Robotic Hysterectomy for Cancer and Benign Pathology

The da Vinci Surgical System is an innovative technology that has advanced the laparoscopic treatment of benign and malignant diseases in gynecology. In this chapter, we will discuss the da Vinci Surgical System technology, including its history, utilization, surgical technique for benign and oncologic hysterectomy, future directions and surgical complications. Through a review of the literature, we aim to chronicle the current trends of application in both benign and oncologic gynecologic conditions and describe the current standards of care in this innovative and evolving operative technology. Although the future utility of robotic surgeries and robotic hysterectomies necessitates further research, the potential application of this surgical method affords great promise

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Mejora de proceso productivo y de calidad del producto de la planta elaboradora de yogur de la empresa Laive S.A.

El presente trabajo tiene como objetivo el diseño de un proyecto de optimización del proceso productivo e incremento significativo de la calidad del producto de la planta elaboradora de yogur LAIVE S.A. El mencionado proyecto constituye uno de los puntos claves del planeamiento estratégico de la compañía definido por la alta dirección. La meta es duplicar las ventas entre los años 2006 y 2010. Para ello el producto debe ser de calidad, cumpliendo los requisitos del cliente, homogéneo y a un costo que permita que el negocio sea sostenible en el tiempo. El crecimiento acelerado de la producción de yogur acompañado del inevitable aumento de maquinarias, con presupuestos limitados y sumados a los cambios en los requisitos del consumidor final en los últimos años, han ido en desmedro del rendimiento y han generado sobre costos. El análisis realizado en el año 2007 de los problemas y sus causas ha presentado diversas posibilidades de mejora. Desde el punto de vista de calidad, cambiando parte del proceso y reordenando el layout de planta, se pueden obtener mejoras rápidas y de este modo cumplir con los requisitos del cliente. Estas mejoras de proceso y reordenamiento del layout mejorarán a su vez los rendimientos del producto generando rentabilidad y permitiendo sostenibilidad del negocio en el tiempo. Se pretende regresar a los rendimientos del año 2005 recuperando de esta forma entre 37.2 y 46.5 toneladas de producto al mes. Este estudio concluye que, para revertir la reducción de productividad observada, es necesario intervenir con el rediseño y puesta en práctica de un modelo de optimización del proceso productivo para la elaboración del yogur LAIVE.Tesi