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Signatur des Originals: S 36/G00842

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Signatur des Originals: S 36/G01385

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Signatur des Originals: S 36/G01386

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publièe par André Vervoort

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L’histoire de la United Shoe Machinery Company (USMC) montre que la réalité ne s’adapte pas toujours aux simplifications de la théorie. Comme le signale l’économie de la fonctionnalité, la stratégie de l’entreprise de vendre l’usage plutôt que la machine fournit plusieurs avantages importants, mais elle a également contribué au fait que les usines de chaussures subissent une véritable dépendance technologique de cette compagnie et au fait que l’USMC soit parvenue à une domination monopolistique du marché. D’autre part, en remettant en cause les rudiments généraux de la théorie économique néoclassique, cette position de monopole n’a pas empêché que l’entreprise ait un fonctionnement efficace et ait facilité la modernisation technologique de l’industrie de la chaussure, aux États-Unis et dans d’autres pays.

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Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.