Auditoria Administrativa : Planeación de la Auditoria Administrativa

Auditoria administrativa es un examen completo y constructivo de la estructura organizativa de la empresa, institución o departamento gubernamental; o de cualquier otra entidad y de sus métodos de control, medios de operación y empleo que de a sus recursos humanos y materiales. Analizaremos lo que representa la planeación de la auditoría administrativa y el impacto que tiene dentro de la empresa. La información que brindamos en este trabajo está sustentada por autores como Alfonso Amador Sotomayor, Erick Benjamín Franklin, de quienes obtuvimos mucha ayuda a través de los libros que han escrito sobre auditoría administrativa. La metodología que se usó para recopilar información en este trabajo fue a través del internet por medio de diversas páginas web las cuales enriquecieron nuestra investigación, se realizó una amplia revisión bibliográfica y a través de esta información podemos aseverar que la auditoria administrativa es complementaria de diferentes disciplinas como la organización y métodos entre otros. La auditoría administrativa puede definirse como la revisión analítica parcial o total de una organización con el propósito de precisar su nivel de desempeño y perfilar oportunidades de mejora para innovar valor y lograr una ventaja competitiva sustentable. A partir de este concepto se pueden determinar objetivos para enmarcarla, entre los cuales los más representativos son los de control, productividad, servicio, calidad, cambio, aprendizaje, interacción y vinculación. En este documento se abordarán las generalidades, importancia, el objeto, las caracterísitcas, las etapas y evolución de la auditoría administrativa asi como su planeación

Serum Concentrations of Symmetric Dimethylarginine and Creatinine in Dogs with Naturally Occurring Chronic Kidney Disease

Citation: Hall, J. A., Yerramilli, M., Obare, E., Yerramilli, M., Almes, K., & Jewell, D. E. (2016). Serum Concentrations of Symmetric Dimethylarginine and Creatinine in Dogs with Naturally Occurring Chronic Kidney Disease. Journal of Veterinary Internal Medicine, 30(3), 794-802. doi:10.1111/jvim.13942Background: Serum concentrations of symmetric dimethylarginine (SDMA) detected chronic kidney disease (CKD) in cats an average of 17.0 months before serum creatinine (Cr) concentrations increased above the reference interval. Objectives: To report on the utility of measuring serum SDMA concentrations in dogs for detection of CKD before diagnosis by measurement of serum Cr. Animals: CKD dogs (n = 19) included those persistently azotemic for ?3 months (n = 5), dogs that were azotemic at the time of death (n = 4), and nonazotemic dogs (n = 10). CKD dogs were compared with healthy control dogs (n = 20). Methods: Retrospective study, whereby serum Cr concentrations were determined by enzymatic colorimetry and serum SDMA concentrations were determined by liquid chromatography-mass spectrometry in dogs with necropsy confirmed CKD. Results: Serum SDMA increased before serum Cr in 17 of 19 dogs (mean, 9.8 months; range, 2.2-27.0 months). Duration of elevations in serum SDMA concentrations before the dog developed azotemia (N = 1) or before the dog died (N = 1) was not determined. Serum SDMA and Cr concentrations were linearly related (r = 0.84; P < .001). Serum SDMA (r = -0.80) and serum Cr (r = -0.89) concentrations were significantly related to glomerular filtration rate (both P < .001). Conclusion and Clinical Importance: Using serum SDMA as a biomarker for CKD allows earlier detection of kidney dysfunction in dogs than does measurement of serum Cr. Earlier detection might be desirable for initiating renoprotective interventions that slow progression of kidney disease. © 2016 American College of Veterinary Internal Medicine

Coordinating resources for prospective medication risk management of older home care clients in primary care : procedure development and RCT study design for demonstrating its effectiveness

Background: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients >= 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Methods: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. Discussion: The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources.Peer reviewe

Polypharmacy and potentially inappropriate medication use in geriatric oncology.

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods

A MULHER NADADORA NA PERSPECTIVA DA REVISTA EDUCAÇÃO PHYSICA (1932-1945): DA ESTRATÉGIA PUBLICITÁRIA À ATLETA POTENCIAL

Artigo Rede CEDES - UFPR publicado no 1º ENCONTRO DA ALESDEApresenta-se uma análise histórica sobre a forma como a natação feminina, sobretudo a mulher nadadora, era abordada no interior da Revista Educação Physica. O presente estudo partiu do levantamento de todas as publicações do periódico (de 1932 a 1945), apresentando a descrição dos conteúdos publicados na Revista que falavam ou citavam a mulher na natação. Após a reflexão, concluiu-se que a mulher passou de estratégia editorial à atleta potencial sob a perspectiva desta Revista.Rede CEDE

Orthostatic stress echocardiography as a useful test to measure variability of transvalvular pressure gradients in aortic stenosis

The aim of the study was to assess the influence of the orthostatic stress test on changes in aortic pressure gradients in patients with aortic stenosis (AS). METHODS: The orthostatic stress test was performed in 56 AS patients. The maximum aortic gradient was compared between the supine and the upright position (using Doppler echocardiography from the apical window). The left hand of each patient was kept on top of their head for both readings. 21 patients were excluded from the study for three reasons: 1) atrial fibrillation (significant beat-to-beat variability of measured gradient), 2) suboptimal Doppler signal during the orthostatic test, and 3) aortic gradient significantly higher in suprasternal or right parasternal windows than in apical window (different direction of stenosed blood jets) in the supine examination. The last limitation (#3) is methodologically important because during the orthostatic examination, only the transapical measurement was used. We were able to analyze 35 AS patients (20 males, 15 females, mean age 74.8 ± 9.2 years). RESULTS: The wide range of severity of AS was examined (maximal aortic gradient in the supine position from 30 to 146 mmHg). With regard to statistical trends, the mean value of the maximum aortic gradient significantly decreased after orthostatic stress (from 87.5 ± 28.6 to 75.8 ± 23.7 mmHg), p > 0.01). In 7 patients (increasing responders) the peak aortic gradient slightly increased during the stress test. Five of the seven only increased by a few percent. The other two patients increased by nearly 10%. In contrast, the remaining 28 AS patients’ gradient decreased by as much as 40% (decreasing responders). CONCLUSIONS: The orthostatic position test frequently generated a decrease of “theoretically fixed at rest” valvular gradient in AS. The combination of the stiffened stenotic valve apparatus and a reduced LV preload may be responsible for this decreasing response

Imaging of all three coronary arteries by transthoracic echocardiography. an illustrated guide

BACKGROUND: Improvements in ultrasound technology has enabled direct, transthoracic visualization of long portions of coronary arteries : the left anterior descending (LAD), circumflex (Cx) and right coronary artery (RCA). Transthoracic measurements of coronary flow velocity were proved to be highly reproducible and correlated with invasive measurements. While clinical applications of transthoracic echocardiography (TTE) of principal coronary arteries are still very limited they will likely grow. The echocardiographers may therefore be interested to know the ultrasonic views, technique of examination and be aware where to look for coronary arteries and how to optimize the images. METHODS: A step-by-step approach to direct, transthoracic visualization of the LAD, Cx and RCA is presented. The technique of examination is discussed, correlations with basic coronary angiography views and heart anatomy are shown and extensively illustrated with photographs and movie-pictures. Hints concerning optimization of ultrasound images are presented and artifacts of imaging are discussed. CONCLUSIONS: Direct, transthoracic examination of the LAD, Cx and RCA in adults is possible and may become a useful adjunct to other methods of coronary artery examination but studies are needed to establish its role