Multidimensional evaluation of performance: experimental application of the balanced scorecard in Ferrara university hospital

<p>Abstract</p> <p>Background and Aims</p> <p>One of the best-known performance planning and evaluation techniques utilising both monetary and non-monetary data is the <it>Balanced Scorecard (BSC)</it>. This is a means of rationalising the global activity of a business in the attempt to create value, and to translate the company vision into a set of tactical objectives and measurable strategies. The aim of this study was to implement and evaluate the use of BSC in two departments of the St. Anna University Hospital, Ferrara: the Analysis Laboratory and Digestive Endoscopy operating units (OU).</p> <p>Materials and methods</p> <p>With the collaboration of the health workers involved, a precise methodological programme was pursued: Definition of the strategic map from 4 perspectives, according to Kaplan and Norton, Definition of the Key Performance Areas (KPA), or macro-objectives, Identification of the cause-effect relationships between KPAs, Identification of the sub-objectives of each KPA, Definition of the Key Performance Indicators (KPI), Definition of the weight/importance of each objective in the global evaluation.</p> <p>Results</p> <p>The information gathered permitted the definition of macro- and sub-objectives for each perspective, as well as determining the relevant indicators, standards, weights, frequency of detection and means of acquisition. Strategic maps showing the cause/effect relationships in each OU were created, as were 'evaluation panels', which describe the global performance of each department. For each perspective, the fundamental data were summarised in one table. Evaluation of each perspective yielded a positive result for the majority of the objectives, and the global result (including all 4 perspectives) was found to be satisfactory.</p> <p>Discussion-Conclusion</p> <p>The Balanced Scorecard was implemented in the abovementioned OUs of St. Anna University Hospital, Ferrara, after the health workers themselves realised the need for change.</p> <p>In our research the employees were pleased to be evaluated, not only for the financial outcomes, but also for the satisfaction of improving internal procedure, relationships with the community and their own growth/learning. BSC is an ideal point of contact between the financial and clinical dimensions of management. However, difficulties in its application were faced, among these, at least in the initial phase, the lack of information systems able to drive it, and the complexity of the research for specific indicators needed to be overcome. The time factor (on average, at least two years are required) and the availability of technological resources were also limiting factors.</p> <p>The rapid diffusion of BSC among the principal international profit and non-profit organisations is testament to its great potential. This project could be seen as a preparatory phase in the strategical analysis of a subsequent business plan.</p

Behavior of bicarbonate ion between capillary blood and saliva during acute exercise

This study includes the monitoring of the behavior of the bicarbonate ions concentration in the capillary blood and in saliva, with the main objective of establishing reliable parameters of the relationship of this variable between these two fluid compartments. The tests were conducted under a modified Balk protocol in the cycloergometer with progressively increasing load of 50 to 50 watts and measurement of bicarbonate ion was held in a gas analyzer ABL 800 FLEX Radiometer, assigned by UNIMED of São Carlos. It was necessary to develop 70 glass capillary 110μL and one adapter to collect saliva, manufactured in PVC. The volunteers (n=10) were selected athletes of the city of São Carlos and local students, all healthy and not using any type of drug, with an average age of 24 ± 4 years. Statistical analysis was done through the InStat software, using the comparison of the average concentration of bicarbonate ion between blood capillary and saliva at each stage (1-7º), getting a p-value \u3c0.0001 and significant confidence interval of 0 .95. Average concentration of bicarbonate were: Blood/Saliva: (1) 23.5 /3.2 - (2) 23.1/2.9 - (3) 21.4/4.0 - (4) 19.7/3.2 - (5) 15.9/2.9 - (6) 19.5/4.0 - (7) 16.6/4.1 mmol/L. The results allowed the establishment of a correlation between the fluids and demonstrates the effectiveness of the proposed method

Peripheral artery disease and blood pressure profile abnormalities in hemodialysis patients

Patients undergoing chronic hemodialysis (HD) are at increased risk for peripheral artery disease (PAD). Both ankle-brachial index (ABI) and ambulatory blood pressure monitoring (ABPM) in the interdialytic period have been shown to be strong predictors of all-cause mortality

Heart rate variability under resting conditions in postmenopausal and young women

The aim of the present study was to compare the modulation of heart rate in a group of postmenopausal women to that of a group of young women under resting conditions on the basis of R-R interval variability. Ten healthy postmenopausal women (mean ± SD, 58.3 ± 6.8 years) and 10 healthy young women (mean ± SD, 21.6 ± 0.82 years) were submitted to a control resting electrocardiogram (ECG) in the supine and sitting positions over a period of 6 min. The ECG was obtained from a one-channel heart monitor at the CM5 lead and processed and stored using an analog to digital converter connected to a microcomputer. R-R intervals were calculated on a beat-to-beat basis from the ECG recording in real time using a signal-processing software. Heart rate variability (HRV) was expressed as standard deviation (RMSM) and mean square root (RMSSD). In the supine position, the postmenopausal group showed significantly lower (P<0.05) median values of RMSM (34.9) and RMSSD (22.32) than the young group (RMSM: 62.11 and RMSSD: 49.1). The same occurred in the sitting position (RMSM: 33.0 and RMSSD: 18.9 compared to RMSM: 57.6 and RMSSD: 42.8 for the young group). These results indicate a decrease in parasympathetic modulation in postmenopausal women compared to young women which was possibly due both to the influence of age and hormonal factors. Thus, time domain HRV proved to be a noninvasive and sensitive method for the identification of changes in autonomic modulation of the sinus node in postmenopausal women

El dossier copia/sur: problemas económicos, políticos, e ideológicos del copyright (derecho de autor) en el sur global

In 2005, a group of scholars and activists, mostly from the global South, created the Copy/South Research Group to analyse, criticise, and confront the oppressive nature of current global copyright regimes, such as those defended by the World Intellectual Property Organisation, and similar ones around the globe. In May 2006, 22 of us, including 15 people from the global South, published THE COPY/SOUTH DOSSIER: Issues in the economics, politics, and ideology of copyright in the global South. The aim of the Dossier was to open up a critical and radical debate on the real impact of copyright laws and how they affect the daily lives of people living in more than 150 developing countries of the global South. We also highlighted issues that are not unique to the Global South, but also affect both sides of the North-South divide. This publication of more than 50 articles was addressed to researchers, educators, librarians, musicians, activists, organizations concerned about access to knowledge, and all of those who want to learn more about the oppressive global role of copyright laws and, in particular, their largely negative role in the developing countries of the global South. Given the democratic objectives of the Copy/South Research Group, the Dossier was not restricted by copyright. Therefore, it has been accessed openly and freely in both electronic and paper formats by thousands of readers from around the world in English. But English is not spoken by all citizens in the global South. With this in mind, the entire 200-page Dossier was translated into Spanish in late 2007 by an enthusiastic team of voluntary translators from Argentina, Bolivia, Cuba, Mexico, Spain, and Venezuela. As for this Spanish version, made with the support of the Intellectual Property Automous Service (SAPI), from the Bolivarian Republic of Venezuela, we must acknowledge the prior SAPI's General Director Eduardo Samán for promoting the making of this translation. Besides the general revision of Gerardo Cárdenas and his labor as main translator, some other volunteers translated or revised important sections of the Spanish edition: María Jesús Morillo (Spain), Oscar Pérez Peña and Gilda Gil (Cuba), Edgardo Civallero (Argentina) and Rafael Carreño (Venezuela), who coordinated the process of translation in 2007. Also it is worth to mention the additional colaboration of Ana Lía López (Bolivia), Richard Castro, Rafael Bellota and Carmen Chirinos (Venezuela), Zapopan Muela and Gonzalo Lara (Mexico), and Lilian Álvarez (Cuba). But what is still more extraordinary about this Spanish translation is that it was completely coordinated and edited by the Servicio Autonomo de la Propiedad Intelectual (SAPI) of the democratic government of the Venezuelan Bolivarian Republic. The Dossier provides “useful material to introduce this topic to teachers and students” and does a good job of “summarizing a complex and conflicting situation” for developing countries, Jumersi La Rosa, SAPI’s new director, said last week in announcing the release of the Spanish edition. She has written a special new introduction for the Spanish-language edition. The Copy South Research Group is very pleased that the radical message of resistance found in the Dossier can now be read by thousands of Spanish-language speakers who are questioning the current copyright regime and who hopefully will be ignited by the ideas in the Dossier to take up the fight against oppressive regimes based on copyright. You can get a copy of the Dossier in Spanish and English by downloading it, free of charge, at http://www.copysouth.org . We also still have a limited number of printed and bound copies of the English-language version of the Dossier. If you would to be mailed a copy of the English-language version, which contains eight posters, send us an e-mail ([email protected]) and include your full postal details. COPY/SOUTH RESEARCH GROUP, 28 April 2008

El dossier copia/sur: problemas económicos, políticos, e ideológicos del copyright (derecho de autor) en el sur global

In 2005, a group of scholars and activists, mostly from the global South, created the Copy/South Research Group to analyse, criticise, and confront the oppressive nature of current global copyright regimes, such as those defended by the World Intellectual Property Organisation, and similar ones around the globe. In May 2006, 22 of us, including 15 people from the global South, published THE COPY/SOUTH DOSSIER: Issues in the economics, politics, and ideology of copyright in the global South. The aim of the Dossier was to open up a critical and radical debate on the real impact of copyright laws and how they affect the daily lives of people living in more than 150 developing countries of the global South. We also highlighted issues that are not unique to the Global South, but also affect both sides of the North-South divide. This publication of more than 50 articles was addressed to researchers, educators, librarians, musicians, activists, organizations concerned about access to knowledge, and all of those who want to learn more about the oppressive global role of copyright laws and, in particular, their largely negative role in the developing countries of the global South. Given the democratic objectives of the Copy/South Research Group, the Dossier was not restricted by copyright. Therefore, it has been accessed openly and freely in both electronic and paper formats by thousands of readers from around the world in English. But English is not spoken by all citizens in the global South. With this in mind, the entire 200-page Dossier was translated into Spanish in late 2007 by an enthusiastic team of voluntary translators from Argentina, Bolivia, Cuba, Mexico, Spain, and Venezuela. As for this Spanish version, made with the support of the Intellectual Property Automous Service (SAPI), from the Bolivarian Republic of Venezuela, we must acknowledge the prior SAPI's General Director Eduardo Samán for promoting the making of this translation. Besides the general revision of Gerardo Cárdenas and his labor as main translator, some other volunteers translated or revised important sections of the Spanish edition: María Jesús Morillo (Spain), Oscar Pérez Peña and Gilda Gil (Cuba), Edgardo Civallero (Argentina) and Rafael Carreño (Venezuela), who coordinated the process of translation in 2007. Also it is worth to mention the additional colaboration of Ana Lía López (Bolivia), Richard Castro, Rafael Bellota and Carmen Chirinos (Venezuela), Zapopan Muela and Gonzalo Lara (Mexico), and Lilian Álvarez (Cuba). But what is still more extraordinary about this Spanish translation is that it was completely coordinated and edited by the Servicio Autonomo de la Propiedad Intelectual (SAPI) of the democratic government of the Venezuelan Bolivarian Republic. The Dossier provides “useful material to introduce this topic to teachers and students” and does a good job of “summarizing a complex and conflicting situation” for developing countries, Jumersi La Rosa, SAPI’s new director, said last week in announcing the release of the Spanish edition. She has written a special new introduction for the Spanish-language edition. The Copy South Research Group is very pleased that the radical message of resistance found in the Dossier can now be read by thousands of Spanish-language speakers who are questioning the current copyright regime and who hopefully will be ignited by the ideas in the Dossier to take up the fight against oppressive regimes based on copyright. You can get a copy of the Dossier in Spanish and English by downloading it, free of charge, at http://www.copysouth.org . We also still have a limited number of printed and bound copies of the English-language version of the Dossier. If you would to be mailed a copy of the English-language version, which contains eight posters, send us an e-mail ([email protected]) and include your full postal details. COPY/SOUTH RESEARCH GROUP, 28 April 2008

Using Text/SMS for an Online Database of Election Returns

A text/SMS-based system to ensure the integrity of election tallies through a database of precinct-level election returns maintained by a nationwide network of volunteer

Remodelamento do miocárdio no exercício com componente anaeróbico.

The extracellular matrix (ECM) components are continuously synthesized and degraded at distinct rates in a process called remodeling involving the expression of matrix metallopeptidases (MMPs) and their inhibitors (TIMPs) in physiological (growth, exercise) or pathological (high blood pressure, myocardial infarction) conditions. The expression of myosin heavy chain (MHC) &#945; and &#946; in the myocardium also changes in response to physiological (exercise) and pathological (energy deprivation, hypothyroidism, diabetes mellitus, hypertension) stimulus. The aim of this work was to study the influence of acute swimming training in Wistar male rats (160-180g) for 6hr/day, in 3 sessions of 2 hr each for 1 to 5 consecutive days, on the MMPs and MHC &#946; expression, compared to the sedentary control group. Blood lactate concentration and heart weight/body weight relation were also determined. Heart weight was increased in relation to body weight in the groups that trained for 4 (p<0.05) and 5 days (p<0.01). Blood lactate levels after all training sessions were significantly increased in all days. Morphological analysis showed no alterations or inflammatory signs compared to controls. The expression of MHC &#946; was analyzed by real time RT-PCR showing that it was significantly increased only after 5 days of training (p<0.01). After 4 days, a tendency to increase was observed but it was not significant. Zymography analysis of muscle extracts indicated a single 66kDa activity band that was significantly increased after 3 (p<0.05), 4 and 5 days (p<0.001) and this activity was enhanced in proportion to the duration of training. In conclusion, the heart of small rodents may be biochemical and functionally early conditioned after an acute program of swimming with an anaerobic component.Universidade Federal de Sao CarlosOs componentes da matriz extracelular (MEC) são continuamente sintetizados e degradados a diferentes taxas em um processo chamado remodelamento envolvendo a expressão de metalopeptidases de matriz (MMPs) e seus inibidores específicos (TIMPs) em condições fisiológicas (crescimento, exercício) ou patológicas (hipertensão arterial, infarto do miocárdio). A expressão das cadeias pesadas de miosina (CPM) &#945; e &#946; no miocárdio apresenta também plasticidade de resposta a estas condições fisiológicas e patológicas. Estudamos a influência do treinamento agudo de natação em ratos Wistar machos com 160 180 gramas, treinados seis horas por dia, em três sessões de duas horas por um até cinco dias consecutivos sobre a expressão de MMPs e CPM-&#946; comparadas ao grupo sedentários, além da variação da concentração de lactato sanguíneo e da relação peso do coração/peso corpóreo. Esta mostrou variação significante no grupo treinado 96 horas (p<0,05) e 120 horas (p<0,01) em relação ao controle. As concentrações de lactato após o exercício foram significativamente maiores para todos os dias de treinamento. A análise da expressão da CPM &#946; em tempo real mostrou aumento significante do grupo 120 horas (p<0,01). Zimografia dos extratos protéicos em gel SDS 12% com gelatina mostrou banda de atividade de massa molecular 66 kDa em todas amostras (controle e treinados) e com aumento de atividade quanto maior o tempo de treinamento, estatisticamente significantes com 72 horas (p<0,05) e 96 e 120 horas (p<0,001). Concluindo, os corações de pequenos roedores podem ser precocemente condicionados bioquímica e funcionalmente após um programa de exercício agudo de natação com componente anaeróbio