Orifice diseases project - experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.

Experience with the first Internet-based course at the Faculty of Medicine, University of São Paulo

PURPOSE: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course. METHOD: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge. RESULTS: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5. CONCLUSIONS: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

Tissue expander complications in plastic surgery: a 10-year experience

INTRODUCTION: Tissue expanders have been of great value in plastic surgery. Tissue expansion was developed for a specific indication; however, within a very short time, the concept of tissue expansion found wide applicability. From 1990 to 1999, 315 expanders in 164 patients were utilized. A retrospective analysis of complications and prognostic factors for complications were done. METHODS: The indications for tissue expansion were burns (50%), trauma (32%), and sequelae of previous surgery (8.8%). The expanders were inserted most frequently in the scalp, trunk and neck. RESULTS: There were 22.2% of complications and the most common were expander exposure (50%), infection (24%) and bad function of the expander (12.8%). The present study revealed an increased rate of minor complications in the group of 0 to 10 years of age and an increased rate of major complications for face and neck expansions compared to trunk expansion. There were no increased complication rates for the other age and anatomic site groups, previous expansion, concomitant expansion and type of expander used. CONCLUSIONS: The outcomes from tissue expansion procedures done in our hospital are similar to those reported in the literature. Tissue expansion is a good and safe technique.

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

Surgical treatment of endocrine exophthalmos by removal of orbital fat: clinical experience

PURPOSE: To report a series of 73 patients with endocrine exophthalmos treated by removal of orbital fat using the transpalpebral approach during the period 1989 to 1999. METHODS: The operation was performed according to the technique described by Olivari. Aesthetic analysis was done preoperatively and postoperatively (more than 6 months after surgery). The number of complications was also observed. RESULTS: The average volume of resected fat was approximately 7.6 mL per orbit. No major complication was observed. In 9 patients with epiphora, all improved. One patient developed postoperative diplopia and 5 complained of temporary diplopia. Appearance improved in 62 patients (85%). CONCLUSION: Surgical removal of orbital fat associated with endocrine exophthalmos provides consistent improvement in appearance with a low rate of complications. Additional procedures may be indicated to improve the cosmetic outcome.

Surgical treatment of rectal prolapse: experience and late results with 51 patients

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

Rating corporate groups a modelling experience

This paper aims to provide a model that allows BPI to measure the credit risk, through its rating scale, of the subsidiaries included in the corporate groups who are their clients. This model should be simple enough to be applied in practice, accurate, and must give consistent results in comparison to what have been the ratings given by the bank. The model proposed includes operational, strategic, and financial factors and ends up giving one of three results: no support, partial support, or full support from the holding to the subsidiary, and each of them translates in adjustments in each subsidiary’s credit rating. As it would be expectable, most of the subsidiaries should have the same credit rating of its parent company.

Enhancing fan experience during live sports broadcasts through second screen applications

When sports fans attend live sports events, they usually engage in social experiences with friends, family members and other fans at the venue sharing the same affiliation. However, fans watching the same event through a live television broadcast end up not feeling so emotionally connected with the athletes and other fans as they would if they were watching it live, together with thousands of other fans. With this in mind, we seek to create mobile applications that deliver engaging social experiences involving remote fans watching live broadcasted sports events. Taking into account the growing use of mobile devices when watching TV broadcasts, these mobile applications explore the second screen concept, which allows users to interact with content that complements the TV broadcast. Within this context, we present a set of second screen application prototypes developed to test our concepts, the corresponding user studies and results, as well as suggestions on how to apply the prototypes’ concepts not only in different sports, but also during TV shows and electronic sports. Finally, we also present the challenges we faced and the guidelines we followed during the development and evaluation phases, which may give a considerable contribution to the development of future second screen applications for live broadcasted events.

Exploring the consumer decision journey and online shoping experience through an emotional prespective

Traditional consumer decision-making models have long used quantitative research to address a link between emotional and rational behavior. However, little qualitative research has been conducted in the area of online shopping as an end-to-end experience. This study aims to provide a detailed phenomenological account of consumers’ online shopping experience and extend Mckinsey & Companys’s consumer decision journey model from an emotional perspective. Six semi-structured interviews and a focus group of nine people are analyzed using Interpretive Phenomenology Analysis and five superordinate themes emerged from the results: emotional experience, empathy and encouragement, in relation to brand preference, emotional encounters in relation to consumer satisfaction and emotional exchange and relationship with a company or brand. A model interrelating these themes is then introduced to visually represent the emotional essence of a large online purchase. This study promises to be applicable as a descriptive, and perhaps, better predictive report for understanding the complex consumer decision-making process as it relates to online consumer behavior. Future research topics are also identified.

Social venture move

This study has the purpose of presenting the path of a social microcredit start-up in Mozambique. Its members had just gotten out of college and decided to put in practice what they had learnt. Even though the whole foundation of the project was developed in Mozambique, the team has extended its experience to other countries: São Tomé and Timor. However, the focus of this study will be solely in the Ilha de Mozambique’s project and the difficulties that it is facing right now, in order to try to find answers that would allow the project entrepreneurs to overcome what is keeping them from having a more successful return rate. The main issue of the project and the worse and unexpected default rate is within the fishing sector. This is peculiar, since the mission is in an island where there are plenty of fish and shellfish. By addressing this problem, and presenting the whole structure of the venture, it is its goal to understand better ways to deal with the difficulties. Its format will be as a case study and it will present as well the macroeconomics of Mozambique to justify the choice of the place, align with the team itself, and why it is possible to have a successful project with as many contacts and sponsors as this one does.

The role of information systems in business process redesign : a case of Turkish electricity market

This study is specifically concerned with the effect of the Enterprise Resource Planning (ERP) on the Business Process Redesign (BPR). Researcher’s experience and the investigation on previous researches imply that BPR and ERP are deeply related to each other and a study to found the mentioned relation further is necessary. In order to elaborate the hypothesis, a case study, in particular Turkish electricity distribution market and the phase of privatization are investigated. Eight companies that have taken part in privatization process and executed BPR serve as cases in this study. During the research, the cases are evaluated through critical success factors on both BPR and ERP. It was seen that combining the ERP Solution features with business processes lead the companies to be successful in ERP and BPR implementation. When the companies’ success and efficiency were compared before and after the ERP implementation, a considerable change was observed in organizational structure. It was spotted that the team composition is important in the success of ERP projects. Additionally, when the ERP is in driver or enabler role, the companies can be considered successful. On the contrary, when the ERP has a neutral role of business processes, the project fails. In conclusion, it can be said that the companies, which have implemented the ERP successfully, have accomplished the goals of the BPR.

Humble leadership and team voice

This study examines the direct and indirect effects of humble leadership on team voice. Although the relationship between leadership styles and voice is widely investigated, humble leadership and team voice, both relatively new constructs, remained out of sight. Drawing upon social interdependence theory, information exchange, team psychological safety, and team-efficacy are proposed to mediate the relationship between humble leadership and team voice. Research is conducted at the team-level analysis and involved 209 team members from 52 teams in 21 companies collected through a snowball sample. Results were provided by the SPSS macro PROCESS using the regression-based approach and bootstrapping techniques. Findings showed that humble leadership is positively related to team voice. Furthermore, findings supported the mediating effect of information exchange. However, no support was given for the mediating effects of team psychological safety and team-efficacy. Theoretical and practical implications of the findings are addressed.

The non-emergency patient transport modelled as a team orienteering problem

This work presents an improved model to solve the non-emergency patients transport (NEPT) service issues given the new rules recently established in Portugal. The model follows the same principle of the Team Orienteering Problem by selecting the patients to be included in the routes attending the maximum reduction in costs when compared with individual transportation. This model establishes the best sets of patients to be transported together. The model was implemented in AMPL and a compact formulation was solved using NEOS Server. A heuristic procedure based on iteratively solving Orienteering Problems is presented, and this heuristic provides good results in terms of accuracy and computation time. Euclidean instances as well as asymmetric real data gathered from Google maps were used, and the model has a promising performance mainly with asymmetric cost matrices.

Wi-Fi fingerprinting in the real world – RTLS@UM at the EvAAL competition

Research and development around indoor positioning and navigation is capturing the attention of an increasing number of research groups and labs around the world. Among the several techniques being proposed for indoor positioning, solutions based on Wi-Fi fingerprinting are the most popular since they exploit existing WLAN infrastructures to support software-only positioning, tracking and navigation applications. Despite the enormous research efforts in this domain, and despite the existence of some commercial products based on Wi-Fi fingerprinting, it is still difficult to compare the performance, in the real world, of the several existing solutions. The EvAAL competition, hosted by the IPIN 2015 conference, contributed to fill this gap. This paper describes the experience of the RTLS@UM team in participating in track 3 of that competition.

7to77, A new database querying experience

Nowadays, the vulgarization of information and communication technologies has reached to a level that the majority of people spend a lot of time using software to do regular tasks, ranging from games and ordinary time and weather utilities to some more sophisticated ones, like retail or banking applications. This new way of life is supported by the Internet or by specific applications that changed the image people had about using information and communication technologies. All over the world, the first cycle of studies of educational systems also has been addressed with the justification that this encourages the development of children. Taking this into consideration, we design and develop a visual explorer system for relational databases that can be used by everyone, from “7 to 77”, in an intuitive and easy way, getting immediate results – a new database querying experience. Thus, in this paper we will expose the main characteristics and features of this visual database explorer, showing how it works and how it can be used to execute the most current data manipulation operations over a database.