<p>Background: It is necessary for a company to hold some unique and irreplicable competitive advantage in order to be able to succeed in a market. In a market where public procurement is an important part the competitive advantages will be characterized by the fact that some of the participants on the market are public organizations and that their actions as for procurement fall under the legislation LOU. The characteristics of competitive advantage also depend on and change with continuous changes on a market. </p><p>Purpose: The purpose of this thesis is to study the competitive advantages that are presenton a current market characterized by public procurement and how these are created. The purposes is also to based on the trends on the market today study and predict the nature of the competitive advantage on the market in the future as well as the changes that we think will occur on the relevant market. </p><p>Realization: We have performed a case study of the market for enteral nutrition where data have been gathered from interviews with participants in the market and from studying the law of public procurement. The data is gathered and analysed based on an adapted model that we have derived from two theoretical perspectives of competitive advantage. The model that looks to the nature and the origin of competitive advantage has been tested and evaluated through application on the market. </p><p>Results: Strategic assets are of great importance in order for a company to create a competitive advantage in the form of being established, relations, being established in municipalities and the offer on the market of enteral nutrition today. These strategic assets and competitive advantages will in the future be characterized by the trends that are present on the market today. These trends are identified as an increasing knowledge, products for specific diseases, cooperation, limited procurements, alternative distribution channels and working towards the patients. The creation and the nature of competitive advantage is shaped by an interaction between the resources and capabilities of the firm and the needs and the needs and the demands of the market.</p>

Objetivo: Optimizar el seguimiento y las medidas de prevención de infecciones para observar su influencia en la evolución de las GEP durante 13 meses, se realizó prueba de hemostasia, antibiótico profilaxis (Ampiciliana/Sulbactam 1,5g E.V.), curaciones diarias por médico tratante durante los 15 días postprocedimiento y se informó a los cuidadores del paciente sobre el correcto manejo. Es objetivo del estudio determinar la incidencia de complicaciones menores y mayores, mortalidad global y asociada al procedimiento, factores predictivos independientes, entre otros, estado nutricional, nivel socioeconómico y de instrucción.

This study compared calorie needs, prescription and intake in enterally fed trauma and burn patients. Calorie needs of twenty-eight sequentially admitted patients were assessed by indirect calorimetry or by the Fick method. Caloric prescriptions were calculated from physicians orders. Following attainment of ordered goal rate, three day caloric intake was averaged. Caloric needs were not statistically different from caloric prescription. Caloric intake was significantly lower than caloric needs (p= 0.001). Intolerance and procedures were frequently cited reasons for withholding feedings. Results of this study suggest that trauma and burn patients may not receive the prescribed level of calories during the initial stage of enteral nutrition support. / Department of Family and Consumer Sciences

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1984.

Gastrostomy is one of the access routes enabling enteral nutrition support to children with eating disorders. It is a method of choice in situations where real assumption of enteral feeding by a nasogastric probe longer than six weeks exists and with undamaged functional digestive system. The possibility to perform enteral feeding outside health care facilities is the most advantageous aspect of gastrostomy for children and their parents. Optimum nursing care is one of the main preconditions of long term functional gastrostomy. This why suitable education of parents and their children in the nutrition support method is necessary. The aim of the work was to map awareness of the issues of gastrostomy in children patients among parents and to propose a unified educational programme aimed at easier insight into the issues. Qualitative research method was applied to the problems. The techniques of study of healthcare documentation and semi standardized interviews with respondents in their home environment were used for data collection. The results of the healthcare documentation studies, which defined the sample of the children with applied gastrostomy, were processed into graphic form for better transparency. The interviews with the respondents in the form of audio recording were transposed into written form and quantified by means of tables enabling the research conclusion to be drawn. The research results showed that practical training of gastrostomy treatment and awareness of possible complications and their solution was the weak point of the education. The above results have confirmed the necessity to elaborate a unique educational programme related to the issues of feeding tube insertion, the care for gastrostomy, support of food, medicines, and possible related complications in terms of learning the ability to prevent complications, identify and solve them.

Dissertacão (Mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências Agrárias / Made available in DSpace on 2012-10-17T02:56:17Z (GMT). No. of bitstreams: 0

Submitted by Nathália Faria da Silva (nathaliafsilva.ufv@gmail.com) on 2017-06-13T12:35:18Z No. of bitstreams: 1 texto completo.pdf: 282077 bytes, checksum: 07f64cbb3c928a371466373200ba572e (MD5) / Made available in DSpace on 2017-06-13T12:35:18Z (GMT). No. of bitstreams: 1 texto completo.pdf: 282077 bytes, checksum: 07f64cbb3c928a371466373200ba572e (MD5) Previous issue date: 2003-01-31 / Secretaria de Educação do Distrito Federal / Avaliou-se o crescimento de Klebsiella pneumoniae estirpe P15 em caldo nutriente adicionado de diferentes fontes de carbono, em dieta enteral comercial nas condições geralmente adotadas durante a estocagem e administração e em dietas com o pH modificado ou adicionadas de prebióticos e nisina + EDTA. Verificou-se que, a adição de adonitol, amido, dulcitol e xilitol ao caldo nutriente, reduziu o crescimento bacteriano em relação ao controle após 11 horas de incubação a 37 0 C. Fontes de carbono como glicose, maltodextrina, maltodextrina mais triglicerídeos de cadeia media e sacarose estimularam o crescimento de K. pneumoniae. A 25 oC foi verificado o crescimento da bactéria nas dietas enterais com pH variando de 4,9 a 7,9 resultando em uma população de 10 7 a 10 9 UFC mL -1 , em 26 horas de incubação o que correspondeu a um aumento de três a cinco ciclos logaritmos na base 10 no número de células. O tempo de geração de K. pneumoniae em dieta enteral a 25 oC, variou de 44,2 a 95,9 minutos com velocidades específicas de crescimento de 0,433 h -1 a 0,941 h -1 . A 15 e 20 oC o crescimento de K. pneumoniae em valores de pH 5,9 a 7,9 também resultou em um aumento de três a cinco ciclos logaritmos na população. O ajuste do pH da dieta para 4,9 resultou em um crescimento menor do que um ciclo logaritmo. Não foi observado o crescimento de K. pneumoniae em dietas com pH 3,9. A 15 e 20 oC constatou-se a redução substancial dos parâmetros cinéticos de crescimento bacteriano avaliados com valores de tempo de geração entre 98,83 e 419,24 minutos e velocidade específica de crescimento entre 0,099 h -1 e 0,420 h -1 . O efeito estimulador do frutooligossacarídeo e de inulina no crescimento de K. pneumoniae, observado em caldo nutriente, não foi constatado quando estes prebióticos foram adicionados em dietas enterais com o pH ajustado para 5,0 e 5,5. A adição de 3,0 mg L -1 do antimicrobiano nisina juntamente com o agente quelante EDTA não promoveu a inibição do crescimento de K. pneumoniae. A baixa concentração de nisina adicionada e provavelmente, a abundância de minerais encontrada na composição de dietas enterais, pode ter contribuído para a ineficácia da nisina sobre a K. pneumoniae. A presença de cápsula foi verificada em células de K. pneumoniae cultivadas em caldo nutriente adicionado de glicose, maltodextrina, maltodextrina + TCM e sacarose e em dietas enterais com pH ajustado entre 3,9 e 6,9. A presença de cápsula não foi observada nas células de K. pneumoniae cultivadas em caldo nutriente adicionado de fontes de carbono como adonitol, amido, dulcitol, xilitol e em dietas incorporadas de frutooligossacarídeo, inulina ou nisina + EDTA em pH 5,0. A acidez titulável expressa em ácido lático da dieta comercial variou, inicialmente, entre 0,94 a 1,22% e após o crescimento de K. pneumoniae foram encontrados valores de 0,80 % após a incubação por 48 horas a 15 oC, 0,76 % a 20 oC e 0,66 % a 25 oC. / Growth of Klebsiella pneumoniae strain P15 in nutrient broth supplemented with different carbon sources, in commercial enteral formula under typical storage and administration conditions and in formula with modified pH or supplemented with prebiotics or nisin A + EDTA was evaluated. Addition of adonitol, starch, dulcitol and xylitol to nutrient broth reduced bacterial growth in relation to the control after 11 hours incubation at 37 o C. Carbon sources such as glucose, maltodextrin, maltodextrin + medium chain triglycerides and sucrose stimulated growth of K. pneumoniae and resulted in populations of greater cellular mass. At 25 o C, bacterial growth was found in formula at pH of 4.9 to 7.9, and reached 10 7 to 10 9 CFU mL -1 after 26 hours incubation, corresponding to an increase of three to five log cycles. Generation time of K. pneumoniae in enteral formula at 25 o C varied from 44.2 to 95.9 minutes, resulting in specific growth rates of 0.433 to 0.941 h -1 . At 15 and 20 o C and pH 5.9 to 7.9, growth of K. pneumoniae also increased three to five log cycles. Adjusting the formula pH to 4.9 resulted in less than one log cycle of growth. No K. pneumoniae growth was observed in formula at pH 3.9. At 15 and 20 o C, a substantial reduction in the bacterial kinetic growth parameters evaluated was observed, with generation times varying from 98.83 to 419.24 minutes and specific growth rates from 0.099 to 0.420 h -1 . The stimulating effect of fructo-oligosaccharides and inulin on K. xipneumoniae growth that was observed in nutrient broth was not found when these prebiotics were added to the enteral formula at pH 5.0-5.5. Addition of 3.0 mg L -1 of the antimicrobial agent nisin together with the chelant EDTA did not inhibit growth of K. pneumoniae. The low nisin concentration and, probably, the abundance of minerals in the enteral formula may have affected EDTA’s chelating action, and thus interfered with nisin’s action. Capsules were present when K. pneumoniae cells were cultivated at pH 3.9 to 6.9 in nutrient broth supplemented with glucose, maltodextrin, maltodextrin + medium chain triglycerides and sucrose. Capsules were not observed when K. pneumoniae cells were cultivated at pH 5.0 in nutrient broth supplemented with adonitol, starch, dulcitol and xylitol or in enteral formula supplemented with fructo-oligosaccharide, inulin or nisin + EDTA. Titratable acidity in commercial enteral formula initially varied between 0.94 and 1.22 %, expressed as equivalent lactic acid. Upon growth of K. pneumoniae, 0.80 % acidity was found at 15 o C, 0.76 % at 20 o C and 0.66 % at 25 o C, after 48 hours of incubation.

Submitted by Nathália Faria da Silva (nathaliafsilva.ufv@gmail.com) on 2017-06-13T19:52:28Z No. of bitstreams: 1 texto completo.pdf: 900033 bytes, checksum: 926dd6909a489ebf5e20a47f5be2e8be (MD5) / Made available in DSpace on 2017-06-13T19:52:28Z (GMT). No. of bitstreams: 1 texto completo.pdf: 900033 bytes, checksum: 926dd6909a489ebf5e20a47f5be2e8be (MD5) Previous issue date: 2004-02-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho teve como objetivo estudar o efeito da admi- nistração de frutooligossacarídeos (FOS) e inulina adicionados a dietas enterais na translocação de Klebsiella em camundongos. Foram utilizados camundongos albinos suíços, com 5 a 6 semanas de vida, divididos em nove tratamentos, contendo diferentes combinações entre FOS, inulina, antibiótico e corticóide, e ausência ou presença de Klebsiella. Nos períodos equivalentes a 1, 2, 4, 6 e 8 dias após a administração da dieta contaminada com Klebsiella via oral, os animais foram sacrificados e seus órgãos: baço, coração, fígado, pulmão e rins, foram coletados, pesados e armazenados em sacos plásticos estéreis, a 4 o C por 24 horas para análise da presença de colônias típicas de Kebsiella. Fragmentos desses órgãos foram mantidos em solução fixadora para estudos histológicos. Com o objetivo de identificar a translocação do intestino para os órgãos analisados, foi feita comparação, com base em marcadores moleculares RAPD, entre a estirpe de Klebsiella inoculada na dieta e aquelas isoladas dos órgãos. Os resultados indicaram que os animais dos tratamentos III, V, VII e VIII, que receberam droga imunodepressora associada ou não com a dieta contaminada apresentaram estabilização ou perda de peso; enquanto aqueles que receberam a dieta com ou sem prebióticos, sem medicação imunodepressora ou presença de Klebsiella na mesma, apresentaram ganho de peso, assim como o grupo controle, alimentado com dieta AIN-93G. A adição de FOS e inulina na dieta, na concentração de 15,3 mg 100 g -1 por dia) resultou em translocação por um período menor de tempo quando comparado aos animais que não receberam prebióticos na dieta. No entanto, essa dose de prebióticos não resultou em aumento do peso do ceco desses animais. Análise do perfil genético das colônias isoladas dos órgãos, demonstraram translo- cação da Klebsiella endógena do animal. Análises histológicas demonstraram características mais intensas de inflamação nos animais imunodeprimidos que receberam a dieta contaminada sem prebióticos, onde foi detectada maior contagem de UFC g -1 típicas de Klebsiella em relação aos animais imunode- primidos que receberam dieta enteral contaminada com prebióticos. / This work aimed to study the effect of the fructooligossaccharide addition (FOS) and inulin in enteral diets in the Klebsiella translocation in mice. Alb swiss mice was used, with 4 to 6 weeks, divided in nine treatments contening different combinations among FOS, inulin, antibiotic and corticoid, and contaminant lack or presence. In the period equivalent to 1, 2, 4, 6, and 8 days after the oral administration of Klebsiella, the animals were sacrificed and its organs: spleen, heart, liver, lung and kidneys were collected, heavy and stored in sterile plastic bags at 4 o C during 24 hours for presence of typical colonies of Klebsiella analysis. Small fragments of those organs were maintained in fixed solution for histologic studies. Aiming to identify which the isolated ones that translocated from the intestine to the analyzed organs, it was made comparison, based in molecular markers RAPD, between the inoculated Klebsiella strain and those ones isolated. The results indicated that the animals that received immunosuppressive chemotherapeutic agent, associated or not with contaminated diet (treatments II, V, VII and VIII), presented stabilization or weight loss. Those animals that received the diet with or without prebiotics, ixwithout immunosuppressive agent or contaminat presence, presented weight gain, as well as the control group, food with AIN-93G diet. The FOS and inulina addition in the diet (15,3 mg 100 g -1 a day) resulted in translocation for a smaller period of time when compared to the animals that didn't receive prebiotics in the diet. However, that prebiotics dose didn't result in increase of the weight of the animals caecum. Analysis of the isolated colonies genetic profile of the tissues suggests Klebsiella endogenous translocation in the animal. Histologic analyses demonstrated more intense characteristic of inflammation in the immunodepressed animals that received the diet without prebiotics and contamined, in relation to the immunodepressed animals that received contaminated diet and with prebiotics.

BESERRA, M. P. P. Método de administração de medicamentos por sonda de alimentação: desenvolvimento, validação e análise da segurança e efetividade. 2016. 126 f. Tese (Doutorado em Ciências Farmacêuticas) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2016. / Submitted by Erika Fernandes (erikaleitefernandes@gmail.com) on 2017-01-20T13:48:21Z No. of bitstreams: 1 2016_tese_mppbeserra.pdf: 5500399 bytes, checksum: d03025db88b29e82f3cbd3c641374ecd (MD5) / Approved for entry into archive by Erika Fernandes (erikaleitefernandes@gmail.com) on 2017-01-20T13:48:29Z (GMT) No. of bitstreams: 1 2016_tese_mppbeserra.pdf: 5500399 bytes, checksum: d03025db88b29e82f3cbd3c641374ecd (MD5) / Made available in DSpace on 2017-01-20T13:48:29Z (GMT). No. of bitstreams: 1 2016_tese_mppbeserra.pdf: 5500399 bytes, checksum: d03025db88b29e82f3cbd3c641374ecd (MD5) Previous issue date: 2016-12-16 / The administration of drugs through the enteral nutrition probe (SNE) is still surrounded by many doubts regarding effectiveness and safety, besides the lack of systematization of the method of prescription and administration of these drugs. Often the interdisciplinary team needs to take responsibility for the decision making in the pharmacotherapy of patients who are probed even without support in the scientific literature. OBJECTIVES: To study from the development to the application, a specific method of medication administration by SNE, exemplified, particularly, by the dispersion of the warfarin tablets. METHOD: The study was divided into five phases, namely: a) the first one was to evaluate the dispersion of 108 solid pharmaceutical forms (FFS) in water within a doser; B) the second phase was the assay of the active principle of warfarin tablets, through high performance liquid chromatography (HPLC); C) the third phase was the pharmacotherapeutic follow-up of patients probed on warfarin; D) the fourth phase was to compare the results of phases two and three for the final analysis of the effectiveness of warfarin administration by catheter; and e) the fifth phase that referred to the safety evaluation of catheter administration through the technique proposed with Use of the dosers, where the connectivity of the dosers with the intravenous devices was evaluated. RESULTS: Of the 108 FFS studied, 75.9% (n = 82) dispersed in less than 20 minutes, being considered suitable for the use of the proposed technique. Warfarin presented acid, oxidative and thermal degradation, being these the main points to be worked in the manipulation of this medicine. It did not present basic or photolytic degradation. A total of 733 drug-related problems were identified in the 20 patients who participated in the pharmacotherapeutic follow-up, 43% (n = 315) of the use of warfarin. There was no difference in the techniques used to prepare the warfarin in the doser. The cost of the dosing device was greater than the cost of the syringe, but the use of the syringe proved to be safer, since there is no connection of it to the intravenous access routes due to its diameter 50% larger than that of the syringe. CONCLUSION: The technique proposed for administering drugs through SNE is feasible in terms of execution time, safety and the variety of FFS that can be dispersed. / A administração de medicamentos via sonda de nutrição enteral (SNE) ainda está cercada por muitas dúvidas quanto à efetividade e segurança, além da falta de sistematização do método de prescrição e administração destes medicamentos. Muitas vezes a equipe interdisciplinar precisa se responsabilizar pela tomada de decisão na farmacoterapia de pacientes sondados mesmo sem respaldo na literatura científica. OBJETIVOS: Estudar desde o desenvolvimento até a aplicação, um método específico de administração de medicamentos por SNE, exemplificado, particularmente, pela dispersão dos comprimidos de varfarina. MÉTODO: O estudo foi dividido em cinco fases, a saber: a) a primeira consistiu em avaliar a dispersão de 108 formas farmacêuticas sólidas (FFS) em água dentro de um dosador; b) a segunda fase foi o doseamento do princípio ativo dos comprimidos de varfarina, através de cromatografia líquida de alta eficiência (CLAE); c) a terceira fase foi a realização do acompanhamento farmacoterapêutico de pacientes sondados em uso de varfarina; d) a quarta fase foi comparar os resultados das fases dois e três para análise final da efetividade da administração de varfarina por sonda, e e) a quinta fase que se referiu a avaliação da segurança na administração de medicamentos por sonda através da técnica proposta com o uso dos dosadores, onde foi avaliada a conectividade dos dosadores com os dispositivos intravenosos. RESULTADOS: Das 108 FFS estudadas 75,9% (n=82) dispersaram em menos de 20 minutos, sendo consideradas aptas à utilização da técnica proposta. A varfarina apresentou degradação ácida, oxidativa e térmica, sendo estes os pontos principais a serem trabalhados na manipulação deste medicamento. Não apresentou degradação básica ou fotolítica. Foram identificados 733 problemas relacionados a medicamentos nos 20 pacientes que participaram do acompanhamento farmacoterapêutico, sendo 43% (n = 315) relacionados ao uso de varfarina. Não houve diferença quanto às técnicas aplicadas para o preparo da varfarina no dosador. O custo do dosador foi maior que o custo da seringa, mas o uso deste mostrou-se mais seguro, uma vez que não há conexão dele com as vias de acesso intravenoso devido ao seu diâmetro 50% maior que o da seringa. CONCLUSÃO: A técnica proposta para administração de medicamentos através de SNE é viável quanto ao tempo de execução, segurança e a variedade de FFS que são passíveis de dispersão.