Propuesta de lineamientos estratégicos orientados a intensificar la cobertura actual de mercado de una empresa sustentada en economía circular

Trabajo final (Licenciatura en Administración con orientación en Dirección General y Comercialización)Propósito: Brindar una propuesta de lineamientos estratégicos a la empresa sustentada en los principios de la Economía Circular orientados a intensificar la cobertura actual de mercado en el barrio de Nueva Córdoba, ya que en dicha zona se recolecta una proporción de bolsas que duplica el volumen total proveniente de zona norte. Metodología: Se desarrollaron entrevistas semiestructuradas tanto a socios como a empleados de la empresa, seguido por cuestionarios destinados a los responsables de los puntos de recolección y a los consumidores. Se identificaron los factores claves de éxito del sector, se realizó un mapa de posiciones competitivas y además un análisis descriptivo de los consumidores con el propósito de identificar los segmentos objetivos. Por último, se propuso lineamientos estratégicos en conjunto con un cuadro de mando integral e indicadores como mecanismo de control y evaluación. Conclusiones: Finalmente se arribó al resultado de que es de vital importancia determinar un marco estratégico sólido para el logro del objetivo de intensificar su cobertura actual de mercado en el barrio de Nueva Córdoba. A tal fin se identificaron los factores claves de éxito de la industria, el posicionamiento competitivo de la empresa y los segmentos objetivos de mercado para impulsar el crecimiento, el volumen procesado y, por lo tanto, la rentabilidad de la organización. Limitaciones: Es posible destacar la resistencia en los miembros de la organización a compartir información relevante, además la muestra tomada puede ignorar algún atributo clave y, por último, los riesgos a posibles sesgos en la información relevada.Fil: Astrada, Irina Trinidad. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina.Fil: Bassi, Camila Soledad. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina.Fil: Bonaventura, Antonella. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina.Fil: Garnero, Florencia Elizabeth. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas; Argentina

Craneotomía en paciente despierto para la resección de glioma en institución con escasos recursos.

Objective The aim of this study is to present a case of intracranial surgery in a 46-year-old male patient for the removal of a low-grade glioma located in the right frontotemporo-insular region with the patient awake during the procedure. In this case the asleep-awake-awake anesthetic technique was used, securing the airway with supraglottic device. Materials and Methods. A review of the literature was performed in databases such as UpToDate, PubMed and ScienceDirect. Discussion Awake surgery, complemented with intraoperative cortical and subcortical stimulation, has been shown to improve the degree of tumor resection and decrease morbidity. However, despite its efficacy and safety, it is used in less than 22% of glioma surgeries, particularly in middle/low-income countries. Conclusion Awake craniectomy is a feasible procedure to perform in resource-poor countries with promising results, low incidence of complications and technical failures.Objetivo El objetivo es presentar un caso de cirugía intracraneal en un paciente masculino de 46 años para la extirpación de glioma de bajo grado ubicado en la región fronto-temporo-insular derecha con el paciente despierto durante el procedimiento. En este caso se utilizó la técnica anestésica dormido-despierto-dormido, vía aérea asegurada con dispositivo supraglótico. Materiales y métodos Se realizó una revisión de la literatura en bases de datos como UpToDate, PubMed y ScienceDirect. Discusión La cirugía en paciente despierto ha demostrado mejorar el grado de resección tumoral y disminuir la morbilidad. Sin embargo, a pesar de su eficacia y seguridad, se utiliza en menos del 22% de las cirugías de gliomas, particularmente, en aquellos países de medianos/bajos ingresos. Conclusión La craniectomía en paciente despierto es un procedimiento factible de realizar en países de escasos recursos, con una baja incidencia de complicaciones, fallas técnicas y resultados prometedores

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society