Factores de riesgo de fuga en anastomosis colo-rectales mecánicas tras cirugía oncológica. Importancia del Factor Cirujano.

Introducción: El cáncer colo-rectal es la tercera neoplasia más común y la segunda causa de mortalidad por cáncer en los países desarrollados. La anastomosis primaria es la norma tras la cirugía exerética, y la fuga anastomótica (FA) es la complicación postoperatoria más importante en este tipo de intervención porque se ha demostrado que aumenta la morbimortalidad y los costes y parece aumentar la tasa de recidiva tumoral a nivel local y disminuir la supervivencia global. En la literatura se han identificado numerosos posibles factores de riesgo de la FA; algunos de ellos están relacionados con el paciente, otros con el tumor y otros también con el factor cirujano tanto a nivel general como individual, sobre todo, el volumen de pacientes intervenidos por cada cirujano y su grado de especialización colo-rectal. Hipótesis: el factor cirujano como individuo puede ser una variable pronóstica con un mayor impacto que otros factores de riesgo de FA ya conocidos. Objetivo: Los objetivos primordiales para confirmar la hipótesis de trabajo son determinar la tasa de FA en los pacientes operados de cáncer de colon izquierdo y recto en el centro así como los factores de riesgo de FA que favorecerían la misma, con especial atención en la influencia del factor cirujano a nivel individual. Método: Se analizaron un total de 800 pacientes consecutivos durante el periodo del estudio (entre enero de 1993 y diciembre de 2009); son intervenidos quirúrgicamente de forma programada o urgente diferida por los cirujanos de una unidad de cirugía colo-rectal de un hospital terciario tras diagnóstico de cáncer de colon izquierdo, sigma o recto. A todos ellos se les realizó una exéresis oncológica con posterior anastomosis intestinal mecánica según la técnica de doble grapado. Se registraron los datos demográficos, tumorales y quirúrgicos de cada paciente, así como los índices ASA (American Society of Anesthesiologists) y POSSUM (Physiological and Operative Severity Score for the en Umeration of Mortality and Morbidity), las complicaciones registradas en el postoperatorio y los resultados de cada cirujano de forma individual. Resultados: Se objetivó una FA durante el estudio en 48 pacientes (6,0%); de éstos, 38 (79,2 %) presentaron una FA mayor. Fallecieron 20 pacientes (2,5%) y, de ellos, 7 (35,0%) secundariamente a una FA. Tras el análisis estadístico de los posibles factores de riesgo de FA alcanzan la significación el hábito tabáquico, la diabetes mellitus, la necesidad de transfusión, el tiempo operatorio y el factor cirujano a nivel individual. El factor cirujano es el factor de riesgo que más parece aumentar la probabilidad de FA (hasta en 13 veces) y este efecto es independiente del volumen de pacientes intervenidos por cada cirujano y de sus características. Conclusiones: La tasa de FA en las anastomosis de colon izquierdo y recto de esta serie es del 6% y la de mortalidad por FA del 0,9%. Se asocian a un aumento de probabilidad de FA la diabetes, el hábito tabáquico, la necesidad de transfusión, el tiempo operatorio prolongado y el factor cirujano a nivel individual. Este último es el factor que más influye independientemente de las características de los pacientes y del volumen de intervenciones quirúrgicas realizadas por los distintos cirujanos.Introduction: the colorectal cancer is the third most common malignancy and the second leading cause of cancer mortality in the developed countries. Primary anastomosis is the norm after excisional surgery and the anastomotic leakage (AL) is the most important complication in the postoperative period. It is well stablished that AL increases both morbidity, mortality and overall demand on hospital resources (namely, critical care, patient stay and costs) and also it appears both to increase the local tumor recurrence rate and to lower the survival rate. As shown in the available literature, there are numerous AL potential risk factors; some of them depend on the patient, some others on the tumor characteristics and finally a number of them on the surgeon himself, in a double way: globally, as indicated by the volume of patients treated by each one of them, and individually, depending on the degree of his/her colorectal specialization. Hypothesis: the AL risk factor associated with a particular surgeon (surgeon factor) can be a much more significant predictor of AL than any other AL risk factors already known. Objective: There are two main tasks to do to confirm the hypothesis of this Doctoral Thesis. The first one is to determine the rate of AL in all patients undergoing left colon and rectal cancer surgery in a same Hospital. The second one is to identify all possible AL risk factors, focussing specially on the surgeon factor. Matherial and Method: A whole population of 800 consecutive patients dating from January 1993 till December 2009 is analyzed in this study. All of them were diagnosticated of left, sigmoid colon or rectum cancer and then operated according with a schedulled surgery protocol. All patients underwent oncologic resection and the subsequent mechanical intestinal anastomosis, which were made following the double stapling technique. Demographic, tumor and surgical data of each patient and the ASA (American Society of Anesthesiologists) and POSSUM (Physiological and Operative Severity Score for the in Umeration of Mortality and Morbidity) indices were recorded and also complications and postoperative results of each particular surgeon. Results: The statistical findings of this Doctoral Thesis show a 6.0% AL rate (48 patients of the whole population) having 38 of them (79.2%) a major FA. The mortality rate was found to be a 2.5% (20 patients) and 7 of them (35.0%) secondary to AL. Smoking, diabetes mellitus, transfusion requirements, operative time and particular surgeon factor are identified by multivariate regression analysis as significantly related to the occurrence of AL. The particular surgeon factor is the most determinant risk factor to increase the likelihood of AL (up to 13 times) and this effect is independent of the volume of patients treated by each surgeon and their characteristics. Conclusions: The prevalence of AL in the anastomosis of left colon and rectum in the analised population of patients reaches a 6% and the observed mortality scores a 0.9%. Diabetes, smoking, need for transfusion, prolongated surgery time and particular surgeon factor are associated with an increased likelihood of AL. Indeed particular surgeon factor is the most influential risk factor of AL regardless of the characteristics of the patients and the volume of surgical procedures performed by each individual surgeon

Global satisfaction within a university subject (organizational behavior and change management) After using project based learning in times of covid-19

[EN] Project-based learning (PBL) is a learning methodology in which students take an active role and academic motivation is encouraged. The method consists of carrying out a project generally in a group, in which the theoretical concepts that give content to the teaching load of the subject are applied, and which has an eminently practical component. In the subject "Organizational Behavior and Change Management" where PBL has been applied in previous courses, we have evaluated the impact of the use of PBL in the confinement situation derived from the COVID-19 pandemic in which classes have moved to taught telematically in the middle of the school calendar and in an unexpected and unplanned way. The results confirm that PBL is an effective and more efficient methodology if possible, in these circumstances. Through direct and anonymous surveys to the students of the subject of this course, the impact of the use of PBL is evaluated both before and after the establishment of confinement and the move to online teaching.Guerola-Navarro, V.; Oltra Badenes, RF.; Gil Gómez, H. (2020). Global satisfaction within a university subject (organizational behavior and change management) After using project based learning in times of covid-19. IATED Academy. 2155-2162. https://doi.org/10.21125/iceri.2020.0517S2155216

Performance of Ti-15Mo alloy obtained by powder metallurgy route weakly alloyed with Fe/Cr elements

[EN] Ti-15Mo alloy can be an excellent choice as a biomaterial for prostheses. This is due to the combination of good mechanical properties and biocompatibility. The Mo is a stabilizing element of the ß phase, which provides a smaller elastic modulus, reducing the risk of stress shielding that induces bone resorption. The present work shows the effect of minor additions of Fe or Cr on flexural fracture toughness in Ti-15Mo alloys obtained by Powder Metallurgy. The electrochemical results indicated that the Ti-15Mo-1Cr, showed greater resistance to corrosion, related to lower ß grain size, less porosity content compared to the other conditions. As the Ti-15Mo-1Fe and Ti-15Mo-3Fe presented more porosity in their microstructure, the saline composition inside the pores is different in concentration and thus makes diffusion difficult compared to other regular and more homogeneous zones. Besides, was verified the effect of the large grain size that decrease the corrosion resistance of the Ti-15Mo-3Cr, demonstrated two influences in the corrosion resistance, porosity and grain size. Toughness decreases with the addition of both elements, more pronounced with Fe than Cr. It is related with lower densification, higher porosity and greater proportion of phase ¿ in grain boundary due to the higher resistance of diffusion of Mo in Ti when Fe is present, which leads to failure by brittle fracture at lower shear stresses.Correa Rossi, M.; López Navarro, P.; Vicente-Escuder, Á.; Amigó, V.; Segovia-López, F. (2022). Performance of Ti-15Mo alloy obtained by powder metallurgy route weakly alloyed with Fe/Cr elements. Social Science Research Network. 1-28. https://doi.org/10.2139/ssrn.400776212

Improving the student transversal competence "Effective oral communication" in the University subject "Introduction to Business Administration"

[EN] Given that the Effective Oral Communication is a fundamental transversal competence for the personal and professional development of any student whose objective is to develop their professional future within a Company, any effort to improve the students' ability to understand their environment is very useful, to synthesize ideas about the information it receives and with which it deals, to expose the conclusions or thoughts about it, and to defend those ideas and discuss them in public if necessary. In the Degree in Business Administration and Management there are many subjects focused on knowing the economic fundamentals for decision making in companies. But the impact of the use of this economic knowledge in decision making seems to be less if the Business Decision Maker is not able to communicate and transmit clearly and effectively their thoughts and decisions [1]. This article aims to establish a development plan for the transversal competence "Effective Oral Communication" to implement during the first course of the subject Introduction to Business Administration in the Degree of Business Administration and Management of the Higher Polytechnic School of Alcoy (EPSA). The expected outcome is a development plan together with assessment surveys through which the students assess the effectiveness of this plan.Guerola-Navarro, V.; Oltra Badenes, RF.; Gil Gómez, H. (2019). Improving the student transversal competence "Effective oral communication" in the University subject "Introduction to Business Administration". IATED. 295-302. https://doi.org/10.21125/iceri.2019.0114S29530

Two different approaches to Organizational Behavior from the perspective of Digital Humanism in the search of Sustainable Development Goal number 8 “Decent work and economic growth”

[EN] Digital Humanism is one of the most relevant trends within the Digital Transformation processes in companies that carry out their activity based on the motivation and empowerment of the group's potentialities over individualities. This trend of humanistic management in an increasingly technical business environment is directly linked to the management theories of Organizational Behavior. Taking advantage of the potential for the development of practical activities within the university subject "Organizational Behavior and Change Management", a contrast plan has been designed and executed for two management models of personal assets, both real and operational in two real companies, and both companies of the same sector and size and with comparable commercial targets (potential clients) (with similar characteristics) but in very different geographical locations. The objective is to detect which are the pillars on which both companies, both in the technology sector (Information and Communication Technology consulting) and therefore highly technical and experienced in digital transformation processes, build their mechanisms for loyalty of their employees and of taking advantage of their capacities within the corresponding work teams. Both companies have the care and attention of their employees among their highest priorities. This activity is linked to the implementation of initiatives aimed at achieving Sustainable Development Goal (SDG) number 8, defined as "Decent work and economic growth" and which aims to stimulate sustainable economic growth by increasing the levels of productivity and technological innovation, seeking to dignify the work of men and women. The conclusions show that, despite the fact that both approaches (of success contrasted by the low turnover rate of its employees) are different, there is a nexus of union and convergence through certain common elements, among which are: Communication, Participation, Motivation and trust.Guerola-Navarro, V.; Oltra Badenes, RF.; Gil-Gomez, H. (2022). Two different approaches to Organizational Behavior from the perspective of Digital Humanism in the search of Sustainable Development Goal number 8 “Decent work and economic growth”. En Proceedings INNODOCT/21. International Conference on Innovation, Documentation and Education. Editorial Universitat Politècnica de València. 29-39. https://doi.org/10.4995/INN2021.2021.13311293

Activity proposal for the improvement of transversal competence “Knowledge of contemporary problems” in a university subject

[EN] The sole proprietorship enterprise, in its legal form of Autonomous Worker, is one of the most frequent and important today. Both for its tax obligations, as for the specific functional and management characteristics, as well as for its relevance in the services sector, it is interesting for the students to know and to assess their details and peculiarities In the planning guide of very few subjects the special characteristics of this business model are detailed, so we think it is interesting to dedicate a practical session to know how different the management of an Autonomous Worker is from that of the rest of corporate legal forms. We sincerely believe that this practical session could improve the learning of the transversal competence “Knowledge of Contemporary Problems” by the students. We also believe that this will be a very interesting experience that will familiarize students with a business reality that they will undoubtedly find in the near future. We propose that the most appropriate format for this teaching activity is that of Active Learning, since it implies a greater active participation of students, with the expectation therefore of better learning outcomes. In this specific case, we propose that an Autonomous Worker, with some academic training in management and administration, attends to the practical session with the students of the subject, and a practical workshop is held in which simulate different aspects of working life and Business of an Autonomous Worker. The result of this activity proposal, and its greatest novelty with respect to other teaching courses, is the proposal of 7 concrete and specific blocks to work with students in "group dynamics" format, as well as the presence of an experienced external speaker with academic training enough, so that students effectively reach the development of the skill that this competence proposes. With that, students are expected to get actively involved and to learn what the professional life of this type of business model is.Guerola Navarro, V.; Gil Gómez, H.; Oltra Badenes, RF. (2021). Activity proposal for the improvement of transversal competence “Knowledge of contemporary problems” in a university subject. En Proceedings INNODOCT/20. International Conference on Innovation, Documentation and Education. Editorial Universitat Politècnica de València. 41-51. https://doi.org/10.4995/INN2020.2020.11792OCS415

Is It Possible to Manage the Product Recovery Processes in an ERP? Analysis of Functional Needs

[EN] In today's business environment, different factors make product return and product recovery increasingly more important in order to recover value and increase the company's profitability. In such an environment, where sustainability concerns and awareness of environmental responsibility in industrial production has considerably grown, reverse logistics (RL) becomes more relevant and, thus, its correct management using suitable information systems (IS) is fundamental. Nevertheless, today's IS in general, and in Enterprise Resources Planning (ERP) in particular, are developed based on conventional logistic processes that do not contemplate the specific characteristics of RL. The main objective of this work is to analyze the functional requirements of an IS to manage product recovery processes that serve as a guide to develop a suitable ERP for RL. The research methodology has been conducted with a qualitative approach, through which the main specific requirements that an IS must meet to manage RL have been stablished, and a data model for the development of solutions to the requirements identified in an ERP system has been proposed. For the development in the ERP it is recommended to start with the requirement of RBOM (Reverse Bill Of Materials) management, since it is the most complex development and has a greater relationship with the rest.Oltra Badenes, RF.; Gil Gómez, H.; Guerola-Navarro, V.; Vicedo, P. (2019). Is It Possible to Manage the Product Recovery Processes in an ERP? Analysis of Functional Needs. Sustainability. 11(16):1-16. https://doi.org/10.3390/su11164380S116111

Customer relationship management and its impact on entrepreneurial marketing: a literature review

[EN] Entrepreneurship is one of the business forces with the greatest power to transform today's society, due to its ability to discover and take advantage of new opportunities to satisfy customer new and changing needs and expectations. Customer relationship management (CRM) has proved to be both a highly influential business management strategy and a powerful business management technology solution, with a particularly relevant impact in the area of entrepreneurship. CRM has helped drive growth and future expectations and has had excellent results in terms of return on investment wherever it has been implemented. An exhaustive review of previously published findings in a specific subject area can uncover new lines of research. This paper uses semi-systematic review to the study of the reality of the link between CRM and entrepreneurial marketing in business. This approach is used to comprehensively describe the state of the art of the impact that CRM can have in the modern business environment, through the empowerment of entrepreneurial marketing. In a structured manner, the present paper reviews the 86 most relevant studies of how CRM affects entrepreneurial marketing policy development through its alignment with relationship marketing and customer-centric business models. The growing use of CRM in companies is one of the pillars of technological and social change in entrepreneurship, being a clear example of how big data can benefit society. The study focuses on the period from 2015 to 2019.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.Guerola-Navarro, V.; Gil Gómez, H.; Oltra Badenes, RF.; Soto-Acosta, P. (2022). Customer relationship management and its impact on entrepreneurial marketing: a literature review. International Entrepreneurship and Management Journal. 1-41. https://doi.org/10.1007/s11365-022-00800-x14

Experience of external collaboration in Organizational Behavior and Change Management subject in practical lesson

[EN] University students are used to attend traditional sessions where the teacher explains theoretical lessons, the contents of which are then applied in practical sessions with identical scripts established to follow the same scheme in practice and theory. This scheme of operation has been traditionally followed, but in some cases, it has caused fatigue and lack of motivation to the students. In the subject ¿Organizational Behavior and Change Management¿ (formerly ¿Comportamiento Organizativo y Gestión del Cambio¿) in the Degree of Informatics Engineering, we have been getting some feedback from students on how to improve the results of the students learning results [1]. Consequently to the received feedback, we have decided to put into practice the participation of external speakers (with high experience in topics related to the subject) that show students the most important values of the content of the subject learning guide, through dynamic group discussion sessions where different topics from those studied in the theoretical sessions are discussed in practical sessions. In this paper we propose the participation of external speakers in practical sessions, as a way to break the routine of academic courses (where teacher of the subject is usually the only speaker in both practical and theoretical sessions). We want to assess the impact that this breakage of the routine can cause in the improvement of the student's perception regarding the evolution of the classes. The second impact that we want to measure is how it affects the motivation of the students, in the practical sessions, the proposal of topics of debate very different from the theoretical themes of the subject, but at the same time directly related to the subject itself. In summary, the expected result of this practical research activity is the evaluation of how students react to these unexpected practical sessions, in an unexpected environment, and with unexpected speakers. This impact will be measured based on the improvement of the assessment that students show as a result of their practical learning.Guerola-Navarro, V.; Oltra Badenes, RF.; Gil Gómez, H.; Herrero-Casanova, M. (2019). Experience of external collaboration in Organizational Behavior and Change Management subject in practical lesson. IATED. 289-294. https://doi.org/10.21125/iceri.2019.0113S28929