Análisis de las variables que inciden en la eficiencia de la gestión clínica en el área de consulta externa

La eficiencia en la gestión clínica de los médicos generales es un pilar fundamental en el control de los recursos en salud y puede generar un impacto positivo en la reducción de gastos innecesarios en el sistema. Se realiza un estudio analítico en donde se diseña una encuesta transversal para identificar las principales variables que puedan influir en la toma de decisiones de los médicos generales en una IPS de Bogotá, y se aplicó a 20 médicos. Los resultados encontrados fueron contrastados con la literatura actual. Se agruparon los resultados con variables como: relación profesional de la salud, organización y costo médico; pertinencia en la remisión a especialistas y formulación de medicamentos y paraclínicos, formación en pregrado de administración en salud, número de trabajos, cansancio físico, y finalmente, se analiza la influencia de la edad con otras variables descritas. Los resultados evidenciaron falta de conciencia por parte de los médicos con relación al control de los recursos que se relacionan con la mala derivación de los pacientes a los especialistas y la formulación de exámenes paraclínicos sin pertinencia adecuada. Sobre los factores descritos influyen características como la edad del médico, la adherencia a las guías de manejo, el cansancio físico y las características del paciente. Por otro lado hay una clara división con relación a la dirección y los médicos, no hay seguimiento a su desempeño, tampoco incentivos que promuevan la prestación del servicio con calidad, capacitación permanente, ni una remuneración adecuada. Finalmente, identificados dichos factores se plantean estrategias de intervención, y con esto generar un impacto adecuado en la optimización del recurso y mejoría de las condiciones laborales.

Resiliencia y variables socio demográficas: implicaciones en la dirección de organizaciones

En el ámbito organizacional es necesario interiorizar y aplicar conceptos que generen herramientas que hagan posible el adecuado funcionamiento de las empresas a efectos de mejorar los resultados en términos económicos. Es importante entender las circunstancias que rodean al mundo y así mismo la manera en la que este funciona, ya que cada vez se ve influenciado por culturas y rasgos que difieren según el espacio geográfico en el que se desarrolle la actividad. Por este motivo es importante identificar personas que influencien positivamente a las organizaciones y sean agentes de cambio que desarrollen planes y estrategias que sean comunes a los objetivos de la organización orientando todos sus esfuerzos a la consecución de metas que la misma se proponga. En las empresas es claro que pueden presentarse problemas que encierren cualquier ámbito, como el personal, empresarial o familiar, lo cual a su vez puede generar desmotivación y falta de ánimo entre quienes desarrollen el rol de líder haciendo que sus responsabilidades no se cumplan a cabalidad. Sin embargo, estos deben tener la capacidad de anteponerse ante este tipo de adversidades de manera profesional con el fin de equilibrar sus emociones y superar el obstáculo de manera satisfactoria, sin pensar en resultados negativos y siendo un ejemplo para sus seguidores; dicha capacidad hoy en día se denomina resiliencia. Por esta razón, a lo largo de este trabajo se realizará una revisión teórica que tendrá como objeto identificar los aspectos generales del concepto de resiliencia y de igual forma encontrar la importancia de este estudio dentro del ámbito organizacional. Así mismo, se analizará la relación existente entre la resiliencia y las variables socio-demográficas: edad, nivel de estudios, estrato económico y género. Dicho análisis se hará posible con la ayuda de estudios realizados a nivel latinoamericano en países como: México, Perú y Colombia.

Caracterización de las variables nutricionales en pacientes incidentes de diálisis peritoneal rts 2011-2012

Los pacientes con enfermedad renal crónica (ERC) terminal se caracterizan por presentar alteraciones nutricionales que se perpetúan independiente de la modalidad de la Terapia de Reemplazo Renal (TRR). En la diálisis peritoneal, tanto APD (automated peritoneal dialysis) como la CAPD (continuous ambulatory peritoneal dialysis) existe un alto riesgo de pérdida de albúmina por el filtrado peritoneal, sin diferencias claras en el estatus nutricional. El presente estudio caracteriza el estado nutricional de los pacientes incidentes en diálisis peritoneal de RTS Bogotá Regional 1, con un seguimiento de un año, para conocer los cambios en las variables nutricionales. Se realizó un estudio de cohortes retrospectivo, analizando 2 grupos según el tipo de diálisis peritoneal escogida (APD o CAPD), con un análisis análisis descriptivo trimestral de las características nutricionales y posteriormente una comparación entre las 2 modalidades de TRR. Encontrando un promedio de edad de 60,8 años, la mayoría hombres y etiología principal nefropatía diabética. La mayoría de las variables nutricionales permanecieron sin cambios durante seguimiento. El Test de equilibrio peritoneal para glucosa y creatinina mostró valores promedio bajo y promedio alto y la mayoría de pacientes un rango nutricional normal. Al comparar APD y CAPD, solo se encontraron de forma aislada, diferencias significativas en algunas variables aisladas. Este es el primer estudio en Colombia que evalúa diferentes aspectos nutricionales en diálisis peritoneal. Aunque con limitaciones metodológicas, es un punto de partida para la realización de estudios más robustos que del estado nutricional de los pacientes en diálisis peritoneal

Aversión al riesgo y eficiencia de escala en los bancos: Incluyendo variables de riesgo y regulación

Este artículo aplica las teorías del enfoque moderno en la medición de la actividad bancaria. Con el fin de determinar la eficiencia de escala y el nivel de aversión al riesgo en los directivos de los bancos en Colombia, utiliza una función de costos translogarítmica multiproducto, que incorpora variables de riesgo y de regulación que caracterizaron y afectaron la actividad bancaria durante el período de crisis financiera. Encuentra que los directivos son adversos al riesgo y por lo tanto, la utilidad está en función de otras variables adicionales al beneficio. Demuestra que las medidas de regulación además de incrementar los costos generan un mayor nivel de aversión al riesgo de los directivos de los bancos, aumentando la demanda de capital financiero hasta niveles que no les permiten minimizar costos. Por último, encuentra que no existen economías de escala al incluir en su medición variables de riesgo y de regulación durante el período de desarrollo de la crisis financiera

Resiliencia y variables sociodemograficas

En el presente trabajo se aborda la definición de una de las variables dentro de lo que se denomina Capital psicológico positivo, la Resiliencia, sus principales características y algunas de las variables socio demográficas que en el estudio pretenden ver el nivel de relación existente entre cada una de ellas (indirecta o directamente) en el proceso resiliente de una persona para posteriores discusiones y su implicación dentro de la gestión empresarial y sus direcciones futuras.

Contribuição para o estudo do linfoma no cão em Portugal : análise da casuística em dois centros de referência

O linfoma é um grupo heterogéneo de neoplasias que apresentam morfologia variável e apresentações clínicas diversas, exigindo diferentes abordagens diagnósticas e terapêuticas. O prognóstico difere bastante entre os canídeos afectados. A presente dissertação refere-se a um estudo retrospectivo (2008-2012), de 50 canídeos com linfoma, com o objectivo de comparar os resultados obtidos com a bibliografia publicada, determinando ainda o impacto do imunofenótipo (B ou T) na sobrevida de cães com linfoma. Foi registado o mesmo número de machos e fêmeas e as raças mais frequentes foram o Boxer, Rottweiller e Cocker Spaniel. O diagnóstico da doença foi realizado maioritariamente por histopatologia de linfonodo (56%), revelando 84% de linfomas da forma multicêntrica. Quando determinado, o imunofenótipo mais frequente foi o de células B (69%). A maioria dos canídeos estava em estadios avançados da doença (III-V) (98%) no momento do diagnóstico, revelando 54% dos casos sub-estadio "b" segundo a OMS. O tratamento quimioterápico mais utilizado foi o protocolo CHOP (n=26) seguido do COP (n=9). A toxicidade hematológica e gastrointestinal secundárias à quimioterapia estiveram em igual número (22% cada), não se observando efeitos adversos em 56% dos cães com linfoma. Por último, o tempo médio de sobrevivência registado foi de 393 dias. Não foi encontrada uma relação estatísticamente significativa entre as variáveis (raça, sub-estadio e sexo) e o imunofenótipo de linfoma, sendo os tempos médios de sobrevivência de linfomas T e B semelhantes, 388 e 463 dias, respectivamente. No nosso caso, as principais diferenças encontradas, relativamente à bibliografia publicada, foram uma quantidade elevada de pacientes em sub-estadio "b" e os tempos médios de sobrevivência semelhantes para os diferentes imunofenótipos.

Co-kriging when the soil and ancillary data are not co-located

Data such as digitized aerial photographs, electrical conductivity and yield are intensive and relatively inexpensive to obtain compared with collecting soil data by sampling. If such ancillary data are co-regionalized with the soil data they should be suitable for co-kriging. The latter requires that information for both variables is co-located at several locations; this is rarely so for soil and ancillary data. To solve this problem, we have derived values for the ancillary variable at the soil sampling locations by averaging the values within a radius of 15 m, taking the nearest-neighbour value, kriging over 5 m blocks, and punctual kriging. The cross-variograms from these data with clay content and also the pseudo cross-variogram were used to co-krige to validation points and the root mean squared errors (RMSEs) were calculated. In general, the data averaged within 15m and the punctually kriged values resulted in more accurate predictions.

"Where am I?" Impact of display and content variables on spatial presence and comprehension in virtual environments

Forgetting immediate physical reality and having awareness of one�s location in the simulated world is critical to enjoyment and performance in virtual environments be it an interactive 3D game such as Quake or an online virtual 3d community space such as Second Life. Answer to the question "where am I?" at two levels, whether the locus is in the immediate real world as opposed to the virtual world and whether one is aware of the spatial co-ordinates of that locus, hold the key to any virtual 3D experience. While 3D environments, especially virtual environments and their impact on spatial comprehension has been studied in disciplines such as architecture, it is difficult to determine the relative contributions of specific attributes such as screen size or stereoscopy towards spatial comprehension since most of them treat the technology as monolith (box-centered). Using a variable-centered approach put forth by Nass and Mason (1990) which breaks down the technology into its component variables and their corresponding values as its theoretical basis, this paper looks at the contributions of five variables (Stereoscopy, screen size, field of view, level of realism and level of detail) common to most virtual environments on spatial comprehension and presence. The variable centered approach can be daunting as the increase in the number of variables can exponentially increase the number of conditions and resources required. We overcome this drawback posed by adoption of such a theoretical approach by the use of a fractional factorial design for the experiment. This study has completed the first wave of data collection and starting the next phase in January 2007 and expected to complete by February 2007. Theoretical and practical implications of the study are discussed.

Forecasting multivariate time series under present-value-model short- and long-run co-movement restrictions

It is well known that cointegration between the level of two variables (e.g. prices and dividends) is a necessary condition to assess the empirical validity of a present-value model (PVM) linking them. The work on cointegration,namelyon long-run co-movements, has been so prevalent that it is often over-looked that another necessary condition for the PVM to hold is that the forecast error entailed by the model is orthogonal to the past. This amounts to investigate whether short-run co-movememts steming from common cyclical feature restrictions are also present in such a system. In this paper we test for the presence of such co-movement on long- and short-term interest rates and on price and dividend for the U.S. economy. We focuss on the potential improvement in forecasting accuracies when imposing those two types of restrictions coming from economic theory.

Lobectomia por carcinoma brônquico : análise das co-morbidades e o seu impacto na morbi-mortalidade pós-operatória

Objetivo: Analisar o impacto das co-morbidades no desempenho pós-operatório de lobectomia por carcinoma brônquico. Pacientes e Métodos: Entre Janeiro de 1998 e Dezembro de 2004, foram estudados retrospectivamente 493 pacientes submetidos à lobectomia por carcinoma brônquico, dentre os quais 305 preencheram os critérios de inclusão. Todos os pacientes foram submetidos à lobectomias com técnica cirúrgica semelhante. Foi realizada análise das co-morbidades de forma a categorizar os pacientes nas escalas de Torrington-Henderson (PORT) e de Charlson, estabelecendo-se assim grupos de risco para complicações e óbito. Resultados: a mortalidade operatória foi 2,9% e o índice de complicações de 44%. O escape aéreo prolongado foi a complicação mais freqüente (20.6%). A análise univariada mostrou que sexo, idade, tabagismo, terapia neoadjuvante e diabetes apresentaram impacto significativo na incidência de complicações. O índice de massa corporal (23,8 ± 4,4), o VEF1 (74,1±24%), bem como a relação VEF1/CVF (0,65 ± 0,1) foram fatores preditivos da ocorrência de complicações. Ambas as escalas de Charlson e PORT foram eficazes na identificação de grupos de risco e na relação com a morbi-mortalidade (p=0,001 e p<0,001). A análise multivariada identificou que o IMC e o índice de Charlson foram os principais determinantes de complicações, enquanto que o escape aéreo prolongado foi o principal fator envolvido na mortalidade (p=0,01). Conclusão: Valores reduzidos de VEF1, VEF1/CVF e IMC baixo, assim como graus 3-4 de Charlson, e 3 de PORT estão associados a maior número de complicações após lobectomias por carcinoma brônquico. Nesta amostra, o escape aéreo persistente esteve fortemente associado à mortalidade.

Forecasting Multivariate Time Series under Present-Value-Model Short- and Long-run Co-movement Restrictions

This paper has two original contributions. First, we show that the present value model (PVM hereafter), which has a wide application in macroeconomics and fi nance, entails common cyclical feature restrictions in the dynamics of the vector error-correction representation (Vahid and Engle, 1993); something that has been already investigated in that VECM context by Johansen and Swensen (1999, 2011) but has not been discussed before with this new emphasis. We also provide the present value reduced rank constraints to be tested within the log-linear model. Our second contribution relates to forecasting time series that are subject to those long and short-run reduced rank restrictions. The reason why appropriate common cyclical feature restrictions might improve forecasting is because it finds natural exclusion restrictions preventing the estimation of useless parameters, which would otherwise contribute to the increase of forecast variance with no expected reduction in bias. We applied the techniques discussed in this paper to data known to be subject to present value restrictions, i.e. the online series maintained and up-dated by Shiller. We focus on three different data sets. The fi rst includes the levels of interest rates with long and short maturities, the second includes the level of real price and dividend for the S&P composite index, and the third includes the logarithmic transformation of prices and dividends. Our exhaustive investigation of several different multivariate models reveals that better forecasts can be achieved when restrictions are applied to them. Moreover, imposing short-run restrictions produce forecast winners 70% of the time for target variables of PVMs and 63.33% of the time when all variables in the system are considered.

Co-movement between two processes with local persistence

This paper introduces a residual based test where the null hypothesis of c:&InOvement between two processes with local persistenc~ can be tested, even under the presence of an endogenous regressor. It, therefore, fills in an existing lacuna in econometrics, in which longrun relationships can also be tested if the dependent and independent variables do not have a unit root, but do exhibit local persistence.

Forecasting multivariate time series under present-value-model short- and long-run co-movement restrictions

Using a sequence of nested multivariate models that are VAR-based, we discuss different layers of restrictions imposed by present-value models (PVM hereafter) on the VAR in levels for series that are subject to present-value restrictions. Our focus is novel - we are interested in the short-run restrictions entailed by PVMs (Vahid and Engle, 1993, 1997) and their implications for forecasting. Using a well-known database, kept by Robert Shiller, we implement a forecasting competition that imposes different layers of PVM restrictions. Our exhaustive investigation of several different multivariate models reveals that better forecasts can be achieved when restrictions are applied to the unrestricted VAR. Moreover, imposing short-run restrictions produces forecast winners 70% of the time for the target variables of PVMs and 63.33% of the time when all variables in the system are considered.

Encapsulation of Local Anesthetic Bupivacaine in Biodegradable Poly(DL-lactide-co-glycolide) Nanospheres: Factorial Design, Characterization and Cytotoxicity Studies

Local anesthetic agents cause temporary blockade of nerve impulses productiong insensitivity to painful stimuli in the area supplied by that nerve. Bupivacaine (BVC) is an amide-type local anesthetic widely used in surgery and obstetrics for sustained peripheral and central nerve blockade. in this study, we prepared and characterized nanosphere formulations containing BVC. To achieve these goals, BVC loaded poly(DL-lactide-co-glycolide) (PLGA) nanospheres (NS) were prepared by nanopreciptation and characterized with regard to size distribution, drug loading and cytotoxicity assays. The 2(3-1) factorial experimental design was used to study the influence of three different independent variables on nanoparticle drug loading. BVC was assayed by HPLC, the particle size and zeta potential were determined by dynamic light scattering. BVC was determined using a combined ultrafiltration-centrifugation technique. The results of optimized formulations showed a narrow size distribution with a polydispersivity of 0.05%, an average diameter of 236.7 +/- 2.6 nm and the zeta potential -2.93 +/- 1,10 mV. In toxicity studies with fibroblast 3T3 cells, BVC loaded-PLGA-NS increased cell viability, in comparison with the effect produced by free BVC. In this way, BVC-loaded PLGA-NS decreased BVC toxicity. The development of BVC formulations in carriers such as nanospheres could offer the possibility of controlling drug delivery in biological systems, prolonging the anesthetic effect and reducing toxicity.

PLGA nanoparticles containing praziquantel: effect of formulation variables on size distribution

Praziquantel has been shown to be highly effective against all known species of Schistosoma infecting humans. Spherical nanoparticulate drug carriers made of poly(D,L-lactide-co-glycolide) acid with controlled size were designed. Praziquantel, a hydrophobic molecule, was entrapped into the nanoparticles with theoretical loading varying from 10 to 30% (w/w). This investigates the effects of some process variables on the size distribution of nanoparticles prepared by emulsion-solvent evaporation method. The results show that sonication time, PLGA and drug amounts, PVA concentration, ratio between aqueous and organic phases, and the method of solvent evaporation have a significant influence on size distribution of the nanoparticles. (C) 2004 Elsevier B.V. All rights reserved.