Supply chain management y logística en la empresa Confecciones María José Ltda.

El presente trabajo hace una relación de la temática revisada y del conocimiento adquirido en el curso de Supply Chain Management y la logística, para lo cual se tomó como referencia una empresa real denominada Confecciones María José Ltda., cuya actividad comercial es la transformación telas en ropa para el sector industrial, así como la distribución de los productos terminados, en la cual se realizó la red estructural, la estructura genérica y además la aplicación de los procesos estratégicos en Supply Chain Management, en la empresa objeto de estudioThe present work makes a relation of the reviewed subject and of the knowledge acquired in the course of Supply Chain Management and the logistics, for which a real company denominated CONFECCIONES MARIA JOSE Ltda., Whose commercial activity is the transformation fabrics in clothing for the industrial sector, as well as the distribution of finished products, in which the Structural Network, the Generic Structure was made and also the application of the strategic processes in Supply Chain Management, in the company under stud

Research on missed nursing care during the COVID-19 pandemic: A scoping review

COVID-19; Atenció d'infermeria perduda; Atenció al pacientCOVID-19; Atención de enfermería perdida; Atención al pacienteCOVID-19; Missed nursing care; Patient careAbstract Background: Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. Aim: This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. Methods: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. Results: We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. Linking Evidence to Action: Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

New TNM staging in lung cancer (8th edition) and future perspectives

Background: Carrying out a correct anatomical classification of lung cancer is crucial to take clinical and therapeutic decisions in each patient. Aim: TNM staging classification provides an accurate anatomical description about the extension of the disease; however, the anatomical burden of the disease is just one aspect that changes the prognosis. Relevance for patients: TNM staging classification is a tool that predicts survival, but we must consider that TNM is just one of the factors that concern the prognosis. The impact of a factor over the prognosis is complex due to: It depends on the specific environment, the treatment strategy, among others, and our level of certainty makes difficult to include all the factors just in a group of stages. In some groups, there are difficulties to get large series due to the low frequency of cases and the small number of events (metastasis, locoregional recurrence). It does not allow to obtain evidence in a short period of time. On the other hand, in the next years, new markers will be incorporated in the coming years, which are going to be included in the new TNM classification. It could help to improve the classification giving more information about prognosis and risk of recurrence. All these aspects are being used by the International Association for the Study of Lung Cancer (IASLC) to develop a new prognosis model. This continues the evolution of TNM system, allows us to overcome the difficulties, and build a flexible framework enough to continue improving the individual prognosis of the patients

Plastic-body arts, pedagogical strategy to reduce aggressive behaviors in children from 4 to 5 years old

Este documento hace referencia al Arte en Procesos de Aprendizaje de la Fundación Universitaria Los Libertadores (PIE), al vincular el desarrollo artístico con los procesos de aprendizaje en la primera infancia. El principal objetivo es influir positivamente en la población de niños de 4 y 5 años del CDI Los Alpes de la ciudad de Magdalena Santa Marta, Magdalena, a través de la transformación de conductas agresivas dadas dentro de la institución durante el desarrollo de las actividades pedagógicas diarias, tal impacto se logró por medio del fomento de las artes plásticas corporales, como estrategias pedagógicas reguladoras de la conducta, en búsqueda de disminuir la problemática. Para tal efecto, se logró promoviendo las artes plásticas-corporal como estrategias pedagógicas para regular el comportamiento en un intento de reducir el problema. Para ello se creó una metodología basada en un enfoque cualitativo, que permitió percibir la realidad social de los individuos de manera interpretativa, debido a que el comportamiento fue analizado de manera observacional y descriptiva, vinculado a un tipo de investigación acción. que permitió describir, identificar e implementar, acciones pertinentes para mitigar problemas en el ámbito educativo. Los resultados mostraron conductas agresivas, hostiles, desafiantes e interrupción en el aula y agresión proyectada a la figura de autoridad, provocando alteraciones en el ambiente escolar, frente a estos accionantes conductuales, se implementó la aplicabilidad de estrategias pedagógicas asociadas a las artes plásticas – corporales que permitieron cambiar el comportamiento de los niños y regular los procesos de agresión e impulsos, así como estudiar sus sentimientos y emociones, creando procesos favorables de interacción social. En conclusión, se puede afirmar que la implementación de estrategias pedagógicas del arte plástico corporal es un aspecto favorable para cambiar el comportamiento de los niños, si queremos mitigar el surgimiento de las prácticas agresivas antes mencionadas en los procesos educativos.This document refers to Art in Learning Processes of the Los Libertadores University Foundation (PIE), which aims to link artistic development with learning processes in early childhood. The main objective is to positively influence the population of 4 and 5 year old children at CDI Los Alpes in the city of Magdalena Santa Marta, Magdalena, through the transformation of aggressive behaviors within the institution during the development of pedagogical activities. daily, such an impact was achieved through the promotion of the plastic-corporal arts, as pedagogical strategies that regulate behavior, in search of reducing the problem. To this end, it was achieved by promoting plastic body art as pedagogical strategies to regulate behavior in an attempt to reduce the problem. For this, a methodology was created based on a qualitative approach, which allowed the social reality of individuals to be perceived in an interpretive manner, because the behavior was analyzed in an observational and descriptive manner, linked to a type of action research. which allowed us to describe, identify and implement relevant actions to mitigate problems in the educational field. The results showed aggressive, hostile, challenging behaviors and interruption in the classroom and aggression projected towards the authority figure, causing alterations in the school environment. In the face of these behavioral triggers, the applicability of pedagogical strategies associated with the plastic arts - body was implemented. that allowed children to change their behavior and regulate the processes of aggression and impulses, as well as study their feelings and emotions, creating favorable processes of social interaction. In conclusion, it can be stated that the implementation of pedagogical strategies of plastic body art is a favorable aspect to change the behavior of children, if we want to mitigate the emergence of the aforementioned aggressive practices in educational processes

Phages and enzybiotics in food biopreservation

Presently, biopreservation through protective bacterial cultures and their antimicrobial products or using antibacterial compounds derived from plants are proposed as feasible strategies to maintain the long shelf-life of products. Another emerging category of food biopreservatives are bacteriophages or their antibacterial enzymes called “phage lysins” or “enzybiotics”, which can be used directly as antibacterial agents due to their ability to act on the membranes of bacteria and destroy them. Bacteriophages are an alternative to antimicrobials in the fight against bacteria, mainly because they have a practically unique host range that gives them great specificity. In addition to their potential ability to specifically control strains of pathogenic bacteria, their use does not generate a negative environmental impact as in the case of antibiotics. Both phages and their enzymes can favor a reduction in antibiotic use, which is desirable given the alarming increase in resistance to antibiotics used not only in human medicine but also in veterinary medicine, agriculture, and in general all processes of manufacturing, preservation, and distribution of food. We present here an overview of the scientific background of phages and enzybiotics in the food industry, as well as food applications of these biopreservatives.SODERCAN | Ref. RH20-XX-032, FAGOFOO

Use of gonadotropins in ovarian stimulation in Spain: Delphi consensus

Two-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Müllerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150–300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients’ comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment.IMPACT STATEMENT What is already known on this subject? There is currently no consensus on the optimal treatment for controlled ovarian stimulation for patients undergoing IVF which leads to highly variable clinical practices. What the results of this study add? This study’s strong point is that, since it is a consensus, it has been possible to include more topics than would normally be dealt with in a systematic review or guidelines, which are generally based on a strict method that restricts the scope of the research. Experts have reached a consensus on most of the statements and based on these they have issued consensus statements that will enable the optimal use of gonadotropins in IVF. What the implications are of these findings for clinical practice and/or further research? This Delphi consensus provides a real-life clinical perspective on gonadotropin usage in IVF

Differences in Survival of Patients With COPD According to the New GesEPOC 2021 Classification of Phenotypes

Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory pathology with high prevalence, morbidity and mortality. The Spanish COPD guideline (GesEPOC) recommends individualizing treatment according to phenotypes. The phenotype classification was updated in 2021. This study aimed to determine the survival of patients by this new classification and compare the predictive capacity of mortality compared to the previous version. Methods: This observational study of COPD patients involved prospective follow-up for 6 years. Demographic and clinical data were collected at the beginning and evolutionary data at the end of the study. Patients were classified according to GesEPOC 2017 and GesEPOC 2021. Univariate survival analysis and multivariate analysis identified mortality risk factors. Results: Of the 273 patients, 243 (89.0%) were male. Ninety-three patients (34.1%) died during follow-up. Regarding phenotypes, 190 patients (69.6%) were non-exacerbators, 69 (25.3%) belonged to the non-eosinophilic exacerbator phenotype and 14 (5.1%) were of the eosinophilic exacerbator phenotype. Compared with non-exacerbator patients, those with the non-eosinophilic exacerbator phenotype had lower survival (p = 0.009). Risk factors independently associated with mortality were older age (p < 0.001), non-eosinophilic exacerbator phenotype (p = 0.017) and a high Charlson index score (p < 0.001). The new classification presented a worse ability to predict mortality than the previous version (area under the curve 0.632 vs 0.566, p = 0.018). Conclusion: Patients with the non-eosinophilic exacerbator phenotype had worse prognoses. This phenotype, advanced age and high comorbidity were mortality risk factors. The GesEPOC 2021 classification predicts mortality worse than the 2017 version. These data must be considered for more individualized management of COPD patients. Resumen: Introducción: La enfermedad obstructiva crónica (EPOC) es una patología respiratoria con elevada prevalencia y alta morbimortalidad. La guía española de la EPOC (GesEPOC) recomienda individualizar el tratamiento según fenotipos. En su última actualización en 2021, se ha actualizado la clasificación de fenotipos. Se realiza este estudio para conocer la supervivencia de los pacientes sobre esta nueva clasificación y para comparar la capacidad predictiva de mortalidad con respecto a la versión previa. Métodos: Estudio observacional de pacientes con EPOC con un seguimiento prospectivo durante 6 años. Se recogieron datos demográficos y clínicos al inicio y datos evolutivos al final del estudio. Se clasificó a los pacientes según GesEPOC 2017 y GesEPOC 2021. Se realizó un análisis univariante de supervivencia y un análisis multivariante para identificar factores de riesgo de mortalidad. Resultados: Del los 273 pacientes, 243 (89,0%) eran varones. Fallecieron 93 sujetos (34,1%) durante el seguimiento. En cuanto a los fenotipos, 190 pacientes (69,6%) eran no agudizadores, 69 (25,3%) pertenecían al fenotipo agudizador no eosinofílico, y 14 (5,1%) eran del fenotipo agudizador eosinofílico. Comparando con los enfermos no agudizadores, los del fenotipo agudizador no eosinofílico tuvieron una menor supervivencia (p = 0,009). Los factores de riesgo independientemente asociados a la mortalidad fueron la edad avanzada (p < 0,001), el fenotipo agudizador no eosinofílico (p = 0,017) y una puntuación elevada en el índice de Charlson (p < 0,001). La nueva clasificación presentó una peor capacidad para predecir mortalidad en comparación con la versión previa (área bajo curva 0,632 vs 0,566, p = 0,018). Conclusión: Los pacientes del fenotipo agudizador no eosinofílico tenían peor pronóstico. Este fenotipo, junto con la edad avanzada y la elevada comorbilidad, fueron factores de riesgo de mortalidad. La clasificación GesEPOC 2021 predice peor la mortalidad con respecto a la versión de 2017. Es importante tener estos datos en cuenta para ofrecer un manejo más individualizado a los pacientes con EPOC

Large T cell clones expressing immune checkpoints increase during multiple myeloma evolution and predict treatment resistance

Tumor recognition by T cells is essential for antitumor immunity. A comprehensive characterization of T cell diversity may be key to understanding the success of immunomodulatory drugs and failure of PD-1 blockade in tumors such as multiple myeloma (MM). Here, we use single-cell RNA and T cell receptor sequencing to characterize bone marrow T cells from healthy adults (n = 4) and patients with precursor (n = 8) and full-blown MM (n = 10). Large T cell clones from patients with MM expressed multiple immune checkpoints, suggesting a potentially dysfunctional phenotype. Dual targeting of PD-1 + LAG3 or PD-1 + TIGIT partially restored their function in mice with MM. We identify phenotypic hallmarks of large intratumoral T cell clones, and demonstrate that the CD27 and CD27 T cell ratio, measured by flow cytometry, may serve as a surrogate of clonal T cell expansions and an independent prognostic factor in 543 patients with MM treated with lenalidomide-based treatment combinations

Resultados de la estadificación clínica ganglionar mediastínica del cáncer pulmonar quirúrgico: datos de la cohorte prospectiva nacional del Grupo Español de Cirugía Torácica Videoasistida

Introducción: El objetivo del estudio es valorar el rendimiento diagnóstico de la tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) en la estadificación clínica mediastínica del cáncer pulmonar quirúrgico según los datos de la cohorte prospectiva del Grupo Español de Cirugía Torácica Videoasistida (GEVATS). Métodos: Se han analizado 2.782 pacientes intervenidos por carcinoma pulmonar primario. Se ha estudiado el acierto diagnóstico en la estadificación mediastínica (cN2). Se ha realizado un análisis bivariante y multivariante de los factores que influyen en el acierto. Se ha estudiado el riesgo de pN2 inesperado en los factores con los que se recomienda una prueba invasiva de estadificación: cN1, tumor central o tamaño mayor de 3cm. Resultados: El acierto global de la TC y PET en conjunto es del 82,9% con VPP y VPN de 0,21 y 0,93. En tumores mayores de 3cm y a mayor SUVmax del mediastino, el acierto es menor, OR de 0,59 (0,44 - 0,79) y 0,71 (0,66 - 0,75), respectivamente. En el abordaje VATS el acierto es mayor, OR de 2,04 (1,52 - 2,73). El riesgo de pN2 inesperado aumenta con el número de los factores cN1, tumor central o tamaño mayor de 3cm: entre el 4,5% (0 factores) y 18,8% (3 factores), pero no hay diferencias significativas con la realización de prueba invasiva. Conclusiones: La TC y PET en conjunto tienen un elevado valor predictivo negativo. Su acierto global es menor en tumores mayores de 3cm y SUVmax del mediastino elevado, y mayor en el abordaje VATS. El riesgo de pN2 inesperado es mayor si cN1, tumor central o mayor de 3cm y no varía significativamente con prueba invasiva