Managing it as a business: the Lutchen's gap in the 100 top organizations based in Brazil

A common problem in IT management involves the lack of business vision on the part of IT executives who align IT to the strategic assumptions of the company, but forget the tactical functions of the former, managed as a business. This is known as the Lutchen's gap. Because of its importance in the context of IT management, this paper is a complementary approach to the preceding one from Rodrigues et al. (2009) and aims at identifying the Lutchen´s gap presence in the management of IT among the 100 top companies located in Brazil. To do this, we proceeded to a description of the profile of IT management in these companies, controlled by the executive board. We used a questionnaire filled out by IT executives, containing 77 questions covering the four functions of IT in a company. The main results indicate that: (a) In the IT's Alignment function, the design of IT reveals dichotomies between business and IT objectives (b) In the IT's Management function, the IT's budget is oriented toward ensuring "delivering" abilities to IT services and differing in the methods of cost control, ranging from apportion by volume, overheads and by ABC cost, (c) in the IT's Deliver function, evidence suggests that IT is managed as a business enabler; and (d) in the IT's Quality and Safety Assurance, IT executives monitor quality and safety events, but are limited to IT's basic operations. In conclusion, in the companies surveyed, IT is seen much more as an" on-demand solution provider", rather than as an instrument of innovation and competitiveness enabler for organizations.Um problema comum em gestão de TI, apontados pelos especialistas, envolve a falta de visão de negócio dos executivos de TI ao alinharem seus departamentos com as premissas estratégicas da empresa e esquecerem-se das funções táticas da TI, onde esta poderia ser gerida como um negócio. Esse é conhecido como o gap de Lutchen e por sua importância no contexto da gestão da TI, este artigo é complementar ao artigo de Rodrigues et al. (2009) e visa identificar a presença do gap de Lutchen, na gestão da TI entre as 100 maiores empresas sediadas no Brasil. Para tanto, procedeu-se a um levantamento do perfil da gestão de TI nessas empresas, na visão de seus executivos. Utilizou-se um questionário, respondido pelos executivos de TI, contendo 77 perguntas que varrem os quatro fundamentos da função da TI na empresa. Os principais resultados indicam que: (a) na função Alinhar, o desenho da TI apresenta dicotomias entre os objetivos dos negócios e os da TI; (b) na função Gerir, observa-se que os orçamentos de TI orientam-se para garantir a capacidade de entregae dos serviços de TI e diferem nos métodos de controle de custo, variando entre rateios por volume, overhead e custo ABC; (c) na função Entregar, as evidências indicam que a TI é gerida como uma capacitadora de negócios; e (d) na função Garantir a Qualidade e Segurança, muitos executivos de TI monitoram eventos de qualidade e segurança, mas limitam-se às operações básicas da TI. Em conclusão, o que se observa nas empresas pesquisadas é que a TI é vista como um sistema fornecedor de soluções,f sob demanda, dos negócios, mais do que como um instrumento capaz de garantir inovação e capacidade competitiva para as organizações

O desenho da gestão da tecnologia da informação nas 100 maiores empresas na visão dos executivos de TI

The objective of this paper is to identify the design of IT management atn the top 100 Brazilian companies. The research method was a quantitative approach, using the descriptive-statistical method to describe the data collected through a questionnaire with 77 questions, based on the rationale of the IT management, proposed by Lutchen (2003). The main results indicate that: a) IT aligns with the basic processes of business, although not fully synchronized; b) IT management adheres to conformity systems (ITIL, COBIT), but does not show optimization of business processes; c) IT delivers the basic demands, but does not impose or use the best automated practices; and d) IT quality is based on documented processes, but lacks indicators to control and orient business improvement. One may infer that IT management, at the top 100 Brazilian companies is essentially based on standard IT conformity systems, under the rationale of solution providers, and not as a business innovator or rule breaker. Thus, in spite of aligning and responding to business basic demand, IT management still does not show clear signs of alignment with the evolving nature of business models, needed to sustain business performance.O objetivo desse artigo é identificar o desenho do gerenciamento da TI nas 100 maiores empresas brasileiras. A pesquisa teve uma abordagem quantitativa e utilizou-se do método estatístico-descritivo para apresentar os dados, coletados por meio de questionário estruturado fechado, com 77 questões baseadas na gestão da TI, dentro da lógica argumentativa de Lutchen (2003). Os principais resultados indicam que: a) há um alinhamento com os processos básicos de negócio, porém, com mostras de dessincronias; b) a gestão está orientada para os sistemas de conformidade (ITIL, COBIT), mas sem otimização dos processos de negócio; c) a TI entrega as demandas básicas, porém sem estrutura para impor e usar as melhores práticas automatizadas; e d) a qualidade apresenta processos documentados, porém com falta de indicadores para o desenvolvimento dos negócios. Infere-se do quadro da pesquisa que a gestão da TI é conduzida essencialmente com base nas metodologias padrões de gestão de TI, muito mais dentro da lógica de fornecedora de soluções do que dentro dos princípios da inovação ou quebra de regras dos negócios. Assim, apesar de alinhar-se e responder às demandas básicas dos negócios, a gestão da TI não dá ainda mostras claras de avanço de aderência à natureza evolutiva dos modelos de negócios necessária à sustentação de desempenho desses

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

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

It outsourcing: methodology for selecting suppliers criterion for competitive advantage

The main reasons that motivate companies to outsource the services of Information Technology (IT) are: reducing costs, improving service quality and concentration on their core competencies. And the decision criteria of the contracting company are focused on those reasons. This article proposes a strategic criterion: the company should hire the supplier that best leverages their competitive advantages. This criterion implies the need to develop a specific methodology to this purpose, which is reported in this paper. To support it, the authors analyzed the models of Porter, Resource-Based View, Balanced Scorecard and the Fields and Weapons of the Competition, and making an option for the latter. The methodology was developed and applied to an Insurance Company and accepted by their leaders

Managing it as a business: the Lutchen's gap in the 100 top organizations based in Brazil

A common problem in IT management involves the lack of business vision on the part of IT executives who align IT to the strategic assumptions of the company, but forget the tactical functions of the former, managed as a business. This is known as the Lutchen's gap. Because of its importance in the context of IT management, this paper is a complementary approach to the preceding one from Rodrigues et al. (2009) and aims at identifying the Lutchen´s gap presence in the management of IT among the 100 top companies located in Brazil. To do this, we proceeded to a description of the profile of IT management in these companies, controlled by the executive board. We used a questionnaire filled out by IT executives, containing 77 questions covering the four functions of IT in a company. The main results indicate that: (a) In the IT's Alignment function, the design of IT reveals dichotomies between business and IT objectives (b) In the IT's Management function, the IT's budget is oriented toward ensuring "delivering" abilities to IT services and differing in the methods of cost control, ranging from apportion by volume, overheads and by ABC cost, (c) in the IT's Deliver function, evidence suggests that IT is managed as a business enabler; and (d) in the IT's Quality and Safety Assurance, IT executives monitor quality and safety events, but are limited to IT's basic operations. In conclusion, in the companies surveyed, IT is seen much more as an" on-demand solution provider", rather than as an instrument of innovation and competitiveness enabler for organizations.Um problema comum em gestão de TI, apontados pelos especialistas, envolve a falta de visão de negócio dos executivos de TI ao alinharem seus departamentos com as premissas estratégicas da empresa e esquecerem-se das funções táticas da TI, onde esta poderia ser gerida como um negócio. Esse é conhecido como o gap de Lutchen e por sua importância no contexto da gestão da TI, este artigo é complementar ao artigo de Rodrigues et al. (2009) e visa identificar a presença do gap de Lutchen, na gestão da TI entre as 100 maiores empresas sediadas no Brasil. Para tanto, procedeu-se a um levantamento do perfil da gestão de TI nessas empresas, na visão de seus executivos. Utilizou-se um questionário, respondido pelos executivos de TI, contendo 77 perguntas que varrem os quatro fundamentos da função da TI na empresa. Os principais resultados indicam que: (a) na função Alinhar, o desenho da TI apresenta dicotomias entre os objetivos dos negócios e os da TI; (b) na função Gerir, observa-se que os orçamentos de TI orientam-se para garantir a capacidade de entregae dos serviços de TI e diferem nos métodos de controle de custo, variando entre rateios por volume, overhead e custo ABC; (c) na função Entregar, as evidências indicam que a TI é gerida como uma capacitadora de negócios; e (d) na função Garantir a Qualidade e Segurança, muitos executivos de TI monitoram eventos de qualidade e segurança, mas limitam-se às operações básicas da TI. Em conclusão, o que se observa nas empresas pesquisadas é que a TI é vista como um sistema fornecedor de soluções,f sob demanda, dos negócios, mais do que como um instrumento capaz de garantir inovação e capacidade competitiva para as organizações

Clinical, tomographic aspects and relevance of torus palatinus: case report of two sisters

Despite the nomenclature suggested to be a tumor, torus palatinus (TP) is an overgrowth of the bone in the palatal region and represents an anatomic variation. Its prevalence varies among the population studied and its etiology is still unclear; however, it seems to be a multifactorial disorder with genetics and environmental involvement. Surgical removal of the TP is indicated in the following circumstances: (1) deglutition and speech impairment, (2) cancer phobia, (3) traumatized mucosa over the torus, and (4) prosthetic reasons. The aim of this case report is describe cases that occurred in two sisters, emphasizing the genetic etiology of this anatomic variation. In addition, intra-oral exam and computed tomography scan (axial, coronal and sagittal view) provided a detailed assessment of the TP and elimination of other possible diagnoses, furthermore allowed a better analyzes of the anatomic relation with adjacentes structures. No surgical removal was indicated for both cases