Desempeño de la orientación de la cadena de abastecimiento en armonia con operaciones y mercadeo en empresas del sector electrico en bogotá

This article offers a descriptive analysis about the performance factor of supply chain orientation (SCOP) based on the harmonization between marketing strategies in several companies in the electrical and electronic sector, through the evaluation of three fundamental constructs: the alignment of the marketing strategy, the performance of the orientation to the supply chain and the organizational performance, fundamental components for the optimal flow of the operational processes in order to satisfy the needs of the stakeholders. An instrument was applied as a survey to 121 people with different macro environments and positions within their organizations. In the research process, there was a misalignment between the logistics and marketing strategies due to the lack of articulation between the functional processes in addition to their respective areas, from the strategic, tactical and operational plans.El presente artículo ofrece un análisis descriptivo acerca del factor desempeño de la orientación a la cadena de abastecimiento (DOGCA) en empresas del sector eléctrico, mediante la armonización entre las estrategias de mercadeo en varias empresas del sector eléctrico y electrónico, mediante la evaluación de tres constructos fundamentales: la alineación de la estrategia de mercadeo, el rendimiento de la orientación a la cadena de abastecimiento y el rendimiento organizacional, componentes fundamentales para el óptimo flujo de los procesos operacionales con el fin de satisfacer las necesidades de los grupos de interés. Se aplicó un instrumento como encuesta a 121 personas con diferentes macro ambientes y posiciones dentro de sus organizaciones. En el proceso investigativo se encontró una desalineación entre las estrategias de logística y mercadeo debido a la falta de articulación entre los procesos funcionales además de sus respectivas áreas, desde los planes estratégicos, tácticos y operacionales

Different indexes of glycemic variability as identifiers of patients with risk of hypoglycemia in type 2 diabetes mellitus

Q1Artículo original1007-1015Introduction: Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice. Methods: A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (<54 mg/dl) was calculated. Area under the curve (AUC) was determined for different indexes as identifiers of patients with risk of hypoglycemia (IRH). Optimal cutoff thresholds were determined from analysis of the receiver operating characteristic curves. Results: CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI. Conclusion: This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes

Efficacy and safety of sensor-augmented pump therapy (SAPT) with predictive low-glucose management in patients diagnosed with type 1 diabetes mellitus previously treated with SAPT and low glucose suspend

Introducción La terapia con bomba de insulina integrada a sistema de monitoreo continuo con suspensión en hipoglucemia (SAPT-LGS) es una alternativa efectiva y segura para el tratamiento en pacientes con diabetes tipo 1 (DM1). La función de suspensión antes del límite bajo (PLGM) reduce la gravedad y la duración de los eventos hipoglucémicos. Sin embargo, la evidencia del beneficio en pacientes tratados previamente con SAPT-LGS es limitada. Métodos Se realizó un estudio longitudinal antes y después con pacientes DM1 tratados con SAPT-LGS que se cambiaron al sistema Minimed® 640G con SmartGuard®, con el fin de evaluar el impacto en los niveles de A1c, hipoglucemia severa (HS), hipoglucemia asintomática (HA) y área bajo la curva (AUC) <70mg/dl después de tres meses de seguimiento. Resultados Se incluyeron 55 pacientes con DM1, de 37.9 (IQR 6, 79) años, A1c basal de 7.52±1.11%. A los 3 meses bajo PLGM, la A1c se redujo significativamente a 7.18%±0.91% (p=0.004). La tasa de HS se redujo de 2.47 (CI 0.44,4.90) a 0.87 (CI 0.22,1.52) eventos/año del paciente (índice de incidencia 0.353 IC 95%, 0.178, 0.637), el AUC <70mg/dl se redujo de 0,59±0,76 a 0,35±0,65mg/dl x minuto (p = 0,030). HA determinado por el cuestionario Clarke resolvió en 23 de 30 pacientes (p=0,002) Conclusiones Este estudio sugiere que PLGM reduce la frecuencia de HS, HA, la exposición a niveles de glucosa por debajo de 70mg/dl y A1c. Con base a estos resultados, esta terapia debería considerarse en pacientes con DM1 tratados previamente con SAPT-LGS que persisten con HS e HA. Se requieren ensayos clínicos adicionales que comparen la eficacia y la seguridad de estas características.Q4Q3Artículo original451-457Background Sensor-augmented insulin pump therapy (SAPT) with low-glucose suspend (LGS) is an effective and safe alternative for treating patients with type 1 diabetes mellitus (T1DM). New predictive low-glucose management (PLGM) systems decrease the severity and duration of hypoglycemic events. However, evidence of benefits in patients previously treated with SAPT-LGS is limited. Methods A prospective before-after study was conducted in patients with T1DM treated with SAPT-LGS, who were switched to the Minimed® 640G system with SmartGuard® to assess the impact on A1c levels, severe hypoglycemia (SH), hypoglycemia unawareness (HU), and area under the curve (AUC) <70mg/dL after three months of follow-up. Results Fifty-five patients with T1DM with a mean age of 37.9 (IQR 6, 79) years and a mean baseline A1c level of 7.52±1.11% were enrolled. After three months under PLGM, A1c levels significantly decreased to 7.18±0.91% (p=0.004). SH rate decreased from 2.47 (CI 0.44, 4.90) to 0.87 (CI 0.22, 1.52) events/patient-year (Incidence rate ratio 0.353, 95% CI 0.178, 0.637), AUC <70mg/dL decreased from 0.59±0.76 to 0.35±0.65mg/dL x minute (p=0.030). HU determined by Clarke questionnaire resolved in 23 out of 30 patients (p=0.002). Conclusions This study suggests that SAPT with PLGM decreases the frequency of SH, HU, exposure to glucose levels below 70mg/dL, and A1c levels. Based on these results, this therapy should be considered in T1DM patients previously treated with SAPT-LGS with persistent SH and HU. Further clinical trials comparing the efficacy and safety of these features are required

Numerical and clinical precision in hypoglycemia of the intermittent FreeStyle Libre glucose monitoring through an NFC-Bluetooth transmitter associated with the xDrip+ algorithm in diabetic patients under insulin therapy

Métodos Estudio de pruebas diagnósticas. Se evaluó la exactitud numérica mediante la diferencia absoluta en los valores con respecto a la glucometría capilar (norma ISO 15197:2015) y la exactitud clínica, mediante las gradillas de error de Clarke y Parkes (Consensus), para mediciones de glucosa inferiores a 70 mg/dl realizadas con el sistema FreeStyle Libre y con la aplicación xDrip+ de estimación digital, en personas con diabetes con insulinoterapia. Resultados Se incluyó a 27 pacientes (TIR 73,4%, TBR70 5,6%), quienes aportaron 83 eventos de hipoglucemia. La exactitud numérica fue adecuada en proporciones similares con el sistema FreeStyle Libre en comparación con la aplicación xDrip+ (81,92% vs. 68,67%, p = 0,0630). La evaluación de la precisión clínica mostró que el 92,8% de las mediciones para xDrip+ y el 98,8% para FreeStyle libre cumplieron el criterio según la gradilla de Parkes (Consensus) (p = 0,0535), y el 79,5 y el 91,6% de las mediciones cumplieron el criterio según la gradilla de Clarke (p = 0,0273) siendo superior con Libre. Conclusiones El uso del transmisor NFC-Bluetooth (Miao-Miao) asociado a la aplicación xDrip+ no mejora la precisión numérica ni clínica para la detección de los eventos de hipoglucemia en los personas con diabetesQ3Q3Introduction There are data capture devices that attach to the FreeStyle Libre sensor and convert its communication from NFC (Near-field communication) to Bluetooth technology, generating real-time continuous glucose monitoring. The accuracy of hypoglycemia measurements displayed by smartphone apps using this device has not been established. Methods Study of diagnostic tests. Numerical accuracy was evaluated, utilizing the absolute difference with respect to capillary glucometry (ISO 15197:2015 standard) and clinical accuracy, using the Clarke and Parkes (Consensus) error grids, for glucose measurements less than 70 mg/dL performed with the FreeStyle Libre system and with the digital estimation xDrip+ app, in diabetic patients managed with insulin therapy. Results Twenty-seven patients were included (TIR 73.4%, TBR70 5.6%), who contributed 83 hypoglycemic events. Numerical accuracy was adequate in similar proportions with the FreeStyle Libre system compared to the xDrip+ app (81.92% vs. 68.67%, p = 0.0630). The clinical accuracy evaluation showed that 92.8% of the measurements for xDrip + and 98.8% for FreeStyle libre met the criteria according to the Parkes (Consensus) grid (p = 0.0535); and 79.5% and 91.6% of the measurements met the criteria according to the Clarke grid (p = 0.0273), being higher with FreeStyle libre. Conclusions The use of the NFC-Bluetooth transmitter (Miao-Miao) associated with the xDrip+ app does not improve numerical or clinical accuracy for detecting hypoglycemic events in diabetic patients managed with insulin therapy, compared to the FreeStyle Libre device.Revista Internacional - IndexadaS

Efficacy of the mHealth application in patients with type 2 diabetes transitioning from inpatient to outpatient care: A randomized controlled clinical trial

Introduction: No studies have assessed the efficacy of telemedicine using a platform for recording and adjusting insulin doses in patients with diabetes mellitus type 2 (DM2) transitioning from inpatient to outpatient care. This study aimed to assess, in a population of patients with DM2, discharged from a tertiary referral hospital, whether treatment based on the use of an mHealth application was associated with better glycemic control at the 3-month follow-up, than standard care. Methods: This open, randomized, controlled clinical trial included adult DM2 patients who were transitioning from inpatient to outpatient care. The efficacy and safety of patient management with and without mHealth was compared at the 3-month follow-up. The primary outcome was the change in the Glycosylated hemoglobin (HbA1c) levels. The secondary outcomes were the rates of hypoglycemic and hyperglycemic events and treatment satisfaction measured using the Insulin Treatment Satisfaction Questionnaire (ITSQ). Results: In total, 86 patients (41 using mHealth) were included in the clinical trial. HbA1c levels showed a significant decrease in both groups. The mean HbA1c level was significantly lower in the mHealth group. Patients using mHealth showed decreased incidence rate ratios of hypoglycemia 3.0 mmol/L [<54 mg/dl], hypoglycemia ranging from 3.0 to 3.8 mmol/L [54 to 70 mg/dl] and severe hypoglycemia. The level of satisfaction assessed using the ITSQ was higher in the mHealth group. Conclusion: Using mHealth in patients with DM2 transitioning from inpatient to outpatient care improves metabolic control and may reduce the hypoglycemia rates

Medio ambiente, sociedad, ética, auditoría y educación. La Investigación Contable en UNIMINUTO Virtual y a Distancia: Contexto y Oportunidades.

En los últimos años la educación a distancia ha mostrado ser capaz de reducir la brecha de inequidad social, de capacitar personas en lugares remotos, de brindar la posibilidad a la comunidad discapacitada y de permitirle a quienes no cuentan con suficientes recursos económicos acceder a la educación superior, la presente investigación da cuenta de los aspectos clave asociados a la decisión de matricularse en el programa de Contaduría Pública en la modalidad distancia tradicional. Se realizó un análisis de las narrativas basado en los resultados de un instrumento aplicado a 150 estudiantes. Para el análisis de datos se empleó la herramienta SenseMaker®. Los resultados evidencian aspectos personales, sociales y culturales que posicionan la oferta de educación en la modalidad a distancia como la institución que permite resignificar la vida de las persona

Medio ambiente, sociedad, ética, auditoría y educación. La Investigación Contable en UNIMINUTO Virtual y a Distancia: Contexto y Oportunidades.

En los últimos años la educación a distancia ha mostrado ser capaz de reducir la brecha de inequidad social, de capacitar personas en lugares remotos, de brindar la posibilidad a la comunidad discapacitada y de permitirle a quienes no cuentan con suficientes recursos económicos acceder a la educación superior, la presente investigación da cuenta de los aspectos clave asociados a la decisión de matricularse en el programa de Contaduría Pública en la modalidad distancia tradicional. Se realizó un análisis de las narrativas basado en los resultados de un instrumento aplicado a 150 estudiantes. Para el análisis de datos se empleó la herramienta SenseMaker®. Los resultados evidencian aspectos personales, sociales y culturales que posicionan la oferta de educación en la modalidad a distancia como la institución que permite resignificar la vida de las persona

Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.En esta tesis se propone un nuevo método para estimar la dosis y el instante de inyección que genere el menor riesgo para una terapia intensiva de insulina. El sistema de dosificación utiliza un algoritmo de optimización para determinar la dosis de insulina y el instante de inyección que reduzcan al máximo el riesgo de hiperglucemia e hipoglucemia posprandial en pacientes diabéticos tipo 1. Para ello, el algoritmo aplica una metodología que cuantifica el riesgo de sufrir diferentes grados de hipoglucemia e hiperglucemia en estado postprandial inducida por la terapia de insulina de acuerdo a los parámetros de cada paciente. Aplicando análisis intervalar modal se predice el nivel de glucosa postprandial considerando la variabilidad intrapaciente y otras fuentes de incertidumbre. Con un planteamiento del peor caso se calcula una predicción más segura de posibles episodios de hiperglucemia e hipoglucemia inducida por la terapia de insulina en términos de dichas incertidumbres

Prediction of postprandial blood glucose under uncertainty and intra-patient variability in type 1 diabetes: a comparative study of three interval models,

The behavior of three insulin action and glucose kinetics models was assessed for an insulin therapy regime in the presence of patient variability. For this purpose, postprandial glucose in patients with type 1 diabetes was predicted by considering intra- and inter-patient variability using modal interval analysis. Equations to achieve optimal prediction are presented for models 1, 2 and 3, which are of increasing complexity. The model parameters were adjusted to reflect the “same” patient in the presence of variability. The glucose response envelope for model 1, the simplest insulin–glucose model assessed, included the responses of the other two models when a good fit of the model parameters was achieved. Thus, under variability, simple glucose–insulin models may be sufficient to describe patient dynamics in most situations.This work was partially supported by the Spanish Ministry of Science and Innovation through Grant DPI-2010-20764-C02, and by the Autonomous Government of Catalonia through Grant SGR 523.García Jaramillo, MA.; Calm, R.; Bondía Company, J.; Vehí, J. (2012). Prediction of postprandial blood glucose under uncertainty and intra-patient variability in type 1 diabetes: a comparative study of three interval models,. Computer Methods and Programs in Biomedicine. 108(1):993-1001. doi:10.1016/j.cmpb.2012.04.003S9931001108