Estudo da entrada de uma pequena empresa no segmento petrolífero

Neste artigo se buscou o estudo de uma empresa de pequeno porte que produz um produto inovador. Trata-se de uma empresa que tenta a inserção num segmento dominado por grandes empresas multinacionais. Parte-se de um balanço da viabilidade econômica à condição de entrada no mercado de fornecimento de bens de capital para a indústria de petróleo. A noção de rentabilidade foi realizada a partir de projeções de demonstrativos de resultados, fluxos de caixa e aplicação de ferramentas para a análise de viabilidade financeira, o que permite afirmar que do ponto de vista financeiro existe viabilidade do negócio e, portanto, à condição de entrada. Contudo, não basta à empresa um produto inovador e projeções positivas de fluxo de caixa quando tem diante de si limites impostos por variáveis diagnosticadas pela Teoria da Economia Industrial

A cadeia de suprimentos do setor de serviço:: o caso de uma empresa de saúde

A gestão da cadeia de suprimentos no setor de serviços médicos é uma área que possuí características singulares, que se diferenciam de acordo com o nível de customização, a intensidade de contato com o cliente, e a ênfase em pessoas ou equipamentos. O objetivo do trabalho foi analisar os desperdícios em uma empresa prestadora de serviços de saúde, situada no interior do Estado de São Paulo. O método de pesquisa foi um estudo de caso, com dados primários que incluem balanço patrimonial e demonstrativo de resultados, custos mensais, número de usuários, receita média, e produção mensal de serviços, fornecidos pela empresa focal, e através desse foi possível formular indicadores de desperdício da cadeia e a identificação dos principais pontos de desperdícios a serem monitorados. Quanto aos resultados, identificou no estudo que o acompanhamento dos desperdícios é fator determinante para que cada elo esteja apto a conseguir eficiência operacional, e consiga priorizar no aumento do valor agregado e satisfação do cliente. A pesquisa concluiu que a aplicação de indicadores para desperdício mostrou-se eficaz para o acompanhamento e controle da evolução da redução das perdas na cadeia

Indicadores-chave para medida de desempenho:: uma proposta para o caso das operadoras de planos de saúde

Embora a implementação e medição de indicadores seja uma forma de se controlar e gerenciar os negócios, as empresas do setor de serviços de saúde ainda carecem da disseminação e do uso de ferramentas para o controle de desempenho. Este trabalho é o resultado de uma pesquisa exploratória realizada numa operadora de planos de saúde. O foco do estudo foi uma análise de indicadores de gerenciamento e controle de gastos comparando perspectivas de diferentes abordagens. Com base em informações secundárias, obtidas no site da ANS, no site da instituição analisada, nos documentos averiguados e em material divulgado na imprensa, o método escolhido foi o estudo de caso da aplicação do Key Performance Indicator (KPI) e uma análise comparativa com o Balance Scorecard. A pesquisa concluiu que a implementação do KPI mostra-se uma ferramenta de gestão aderente às necessidades das empresas do segmento, uma vez que os indicadores levam em conta as especificidades da empresa, informando de forma clara e objetiva os aspectos importantes para o gerenciamento do negócio

Patient and disease pre-operative factors influencing surgical procedure choice for breast cancer treatment

Background/Objective: To address disparities of care in breast cancer treatment, it is important to understand pre‐operative factors that could affect the surgical decision‐making process. Methods: This prospective cohort study evaluates patient‐reported outcomes in women undergoing breast cancer treatment at a metropolitan health care system. Each new breast cancer case undergoes tumor board discussion, and patients have same‐day consultations with various specialties. Based on their procedure choice, women choose to complete pre‐ and post‐operative Breast‐Q© Breast‐ conserving Surgery (BCS), Mastectomy (M), or Reconstruction ® modules and demographic surveys. Individual effects of pre‐operative factors on procedure choice were assessed using ANOVA for continuous variables and chi‐squared for categorical. Significant factors (p≤0.05) were added to a multinomial logistic regression model. Results: A total of 375 women completed pre‐operative surveys (BCS=244, M=39, BR=92). Compared to BR, those chose BCS were older (RRR=1.094, p\u3c0.001) with larger BMIs (RRR=1.094, p=0.001), without a history of breast cancer (RRR=0.130 (yes vs. no), p=0.016), and Stage I disease (RRR=4.920, p\u3c0.001). Women making more than $200K (RRR=4.56x105 (vs. 35K), p\u3c0.0001) were also more likely to undergo BR. Compared to BCS, women undergoing neoadjuvant chemotherapy (RRR=3.591, p=0.047) and Stage II disease (RRR=4.238, p=0.040) were more likely to undergo mastectomy alone, whereas race, education, employment, and most incomes did not correlate with procedure choice. Conclusions: Our data suggest that racial and socioeconomic disparities in procedure type can be addressed by presenting equally effective surgical strategies to all patients in a multidisciplinary model that allows patients to interact with plastic surgeons, radiation oncologists, and surgical and medical oncologists

Patient factors that affect pre-operative patient-reported outcomes in women undergoing breast cancer surgery

Background/Objective: Understanding the impact of patient, disease, and treatment factors on pre‐ operative patient reported outcomes (PROs) is important to guide surgical decision‐making with breast cancer. Methods: This prospective cohort study evaluates PROs in women undergoing breast cancer treatment at a metropolitan health care system. New cases undergo tumor board discussion and same‐day consultations with various specialties. Women choose to complete pre‐ and post‐operative Breast‐Q© Breast‐conserving surgery (BCS), mastectomy (M), or reconstruction ® modules and demographic surveys. Individual associations to pre‐operative Breast‐Q survey scores were assessed using linear regression models (1 for each Breast‐Q survey type). Variables significant for at least 1 survey were included in multiple linear regression models. Results: A total of 375 women completed the pre‐operative surveys (BCS=244, M=39, BR=92). Procedure choice, laterality, race, marital status, employment, prior breast cancer, neoadjuvant chemotherapy, or history of radiation or chemotherapy did not impact PROs. Breast satisfaction decreased with higher BMI (est=‐0.367, p=0.045) and Stage II disease (est=‐11.011 (vs. Stage 0), p=0.008). Lower psychosocial score was associated with younger age (est=0.271, p=0.002), higher BMI (est=‐0.367, p=0.014), and income \u3c$35k (est=0.172 (vs. 35k+), p=0.016). Similarly, lower physical well‐being of the chest was associated with younger age (est=0.207, p=0.011), higher BMI (est=‐0.285, p=0.039), and income \u3c$35k (est=0.218 (vs. 35k+, p=0.039). Sexual well‐being decreased with higher BMI (est=‐0.545, p=0.004) and income \u3c$35k (est=0.135 (vs. 35k+), p=0.016). Conclusions: While factors such as age, BMI, and stage of disease are difficult to change prior to surgery, patients with lower income may need special interventions to assist them through the treatment process

Impactos preliminares da COVID-19 nas operadoras de grande porte da saúde suplementar brasileira: Preliminary Impacts of COVID-19 on Large Brazilian Supplementary Health Insurance Companies

Introdução – Esse estudo aborda dados preliminares dos efeitos da pandemia da covid-19 nas empresas privadas de grande porte de assistência de saúde. Para efeitos dessa pesquisa, foram consideradas as 5 maiores operadoras médico-hospitalares do brasil. Objetivo – Apresentar os resultados preliminares dos movimentos estratégicos das 5 maiores operadoras médico-hospitalares durante o período de pandemia da Covid19. Metodologia – O trabalho utilizou informações oriundas de fontes secundárias, com análise de conteúdos de publicações e da base de dados históricos da ANS, bem como dados apresentados no site das próprias empresas (internet e intranet, para análise descritiva dos impactos preliminares da COVID-19 nas operadoras selecionadas para o estudo. Resultados - Foi possível observar um discreto aumento no número de beneficiários das operadoras, e uma redução relevante na sinistralidade em 2020, em praticamente todas as empresas do setor. Diferentemente de outros anos, em que o crescimento de beneficiários era reflexo do aquecimento econômico nos setores produtivos no país, o movimento observado durante a pandemia está relacionado com o medo da população em não ter acesso aos recursos de saúde necessários caso afetada diretamente pela covid. A queda na sinistralidade tem relação com a redução no número de atendimentos médicos e de internações com procedimentos agendados, e impactaram na redução dos custos assistenciais. Conclusões - Os efeitos da pandemia ainda são de curtíssimo prazo, e não é possível afirmar que os resultados econômico-financeiros obtidos em 2020 serão mantidos, e nem que as empresas analisadas não serão mais afetadas pela crise num futuro próximo, porém os resultados indicam que pontualmente a pandemia trouxe novos beneficiários e redução nos custos das operadoras analisadas

Addressing COVID-19 in the surgical ICU: Incidence of antibodies in healthcare personnel at a quaternary care center

Background: There is concern that frontline healthcare personnel (HCP) are at increased risk of exposure to COVID-19 compared to the general population. Multiple studies have demonstrated significant seroprevalence of COVID-19 antibodies in HCP. Increased seropositivity has been associated with reduced use of personal protective equipment (PPE) along with reported PPE shortages. This investigation aims to determine the seroprevalence of COVID-19 in frontline HCP working at a quaternary care center that was heavily impacted by the initial surge of COVID-19, while also identifying underlying factors associated with increased seropositivity. Methods & Materials: HCP who participated in the management of COVID-19 patients were recruited from April 27 to May 13 of 2020. Unidentifiable demographic data was collected, including a questionnaire to identify potential exposure, symptoms, medical comorbidities, and adherence to PPE usage on a scale of 1 to 5 (1 being always, 5 being never). Serological testing was performed using CMC-19D SARS-CoV-2 (COVID-19) Rapid Antibody Test manufactured by Audacia Bioscience. Seropositivity was captured by formation of a dark band at the G (IgG) and C (control) positions on the test device, while IgM alone was considered a false positive. Pearson chi-squared and Fisher exact tests were performed to analyze categorical variables. SPSS version 27.0 was used for statistical analysis (SPSS, Armonk, NY). Conclusion: Overall seropositivity of IgG antibodies was 10.6%. Non-ICU personnel showed higher seroprevalence compared to ICU personnel, this may be attributed to decreased reported adherence to strict PPE usage in non-ICU areas compared to ICU areas during patient contact. Compared to MICU, SICU personnel appeared to be less compliant with frequency of PPE use outside patient rooms. Adherence to PPE usage outside patient contact was a predictor of seropositivity, and non-ICU personnel had a tendency toward high seroprevalence.https://scholarlycommons.henryford.com/sarcd2021/1003/thumbnail.jp

Relationship between neuropsychological and clinical aspects and suicide attempts in euthymic bipolar patients

Some studies have investigated the possible relationship between suicide attempts and impulsivity in patients with bipolar disorder. The objective of this study was to assess the relationship between neuro-psychological and clinical aspects and suicide behavior in euthymic bipolar patients. The Iowa Gambling Task and the Conner's Continuous Performance Test evaluated impulsivity in 95 euthymic bipolar patients - 42 suicide attempters and 115 normal control participants. A factorial analysis evaluated the adequacy of the instruments. Furthermore, a multiple regression analysis was done in order to develop a model to predict suicide attempts. Our results point to a specific type of impulsivity related to making decisions, lack of planning and borderline personality disorder comorbidity. This type of impulsivity is a risk factor for suicide attempts in patients with bipolar disorder

Tomografia de corpo todo no trauma e seus desfechos na mortalidade: uma revisão sistemática: Whole body tomography in trauma and its outcomes in mortality: a systematic review

A tomografia computadorizada de corpo inteiro é altamente sensível e representa o padrão-ouro no cenário de diagnóstico da sala de trauma. WBCT fornece uma ferramenta de diagnóstico rápido, que reduz a mortalidade em pacientes gravemente feridos. A lesão traumática é a terceira principal causa de morte em geral. Para otimizar os resultados nesses pacientes, os hospitais empregam imagens de tomografia computadorizada de corpo inteiro (WBCT) devido ao alto rendimento diagnóstico e potencial para identificar lesões perdidas. No entanto, isso atrasa intervenções de tempo crítico. Atualmente, há uma ausência de qualquer evidência de alto nível para apoiar ou refutar qualquer visão. Uma busca sistemática da literatura foi realizada nas bases de dados MEDLINE, Embase, Web of Science, Cochrane Library e demais bases dedados eletrônicas. As publicações eram elegíveis se contivessem dados originais comparando TC de corpo total imediata em pacientes com trauma e associação com a mortalidade. A análise mostra que a TC está associada a melhores resultados, incluindo uma menor taxa de mortalidade geral, entretanto estudos randomizados e controlados merecem ser realizados para que se possa estabelecer de forma fidedigna essa relação

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030