Mejora del enfoque comercial en la fase de definición de un proyecto informático

Aquest TFC mira d'analitzar els aspectes comercials que intervenen en les fases inicials de l'execució de projectes informàtics, concretament en la fase d'aprovació i, encara més detingudament, en la fase de definició. Aquestes fases són les mes crítiques per a les entitats dedicades a la gestió de projectes, perquè és on es decideix si són viables.

Enfoque comercial de la fase de definición de un proyecto informático

Projecte que estudia amb detall cadascun dels processos que cal seguir per a portar a terme el desenvolupament de la fase de definició d'un projecte informàtic. Aquest estudi ens ha ajudat a obtenir els coneixements necessaris sobre les diferents característiques d'aquests processos. Una vegada hem acabat el desenvolupament del projecte, es pot dir que el resultat que podem obtenir és la necessitat que tenen les empreses d'incorporar a la fase de definició d'un procés informàtic un enfocament més comercial que el que tenen avui dia. Aquest enfocament més comercial s'ha anat incorporant al llarg dels anys i a poc a poc al desenvolupament dels projectes en general i, en particular, a la fase que ens ocupa, la fase de definició. Tot i així, la realitat és que no està tan estès ni és tan emprat com es podria pensar. Moltes empreses encara no l'entenen com un pas necessari i imprescindible dins la fase de definició d'un projecte informàtic. La majoria no l'empren com un procés que calgui seguir en la definició de tots els seus projectes i continuen pensant que es pot arribar a l'objectiu sense aplicar aquest enfocament.

L'Apologie pour Origène de Pamphile et Eusèbe et les développements sur Origène dans le livre VI de l'Histoire ecclésiastique

(Résumé de l'ouvrage) Il dualismo della vita dell'esegeta a 30 anni dalla ricostruzione di Pierre Nautin, tra documentazione e interpretazione.

Gestión de proyectos : enfoque más comercial de la fase de definición de un proyecto informático

El desarrollo de este Trabajo, identificado por los diferentes capítulos que lo componen, se ha definido siguiendo un hilo conductor que nos permite desgranar la Gestión de Proyectos informáticos, y de esta manera poder hacer una mejor penetración en su fase de definición, para poder aportar mejoras en su enfoque más comercial.Esta fase engloba áreas tales como definir el objeto del proyecto, fijar objetivos, acordar presupuestos, etc., es decir, esta fase de definición del proyecto representa su mismo fundamento. Por lo tanto, la manera en qué se lleve a cabo, marcará la pauta para el resto del proyecto. Profundizando en la gestión de Proyectos podemos evidenciar que la fase de definición se puede considerar una de las fases más importante de cualquier proyecto. A menos que se lleve a cabo correctamente, el proyecto tiene pocas probabilidades de éxito.Por lo tanto, el planteamiento de este Trabajo, está basado en un guión que da una visión general de la Gestión de Proyectos, para posteriormente profundizar en el enfoque más comercial de la fase de definición, de una manera natural.

Evaluation à l'aide d'un livre de bord des compétences cliniques acquises par des stagiaires en médecine. [Evaluation using a logbook of mastering of clinical skills by medical students]

La maîtrise des compétences cliniques est extrêmement importante pour le médecin. Leur enseignement est aujourd'hui facilité grâce à la disponibilité du «Swiss Catalogue of Learning Objectives for Undergraduate Medical Training» où sont décrits les niveaux de compétence à atteindre au terme des études de médecine. Un carnet de bord a été préparé à la Faculté de biologie et de médecine de Lausanne à partir de ce document. Il a permis de mettre en évidence chez les étudiants une très nette amélioration de la maîtrise des compétences cliniques entre le début et la fin des stages en médecine interne, chirurgie/orthopédie, pédiatrie, gynécologie/obstétrique et psychiatrie. Un tel outil devrait permettre dans l'avenir de mieux guider l'apprentissage des étudiants et de suivre leurs progrès à chaque étape du curriculum. [Abstract] The mastering of the clinical skills is of utmost importance for the physician. The teaching of the skills is nowadays made easier with the <<Swiss Catalogue of Learning Objectives for Undergraduate Medical Training>> which lists all the skills and their respective level of expected mastering at graduation. In order to do a survey on how good the students are at those skills, a logbook based on this document has been setup at the Faculty of biology and medicine of the University of Lausanne. This has shown that students went through a clear progression of the mastering of the skills during their elective year in internal medicine, surgery/orthopaedics, paediatric, obstetric and gynaecology as well as psychiatry. Such an instrument should in the future help to better guide the learning process of the clinical skills and to do a better follow-up of their progress.

Proceso INFORNUT: validación de la fase de filtro-FILNUT--y comparación con otros métodos de detección precoz de desnutrición hospitalaria.

INTRODUCTION According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. OBJECTIVES To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. MATERIAL AND METHODS In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT and INFORNUT were done. The settings of the INFORNUT filter were: albumin < 3.5 g/dL, and/or total proteins <5 g/dL, and/or prealbumin <18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol <180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. RESULTS In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66.9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. CONCLUSIONS Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.