Tempos de espera cirúrgicos: situação em Portugal e determinantes

RESUMO - Objectivos Um dos problemas mais comuns nos sistemas de saúde e particularmente naqueles que têm uma estrutura predominantemente pública são os elevados Tempos Espera (TE) para cirurgia. Este projecto tem como principal objectivo identificar a importância relativa em Portugal das determinantes do TE cirúrgico. Metodologia Para clarificar essa importância, aplicou-se um questionário desenvolvido pelo Fraser Institute, utilizado para a análise anual dos TE no Canadá, recorrendo a um painel de peritos e através da realização da técnica Delphi, procurou-se consensualizar quais as determinantes das Listas Espera (LE), mais importantes. Para ilustrar a diversidade de perspectivas, recorreu-se também à análise de trabalhos realizados por inúmeras organizações, onde pudemos observar e recolher distintas abordagens, políticas e técnicas da questão das LE em países com diferentes tipos de sistemas de saúde. Resultados Os resultados obtidos revelam que os peritos consideraram a disponibilidade de tempo no Bloco Operatório (BO) e a de anestesiologistas, como as determinantes com maior impacto no aumento das LE. Conclusões Dos dados recebidos relativos ao Sistema Integrado Gestão Inscritos Cirurgia (SIGIC), bem como dos retirados de relatórios oficiais, concluímos que as LE cirúrgicas tiveram evolução positiva, nomeadamente na redução da mediana do TE da Lista Inscritos Cirurgia (LIC) (meses), no entanto, os objectivos dos Tempos Máximos Resposta Garantidos (TMRG) não estão a ser cumpridos. A análise das diferentes iniciativas e estratégias políticas para combater as LE, permitiu-nos sugerir caminhos a explorar, tendo como objectivo minorar o problema das LE: cuidados integrados, optimização da eficiência na utilização da capacidade instalada e maior aposta na cirurgia de ambulatório.

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Dissertação de mestrado em Design e Marketing

Implantació de SAP en un Grup Constructor

L'objectiu d'aquest TFC és analitzar la implantació d'un sistema de gestió integral, i més concretament el SAP R/3, dins un grup empresarial constituït per empreses amb diverses activitats, entre les quals destaquen les següents: fabricació de material de construcció, edificació d'obra pública, edificació d'habitatges, prestació de serveis de manteniment del mobiliari urbà, gestió d'aigües i sanejament.

Sistemes d'informació : ERP

El treball presentat fa l'estudi i l'anàlisi per a la implementació d'un sistema de gestió integrat ERP (Enterprise Resource Planning) a l'empresa TEXFIL, centrat únicament en solucions empresarials estàndards de paquets integrats per a la planificació dels recursos de l'empresa. Tot i que al llarg del document es fa esment de diferents fabricants de sistemes ERP, nosaltres, a petició del nostre client, ens hem centrat bàsicament en el sistema SAP R/3.

Implantación de un sistema ERP SAP

Aquest treball té com a objectiu plantejar i desenvolupar les activitats que s'han de dur a terme en un projecte d'implantació del sistema d'informació integrat ERP (Enterprise Resource Planning) SAP R/3 en una empresa espanyola del sector farmacèutic.

Redefinición de indicadores y planificación del proceso de recogida de datos de la Biblioteca Virtual de la Universitat Oberta de Catalunya

Pre-print.

Redefinición de indicadores y planificación del proceso de recogida de datos de la Biblioteca Virtual de la Universitat Oberta de Catalunya

Pre-print.

Genetic diversity and antimicrobial resistance in Streptococcus agalactiae strains recovered from female carriers in the Bucharest area

For the first time, we used multilocus sequence typing (MLST) to understand how Romanian group B streptococcus (GBS) strains fit into the global GBS population structure. Colonising isolates recovered from adult human females were tested for antibiotic resistance, were molecularly serotyped based on the capsular polysaccharide synthesis (cps) gene cluster and further characterised using a set of molecular markers (surface protein genes, pilus-encoded islands and mobile genetic elements inserted in the scpB-lmb intergenic region). Pulsed-field gel electrophoresis was used to complement the MLST clonal distribution pattern of selected strains. Among the 55 strains assigned to six cps types (Ia, Ib, II-V), 18 sequence types (STs) were identified by MLST. Five STs represented new entries to the MLST database. The prevalent STs were ST-1, ST-17, ST-19 and ST-28. Twenty molecular marker profiles were identified. The most common profiles (rib+GBSi1+PI-1, rib+GBSi1+PI-1, PI-2b and alp2/3+PI-1, PI-2a) were associated with the cps III/ST-17 and cps V/ST-1 strains. A cluster of fluoroquinolone-resistant strains was detected among the cps V/ST-19 members; these strains shared alp1 and IS1548 and carried PI-1, PI-2a or both. Our results support the usefulness of implementing an integrated genotyping system at the reference laboratory level to obtain the reliable data required to make comparisons between countries.

LSTA Five Year Plan 2003-2007, 2007

The Iowa Commission of Libraries, the State Library’s governing board, convened the Library Services Task Force in August 2000. This group consisted of 46 Iowans from across the state, including librarians from all types of libraries, library trustees, legislators, members of Iowa Regional Library system (now called Library Service Areas) and Area Education Agencies, and citizens. Their mission was to make recommendations to the Commission on positioning libraries to effectively and efficiently meet the future needs of Iowans. Needs and expectations of Iowa Library customers and funding authorities were identified and examined by the Task Force, and are reflected in its recommendations. The Commission received the Task Force recommendations in December 2000, carefully studied them, solicited input from the Iowa library community, and with a few changes, forwarded the recommendations to the Governor and the Iowa General Assembly. These recommendations are now known as Iowa Commission of Libraries priorities and serve as a blueprint for future development of the Iowa library system. A second need assessment was conducted in 2001 as part of the process to formulate the joint Library Service Area – State Library Plan of Service 2003-2005. Biennial development of this plan is mandated by the Code of Iowa. In 2001, Library Service Area and Library Development staff from the State Library chose to completely revamp this plan, and used the process outlined in the The New Planning for Results by Sandra Nelson (the Public Library Association planning model) to do so. The group conducted a strengths/weaknesses/opportunities/threat analysis of the Iowa library situation, identified needs and put them in priority order, and identified service responses. Needs identified by the Library Services Task Force were similar to those identified by the Library Service Area and Library Development staff group. These needs were further analyzed and documented by State Library staff during the development of the LSTA plan. Sources consulted are identified in the text of the LSTA plan and/or listed at the close of this document. The text of the Library Services Task Force report and the documents created during the development of the Plan of Service 2003-2005 are cited in the appendix to this document.

Implantació d'un sistema de gestió integrada: ISO 9001:00, ISO 14001:04 i OHSAS 18001:07, en un centre d'estètica i perruqueria

En aquests últims anys, són moltes les empreses que han optat per la utilització de sistemes de gestió normalitzats, per a garantir la rendibilitat i fiabilitat dels resultats de la implantació del sistema de gestió en qüestió. A la dècada dels 90 va ser quan la implantació de sistemes de gestió va començar a ser important en la majoria de sectors econòmics. L’evolució en els sistemes de gestió a trets generals va iniciar-se primerament en l’àmbit de la qualitat, seguidament en la gestió ambiental i en última instància en la prevenció de riscos laborals. Aquests tres tipus de sistemes de gestió, en els últims anys s’han anat integrant, de manera que s’han reduït els recursos i els esforços emprats en la gestió, millorant significativament l’eficàcia i l’eficiència d’aquests sistemes. L’objectiu principal que persegueix aquest projecte, és definir un sistema de gestió que permeti a l’empresa conduir les seves activitats de forma simplificada i ordenada, i que alhora faciliti la informació necessària per a corregir i millorar les activitats. Un altre objectiu que pretén aconseguir aquest projecte, és el de dissenyar un SGI que aprofiti les sinèrgies generades en els diferents àmbits de la pròpia empresa i fomenti les interaccions entre els diferents nivells de l’organització. En conseqüència, millorarà de forma important els fluxos d’informació dins de l’empresa minimitzant els esforços i la pèrdua d’informació. El mètode escollit per a la implantació del SGI, ha estat la Gestió per Processos, la qual es basa en la definició i seguiment dels processos de l’empresa, partint de les necessitats del client i acabant quan aquestes estan satisfetes. En conclusió, a la finalització del present projecte s’obtindrà un SGI, amb tots els processos de l’empresa definits i implantats, que doni compliment a les normes UNEEN-ISO 9001:00, UNE-EN-ISO 14001:04 i OHSAS 18001:07. Aquest SGI, que s’ha realitzat des d’un punt de vista documental i teòric, suposarà una millora de l’eficàcia operativa dels processos i una important millora competitiva de l’empresa.

Factores involucrados en el proceso de toma de decisiones en bibliotecas de tamaño medio y pequeño. Resultados del proyecto DECIMAL.

Se presentan los resultados de la investigación realizada en el marco del proyecto europeo DECIMAL, que tiene como objetivo el desarrollo de un módulo integrado de soporte de la toma de decisiones para sistemas automatizados usados en bibliotecas pequeñas y medianas. La investigación cuantitativa y cualitativa llevada a cabo en el Reino Unido, Italia y España se ha basado en una combinación de diversos métodos: revisión de la literatura, entrevistas semiestructuradas, cuestionarios y grupos de discusión en ocasión de los dos seminarios de presentación realizados. Se distinguen dos líneas básicas de investigación: la primera en torno a la utilización real de indicadores y medidas para la gestión y evaluación de la actividad del centro, así como su interés potencial en el caso que no se hayan aplicado por el momento, y la segunda en torno al tipo de decisiones más habituales en los centros y los factores que inciden en este proceso (fuentes de información utilizadas, cultura institucional, formación, nivel de satisfacción). El artículo está centrado en los resultados obtenidos en las bibliotecas españolas, aunque se mencionan también los resultados globales a modo de comparación. Las conclusiones del estudio han dado como resultado la especificación de las necesidades de los usuarios, sobre cuya base se ha diseñado el módulo de soporte a la toma de decisiones. El proyecto ha concluido con una fase de evaluación del prototipo que ha implicado el desarrollo de cuatro versiones sucesivas del módulo con la finalidad de resolver los problemas presentados durante el proceso de evaluación.

Panoràmica dels sistemes de gestió de biblioteques al segle XXI

In the past decade, a number of trends have come together in the general sphere of computing that have profoundly affected libraries. The popularisation of the Internet, the appearance of open and interoperable systems, the improvements within graphics and multimedia, and the generalised installation of LANs are some of the events of the period. Taken together, the result has been that libraries have undergone an important functional change, representing the switch from simple information depositories to information disseminators. Integrated library management systems have not remained unaffected by this transformation and those that have not adapted to the new technological surroundings are now referred to as legacy systems. The article describes the characteristics of systems existing in today's market and outlines future trends that, according to various authors, include the disappearance of the integrated library management systems that have traditionally been sold.

Factores involucrados en el proceso de toma de decisiones en bibliotecas de tamaño medio y pequeño. Resultados del proyecto DECIMAL.

Se presentan los resultados de la investigación realizada en el marco del proyecto europeo DECIMAL, que tiene como objetivo el desarrollo de un módulo integrado de soporte de la toma de decisiones para sistemas automatizados usados en bibliotecas pequeñas y medianas. La investigación cuantitativa y cualitativa llevada a cabo en el Reino Unido, Italia y España se ha basado en una combinación de diversos métodos: revisión de la literatura, entrevistas semiestructuradas, cuestionarios y grupos de discusión en ocasión de los dos seminarios de presentación realizados. Se distinguen dos líneas básicas de investigación: la primera en torno a la utilización real de indicadores y medidas para la gestión y evaluación de la actividad del centro, así como su interés potencial en el caso que no se hayan aplicado por el momento, y la segunda en torno al tipo de decisiones más habituales en los centros y los factores que inciden en este proceso (fuentes de información utilizadas, cultura institucional, formación, nivel de satisfacción). El artículo está centrado en los resultados obtenidos en las bibliotecas españolas, aunque se mencionan también los resultados globales a modo de comparación. Las conclusiones del estudio han dado como resultado la especificación de las necesidades de los usuarios, sobre cuya base se ha diseñado el módulo de soporte a la toma de decisiones. El proyecto ha concluido con una fase de evaluación del prototipo que ha implicado el desarrollo de cuatro versiones sucesivas del módulo con la finalidad de resolver los problemas presentados durante el proceso de evaluación.

Three essays on major trends in a slow clockspeed industry : the case of industrial automation

The motivation for this research initiated from the abrupt rise and fall of minicomputers which were initially used both for industrial automation and business applications due to their significantly lower cost than their predecessors, the mainframes. Later industrial automation developed its own vertically integrated hardware and software to address the application needs of uninterrupted operations, real-time control and resilience to harsh environmental conditions. This has led to the creation of an independent industry, namely industrial automation used in PLC, DCS, SCADA and robot control systems. This industry employs today over 200'000 people in a profitable slow clockspeed context in contrast to the two mainstream computing industries of information technology (IT) focused on business applications and telecommunications focused on communications networks and hand-held devices. Already in 1990s it was foreseen that IT and communication would merge into one Information and communication industry (ICT). The fundamental question of the thesis is: Could industrial automation leverage a common technology platform with the newly formed ICT industry? Computer systems dominated by complex instruction set computers (CISC) were challenged during 1990s with higher performance reduced instruction set computers (RISC). RISC started to evolve parallel to the constant advancement of Moore's law. These developments created the high performance and low energy consumption System-on-Chip architecture (SoC). Unlike to the CISC processors RISC processor architecture is a separate industry from the RISC chip manufacturing industry. It also has several hardware independent software platforms consisting of integrated operating system, development environment, user interface and application market which enables customers to have more choices due to hardware independent real time capable software applications. An architecture disruption merged and the smartphone and tablet market were formed with new rules and new key players in the ICT industry. Today there are more RISC computer systems running Linux (or other Unix variants) than any other computer system. The astonishing rise of SoC based technologies and related software platforms in smartphones created in unit terms the largest installed base ever seen in the history of computers and is now being further extended by tablets. An underlying additional element of this transition is the increasing role of open source technologies both in software and hardware. This has driven the microprocessor based personal computer industry with few dominating closed operating system platforms into a steep decline. A significant factor in this process has been the separation of processor architecture and processor chip production and operating systems and application development platforms merger into integrated software platforms with proprietary application markets. Furthermore the pay-by-click marketing has changed the way applications development is compensated: Three essays on major trends in a slow clockspeed industry: The case of industrial automation 2014 freeware, ad based or licensed - all at a lower price and used by a wider customer base than ever before. Moreover, the concept of software maintenance contract is very remote in the app world. However, as a slow clockspeed industry, industrial automation has remained intact during the disruptions based on SoC and related software platforms in the ICT industries. Industrial automation incumbents continue to supply systems based on vertically integrated systems consisting of proprietary software and proprietary mainly microprocessor based hardware. They enjoy admirable profitability levels on a very narrow customer base due to strong technology-enabled customer lock-in and customers' high risk leverage as their production is dependent on fault-free operation of the industrial automation systems. When will this balance of power be disrupted? The thesis suggests how industrial automation could join the mainstream ICT industry and create an information, communication and automation (ICAT) industry. Lately the Internet of Things (loT) and weightless networks, a new standard leveraging frequency channels earlier occupied by TV broadcasting, have gradually started to change the rigid world of Machine to Machine (M2M) interaction. It is foreseeable that enough momentum will be created that the industrial automation market will in due course face an architecture disruption empowered by these new trends. This thesis examines the current state of industrial automation subject to the competition between the incumbents firstly through a research on cost competitiveness efforts in captive outsourcing of engineering, research and development and secondly researching process re- engineering in the case of complex system global software support. Thirdly we investigate the industry actors', namely customers, incumbents and newcomers, views on the future direction of industrial automation and conclude with our assessments of the possible routes industrial automation could advance taking into account the looming rise of the Internet of Things (loT) and weightless networks. Industrial automation is an industry dominated by a handful of global players each of them focusing on maintaining their own proprietary solutions. The rise of de facto standards like IBM PC, Unix and Linux and SoC leveraged by IBM, Compaq, Dell, HP, ARM, Apple, Google, Samsung and others have created new markets of personal computers, smartphone and tablets and will eventually also impact industrial automation through game changing commoditization and related control point and business model changes. This trend will inevitably continue, but the transition to a commoditized industrial automation will not happen in the near future.

Harmonization ofsignificant environmental aspects and their risk assessment in UPM paper and pulp mills

Työn tavoite onharmonisoida yhtenäiset rakenteet UPM:n paperi- ja sellutehtaiden merkittävilleympäristönäkökohdille sekä niiden ympäristöriskienhallintajärjestelmille. Näin saavutetaan yhteneväiset tavoitteet ja analysointikeinot yrityksen yksiköille. Harmonisointiprosessi on osa koko yrityksen ympäristöhallintajärjestelmän kehittämistä. Ja konsernin EMS -prosessi puolestaan konvergoi konsernin integroidun johtamisjärjestelmän kehitystä. Lisäksi työn tapaustutkimuksessa selvitettiin riskienhallintajärjestelmien integroitumispotentiaalia. Sen avulla saavutettaisiin paremmin suuren yrityksen synergia-etuja ja vuorovaikutteisuutta toimijoiden kesken, sekä parannettaisiin riskienhallintajärjestelmän mukautuvuutta ja käytettävyyttä. Työssä käsitellään kolmea esimerkkiä, joiden pohjalta tehdään esitys harmonisoiduille merkittäville ympäristönäkökohdille sekä riskienhallintajärjestelmien parametreille. Tutkimusongelmaa lähestytään haastattelujen, kirjallisuuden, yrityksen PWC:llä teettämän selvityksen sekä omien päätelmien avulla. Lisäksi työssä esitetään ympäristöhallintajärjestelmän tehokkuuden todentaminen ympäristösuorituskyvyn muuttujiin suhteutettuna. Pohjana jatkuvan kehityksen päämäärälle on organisaatio-oppiminen, niin yksittäisen työntekijän, tiimien kuin eri yksiköiden kesken. Se antaa sysäyksen aineettoman omaisuuden, kuten ympäristö-osaamisen, hyödyntämiseen parhaalla mahdollisella tavalla. Tärkeimpinä lopputuloksina työssä ovat ehdotukset harmonisoiduille merkittäville ympäristönäkökohdille sekä ympäristöriskienhallintajärjestelmän määritetyille komponenteille. Niitä ovat määritelmät ja skaalat riskien todennäköisyydelle, seurauksille sekä riskiluokille. Työn viimeisenä osana luodaan pohja tapaustutkimuksen avulla Rauman tehtaan jätevedenpuhdistamon kahden erilaisen riskienhallintajärjestelmän integroitumiselle.