Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

Decision-Making in Social Enterprises: Exploring the Link between Employee Participation and Organizational Commitment

This article studies the influence of the procedural justice resulting from participation in decision-making on employees' affective commitment in social enterprises. It also examines whether any potential link between participation and commitment is due to social exchange, as is the case with for-profit companies. The study is based on data from employees of French work integration social enterprises. The results confirm the positive relationship between procedural justice and affective commitment and the mediating role of perceived organizational support and leader-member exchanges. Managerial recommendations are then given to best maintain or increase employees' involvement in the decision-making processes of social enterprises.

Effectiveness of interventions targeting frequent users of emergency departments: a systematic review

Texte intégral: http://www.springerlink.com/content/3q68180337551r47/fulltext.pdf

Determinants of organizational form: Transaction costs and institutions in the European trucking industry

We explain why European trucking carriers are much smaller and rely more heavily on owner-operators(as opposed to employee drivers) than their US counterparts. Our analysis begins by ruling outdifferences in technology as the source of those disparities and confirms that standard hypothesesin organizational economics, which have been shown to explain the choice of organizational form inUS industry, also apply in Europe. We then argue that the preference for subcontracting oververtical integration in Europe is the result of European institutions particularly, labor regulationand tax laws that increase the costs of vertical integration.

O processo de implementação da auditoria interna numa autarquia local

O contexto atual que premeia o mundo das organizações exige muitas mudanças nos processos administrativos, principalmente, ao planeamento e controlo das operações económico-financeiras, de modo que os padrões de eficiência e eficácia garantem a sobrevivência organizacional. A auditoria interna tem-se demonstrado a sua real importância, destacando-se como uma eficiente ferramenta de apoio à administração, para verificação da eficiência e eficácia das atividades e a identificação de todos os procedimentos internos e das políticas definidas pela organização. No domínio das organizações públicas, particularmente as Autarquias Locais, as entidades reconhecem a importante necessidade de implementar uma Auditoria Interna que permitem que estas atuam de forma eficiente e eficaz. É neste contexto, que o presente trabalho tem como objetivo geral demonstrar em termos teóricos e práticos a importância da implementação da Auditoria Interna num Município e a sua contribuição para a melhoria da eficiência na gestão do município em estudo, assim como os objetivos específicos. A fundamentação teórica assenta-se na luz das contribuições teóricas de uma análise exploratória dos documentos, revisão bibliográfica, artigos, diretivas e monografias, bem como análise de recursos da internet, pesquisas de diferentes sites relacionados com o tema, visando a aquisição de um bom nível de conhecimento. O estudo de caso foi realizado na Câmara Municipal do Porto Novo, onde foi-me concedido um estágio profissional que permitiu uma melhor interação com o objeto de estudo por forma a apresentar uma melhor proposta. The current context that rewards the world organizations requires many changes in administrative procedures, especially the planning and control of economic-financial operations, so that the standards of efficiency and effectiveness to ensure organizational survival. Internal audit has demonstrated its real importance, especially as an effective tool to support the management, to evaluate the efficiency and effectiveness of activities and identification of all internal procedures and policies defined by the organization. In the field of public organizations, particularly the Local Government, companies recognize the necessity of implementing a Municipal Internal Auditing, so that they could operate efficiently and effectively. In this context, the present work aims to demonstrate in general, in theoretical and practical terms the importance of the implementation of Internal Audit in a municipality and its contribution in the improvement of efficiency in the management of the municipality under study, as well as the specific objectives. The theoretical support is based on the light of the theoretical contributions of an exploratory analysis of documents, literature review, articles, monographs and policies, as well as analysis of Internet resources, research different sites related to the subject, aimed of acquiring a good level of knowledge. The case study was conducted in the Municipality of Porto Novo, where I was awarded an internship that allowed me to have much interaction with the organization so I could present better suggestions.

Should we await IFN-free regimens to treat HCV genotype 1 treatment-naive patients? A cost-effectiveness analysis (ANRS 95141).

BACKGROUND & AIMS: In treatment-naive patients mono-infected with genotype 1 chronic HCV, treatments with telaprevir/boceprevir (TVR/BOC)-based triple therapy are standard-of-care. However, more efficacious direct-acting antivirals (IFN-based new DAAs) are available and interferon-free (IFN-free) regimens are imminent (2015). METHODS: A mathematical model estimated quality-adjusted life years, cost and incremental cost-effectiveness ratios of (i) IFN-based new DAAs vs. TVR/BOC-based triple therapy; and (ii) IFN-based new DAAs initiation strategies, given that IFN-free regimens are imminent. The sustained virological response in F3-4/F0-2 was 71/89% with IFN-based new DAAs, 85/95% with IFN-free regimens, vs. 64/80% with TVR/BOC-based triple therapy. Serious adverse events leading to discontinuation were taken as: 0-0.6% with IFN-based new DAAs, 0% with IFN-free regimens, vs. 1-10% with TVR/BOC-based triple therapy. Costs were euro60,000 for 12weeks of IFN-based new DAAs and two times higher for IFN-free regimens. RESULTS: Treatment with IFN-based new DAAs when fibrosis stage ⩾F2 is cost-effective compared to TVR/BOC-based triple therapy (euro37,900/QALY gained), but not at F0-1 (euro103,500/QALY gained). Awaiting the IFN-free regimens is more effective, except in F4 patients, but not cost-effective compared to IFN-based new DAAs. If we decrease the cost of IFN-free regimens close to that of IFN-based new DAAs, then awaiting the IFN-free regimen becomes cost-effective. CONCLUSIONS: Treatment with IFN-based new DAAs at stage ⩾F2 is both effective and cost-effective compared to TVR/BOC triple therapy. Awaiting IFN-free regimens and then treating regardless of fibrosis is more efficacious, except in F4 patients; however, the cost-effectiveness of this strategy is highly dependent on its cost.

Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism.

BACKGROUND: Low-molecular-weight heparin (LMWH) appears to be safe and effective for treating pulmonary embolism (PE), but its cost-effectiveness has not been assessed. METHODS: We built a Markov state-transition model to evaluate the medical and economic outcomes of a 6-day course with fixed-dose LMWH or adjusted-dose unfractionated heparin (UFH) in a hypothetical cohort of 60-year-old patients with acute submassive PE. Probabilities for clinical outcomes were obtained from a meta-analysis of clinical trials. Cost estimates were derived from Medicare reimbursement data and other sources. The base-case analysis used an inpatient setting, whereas secondary analyses examined early discharge and outpatient treatment with LMWH. Using a societal perspective, strategies were compared based on lifetime costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. RESULTS: Inpatient treatment costs were higher for LMWH treatment than for UFH (dollar 13,001 vs dollar 12,780), but LMWH yielded a greater number of QALYs than did UFH (7.677 QALYs vs 7.493 QALYs). The incremental costs of dollar 221 and the corresponding incremental effectiveness of 0.184 QALYs resulted in an incremental cost-effectiveness ratio of dollar 1,209/QALY. Our results were highly robust in sensitivity analyses. LMWH became cost-saving if the daily pharmacy costs for LMWH were < dollar 51, if > or = 8% of patients were eligible for early discharge, or if > or = 5% of patients could be treated entirely as outpatients. CONCLUSION: For inpatient treatment of PE, the use of LMWH is cost-effective compared to UFH. Early discharge or outpatient treatment in suitable patients with PE would lead to substantial cost savings.

Organizational capital and employment fluctuations

In this paper I present a model in which production requires two types of labor inputs: regular productive tasks and organizational capital, which is accumulated by workers performing organizational tasks. By allocating more workers from organizational to productive tasks, firms can temporarily increase production without hiring. The availability of this intensive margin of labor adjustment, in combination with adjustment costs along the extensive margin (search frictions, firing costs, training costs), makes it optimal to delay employment adjustments. Simulations indicate that this mechanism is quantitatively important even if only a small fraction of workers perform organizational tasks, and explains why the hiring rate is persistent and why employment is slow to recover after the end of a recession.

Managing by values in the next milenium: Cultural redesign for strategic organizational change

The system of beliefs and values, that shaped the model for management and organizations during the 20th century, is just not good enough today. In order to keep a business functioning well and competing successfully in markets that are increasingly more global, complex, professionally demanding, constantly changing and oriented towards quality and customer satisfaction a new model is needed. In this paper, we will propose that both Management by Instructions (MBI) and Management by Objectives (MBO) today give notoriously inadequate results. By contrast, description of a new approach labeled: Management by Values (MBV), seem to be emerging as a strategic leadership tool. The paper outlines this approach and discusses the implementation of MBV as a tool to redesign culture in organizations and prepare them for the next millenium.

Effectiveness of career counseling: A one-year follow-up

The aim of this study was to analyze the psychometric properties of the Career Adapt-Abilities Scale (CAAS) in a French-speaking Swiss sample and its relationship with personality dimensions and work engagement. The heterogeneous sample of 391 participants (Mage = 39.59, SD = 12.30) completed the CAAS-International and a short version of the Utrecht Work Engagement Scale. To assess personality dimensions, participants completed either the Zuckerman-Kuhlman-Aluja Personality Questionnaire (n=283) or the NEO-FFI-R (n=108). The internal consistencies for the four subscales and total scores of the CAAS ranged from good to excellent, and skewness and kurtosis values indicated that scores were normally distributed. Gender differences and cor- relations with age were small or negligible. Several CFA models confirmed the factor structure of the French version of the CAAS-International, with loadings very similar to the ones observed for the international form. Adaptability was related to different personality dimensions, particularly neuroticism and conscientiousness, and also to work engagement. When predicting work engage- ment, career adaptability had a significant incremental validity over personality dimensions. Fi- nally, career adaptability partially moderated the relationship between personality and work engagement, suggesting that career adaptability also contributes to regulating the expression of personality dispositions.

Is accountability a double-edged sword? Experimental evidence on the effectiveness of internal controls to prevent fraud

Recent legislations oblige organizations to monitor the effectiveness of internal control mechanisms that are necessary to prevent fraud. However, little is known about the effectiveness of different internal controls. We investigate whether the duty to sign work results-one of the most prominent internal control mechanisms-is effective to prevent fraud under different superior instructions. We use a 2×2 between-subjects experimental design with accountability (duty to sign work results vs. no duty to sign) and superior instructions (with vs. without profit maximization cue) as independent variables. Both manipulations of superior instructions reminded people to respect accounting standards and principles but in one condition, an instruction to increase revenues was integrated as profit maximization cue. We expected this cue to trigger a profit maximization decision frame that increases the likelihood for fraudulent revenue recording. 58 managers from an executive MBA class participated in the experiment. We find that superior instructions interact with accountability. Fraudulent revenue recording was particularly observed when people received instructions to increase revenues and had to sign their work results. Consequently, fraudulent behavior can occur without pressure to commit fraud due to profit maximization cues that are communicated by a superior and despite implemented internal control mechanisms. We discuss possible implications of our results for the prevention of fraudulent behavior.

Governor's Task Force on Efficiencies and Cost-Effectiveness in Iowa State Government,Final Report, December 1983

A special task force was formed and worked through its various committees to uncover and investigate possible areas for cutting costs and saving money in State Government operations. A total of 81 recommendations are made in this report, with potential savings of over $32 million during the next several years.