Casos empresariales, Volumen III: Una visión desde la administración y la competitividad

A continuación, se presenta el tercer volumen del libro Casos empresariales: una visión desde la administración y la competitividad; cabe anotar que, estos cuatro estudios empresariales surgen del trabajo entre estudiantes y docentes de los programas de pregrado de Administración de Empresas y la Especialización en Gestión Empresarial, de la Escuela de Administración y Competitividad del Politécnico Grancolombiano, con el apoyo de empresarios que han dado un espacio para conocer su realidad y en un común ejercicio entre academia y empresa. Estructura de la obra consiste en un primer capítulo, denominado “Evaluación de la capacidad internacional y la factibilidad comercial de una empresa marroquinera en Colombia”, el cual presenta un estudio sectorial en el que se toma como base la realidad de una empresa marroquinera; aquí se revisa la situación que ha enfrentado en los últimos dos años y se propone una estrategia de negocios con posibilidades de apertura de mercado en el exterior. Lo anterior se da aprovechando la madurez que ha alcanzado el comercio electrónico y la mayor visualización de los procesos de exportación para los empresarios colombianos. El segundo capítulo se enfoca en un análisis prospectivo para la empresa “Global Manager Investment S.A.S —asesoría y consultoría en migración”. Se aborda un tema que, a todas luces, se encuentra a la orden del día y llama la atención de los interesados en migrar a otro país, gracias a las diversas posibilidades laborales, académicas, de negocios que se presentan, sobre todo, en países desarrollados o con amplias posibilidades para mejorar la calidad de vida; por lo tanto, en este capítulo se proponen nuevas posibilidades para la empresa. El capítulo tres presenta un análisis estratégico para la empresa LPK Constructores, como resultado de una consultoría universitaria en la que se establece la situación actual que enfrenta la empresa frente al mercado y a sus procesos internos. Con estos resultados se proponen estrategias por seguir. En el capítulo cuatro se presenta el segundo análisis prospectivo de esta edición para la empresa Ferredistribuciones Éxito. Acá se identifican los escenarios futuros que la compañía tiene posibilidad de implementar en los próximos diez años; dichos escenarios se formulan con base en información brindada por el empresario y la investigación realizada en el transcurso de la consultoría. ISBN digital: 978-628-7534-97-

Gestión ambiental y desarrollo agropecuario sostenible

Este libro reúne las principales investigaciones desarrolladas por estudiantes, docentes y egresados de la Escuela de Ciencias Agrícolas, Pecuarias y del Medio Ambiente (ECAPMA) de la Universidad Nacional Abierta y a Distancia UNAD y su Grupo de Investigación INYUMACIZO, categorizado en A por Minciencias, el cual desde hace más de una década viene desarrollando investigación científica y aplicada de alto impacto en la región surcolombiana,especialmente en los departamentos de Tolima, Huila, Caquetá y Putumayo.Se deriva a partir de un riguroso trabajo interdisciplinar y de aliados estratégicos (autoridades ambientales, alcaldías municipales, empresas de servicios públicos domiciliarios, sector productivo, entre otros), para convertirse en una valiosa herramienta de gestión, planificación y toma de decisiones para el sector ambiental y agropecuario de la región surcolombiana.El libro está dividido en dos capítulos. Un primer capítulo denominado Gestión ambiental y un segundo capítulo denominado Desarrollo agropecuario sostenible. Los resultados obtenidos en cada capítulo, así como el marco metodológico propuesto en cada una de las investigaciones brindan alternativas de gestión y desarrollo agropecuario sostenible, permitiendo conocer las potencialidades de cada sistema analizado, y sirviendo como línea base para mejorar la productividad y competitividad del sector.En este contexto, el libro presentado se constituye en un recurso valioso de consulta con el fin de brindar herramientas de análisis, soporte, planificación y gestión de los recursos naturales y el territorio a profesionales, técnicos, consultores, estudiantes de ciencias agropecuarias, ambientales, ingenierías, entre otros, interesados en temas de gestión ambiental y desarrollo agropecuario sostenible

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)