Sensibilidad y especificidad del ecocardiograma transtorácico para el diagnóstico de enfermedad coronaria

Introducción: La enfermedad coronaria es la principal causa de muerte en Colombia y el mundo en personas mayores de 45 años (1, 2). Con la variación en los perfiles epidemiológicos se espera que aumente su prevalencia y costo, disminuyendo la mortalidad. En el estudio diagnóstico de enfermedad coronaria, se realizan múltiples pruebas paraclínicas, dentro de estas, el ecocardiograma es muy utilizado y sus recomendaciones de uso se basan en estudios de hace más de 10 años (3). Metodología: Se realizó un estudio de prueba diagnóstica para determinar las características operativas del ecocardiograma transtorácico para el diagnóstico de enfermedad coronaria frente al cateterismo cardiaco en pacientes con dolor torácico. Resultados: Se analizaron 290 pacientes con una edad promedio de 67 años y 68% hombres; el 74.1% tenía hipertensión arterial y el 24.5% de diabetes mellitus. En el 61% de los pacientes se evidenció enfermedad coronaria por angiografía. La sensibilidad del ecocardiograma transtorácico para enfermedad coronaria fue del 70%, especificidad del 55%, valor predictivo negativo del 54% y valor predictivo positivo del 71%; con una efectividad del 65% y una capacidad predictora del 60.6% (p=0.02). Discusión: La anatomía coronaria fue similar a la descrita previamente, siendo las lesiones multivaso presente en un 41% y la lesión de un vaso fue del 22% (4, 5). Teniendo en cuenta la sensibilidad del 70% y especificidad del 55%, la facilidad de acceso, características no invasivas y el bajo costo; nos permiten recomendar utilizarlo como guía diagnóstica en el contexto del dolor torácico en el servicio de urgencias.

La sabiduría como competencia gerencial

Aunque el concepto de sabiduría ha sido ampliamente estudiado por expertos de áreas como la filosofía, la religión y la psicología, aún enfrenta limitaciones en cuanto a su definición y evaluación. Por esto, el presente trabajo tiene como objetivo, formular una definición del concepto de sabiduría que permita realizar una propuesta de evaluación del concepto como competencia en los gerentes. Para esto, se realizó un análisis documental de tipo cualitativo. De esta manera, se analizaron diversos textos sobre la historia, las definiciones y las metodologías para evaluar tanto la sabiduría como las competencias; diferenciando la sabiduría de otros constructos y analizando la diferencia entre las competencias generales y las gerenciales para posteriormente, definir la sabiduría como una competencia gerencial. Como resultado de este análisis se generó un prototipo de prueba denominado SAPIENS-O, a través del cuál se busca evaluar la sabiduría como competencia gerencial. Como alcances del instrumento se pueden identificar la posibilidad de medir la sabiduría como competencia en los gerentes, la posibilidad de dar un nuevo panorama a las dificultades teóricas y empíricas sobre la sabiduría y la posibilidad de facilitar el estudio de la sabiduría en ambientes reales, más específicamente en ambientes organizacionales.

Estado situacional de los modelos basados en agentes y su impacto en la investigación organizacional

En un mundo hiperconectado, dinámico y cargado de incertidumbre como el actual, los métodos y modelos analíticos convencionales están mostrando sus limitaciones. Las organizaciones requieren, por tanto, herramientas útiles que empleen tecnología de información y modelos de simulación computacional como mecanismos para la toma de decisiones y la resolución de problemas. Una de las más recientes, potentes y prometedoras es el modelamiento y la simulación basados en agentes (MSBA). Muchas organizaciones, incluidas empresas consultoras, emplean esta técnica para comprender fenómenos, hacer evaluación de estrategias y resolver problemas de diversa índole. Pese a ello, no existe (hasta donde conocemos) un estado situacional acerca del MSBA y su aplicación a la investigación organizacional. Cabe anotar, además, que por su novedad no es un tema suficientemente difundido y trabajado en Latinoamérica. En consecuencia, este proyecto pretende elaborar un estado situacional sobre el MSBA y su impacto sobre la investigación organizacional.

Riesgo psicosocial y satisfacción laboral en la gerencia de recursos humanos de una empresa de servicios públicos de Bogotá

estudiar la relación entre los factores de riesgo psicosocial y la satisfacción laboral del personal de la Gerencia de Recursos Humanos de una empresa de servicios públicos de Bogotá, con el fin de proponer un plan de intervención

Estudio de las interacciones intra-específicas (la competición, la cooperación y la depredación) en las organizaciones: revisión de literatura

Las organizaciones son un ente social y económico que según la teoría clásica debe ser vista como una estructura administrativa. Para Mooney (1947) existen principios los cuales baso en la teoría organización, en donde busca establecer relaciones entre principios, procesos y efectos. Por lo que el satisfacer las necesidades de una población debe ser un proceso que involucre intereses particulares .En este caso la organización debe ser estudiada y evaluada como un sistema que tiene diferentes jerarquías y agentes que interactúan entre si, para cumplir un objetivo. Las relaciones que se generan dentro de una organización, y en este caso una organización privada tienden a dar respuesta a muchas necesidades que como procesos se presentan en el diario vivir; es así como se habla del éxito de las organizaciones basado en la competitividad que generan las habilidades y actitudes del personal, el número de variables, fenómenos y efectos, que busca que los empleados asuman actitudes que conlleven a tomar buenas decisiones (Garcia, 2009 ). Es importante resaltar en las organizaciones, los fenómenos de liderazgo, poder e influencia, cada concepto independiente pero visto conjuntamente desde un panorama organizacional, donde toda relación intraespecifica deben determinarse en los diferentes comportamientos, conductas y culturas del personal de la empresa (Fuentes, 2004). La depredación, competencia y cooperación, son conceptos que indudablemente están presentes en todos los procesos de la organización y serán determinantes en la perdurabilidad de la misma. Por último, la presente investigación pretende establecer los efectos de los fenómenos sociales de liderazgo, poder e influencia sobre las interacciones intra-especificas (competencia, cooperación y depredación) al interior de una organización, de tal manera que se logre explicar el efecto y la correlación que existe entre unos y otros fenómenos (Castro, 2012).

Modelo de gestión del conocimiento para una empresa del sector de insumos químicos para la industria farmacéutica, cosmética y de alimentos: caso Disaromas S.A.

La creación de conocimiento al interior de las organizaciones es visible mediante la dirección adecuada del conocimiento de los individuos, sin embargo, cada individuo debe interactuar de tal manera que forme una red o sistema de conocimiento organizacional que consolide a largo plazo las empresas en el entorno en el que se desenvuelven. Este documento revisa elementos centrales acerca de la gestión de conocimiento visto desde varios autores y perspectivas e identifica puntos clave para diseñar un modelo de gestión de conocimiento para una empresa del sector de insumos químicos para la industria farmacéutica, cosmética y de alimentos de la ciudad de Bogotá.

Climate change and the emergence of new organizational landscapes

There is general agreement across the world that human-made climate change is a serious global problem,although there are still some sceptics who challenge this view. Research in organization studies on the topic is relatively new. Much of this research, however, is instrumental and managerialist in its focus on ‘win-win’ opportunities for business or its treatment of climate change as just another corporate social responsibility (CSR) exercise. In this paper, we suggest that climate change is not just an environmental problem requiring technical and managerial solutions; it is a political issue where a variety of organizations – state agencies, firms, industry associations, NGOs and multilateral organizations – engage in contestation as well as collaboration over the issue. We discuss the strategic, institutional and political economy dimensions of climate change and develop a socioeconomic regimes approach as a synthesis of these different theoretical perspectives. Given the urgency of the problem and the need for a rapid transition to a low-carbon economy, there is a pressing need for organization scholars to develop a better understanding of apathy and inertia in the face of the current crisis and to identify paths toward transformative change. The seven papers in this special issue address these areas of research and examine strategies, discourses, identities and practices in relation to climate change at multiple levels.

Discursos e a construção do "real": um estudo do processo de formação e institucionalização do campo da biotecnologia

Comprehension of the processes of formation of new organizational fields is the main objective that stimulated the theoretical reflection and empirical research that I present in this paper. My intention here is to uphold the potential for the application of seemingly dichotomous perspectives in terms of the objectivity/subjectivity dimension in the comprehension of the objective in question. The contribution of Foucault, with his concept of discourse, is linked to the proposal of critical constructivism represented by Latour and studies of science and technology. Juxtaposing these perspectives, I examined the dynamics of the biotechnological field on the basis of the dialectic of movements of demarcation/circularity, which is basically a simultaneous movement of (dis)construction of the boundaries of a field. The dialectic of demarcation/circularity is made up of the set of relations established between heterogeneous elements ¿ institutions, economic and social processes, behavioral patterns, systems of norms, techniques, types of classification, forms of characterization, in other words it finds ways of emerging in the course of discursive formations. This theoretical proposal ¿ which incorporates an overlooked dimension in institutional analysis, especially in organization studies (power) ¿ has the advantage of contributing to enhancing comprehension of the dynamics of institutionalization. By proposing that the institutional processes arise within discursive fields, the argument put forward is that such processes contribute to the productivity of the power relations in these fields. In empirical terms, I conducted a descriptive and exploratory research directed at the biotechnology sector. The research was based on a historical perspective, since the analysis spans the period from the origins of genetic science (beginning of the 20th century) through to recent developments in biotechnology in the USA (beginning of the 21st century). The USA was chosen as the locus of research, principally due to the fact that structuring of the field of biotechnology originated in that country, subsequently spreading to other countries around the world. Starting from this theoretical and methodological framework, three discursive formations are highlighted: organization, information and network. Each of the discursive formations is characterized by a dominant set of discourses that prepare the ground for the appearance and (trans)formation of the focus-objects under analysis. In this process, organizations appear in at least two ways: as boundary-organizations ¿ which are important for understanding the movement of the approximation of different discursive domains ¿ and as new organizations, which accompany the (trans)formation of new fields, whereby prevailing discourses materialize at a given historical moment and contribute to breathe life into new discourses, which in turn spark off new power relations. Among the conclusions of this work, I would highlight the following: questioning the 'organizational' dimension of the fields; the relationship revealed not only between the discourses and the institutionalized practices, but also with the process of construction of legitimacy; and the redefinition of the concept of organizations, based on new conceptions relating to the limits of the topic, the objectivity/subjectivity, and space/time dichotomy.

O global e o contextual no aprendizado gerencial de multinacionais: uma perspectiva brasileira

The major purpose of this thesis is to verify, from a Brazilian perspective, how global and contextual issues influence the management learning in Multinationals. The management learning derived from the interaction of holding and sidiaries/colligates of Multinational corporation is supposed to be subject to convergent and divergent forces, the former related to global and standardized organizational practices, and the latter, is seen as a social practice subject to cultural and organizational singularities. A model was constructed to relate the dichotomy between the universality of the management practices and technologies and the particularity of the contexts where they operate, to the dichotomy between the singularities in organization and national level. This model is composed of the international, global, managerial and inter-organizational dimensions related, respectively, to the cultural and political diversity; to the universal forces of practices and values; to the managerial capabilities and resources in the organization, consolidated as best practices and to the interaction between holding and subsidiaries and the resulted learning. The combined result of these dimensions influences the knowledge flow and the learning derived from it. The field research was constituted of five cases of internationalized Brazilian firms, with a solid experience in their management systems. The main subjects of this study were executives and ofessionals/managers who respond to the management development. The data were first collected in the headquarters and complemented with visits to subsidiaries/joint ventures in other countries, in loco or with expatriated people who return to Brazil. The central supposition was validated. So, the management learning ¿ is driven by the global capitalism practices and by the global culture where they are immersed, reproducing a hegemonic vision and a common language (global dimension); ¿ incorporates the more propagated and dominant managerial values, although there are some variations when they are applied in the subsidiaries/joint ventures; is the product of the assimilation of international recognized and planned managerial practices, with the acculturation power, although not completely; is the result mainly of the managerial practice in work; is impacted not only by cross-cultural and managerial factors, but also by the business environment of the firm; is given according to the capabilities and resources in the organization, guiding the form of assimilation of practices and technologies, with global application or not (managerial dimension); ¿ is affected by the cross-cultural diversity involving the countries of the holding and the subsidiaries/joint ventures where the firm is and is given as a reproduction of the political context of the holding and subsidiaries countries (international dimension); ¿ faces aligned concurrent institutional pressures between corporate or global systems, practices of other subsidiaries/joint ventures and local practices; is more difficult to reach when there is not permeability between organizational cultures and identities of a Multinational firm; is affected by how much the relationship process across these unities is self-referenced; is facilitated by the construction and improvement of the knowledge network (interorganizational dimension). Finally some contributions of this study are exposed, including extensions of the proposed model and suggestions, recommendations for future research.

Modelagem organizacional : o sistema comercial da Companhia de Saneamento do Parana - SANEPAR

Este trabalho estã centrado no estudo do caso -- Sistema Comercial da Companhia de Saneamento do Paranã - SANEPAR e consequentemente na apresentação de alternativas organizacionais voltadas para o estabelecimento de coerência entre objetivos, recursos e ambiência que envolvem esse sistema. Foi dese~volvido tendo como base teórica o modelo de anãlise organizacional sustentado por Jay R. Galbraith em ORGANIZATION DESIGN, 1977. Calcado num diagnóstico participativo, foi buscado o alcance de objetivos voltados para o conhecimento de aspectos do sistema, como transação ambiental, a natureza das tarefas, a estrutura e o processo de tomada de decisão. Para tanto, foi recomendado a aplicação de um IIMix Organizacional composto de 6 estrategias basicas, provenientes tanto da administração classica quanto da contingencial/orgânica. Pela situação organizacional encontrada, se concluiu que o Sistema Comercial da SANEPAR apresenta uma administração difusa e, bastante descaracterizada estruturalmente, o que compromete a eficiência de seu desempenho. Sua ãrea de competência/autoridade funcional, estã subordinada a um orgao de planejamento que, alem das suas atividades peculiares, tambem se encarrega da direção do Sistema Comercial. Essa situação incide na qualidade dos resultados finais necessarios, i. e, na eficacia e efetividade dos dois sistemas dentro do contexto em que atuam, visto estarem seus principais recursos, humanos, gerando decisões sem uma base informacional consistente e relevante e, dentro de um desenho estrutural que dificulta a consecução dos resultados. O mix recomendado visa dotar o sistema de maior capacidade de transaçao com o ambiente em geral, via uma administração estrategica calcada num desenho estrutural concebido para propiciar informação precisa, decisao relevante e alcance de resultados necessãrios. r proposto visando subordinar o sistema diretamente a uma Diretoria, emancipando-o da subordinação ao Planejamento e, elevando sua autoridade, ao mesmo nivel de importância dos principais sistemas da Empresa. Dessa forma, foi planejada uma atuação gerencial mais dinâmica e profissional ao sistema via processo de tomada de decisão lógico, releva~ te e conhecido. Assim, objetiva-se reduzir a niveis insignificantes a incerteza constatada, principal causadora dos atrasos e distorções ocorrentes no processo e alcance dos resultados desejados. Esses instrumentos, certamente, facilitarão as relações no interior do sistema e, deste, com o ambiente em geral, garantindo assim, a abertura do caminho rumo ao atinamento da eficácia e efetividade gerencial.

Caracterização do processo de trabalho do cirurgiãodentista na estratégia de saúde da família do município de Parnamirim-RN

Family Health Strategy (FHS), founded in 1994 has appeared to play a strategic role in the SUS construction and consolidation. It has reaffirmed its Principles and Guidelines and has elected family as core of attention. The principle that has guided the work concerns the quality of the relationship between professional and family. Thus, the FHS has the family as a subject of health-disease process, and relations with its own characteristics and can be partners in building their health and improvement of quality of life of its members and the entire community. This study aims to characterize the surgeon-dentist (SD) working process in the family health strategy, from the knowledge of the SD integration with other team members; organization of services; development of shares, changes perceived by SDs, as well as knowing the surgeon-dentist profile who is part of this strategy. The collecting tool used was a semi-structured questionnaire, in which participated 30 professionals. As for profile, most professionals were women, completed the graduation in public university and did not have any training to work by joining the FHS. Almost all have other public or private working ties. They often carry out activities with students, and occasionally do home visits. In relation to team work, in activities such as home visits, school health, community activities, among others, they sometimes seek the cooperation of other members. The way of accessing for users in the most part has occurred through the schedule. The most frequently activities made to the Centro Especialidades Odontológicas (CEO), are in Endodontics and Prosthesis. The majority of them participate in team meetings, but they do not have frequency set to happen. As for the planning and programming of activities to be conducted, most said that individually develops them. Concerning the performance of their duties, most reported being satisfied, but that improvements could happen. Besides, they reported improvements in dental care following the inclusion of SD in the FHS in various aspects, such as access, organization, humanization, care and oral disease prevention. The professionals had poor integration with other team members, in addition to have a profile to more individualistic work, a fact seized by way of development and planning of actions. They work the actions in individual and curative way, in detriment promotion and collective ones. They work humanization, definition of territory and adscript population. Thus, it is concluded that the working process developed by SDs, includes the part which is advocated by FHS. This points out to a greater undertaking of this process aiming to detect the weakness met in order to reach the potential that the FHS represents in organization of basic attention

Democratic governance and gender: possible linkages

Includes bibliography

Professores iniciantes: marcas de alteridade na constituição da profissionalidade docente

Pós-graduação em Educação - IBRC