Business process reengineering and it's effects on organizational performancee

Günümüzde yaşanan hızlı değişim ve teknolojik gelişmelere bağlı olarak, şirketler rekabet edebilme gücünü arttırmak amacıyla yeni yönetim yaklaşımları arayışı içine girmişlerdir Teknolojik gelişmeler, müşteri beklentilerinde artış ve istikrarsız ekonomi, işletmeler için değişimi zorunlu kılmıştır. İşletmelerin çalışma şartları ve çevreleri sürekli değişmektedir. Bu değişi¬me ayak uydurabilmek, rekabet edebilmenin ve hatta yeni fırsatlar yakalayıp değerlendirebilmenin ön şartı olmuştur. Değişim mühendisliği (DM) temelde iş süreçlerinin yeniden tanımlanması ve tasarlanmasıdır. DM sürecin organize edilmesindeki yöntemleri, süreçte yer alan katılımcıların rollerini, süreç basamaklarının yapısını/düzenini değiştirir. Endüstriyel firmaların rekabet edebilirlikleri karşısında bir çok engel vardır. İşletmelerin sahip olduğu endüstriyel iş operasyonları uzun vadede yeterince etkili değildir. Yenileme yeteneği ve köklü değişiklikler yapmak gelecekteki rekabet edebilirliği korumak için gereklidir. Değişim mühendisliği iş akışlarını ve bir organizasyonun verimliliğini optimize etmek amacıyla süreçleri, sistemi, politikaları ve organizasyonel yapıları destekleyerek bunların hızlı ve radikal bir şekilde yeniden dizayn edilmelerini sağlayan endüstri mühendisliği ve yönetim bilimi alanındaki son yeniliklerden birisidir.The firms are nowadays in search of brand new management approachs in order to increase their competition pover related to rapid changes and technological developments. Technological developments, increasing customers expectations and unstable economy make the companies change. Organizational environment and work place conditions are changing. Adapting to recent conditions is the only way to compete. Business process reengineering (BPR) is mainly re-organizing the work processes. BPR changes the methods of process organizations, the roles of the practitioners, the structure and order of process levels.There are many challenges that industrial enterprises face to maintain their competitiveness. Running industrial operation effectively is not enough in the long run. Capabilities of innovation and utilizing innovativeness in new ways are required in future competition. Business Process Reengineering (BPR) is one of the most recent innovations in industrial engineering and management science which represents the rapid and radical redesign of strategic, valueadded processes and the system, policies and organizational structures that support them to optimize the work flows and productivity of an organization

Metastatik küçük hücre dışı akciğer kanseri hastalarının ikinci veya ileri sıra tedavisinde immünoterapinin gerçek yaşam analizi

Background: Immunotherapy agents such as atezolizumab and nivolumab are appropriate option for non-small cell lung cancer (NSCLC) accounts in the absence of driver mutation, regardless of PDL-1 expression in second and later line setting. Herein we aimed to evaluate the efficacy and safety of immunotherapy for the second and later line settings in metastatic NSCLC patients as a single center experience. Methods: Totally, 37 patients with metastatic NSCLC who received atezolizumab or nivolumab in the second or later lines were included. Clinicopathological features of patients and survival outcomes were analyzed. The safety profile and the factors that may predict survival were also evaluated. Results: Twenty-nine (78.4%) of patients were men and 8 of patients (21.6%) were woman with median age of 61 years (range:42-80). Atezolizumab was preferred in 22 (59.5%) of these patients and nivolumab in 15 (40.5%) of them. Objective response rate was 35.1%. At a median follow up of 22.5 months, median progression-free survival (PFS) was 4.7 months, median overall survival (OS) was 24.1 months. Univariate analysis for PFS revealed that gender (p=0.03), age (p=0.005), the presence of brain metastasis (p=0.02), PDL-1 status >1% (p=0.035), ECOG PS (p=0.04) and the good response to frontline treatment (p=0.015) were found to be significant prognostic indicators. It also showed that the presence of brain metastasis (p=0.03), PDL-1 status >1% (p=0.027), good response to frontline treatment (p=0.022) and atezolizumab preference (p=0.018) were prognostic factors for OS. Conclusion: Our real-life analysis indicated that atezolizumab and nivolumab improved survivals with good safety profile in second and later lines treatment of metastatic NSCLC patients.Atezolizumab ve nivolumab, driver mutasyon yokluğunda, küçük hücre dışı akciğer kanserinin (KHDAK) ikinci ve sonraki basamak tedavisinde PDL-1 durumundan bağımsız olarak kullanılabilen iyi bir seçenektir. Burada, metastatik KHDAK’li hastalarda ikinci ve sonraki sıra tedavide immünoterapinin etkinliğini ve güvenliğini değerlendirmeyi tek Merkez deneyimi olarak amaçladık. Gereç ve yöntem: Çalışmaya, ikinci veya sonraki sıralarda atezolizumab veya nivolumab alan toplam 37 metastatik KHDAK hastası dahil edildi. Hastaların klinikopatolojik özellikleri ve sağkalım sonuçları analiz edildi. Güvenlik profili ve sağkalımı öngörebilecek faktörler değerlendirildi. Bulgular: Hastaların 29'u (%78.4) erkek, 8'i (% 21.6) kadın, ortanca yaş 61 (aralık: 42-80) idi. Bu hastaların 22'sinde (%59.5) atezolizumab, 15'inde (% 40.5) nivolumab tercih edilmişdi. Objektif yanıt oranı %35.1 idi. Medyan 22.5 aylık takipte, medyan progresyonsuz sağkalım 4.7 (PSK) ay iken, medyan genel sağkalım (OS) 24.1 ay olarak bulundu. PFS için tek değişkenli analizde, cinsiyet (p=0.03), yaş (p=0.005), beyin metastazı varlığı (p=0.02), PDL-1 durumu >%1 (p=0.035), ECOG PS (p=0.04) ve ilk sıra tedaviye iyi yanıt varlığı (p=0.015) anlamlı prognostik göstergeler olarak bulundu. OS için ise, beyin metastazı varlığı (p=0.03), PDL-1 durumu >%1 (p=0.027), ilk sıra tedaviye iyi yanıt varlığı (p=0.022) ve atezolizumab tercihi (p=0.018) prognostik faktörler olarak bulundu. Sonuçlar: Gerçek hayat analizimiz, atezolizumab ve nivolumabın, metastatik KHDAK hastalarının ikinci ve sonraki basamak tedavilerinde iyi güvenlik profili ile sağkalımı iyileştirdiğini gösterdi

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic markers in patients with extensive-stage small cell lung cancer treated with atezolizumab in combination with chemotherapy

Atezolizumab is now the standard treatment for extensive-stage small cell lung cancer (ES-SCLC). Herein, we investigated the prognostic role of inflammatory markers in patients treated with atezolizumab plus chemotherapy and evaluated the efficacy and safety of adding atezolizumab to chemotherapy for patients with ES-SCLC and prognostic and predictive factors as a real-life experience. This retrospective study included 55 patients who received front-line atezolizumab with etoposide plus platin regimen for ES-SCLC. We analyzed the survival outcomes and factors that may predict response and survival. The objective response rate (ORR) was 81.8%. At a median follow-up of 23.5 months, the median progression-free survival (PFS) time was 10.8 months, and the median overall survival (OS) time was 15.2 months. In univariate analysis for PFS, limited-stage disease at the time of diagnosis, the presence of prophylactic cranial irradiation (PCI), the presence of liver metastasis, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were found to be prognostic factors (P = .041, P = .034, P = .031, P = .004, and P = 135.7. Similarly, median PFS was 14.9 months in patients with NLR ≤ 3.43, while it was 9.6 months in patients with > 3.43. Univariate analysis for OS revealed that limited stage at the time of diagnosis, NLR and PLR were significant prognostic indicators (P = .01, P = .006, and P = .007, respectively). Median OS time for patients with both NLR ≤ 3.43 and PLR ≤ 135.7 was significantly better than that of patients with NLR > 3.43 and PLR > 135.7 (16.9 vs 11.3 and 16.9 vs 11.5 months, respectively). Logistic regression analysis demonstrated that PLR was an independent significant predictive factor for the response to atezolizumab plus chemotherapy (OR: 0.07, P = .028). The patients with PLR ≤ 135.7 were significantly good responders to atezolizumab plus chemotherapy treatment. Real-life data demonstrated a significant correlation between survival and NLR and, PLR in ES-SCLC patients treated with atezolizumab. In addition, PLR was a significant predictive indicator of response to atezolizumab plus chemotherapy

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Real-life analysis of immunotherapy as the second or later lines treatment in patients with metastatic non-small cell lung cancer

..

Toxicity of Zn-Fe Layered Double Hydroxide to Different Organisms in the Aquatic Environment

The application of layered double hydroxide (LDH) nanomaterials as catalysts has attracted great interest due to their unique structural features. It also triggered the need to study their fate and behavior in the aquatic environment. In the present study, Zn-Fe nanolayered double hydroxides (Zn-Fe LDHs) were synthesized using a co-precipitation method and characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and nitrogen adsorption-desorption analyses. The toxicity of the home-made Zn-Fe LDHs catalyst was examined by employing a variety of aquatic organisms from different trophic levels, namely the marine photobacterium Vibrio fischeri, the freshwater microalga Pseudokirchneriella subcapitata, the freshwater crustacean Daphnia magna, and the duckweed Spirodela polyrhiza. From the experimental results, it was evident that the acute toxicity of the catalyst depended on the exposure time and type of selected test organism. Zn-Fe LDHs toxicity was also affected by its physical state in suspension, chemical composition, as well as interaction with the bioassay test medium

Toxicity of Zn-Fe Layered Double Hydroxide to Different Organisms in the Aquatic Environment

The application of layered double hydroxide (LDH) nanomaterials as catalysts has attracted great interest due to their unique structural features. It also triggered the need to study their fate and behavior in the aquatic environment. In the present study, Zn-Fe nanolayered double hydroxides (Zn-Fe LDHs) were synthesized using a co-precipitation method and characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and nitrogen adsorption-desorption analyses. The toxicity of the home-made Zn-Fe LDHs catalyst was examined by employing a variety of aquatic organisms from different trophic levels, namely the marine photobacterium Vibrio fischeri, the freshwater microalga Pseudokirchneriella subcapitata, the freshwater crustacean Daphnia magna, and the duckweed Spirodela polyrhiza. From the experimental results, it was evident that the acute toxicity of the catalyst depended on the exposure time and type of selected test organism. Zn-Fe LDHs toxicity was also affected by its physical state in suspension, chemical composition, as well as interaction with the bioassay test medium

Impact of SPARC expression on treatment response of pembrolizumab and brain metastasis in patients with metastatic non-small cell lung cancer

Background: Non-small cell lung cancer (NSCLC) often exhibits elevated Secreted Protein Acidic and Cysteine-Rich (SPARC) expression. In this study, we investigated the impact of SPARC expression on clinicopathologic features, pembrolizumab response, and prognosis in metastatic NSCLC patients. Methods: Thirty-six patients diagnosed with metastatic NSCLC without actionable driver mutation and who received pembrolizumab with or without chemotherapy were included in this study. PD-L1 and SPARC expression were evaluated, with PD-L1 expression categorized based on tumor proportion score and SPARC staining intensity graded as 1+, 2+, and 3 +. Patients’ characteristics were compared across groups, and possible predictive markers were determined by binary logistic regression analysis. Results: No significant associations were found between SPARC expression and smoking status, histopathological tumor type, T and N status, and liver and bone metastasis. Higher SPARC expression was significantly linked to lower brain metastasis rates but higher CNS progression rates (p = 0.022 and p = 0.011, respectively. The objective response rate (ORR) showed a trend of being higher in the SPARC 1 + group (85.7% vs. 43.8% and 50.0% in 2 + and 3 + groups, respectively, p = 0.052. Univariate analysis did not find SPARC expression to be a significant prognostic factor for progression-free survival (PFS) (p = 0.7) and overall survival (OS) (p = 0.07).SPARC 1 + expression negatively affected the pembrolizumab response(p = 0.04,OR:0.11, 95%CI 0.01–0.92). Conclusions: Our study sheds light on a novel aspect of SPARC expression as a potential predictor of pembrolizumab response and a marker for CNS progression in metastatic NSCLC patients treated in the first-line setting

Antiandrojen tedavisi altında oligo-progresyon gelişen metastatik kastrasyona dirençli prostat kanserli hastalarda metastaza yönelik vücut radyoterapisinin sağkalım etkisi

Objective: Androgen pathway inhibitors have a significant impact on the treatment of prostate cancer. The treatment approach is controversial in patients who develop oligo-pro-gression under anti-androgen therapy. This study aimed to in-vestigate the effects of metastasis-directed stereotactic body radiotherapy (SBRT) on survival in the first-line setting of patients with metastatic castration-resistant prostate cancer who contin-ued the antiandrogen therapy after oligo-progression. Materials and Methods: Fifty-seven metastatic castration-re-sistant (serum testosterone <50 ng/dl) prostate cancer patients treated with abiraterone or enzalutamide in the first-line setting were analysed retrospectively. Thirty-nine of the patients with the oligo-progressive disease, which was defined as <= 3 lesions on imaging, received SBRT by continuing the same antiandro-gen therapy. Results: The median age was 70 (range 40-85). In the castra-tion-sensitive setting, 27 (47.4%) patients received docetaxel. The oligo-progressive metastatic sites were as follows: bone in 21 (52.3%), lymph node in 6 (15.3%) and visceral metastasis in 12 (30.9%) patients. Abiraterone and enzalutamide were preferred in 47.4% and 52.6% of patients, respectively. The 12-month pro-gression-free survival (PFS) was 79.0% and 88.9% in patients who received or did not receive SBRT (p<0.001). SBRT-related grade 1-2 toxicity was observed in 35 (61.4%) patients. SBRT was also an independent risk factor for PFS (p=0.007, HR:15.7; 95% CI 2.05-118.7). The presence of visceral metastases, isolated bone metastases, the choice of anti-androgen therapy, and Eastern Cooperative Oncology Group Scale Performance Status (ECOG PS) were not significantly associated with PFS. SBRT had no im-pact on overall survival. Conclusion: Patients treated with metastasis-directed SBRT without changing treatment in the oligo-progression setting had worse survival outcomes. Thus, metastasis-directed SBRT with continuation of the same antiandrogen therapy should be prior-itised only in selected cases.Amaç: Androjen yolağı inhibitörleri prostat kanserinin tedavisinde önemli etkiye sahiptir. Anti-androjen tedavisi altında oligo-progresyon gelişen hastalarda tedavi yaklaşımı tartışmalıdır. Bu çalışma, metastaza yönelik stereotaktik vücut radyoterapisinin (SBRT) oligo-ilerlemeden sonra antiandrojen tedavisine devam eden metastatik kastrasyona dirençli prostat kanserli hastalarda birinci basamakta sağkalım üzerindeki etkilerini araştırmayı amaçladı. Gereç ve yöntem: Birinci basamakta abirateron veya enzalutamid ile tedavi edilen 57 metastatik kastrasyon dirençli (serum testosteron <50 ng/dl) prostat kanseri hastası retrospektif olarak analiz edildi. Görüntülemede ≤3 lezyon olarak tanımlanan oligo-progresif hastalığı olan 39 hasta aynı antiandrojen tedavisine devam edilerek SBRT aldı. Bulgular: Medyan yaş 70 (dağılım 40-85) idi. Kastrasyona duyarlı ortamda, hastaların 27’si (%47,4) dosetaksel almıştır. Oligo-progresif metastatik bölgeler 21 (%52,3) hastada kemik, 6 (%15,3) hastada lenf nodu ve 12 (%30,9) hastada visseral metastaz olarak saptandı. Abirateron ve enzalutamid sırasıyla %47,4, %52,6hastada tercih edildi. SBRT alan ve almayan hastalarda 12 aylık progresyonsuz sağkalım (PFS) %79,0 ve %88,9 idi (p<0,001). Otuz beş (%61,4) hastada SBRT ile ilişkili derece 1-2 toksisite gözlendi. SBRT ayrıca PFS için bağımsız bir risk faktörüydü (p=0,007, HR:15,7; %95 GA 2,05-118,7). Visseral metastazlar, izole kemik metastazları, anti-androjen tedavi seçimi ve Eastern Cooperative Oncology Group (ECOG) performans skalası varlığı, PFS ile istatistiksel olarak anlamlı değildi. SBRT’nin genel sağkalım üzerinde hiçbir etkisi olmamıştır. Sonuç: Oligo-progresyon durumunda tedaviyi değiştirmeden metastaza yönelik SBRT ile tedavi edilen hastalarda sağkalım sonuçları daha kötüydü. Bu nedenle, aynı antiandrojen tedavisine devam edilerek metastaza yönelik SBRT’ye sadece seçilmiş vakalarda öncelik verilmelidir

The role of 18F-FDG PET/CT in predicting the neoadjuvant treatment response in patients with locally advanced breast cancer

Purpose: Patients with locally advanced breast cancer (LABC) should be treated with neoadjuvant chemotherapy (NAC). Pathological complete response (pCR) is related to better disease-free survival (DFS). The best strategy for assessing the efficacy of NAC has not been established yet, but several studies have shown that 18F-FDG PET/CT is a potential imaging tool for assessing pCR. The aim of this study is to investigate the merits of 18F-FDG PET/CT imaging in predicting pCR in both axillary and breast tissue and to establish a threshold maximum standard uptake value (SUVmax) for predicting the response after completion of NAC. Methods: A total of 186 LABC patients, treated with an NAC regimen according to tumor subtype, were retrospectively analyzed in this study. All patients underwent 18F-FDG PET/CT imaging before and after completion of NAC. PET parameters were measured in the most FDG avid breast tissue and axillary lymph nodes. We analyzed the correlation between the tumor SUVmax of the PET/CT response and the pCR after surgery. DFS was also evaluated with respect to pCR. Results: Higher pCR rates were significantly associated with a higher tumor grade, an initial Ki-67 >= 20% (p = 0.03 and p = 0.003, respectively), a triple-negative subtype (32.9%), and a human epidermal growth factor receptor 2 (HER-2)-positive subtype (24.7%) (p < 0.001). There was a significant correlation between the pCR and a complete response in 18F-FDG PET/CT (p < 0.001). The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT to determine the pCR after NAC were 100%, 72.2%, 85%, 75.2%, and 100%, respectively. We demonstrated a 1.1 cutoff SUVmax for breast tumors after NAC (OR: 3.94, 95% CI: 1.14-5.05, p = 0.004), the 18F-FDG PET/CT response to NAC (OR: 0.50, 95% CI: 0.25-0.99, p = 0.003), and the molecular subtype of breast tumors (OR: 0.58, 95% CI: 0.38-0.88, p = 0.011). Conclusion: Our results confirm that 18F-FDG PET/CT is a useful method for predicting the NAC response in LABC