Search

Background. Infection in acute pancreatitis will worsen the disease prognosis. The aim of our study was to analyze the role of procalcitonin as a prognostic biomarker for infections and clinical severity. Method. A prospective single-cohort observational study of patients diagnosed of acute pancreatitis (n = 152) was designed. PCT determination was tested on admission (first 72 hours). Infections (biliary, extrapancreatic and infected pancreatic necrosis), need for antibiotics, need for urgent ERCP and severity scores for acute pancreatitis was assessed. ROC curves were designed and the area under the curve was calculated. Logistic regression for multivariate analysis was performed to evaluate the association between procalcitonin optimal cut-off level and major complications. Results. PCT > 0.68mg/dL had higher incidence of global infection, acute cholangitis, bacteraemia, infected pancreatic necrosis, use of antibiotics in general, and need for urgent ERCP. In the multivariate regressions analysis, PCT > 0.68mg/dL at admission demonstrated to be a strong risk factor for complications in acute pancreatitis. Discussion. PCT levels can be used as a reliable laboratory test to predict infections and the clinical severity of acute pancreatitis. High levels of PCT predict antibiotics prescription as well as the need for urgent ERCP in patients with concomitant clinically severe cholangitis.

Purpose The purpose of this paper is to present a practical instrument for self-evaluation of maturity in the processes of procurement and supply management, applicable to small and medium-size companies, as well as to show how the use of this evaluation tool may help companies to decide what to improve in these processes. Design/methodology/approach Based on an empirical and theoretical framework, the instrument developed measures the maturity of procurement and supply management activities in four macro-processes: materials management, purchase process, supplier evaluation process and process of procurement planning. For testing the self-evaluation instrument, the authors evaluated the maturity of 48 hospitals and 37 metal-mechanic manufacturing companies located in the southern region of Brazil. To show how to use this tool to decide what to improve in procurement and supply processes, the authors conducted a comparative analysis of a hospital and a metal-mechanic company, in relation to the sample of the same segment. Findings The results show that the instrument is reliable for practical application. Metal-mechanic industries have a greater maturity in the purchase process than in the other three macro-processes. The management of materials is the most mature macro-process in hospitals. Comparing hospitals to metal-mechanic companies, the present research shows that, between 20 and 99 employees, hospitals tend to have a higher level of maturity in the purchase process than metal-mechanic companies. With 100 employees or more, metal-mechanic companies are more mature than hospitals in procurement planning and in selection/evaluation of suppliers. Originality/value Presenting a useful self-evaluation instrument, this work demonstrates that the measurement of the maturity level, and benchmarking it with other companies, may help a firm to decide what to improve in its processes of procurement and materials management, showing how an economic sector can understand itself better. Few scientific studies have practical application to the assessment of the degree of maturity of procurement and supply management processes. Besides that the authors did not find other papers presenting a comparison of different segments.

Monitoring and controlling costs are relevant matters to any organization, especially hospitals which usually encounter limitations in relation to available resources, as this information is vital to successful management. The literature frequently points to the advantages of using different cost systems for service organizations, especially those involved in the health care industry, although these models have not been validated in a complete hospital organization, nor have their real and effective benefits been identified. As such, the objective of this study is to demonstrate the use of absorption costing joined with the RKW system for generating managerial information in a hospital organization, thus making use of a parallel system of costing and costs and thereby relating them to fulfillment of legal precepts. The research was conducted starting with an interview held in November 2007 with the person responsible for hospital costs, followed by documental analysis. In light of the discoveries of the research and review of the literature it can be concluded that the traditional absorption system joined with the RKW system allows for monitoring of costs of hospital procedures with an acceptable level of precision, and is an important instrument in management.