aggregate Planning IMS.

Stock assessment for fishery management - A framework guide to the stock assessment tools of the Fisheries Management Science Programme (FMSP)

This document provides guidelines for fish stock assessment and fishery management using the software tools and other outputs developed by the United Kingdom's Department for International Development's Fisheries Management Science Programme (FMSP) from 1992 to 2004. It explains some key elements of the precautionary approach to fisheries management and outlines a range of alternative stock assessment approaches that can provide the information needed for such precautionary management. Four FMSP software tools, LFDA (Length Frequency Data Analysis), CEDA (Catch Effort Data Analysis), YIELD and ParFish (Participatory Fisheries Stock Assessment), are described with which intermediary parameters, performance indicators and reference points may be estimated. The document also contains examples of the assessment and management of multispecies fisheries, the use of Bayesian methodologies, the use of empirical modelling approaches for estimating yields and in analysing fishery systems, and the assessment and management of inland fisheries. It also provides a comparison of length- and age-based stock assessment methods. A CD-ROM with the FMSP software packages CEDA, LFDA, YIELD and ParFish is included.

Operations research/management science tools for integrating people with disabilities into employment. A study on Valencia`s Sheltered Work Centres for Disabled

People with disabilities have a right to a full life in every sense and one of those fundamental rights is the possibility to work. In this paper, the importance of social employment integration of disabled people is highlighted as one of the stakeholders to be satisfied by companies in the new framework that corporate social responsibility is constructing. The objective of the paper is to revise the benefits of some well-known operations research/management science tools that, if applied correctly, have a double positive impact on work accessibility and improved productivity. The responses collected from managers of Valencia`s ShelteredWork Centres for Disabled by means of a structured questionnaire are used to analyse the level of implementation of these tools and their impact depending on the type of centre, the kind of disability and other structural variables.

Model Configuration And Data Management In The Short-Term Water Information Forecasting Tools

The Short-term Water Information and Forecasting Tools (SWIFT) is a suite of tools for flood and short-term streamflow forecasting, consisting of a collection of hydrologic model components and utilities. Catchments are modeled using conceptual subareas and a node-link structure for channel routing. The tools comprise modules for calibration, model state updating, output error correction, ensemble runs and data assimilation. Given the combinatorial nature of the modelling experiments and the sub-daily time steps typically used for simulations, the volume of model configurations and time series data is substantial and its management is not trivial. SWIFT is currently used mostly for research purposes but has also been used operationally, with intersecting but significantly different requirements. Early versions of SWIFT used mostly ad-hoc text files handled via Fortran code, with limited use of netCDF for time series data. The configuration and data handling modules have since been redesigned. The model configuration now follows a design where the data model is decoupled from the on-disk persistence mechanism. For research purposes the preferred on-disk format is JSON, to leverage numerous software libraries in a variety of languages, while retaining the legacy option of custom tab-separated text formats when it is a preferred access arrangement for the researcher. By decoupling data model and data persistence, it is much easier to interchangeably use for instance relational databases to provide stricter provenance and audit trail capabilities in an operational flood forecasting context. For the time series data, given the volume and required throughput, text based formats are usually inadequate. A schema derived from CF conventions has been designed to efficiently handle time series for SWIFT.

Development of advanced tools and methods for the assessment and management of risk due to atypical major accident scenarios

Proper hazard identification has become progressively more difficult to achieve, as witnessed by several major accidents that took place in Europe, such as the Ammonium Nitrate explosion at Toulouse (2001) and the vapour cloud explosion at Buncefield (2005), whose accident scenarios were not considered by their site safety case. Furthermore, the rapid renewal in the industrial technology has brought about the need to upgrade hazard identification methodologies. Accident scenarios of emerging technologies, which are not still properly identified, may remain unidentified until they take place for the first time. The consideration of atypical scenarios deviating from normal expectations of unwanted events or worst case reference scenarios is thus extremely challenging. A specific method named Dynamic Procedure for Atypical Scenarios Identification (DyPASI) was developed as a complementary tool to bow-tie identification techniques. The main aim of the methodology is to provide an easier but comprehensive hazard identification of the industrial process analysed, by systematizing information from early signals of risk related to past events, near misses and inherent studies. DyPASI was validated on the two examples of new and emerging technologies: Liquefied Natural Gas regasification and Carbon Capture and Storage. The study broadened the knowledge on the related emerging risks and, at the same time, demonstrated that DyPASI is a valuable tool to obtain a complete and updated overview of potential hazards. Moreover, in order to tackle underlying accident causes of atypical events, three methods for the development of early warning indicators were assessed: the Resilience-based Early Warning Indicator (REWI) method, the Dual Assurance method and the Emerging Risk Key Performance Indicator method. REWI was found to be the most complementary and effective of the three, demonstrating that its synergy with DyPASI would be an adequate strategy to improve hazard identification methodologies towards the capture of atypical accident scenarios.

Authoring tools and management information systems: study of a generalizable architecture

The need to effectively manage the documentation covering the entire production process, from the concept phase right through to market realise, constitutes a key issue in the creation of a successful and highly competitive product. For almost forty years the most commonly used strategies to achieve this have followed Product Lifecycle Management (PLM) guidelines. Translated into information management systems at the end of the '90s, this methodology is now widely used by companies operating all over the world in many different sectors. PLM systems and editor programs are the two principal types of software applications used by companies for their process aotomation. Editor programs allow to store in documents the information related to the production chain, while the PLM system stores and shares this information so that it can be used within the company and made it available to partners. Different software tools, which capture and store documents and information automatically in the PLM system, have been developed in recent years. One of them is the ''DirectPLM'' application, which has been developed by the Italian company ''Focus PLM''. It is designed to ensure interoperability between many editors and the Aras Innovator PLM system. In this dissertation we present ''DirectPLM2'', a new version of the previous software application DirectPLM. It has been designed and developed as prototype during the internship by Focus PLM. Its new implementation separates the abstract logic of business from the real commands implementation, previously strongly dependent on Aras Innovator. Thanks to its new design, Focus PLM can easily develop different versions of DirectPLM2, each one devised for a specific PLM system. In fact, the company can focus the development effort only on a specific set of software components which provides specialized functions interacting with that particular PLM system. This allows shorter Time-To-Market and gives the company a significant competitive advantage.