Delivery of drinking, eating and mobilising (DrEaMing) and its association with length of hospital stay after major noncardiac surgery: observational cohort study

BACKGROUND: Enhanced recovery pathways are associated with improved postoperative outcomes. However, as enhanced recovery pathways have become more complex and varied, compliance has reduced. The ‘DrEaMing’ bundle re-prioritises early postoperative delivery of drinking, eating, and mobilising. We investigated relationships between DrEaMing compliance, postoperative hospital length of stay (LOS), and complications in a prospective multicentre major surgical cohort. METHODS: We interrogated the UK Perioperative Quality Improvement Programme dataset. Analyses were conducted in four stages. In an exploratory cohort, we identified independent predictors of DrEaMing. We quantified the association between delivery of DrEaMing (and its component variables) and prolonged LOS in a homogenous colorectal subgroup and assessed generalisability in multispecialty patients. Finally, LOS and complications were compared across hospitals, stratified by DrEaMing compliance. RESULTS: The exploratory cohort comprised 22 218 records, the colorectal subgroup 7230, and the multispecialty subgroup 5713. DrEaMing compliance was 59% (13 112 patients), 60% (4341 patients), and 60% (3421), respectively, but varied substantially between hospitals. Delivery of DrEaMing predicted reduced odds of prolonged LOS in colorectal (odds ratio 0.51 [0.43–0.59], P<0.001) and multispecialty cohorts (odds ratio 0.47 [0.41–0.53], P<0.001). At the hospital level, complications were not the primary determinant of LOS after colorectal surgery, but consistent delivery of DrEaMing was associated with significantly shorter LOS. CONCLUSIONS: Delivery of bundled and unbundled DrEaMing was associated with substantial reductions in postoperative LOS, independent of the effects of confounder variables. Consistency of process delivery, and not complications, predicted shorter hospital-level LOS. DrEaMing may be adopted by perioperative health systems as a quality metric to support improved patient outcomes and reduced LOS

The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery

INTRODUCTION: Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. METHODS AND ANALYSIS: The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients' outcomes, with the aim of supporting local quality improvement. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians

Implementação da Predição Intra HEVC em Processadores Multicore

Dissertação de Mestrado em Engenharia Electrotécnica e de Computadores apresentada à Faculdade de Ciências e Tecnologia da Universidade de Coimbra.Esta dissertação possui como foco principal o estudo do algoritmo do novo standard dos codificadores de vídeo, HEVC, tendo como centro da investigação a parte referente aos modelos de predição, mais precisamente o modelo de predição Intra. Foram estudados e implementados métodos de paralelização a nível dos dados, por forma a analisar os benefícios dessa implementação aplicados à zona destinada ao cálculo da predição Intra presente no algoritmo do HEVC. Esses estudos destinam-se à investigação e análise da aplicação do codificador em processadores Multicore. Tal como o mundo se deixou encantar pela “caixa mágica”, a televisão, desde o ano 1923, em que as imagens nela transmitidas passaram por uma série de transformações e evoluções tais como a imagem a cores e chegando à recente imagem High Definition, também agora o desenvolvimento dos computadores e das novas plataformas móveis de comunicação se tornou o novo foco de interesse. Impulsionou uma mudança de paradigma no modo de visualização dos vídeos, sendo mais comum a visualização dos mesmos nos computadores ou smartphones do que nos tradicionais aparelhos televisivos. Esta evolução acarreta custos associados com o aumento de informação que é necessário transmitir e processar. Neste contexto surge o conceito de codificador de vídeo, cujo principal objectivo é a obtenção de uma qualidade de vídeo cada vez melhor, trazendo ao mesmo tempo uma melhoria relativamente aos custos de transmissão, com a redução dos débitos associados. O avanço dos codificadores e da compressão dos vídeos tornou-se assim um factor essencial no acompanhamento do desenvolvimento das novas plataformas e tecnologias de visualização vídeos digitais.This work has focused primarily on the study of the new algorithm of standard video encoders, HEVC, with the center of the research regarding the prediction models, specifically the Intra Prediction model. Methods of data-level parallelization were studied and implemented, in order to analyze the benefits of this implementation applied to the area for the calculation of Intra prediction algorithm in HEVC. These studies are aimed at research and analysis of the application of this encoder on multicore processors. Just like the world has been enchanted by the "magic box", television, since the year 1923 where the images transmitted by it suffered profound changes and developments, such as appearance of the color image and getting to the recent High Definition image, also now the development of computers and new mobile platforms of communication become the new focus of interest. It spurred a paradigm shift in the means by which we watch vídeos, where it has become as common, viewing videos on computers or smartphones as in the traditional televisions. This trend carries costs associated with the increase of information to be transmitted and processed. In this context, appears the concept of the video encoder. The main objective of the encoder is to obtain a better video quality, while bringing improvement on the transmission costs with the reduction in bandwidth associated. The progress of video encoders and video compression thus became a key factor in the development of new display platforms and technologies of digital videos

Certificação dos sistemas de gestão de recursos humanos - antecedentes e prospetiva : o caso da Marinha Portuguesa

Dissertação de mestrado em Gestão de Recursos Humanos e Análise Organizacional, Universidade Lusíada, 2020Exame público realizado em 6 de Janeiro de 2021O presente estudo de caso tem como objetivo principal averiguar se, a certificação é uma mais-valia na melhoria contínua do sistema de gestão de recursos humanos na Marinha Portuguesa. Adicionalmente, pretende-se apurar as razões pela qual a Instituição optou por certificar o seu sistema no âmbito da norma portuguesa NP 4427:2004 Sistemas de gestão de recursos humanos. Com a revisão da norma pretende-se identificar as alterações que a NP 4427:2018 Sistemas de gestão das pessoas, vai implicar no sistema de gestão de recursos humanos. O estudo empírico baseia-se numa revisão da literatura referente à gestão estratégica de recursos humanos, às práticas de elevado desempenho e à gestão sustentável de recursos humanos. Para a recolha de dados, procedeu-se à realização de entrevistas a elementos da instituição, por forma a recolher informação que permita sustentar o respetivo estudo. Os resultados obtidos sugerem que com a revisão da norma se verificou uma aproximação à gestão sustentável de recursos humanos e a um aumento da implementação de boas práticas. De uma forma geral, a análise dos resultados permite concluir que um sistema de gestão de recursos humanos certificado traz valor acrescentado à Marinha Portuguesa, contribuindo para a sustentabilidade a nível económico, social e ambiental.The main goal of this case study is to determine if certification is an asset in the continuous improvement of the human resources management system in the Portuguese Navy. It also holds the purpose to learn the reasons why the Institution chose to certify its system under the Portuguese standard NP 4427: 2004 Human resource management systems. The revision of the norm aims to identify the changes that NP 4427: 2018 People management systems will imply in the human resources management system. This study is based on a review of the literature on strategic human resource management, high-performance practices and sustainable human resource management. Interviews were conducted with elements of the institution, in order to collect information to support the study. With the revision of the norm, the obtained results suggest a sustainable approach to human resource management and an increase in the implementation of good practices. In general, the analysis of the results allows us to conclude that a certified human resources management system brings added value to the Portuguese Navy, contributing to an economic, social and environmental level of sustainability

Nanocellulose-based membrane as a potential material for high performance biodegradable aerosol respirators for SARS-CoV-2 prevention: a review

International audienc

Business investment project: Cold Orange Juice

Tras la llegada de la Pandemia por el COVID-19, en la República de Panamá, son muchas las personas que tomaron la decisión de abrir nuevos negocios denominados como “emprendimientos”, es por ello que, en esta ocasión, se estará desarrollando el tema de inversión bajo el nombre “Cold Orange Juice”. Dentro de esta investigación se evalúa los márgenes de ganancias producidos después de deducir todos los gastos que conllevó implementar dicha producción, en otras palabras, se mide la rentabilidad del proyecto, dichos cálculos se realizaron mediante un estudio financiero, tomando en consideración cada uno de sus valiosos recursos económicos (activos y capitales). Cold Orange Juice está ubicada en una de las zonas más pobladas y concurridas de la provincia de Panamá Oeste como lo es el distrito de Arraiján, adicional a esto, solo se cuenta con una sola sucursal y la misma mantiene definida su estructura organizacional siguiendo los parámetros del orden jerárquico según funciones, es decir, inicia con el establecimiento de un gerente general hasta el personal encargado del departamento de producción.After the arrival of the Pandemic by the COVID-19, in the Republic of Panama, there are many people who took the decision to open new businesses called “enterprises”, which is why, on this occasion, the issue of investment will be developed under the name “Cold Orange Juice”. This research assesses the profit margins produced after deducting all the expenses involved in implementing such production, in other words, the profitability of the project is measured; these calculations were made by means of a financial study, taking into account each of its valuable economic resources (assets and capital). Cold Orange Juice is located in one of the most populated and crowded areas of the province of Panama Oeste as is the district of Arraijan additional to this, there is only one branch and the same keeps defined its organizational structure following the parameters of the hierarchical order according to functions, that is, it starts with the establishment of a general manager up to the staff in charge of the production department

Delivery of drinking, eating and mobilising (DrEaMing) and its association with length of hospital stay after major noncardiac surgery: observational cohort study.

BACKGROUND Enhanced recovery pathways are associated with improved postoperative outcomes. However, as enhanced recovery pathways have become more complex and varied, compliance has reduced. The 'DrEaMing' bundle re-prioritises early postoperative delivery of drinking, eating, and mobilising. We investigated relationships between DrEaMing compliance, postoperative hospital length of stay (LOS), and complications in a prospective multicentre major surgical cohort. METHODS We interrogated the UK Perioperative Quality Improvement Programme dataset. Analyses were conducted in four stages. In an exploratory cohort, we identified independent predictors of DrEaMing. We quantified the association between delivery of DrEaMing (and its component variables) and prolonged LOS in a homogenous colorectal subgroup and assessed generalisability in multispecialty patients. Finally, LOS and complications were compared across hospitals, stratified by DrEaMing compliance. RESULTS The exploratory cohort comprised 22 218 records, the colorectal subgroup 7230, and the multispecialty subgroup 5713. DrEaMing compliance was 59% (13 112 patients), 60% (4341 patients), and 60% (3421), respectively, but varied substantially between hospitals. Delivery of DrEaMing predicted reduced odds of prolonged LOS in colorectal (odds ratio 0.51 [0.43-0.59], P<0.001) and multispecialty cohorts (odds ratio 0.47 [0.41-0.53], P<0.001). At the hospital level, complications were not the primary determinant of LOS after colorectal surgery, but consistent delivery of DrEaMing was associated with significantly shorter LOS. CONCLUSIONS Delivery of bundled and unbundled DrEaMing was associated with substantial reductions in postoperative LOS, independent of the effects of confounder variables. Consistency of process delivery, and not complications, predicted shorter hospital-level LOS. DrEaMing may be adopted by perioperative health systems as a quality metric to support improved patient outcomes and reduced LOS

Avaliação no Ensino Médico: o papel do portfólio nos currículos baseados em metodologias ativas

As atuais mudanças na educação médica - relacionadas às transformações em curso nas sociedades democráticas contemporâneas - têm colocado em questão, de modo cada vez mais incisivo, os aspectos relativos à avaliação dos processos de ensino-aprendizagem, cabendo a formulação de novos métodos/estratégias, capazes de ultrapassar a orientação somativa prevalecente na avaliação. Neste contexto, discutem-se, no presente artigo, elementos para a construção desta nova avaliação, destacando-se o uso do portfólio