Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation.

Cytomegalovirus (CMV) continues to be one of the most common infections after solid-organ transplantation, resulting in significant morbidity, graft loss, and adverse outcomes. Management of CMV varies considerably among transplant centers but has been become more standardized by publication of consensus guidelines by the Infectious Diseases Section of The Transplantation Society. An international panel of experts was reconvened in October 2012 to revise and expand evidence and expert opinion-based consensus guidelines on CMV management, including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues. The following report summarizes the recommendations.

Calidad de vida laboral y liderazgo en trabajadores asistenciales y administrativos en un centro oncológico de la ciudad de Bogotá

El propósito de este estudio fue describir la Calidad de vida laboral (CVL) y el estilo de liderazgo percibido por el personal administrativo/asistencial de un centro oncológico y estimar la asociación entre ellas, considerando las características sociodemográficas. Para ello se aplicó el Cuestionario de Vida profesional [CVP-35] y el Test de Adjetivos de Pitcher [PAT]. En general, los participantes presentan una CVL satisfactoria, caracterizada principalmente por motivación intrínseca, lo cual fue más evidente en el personal asistencial. Respecto al liderazgo, se observó una percepción de ausencia de liderazgo o características poco deseables de éste, lo cual aunque no determina la CVL, si constituye un factor modulador de la misma, las variables sociodemográficas no guardaron relación con la CVL. Por último se resalta la responsabilidad social que tienen los directivos sobre bienestar de los trabajadores de la salud, y consecuentemente sobre la atención al paciente. Se discuten estos hallazgos y lo pertinente de utilizar las categorías emergentes del PAT.

Warfarin doses for anticoagulation therapy in elderly patients with chronic atrial fibrillation

OBJECTIVE: Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Stable anticoagulation is defined as the time within > 70% of the therapeutic range. However, the dosage required to achieve stable anticoagulation remains unknown. The aim of this study was to analyze the warfarin dose necessary for the maintenance of stable oral anticoagulation therapy in elderly patients. METHODS: We analyzed 112 consecutive outpatients with atrial fibrillation who were >= 65 years of age, had received anticoagulation therapy with warfarin for more than 1 year and had a stable international normalized ratio between 2.0 and 3.0 for >= 6 months. The international normalized ratio was measured in the central laboratory using the traditional method. RESULTS: The patients were stratified according to the following age groups:,75 or >= 75 years and <80 or >= 80 years. The mean daily doses of warfarin were similar for patients, <75 or >= 75 years (3.34 +/- 1.71 versus 3.26 +/- 1.27 mg/day, p = 0.794) and <80 or >= 80 years (3.36 +/- 1.49 versus 3.15 +/- 1.23 mg/day, p = 0.433). In 88 (79%) patients, the daily warfarin dose was between 2 and 5 mg/day; in 13 (11%) patients, the daily warfarin dose was,2.0 mg/day; and in 11 (10%) patients, the daily warfarin dose was >5.0 mg/day. The correlation between the daily warfarin dose and the international normalized ratio was 0.22 (p = 0.012). CONCLUSION: Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed.

Modelo de competencias profesionales para directivos escolares: desarrollo y aplicación al ámbito de la educación particular subvencionada, Chile

La trascendencia de la educación sobre la construcción del capital humano y social, ha sido vastamente discutido, considerando entre otros elementos, la correlación entre las inversiones en educación, las políticas educativas, los actores involucrados, y los efectos que tienen sobre la calidad de la educación. Esto se refleja en los esfuerzos, de los diferentes estamentos, por mejorar los resultados del proceso educativo, intentando construir una sociedad más equitativa en la cual todo individuo pueda tener acceso a una educación de calidad, que permita tener las mismas oportunidades para el desarrollo personal, profesional y social. La educación entonces, pasa a ser un pilar fundamental en los modelos de desarrollo - y un tema de debate constante- en especial en aspectos tales como: resultados de aprendizaje, gestión y efectividad escolar, como ejes para mejorar la construcción del capital humano en la sociedad. En Chile, a partir de un proceso de descentralización de la educación iniciado en los 80, el modelo de planificación y gestión de la educación pública fue transformado, pasando de un modelo centralizado a un enfoque en el cual el establecimiento educacional – el proyecto educativo – adquiere autonomía de gestión que se vuelve determinante en la calidad de la educación. Es al interior de los establecimientos escolares donde los diferentes agentes educativos llevan a cabo los procesos pedagógicos y administrativos, y se generan las condiciones para poder desarrollar una educación de calidad. Durante los últimos 30 años, los esfuerzos se han centrado en las capacidades docentes y en alcanzar la cobertura universal. Sin embargo, en los últimos 10 años la investigación aplicada ha evidenciado que los directores y equipos directivos tienen efectos directos e indirectos sobre la gestión escolar, pedagógica y de convivencia dentro de la escuela a través de su desempeño y liderazgo escolar. Es en este contexto, que se propone esta investigación con el fin de contribuir en el fortalecimiento de las capacidades de estos actores y promover un desempeño que impacte positivamente en la calidad de los aprendizajes en las escuelas Esta tesis se estructura en cinco capítulos. En el primer capítulo, se define y analiza el marco conceptual de la investigación centrado en los dos ejes de este trabajo: por un lado, conceptos de competencia, competencias profesionales; y por otro lado, liderazgo y dirección escolar, definiendo el concepto de competencias profesionales para la dirección escolar. A continuación, en el segundo capítulo, se presenta un análisis del contexto enfocado en el proceso de descentralización de la educación pública en Chile y sus efectos sobre el rol de los directivos escolares en Chile, el cual a través de su proceso de evolución ha transformado las responsabilidades de este estamento, en cuanto la gestión y la administración de los proyectos educativos definiendo un perfil del directivo escolar. Complementariamente, y en función de la gestión directiva, se realiza una conceptualización de buenas prácticas directivas como los instrumentos a través de las cuales se movilizan los elementos de competencia. En el tercer capítulo, se presenta la propuesta de modelo de competencias profesionales para la dirección escolar, como la principal aportación de esta investigación, que se sustenta sobre cuatro componentes como base científica: el enfoque holístico de competencia, el enfoque de dirección de proyectos de la International Project Management Association (IPMA), el paradigma de gestión escolar y el modelo Working with People (WWP). La propuesta considera una metodología de implementación para el desarrollo de procesos de intervención para la mejora de la gestión escolar, articulando las competencias profesionales directivas y las prácticas de gestión, como los principales componentes del modelo. En el cuarto capítulo se presenta la aplicación del modelo propuesto en un estudio de caso desarrollado en el Colegio público Kings´ School de San Bernardo (Chile), un establecimiento particular subvencionado, del área urbana de Santiago con condiciones socioeconómicas media, con un alto porcentaje de vulnerabilidad y cuyos resultados en las pruebas de evaluación nacionales evidencian una caída. La aplicación del modelo se realiza a lo largo del curso 2012-13, trabajando de forma directa con el equipo de dirección, a través de un proyecto de innovación educativa, diseñando e implementando una propuesta de intervención de la cual se sistematizan los resultados y los aprendizajes obtenidos. A partir de la investigación y los resultados obtenidos permiten concluir que el modelo propuesto puede ser considerada una herramienta estratégica de planificación e intervención para la gestión de proyectos educativos, promoviendo que a los equipos directivos contrastar su realidad con los estándares propuestos, y de esta forma poder articular las capacidades – en términos de competencias - de los recursos humanos con las prácticas directivas que buscan lograr los objetivos y resultados esperados, incidiendo positivamente en los resultados de aprendizaje y la calidad educativa. ABSTRACT The importance of education on the construction of human and social capital, has been vastly discussed, considering among other things, the correlation between investments in education, educational policies, stakeholders, and the effects they have on education quality. This is reflected on the efforts of different stakeholders, to improve educational outcomes, trying to build a more equitable society in which every individual can have access to quality education, allowing the same opportunities for personal, professional and social development. Education then becomes a cornerstone at development models - and a topic of constant discussion, especially in areas such as learning outcomes, management and school effectiveness, as core concepts to improve the construction of human capital in the society. In Chile, after a process of decentralization of education that started in the 80s, planning and management model of public education was transformed from a centralized approach to a decentralized perspective in which schools - the educational project - acquires management autonomy and becomes determinant in the quality of education outcomes. It is within the school context where teachers, principals and administrative assistants held teaching and administrative processes, and generates the conditions to develop quality education. During the past 30 years, efforts have been focused on teaching skills and achieve universal coverage. However, in the last 10 years applied research has shown that the principals and management teams have direct and indirect effects on school management, teaching and school environment through their performance and school leadership. This research is proposed within this context in order to contribute to strengthen the capacities of these actors, and promote a professional performance that will positively impact schools´ quality of learning. This thesis is divided into five chapters. The first chapter defines and analyzes the conceptual framework focused on the two main ideas of this work: first, concepts of competence, professional competence; and secondly, leadership and school management, defining the concept of professional competences for school leadership. Then, in the second chapter is developed a context analysis focused on the process of decentralization of public education in Chile, and its effects on the role of school leaders which through this process has been transformed the responsibilities on management and administration of educational projects, allowing to define a school leader’s profile. In addition, and related to principals´ management, it is proposed a conceptualization of school leadership best practices, as the instruments through which competence elements are mobilized and placed in action. Within chapter three, is presented the proposed model of professional competences for school principals, as the main contribution of this research which is based on four components as scientific basis: holistic competence approach, project management approach from the International Project management Association (IPMA), effective school management paradigm; and Working with People model (WWP). The proposal considers an implementation methodology for the development of intervention processes to improve school management, articulating professional competences and school leadership practices, as main elements of the model. Chapter four presents the implementation of the proposed model, using a case study at the Kings´ School of San Bernardo (Chile), subsidized school located at the urban area of Santiago with average socioeconomic conditions, with a high percentage of vulnerability and whose national educational assessment results show a fall. Model implementation was developed through 2012- 2013, working directly with the management team, through an innovative educational management project, designing and implementing an intervention which processes, results and lessons learned are systematized. Research and obtained results through its implementation indicates that the proposed model can be considered a strategic tool for planning and operational management for educational projects, encouraging the principals to compare their reality with the proposed standards, and thus articulate capacity - in terms of competences – in human resources with principals´ practices to achieve the objectives and expected results, impacting positively on learning outcomes and educational quality.

ELECTRONIC GOVERNMENT POLICIES IN BRAZIL: CONTEXT, ICT MANAGEMENT AND OUTCOMES

The State Reform processes combined with the emergence and use of Information and Communication Technology (ICT) originated electronic government policies and initiatives in Brazil. This paper dwells on Brazilian e-government by investigating the institutional design it assumed in the state's public sphere, and how it contributed to outcomes related to e-gov possibilities. The analyses were carried out under an interpretativist perspective by making use of Institutional Theory. From the analyses of interviews with relevant actors in the public sphere, such as state secretaries and presidents of public ICT companies, conclusions point towards low institutionalization of e-gov policies. The institutional design of Brazilian e-gov limits the use of ICT to provide integrated public services, to amplify participation and transparency, and to improve public policies management.

Management Approaches to Merger Evoked Cultural Change and Acculturation Outcomes

In a study of merger-evoked cultural change in three organizations, quantitative and qualitative data were collected from individuals at all employment levels in both merger partners within each organization. Results were that most individuals perceived that the merger had impacted significantly on them personally. There was, however, a perceived lack of congruence between the organizational cultures of merging partners, resulting in cultural clashes and significant changes to the organizations' organizational cultures. More specifically, outcomes for both individuals and the subsequent acculturation following the mergers were related to the approach adopted to manage the merger process: incremental, immediate, or indifferent.

Surgical management of lung cancer in Western Australia in 1996 and its outcomes

Background: All cases of lung cancer diagnosed in Western Australia in 1996 in which surgery was the primary treatment, were reviewed. Reported herein are the characteristics of the patients, the treatment outcomes and a comparison of the management undertaken with that recommended by international guidelines. Methods: All patients with a new diagnosis of lung cancer in Western Australia in the calendar year of 1996 were identified using two different population-based registration systems: the Western Australian (WA) Cancer Registry and the WA Hospital Morbidity Data System. A structured questionnaire on the diagnosis and management was completed for each case. Date of death was determined through the WA Cancer Registry. Results: Six hundred and sixty-eight patients with lung cancer were identified; 132 (20%) were treated with surgery. Lobectomy was the most frequently performed procedure (71%), followed by pneumonectomy (19%). Major complications affected 23% of patients. Postoperative mortality was 6% (3% lobectomy, 12% pneumonectomy). At 5 years the absolute survival was as follows for stage I, II, IIIA, IIIB, respectively: 51%, 45%, 12%, 5%. Conclusions: Investigations and choice of surgery in WA in 1996 reflect current international guidelines. The survival of patients with resectable lung cancer remains unsatisfactory.

Electronic government policies in Brazil: context, ICT management and outcomes

The State Reform processes combined with the emergence and use of Information and Communication Technology (ICT) originated electronic government policies and initiatives in Brazil. This paper dwells on Brazilian e-government by investigating the institutional design it assumed in the state's public sphere, and how it contributed to outcomes related to e-gov possibilities. The analyses were carried out under an interpretativist perspective by making use of Institutional Theory. From the analyses of interviews with relevant actors in the public sphere, such as state secretaries and presidents of public ICT companies, conclusions point towards low institutionalization of e-gov policies. The institutional design of Brazilian e-gov limits the use of ICT to provide integrated public services, to amplify participation and transparency, and to improve public policies management.

Ranibizumab in the management of advanced Coats disease Stages 3B and 4: long-term outcomes.

BACKGROUND: Laser photocoagulation and cryotherapy to completely destroy telangiectatic vessels and ischemic retina in Coats disease is barely applicable in advanced cases with total retinal detachment, and globe survival is notoriously poor in Stages 3B and 4. Anti-vascular endothelial growth factor intravitreal injections may offer new prospects for these patients. METHODS: This study is a retrospective review of all consecutive patients with Coats disease treated with neoadjuvant or adjuvant intravitreal ranibizumab plus conventional and amblyopia treatment as appropriate. RESULTS: Nine patients (median age, 13 months) presenting Coats Stages 3B and 4 (5 and 4 eyes, respectively) were included. Iris neovascularization resolved within 2 weeks and retinal reapplication within 4 months in all patients. At last follow-up, globe survival was 100% with anatomical success in 8 of the 9 eyes. With a median follow-up of 50 months, fibrotic vitreoretinopathy was developed in 5 of the 9 cases, one leading to tractional retinal detachment and ultimately phthisis bulbi. The remaining 4 of the 9 eyes achieved some vision (range, 0.02-0.063). CONCLUSION: To the best of the authors' knowledge, this is the largest reported series of late-stage Coats undergoing anti-vascular endothelial growth factor therapy, a homogenous cohort of patients treated with a single agent and with the longest follow-up. This study supports the role of ranibizumab in advanced disease by transient restoration of the hemato-retinal barrier and suppression of neovascularization to facilitate classic treatment. At the last follow-up, the authors report unprecedented anatomical success and functional outcome.