A fast-track program reduces complications and length of hospital stay after open colonic surgery.

BACKGROUND & AIMS: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery. METHODS: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol. RESULTS: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2-30 vs 9 days, respectively; range, 6-30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7-10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367-8.283; P = .008) as independent predictors of postoperative complications. CONCLUSIONS: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program.

Ambiente favorável ao desenvolvimento de inovações e cultura organizacional: integração de duas perspectivas de análise

O objetivo neste trabalho foi propor uma perspectiva de análise do ambiente propício à inovação com a incorporação da variável cultura organizacional. A base da análise recai sobre a adaptação da metodologia proposta por Van de Ven, Angle e Poole (2000). A contribuição proposta neste trabalho situa-se na adaptação da metodologia, retirando o foco do processo de inovação para o ambiente de inovação. Para que fosse contemplado todo o ambiente, foi necessária a inclusão de uma análise dos comportamentos coletivos organizacionais. Incorporaram-se questões que envolvem aspectos relacionados com a cultura organizacional, sob a perspectiva dos estudos de Bates et al. (1995). O questionário proposto pelo Minnesota Innovation Research Program (MIRP), com 45 questões adaptadas para o levantamento do ambiente de inovação, foi aplicado a 349 empregados de uma empresa de grande porte do setor metal-mecânico. Com a técnica de modelagem de equações estruturais (MEE), testou-se o modelo apresentado pelo MIRP, considerando as dimensões externas e internas ao grupo de inovação e os resultados decorrentes do ambiente de inovação. Em um segundo momento, um novo teste com a incorporação da variável cultura organizacional foi realizado. Os resultados apontaram que o segundo teste obteve um melhor ajuste, em torno de 27%, indicando que a variável impactou o resultado da modelagem. Convém ressaltar que o construto apresentado foi baseado em um levantamento teórico e para sua validação necessita de gama maior de resultados empíricos.

Efectividad comparativa del seguimiento remoto a personas con marcapasos cardíacos frente al convencional: calidad de vida a los 6 meses.

BACKGROUND The use of remote follow-up (RF) of people with pacemakers (PM) is limited in comparison to the hospital modality (HS), being still poor the scientific evidence that shows their comparative effectiveness. The aim of this study was to compare the quality of life in individuals with different modalities of follow-up. METHODS Controlled, not randomized nor masked clinical trial, with data collection at pre and post-implantation of pacemakers during the 6 months follow-up. All patients over 18 years-old who were implanted a PM during the study period were selected (n = 83), and they were assigned to RF (n = 30) or HF (n = 53) groups according to their personal characteristics and patient's preferences. Baseline characteristics and number of visits to the hospital were analysed, the EuroQol-5D (EQ5D) questionnaire was administered to evaluate the health-related quality of life, and Duke Activity Status Index (DASI) to assess the functional capacity. RESULTS There were no significant differences between both groups in relation to the baseline analysis, EQ5D (RF:0.7299; HF:0.6769) and DASI (RF:21.41; HF:19.99). At 6 months the quality of life was improved in both groups (EQ5D RF:0.8613; HF:0.8175; p = 0,439) still without significant differences between them. DASI score was similar to baseline (20.51 vs 21.80). RF group performed less transmissions/visits per patient (1.57) than hospital group (1.96; relative reduction 31%; p = 0.015). CONCLUSIONS Remote follow-up of people with pacemakers might be considered as an equivalent option to the hospital follow-up in relation to the quality of life and it reduces the number of hospital visits.

Ambiente favorável ao desenvolvimento de inovações: proposição de um modelo de análise organizacional

A metodologia desenvolvida pelo Minnesota Innovation Research Program para avaliação dos processos de inovação, denominada Minnesota Innovation Survey (MIS) serviu de base para a proposição de um modelo de análise de ambiente propício ao desenvolvimento de inovações. A necessidade da proposição de um novo modelo surgiu a partir da observação dos resultados de pesquisas que utilizaram a mesma metodologia, em que questões e dimensões se apresentavam altamente correlacionadas, gerando redundância de medição de construtos e pouca precisão nos resultados. Com isso buscou-se, por meio de embasamento teórico e estatística multivariada, reduzir o número de construtos afins no intuito de evitar a multicolinearidade e os resultados dúbios. A metodologia utilizada para o desenvolvimento do modelo proposto caracteriza-se como descritiva com método quantitativo. Foram aplicados questionários da metodologia MIS a 349 empregados de uma empresa metal mecânica. A aplicação do modelo original obedeceu a todos os passos prescritos, mostrando a aderência por meio de modelagem de equações estruturais. Como resultado verificou-se que a redução de dados proveniente dos testes estatísticos impactou significantes alterações na metodologia de base, caracterizando o surgimento de uma nova metodologia de análise pela diminuição de 70% dos dados multivariados. Conclui-se que a nova metodologia, apesar de eliminar 65 questões do instrumento de coleta de dados, não reduz seu poder de explicação e eficácia quanto às relações dos ambientes organizacionais com os resultados da inovação. Em termos de execução de pesquisa, o novo modelo facilita a coleta de dados, minimiza a dispersão do respondente no momento do preenchimento do questionário, aumentando a confiabilidade dos dados, fornece informações acuradas sobre o ambiente inovador e garante robustez de análise. Empresas podem beneficiar-se desse instrumento de pesquisa por ser de fácil aplicação, entendimento e análise.

The effect of recalled previous work environment on return to work after a rehabilitation program including vocational aspects for trauma patients.

INTRODUCTION: The aim of the present study was to assess the association between remembered previous work place environment and return to work (RTW) after hospitalisation in a rehabilitation hospital. METHODS: A cohort of 291 orthopedic trauma patients discharged from hospital between 15 December 2004 and 31 December 2005 was included in a study addressing quality of life and work-related questions. Remembered previous work environment was measured by Karasek's 31-item Job Content Questionnaire (JCQ), given to the patients during hospitalisation. Post-hospitalisation work status was assessed 3 months, 1, and 2 years after discharge, using a questionnaire sent to the ex-patients. Logistic regression models were used to test the role of four JCQ variables on RTW at each time point while controlling for relevant confounders. RESULTS: Subjects perceiving a higher physical demand were less likely to return to work 1 year after hospital discharge. Social support at work was positively associated with RTW at all time points. A high job strain appeared to be positively associated with RTW 1 year after rehabilitation, with limitations due to large confidence intervals. CONCLUSIONS: Perceptions of previous work environment may influence the probability of RTW. In a rehabilitation setting, efforts should be made to assess those perceptions and, if needed, interventions to modify them should be applied.

Relation between atherogenic dyslipidemia and the Adult Treatment Program-III definition of metabolic syndrome (Genetic Epidemiology of Metabolic Syndrome Project).

Genetic Epidemiology of Metabolic Syndrome is a multinational, family-based study to explore the genetic basis of the metabolic syndrome. Atherogenic dyslipidemia (defined as low plasma high-density lipoprotein cholesterol with elevated triglycerides (&lt;25th and &gt;75th percentile for age, gender, and country, respectively) identified affected subjects for the metabolic syndrome. This report examines the frequency at which atherogenic dyslipidemia predicts the metabolic syndrome of the National Cholesterol Education Program Adult Treatment Panel III (ATP-III). One thousand four hundred thirty-six (854 men/582 women) affected patients by our criteria were compared with 1,672 (737 men/935 women) unaffected persons. Affected patients had more hypertension, obesity, and hyperglycemia, and they met a higher number of ATP-III criteria (3.2 +/- 1.1 SD vs 1.3 +/- 1.1 SD, p &lt;0.001). Overall, 76% of affected persons also qualified for the ATP-III definition (Cohen's kappa 0.61, 95% confidence interval 0.59 to 0.64), similar to a separate group of 464 sporadic, unrelated cases (75%). Concordance increased from 41% to 82% and 88% for ages &lt; or =35, 36 to 55, and &gt; or =55 years, respectively. Affected status was also independently associated with waist circumference (p &lt;0.001) and fasting glucose (p &lt;0.001) but not systolic blood pressure (p = 0.43). Thus, the lipid-based criteria used to define affection status in this study substantially parallels the ATP-III definition of metabolic syndrome in subjects aged &gt;35 years. In subjects aged &lt;35 years, atherogenic dyslipidemia frequently occurs in the absence of other metabolic syndrome risk factors.

Iowa Client Assistance Program Division of Persons with Disabilities Annual Report, 2002

Annual Report for Departmemnt of Human Rights

2004 Highway Accomplishment Program, July 1, 2003 to June 30, 2004

Future plans for funding for Iowa Department of Transportation Report

Iowa Highway Safety Program, Iowa Department of Public Safety, 2001

Annual Highway Safety Report for Iowa Department of Public Safety.

Iowa Highway Safety Program, Iowa Department of Public Safety, 2002

Annual Highway Safety Report for Iowa Department of Public Safety.

Full-Size Off-Highway Vehicle Registration Program, December 30, 2003

Report submitted by the Iowa Department of Natural Resources and the Iowa Department of Transportation to the General Assembly as required by Senate File 458, section 152, passed by the 2003 General Assembly and signed May 30, 2003.

F-1, Food Stamp Program State Summary, December 2003

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, Statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

Program, Highlights & Budget Summaries, 2004

Budget in Brief from the Governor's Office