7 research outputs found
The trainings as preventive actions in quality management system
No full textArtykuł ma na celu przedstawienie wybranych elementów efektywnego podnoszenia jakości świadczonych usług poprzez proces uczenia się, a tym samym konsekwentne dążenie do uzyskania statusu organizacji "uczącej się". Ponadto ukazuje, że dobrze zaplanowany i wdrożony system szkoleń dla wszystkich pracowników, począwszy od kadry kierowniczej, a skończywszy na ludziach wykonujących najprostsze czynności operacyjne, przyczynia się do zdobywania wiedzy i rozwijania zawodowych kwalifikacji pracowników. Omówiono także wpływ efektywnego wykorzystania wiedzy i umiejętności na poprawę jakości procesów na każdym etapie ich realizacji, a tym samym zapobieganie wystąpieniu działań korygujących i reklamacji. Zaprezentowano, że szkolenia w systemie zarządzania jakością wymagają cierpliwości i konsekwencji w działaniu, aby dały one dobre wyniki i stały się adekwatne do zaistniałych potrzeb, mimo istnienia wielu czynników mających wpływ na osiągnięcie zamierzonego celu. Artykuł prezentuje istotę organizacji i planowania szkoleń, zaangażowanie pracowników oraz wpływ firm prowadzących szkolenia na realizację działań doskonalących i zapobiegawczych. Rozważania są prowadzone w odniesieniu do wytycznych zawartych w normach ISO, analizy zagadnień omawianych w literaturze i doświadczeń autora jako osoby odpowiedzialnej za koordynowanie wdrożonego systemu jakości.The purpose of article is to describe the selected elements of the effective increase in the quality of the services provided by means of the learning process, and therefore also through a consistent aspiration to acquiring the status of a learning organization. It also indicates that a well-planned and introduced system of trainings for all employees, starting from the senior staff to people performing the simplest operating activities is contributing to the knowledge acquisition and developing professional qualifications of employees. The paper also discusses the influence of effective usage of knowledge and the ability on the improvement of the quality of processes at every stage of their realization and, at the same time, preventing the appearance of corrective actions and customer complaints. The article also shows that trainings in the quality management system require patience and determination in acting so that they give good results and became adequate to the real needs in spite of the existence of many factors influencing the achievement of the deliberate objective. The article describes the issue of an organization and training planning, employees' commitment and the role of the training companies in the implementation of corrective and prevention actions. The dissertation is kept in accordance with the guidelines included in ISO norms, the analysis of issues discussed in literature and experienced by the author as the person responsible for coordinating the implemented quality system
Cardiac involvement in polymyositis and dermatomyositis: diagnostic approaches.
No full textPolymyositis (PM) and dermatomyositis (DM) are rare idiopathic inflammatory myopathies (IIM). Myocardial involvement in patients with IIM is an unfavorable prognostic factor and one of the most common cause of mortality in this group of patients. The purpose of this review is the presentation of current knowledge on cardiovascular manifestations observed in IIM. Published in English data until December 2021 were selected. Clinical symptoms suggesting cardiac involvement are non-specific and require a differential diagnosis in accordance with cardiological guidelines. Troponin I is specific to cardiac injury and should be preferred to other markers to evaluate the myocardium in IIM. Abnormalities in electrocardiography are common in IIM , especially non-specific changes of ST-T segment. In standard echocardiography left ventricular diastolic dysfunction is reported frequently. New diagnostic technologies can reveal clinically silent myocardial abnormalities. However, prognostic value of subclinical impairment of myocardial function require further studies
Application of QRA (Quantive Risk Assessment) in the practice of environmental protection in Europe and the U.S.
No full textW artykule omówiono zastosowanie i użyteczność narzędzi -oceny/analizy ryzyka wraz z zarządzaniem ryzykiem - służących do minimalizacji zagrożeń dla życia i zdrowia ludzkiego oraz dla ekosystemów, stosowanych przy postępowaniu z zanieczyszczeniami środowiska. Quantitative Risk Assessment (QRA) - Ilościowa Ocena Ryzyka. QRA ma w szczególności zastosowanie przy oczyszczaniu terenów zanieczyszczonych i rewitalizacji obszarów po długim wykorzystaniu przemysłowym. Podano przykłady zastosowania QRA w praktyce.The article discusses the use and the usefulness of the tools - the assessment / risk analysis and risk management - designed to minimize risks to life and human health and ecosystems, used to dealing with pollution. QRA apply In particular to clean up contaminated sites and revitalization after a long industrial use. QRA are examples of applications in practice
Pregnancy outcomes in women with rheumatic mitral valve disease: Results from the registry of pregnancy and cardiac disease
No full textBACKGROUND: Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease. METHODS: The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient-center-country). RESULTS: Most patients came from emerging countries (75%). Mitral stenosis (MS) with or without mitral regurgitation (MR) was present in 273 women, isolated MR in 117. The degree of MS was mild in 20.9%, moderate in 39.2%, severe in 19.8%, and severity not classified in the remainder. Maternal death during pregnancy occurred in 1 patient with severe MS. Hospital admission occurred in 23.1% of the women with MS, and the main reason was heart failure (mild MS 15.8%, moderate 23.4%, severe 48.1%; P<0.001). Heart failure occurred in 23.1% of patients with moderate or severe MR. An intervention during pregnancy was performed in 16 patients, 14 had percutaneous balloon mitral commissurotomy, and 2 had surgical valve replacement (1 for MS, 1 for MR). In multivariable modeling, prepregnancy New York Heart Association class 〉1 was an independent predictor of maternal cardiac events. Follow-up at 6 months postpartum was available for 53%, and 3 more patients died (1 with severe MS, 1 with moderate MS, 1 with moderate to severe MR). CONCLUSIONS: Although mortality was only 1.9% during pregnancy, ∼50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications
Insulinopodobny czynnik 3 - nowy hormon związany z zespołem policystycznych jajników?
No full textIntroduction: The aim of this study was to find a correlation between insulin-like factor 3 (INSL3) and androgens: androstenedione (A),
free testosterone (fT), and total testosterone (T), in two groups of polycystic ovary syndrome (PCOS) women: those with a body mass
index (BMI) lower than 25 kg/m2 and those with a BMI higher than 25 kg/m2. The association between INSL3 and other serum parameters:
luteinising hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone sulphate (DHEA-S), sex hormone binding globulin
(SHBG) and glucose and insulin were also investigated.
Material and methods: The study group comprised 37 PCOS women aged 27 ± 4 years. The control group consisted of 34 healthy, premenopausal
women (aged 24.2 ± 1.2) with regular menses and no signs of hyperandrogenism. There were 27 PCOS women of normal
weight (BMI < 25 kg/m2), and ten overweight individuals (BMI ≥ 25–30 kg/m2). Correlations between level of INSL3 and LH, FSH, T, fT,
A, DHEA-S, SHBG, metabolic tests, height, weight, and WHR (waist-to-hip ratio) were also investigated.
Results: PCOS women showed non-significantly higher levels of INSL3 compared to the healthy controls (64.6 ± 27.7 and 62.7 ± 20.0 ng/mL,
respectively). However, we identified very strong correlations between INSL3 and androstenedione (r = 0.48, p = 0.0115), and free
(r = 0.44, p = 0.0108) and total testosterone (r = 0.46, p = 0.0057) in the PCOS subgroup with a BMI of < 25 kg/m2. There was no statistically
significant correlation between INSL3 and LH in any subject of the PCOS group, nor between INSL3 and FSH, DHEA-S, glucose,
basal insulin concentration or HOMA-IR.
Conclusions: We found a positive correlation between INSL3 and androgens in PCOS women, especially those with a BMI of < 25 kg/m2.
This may play a key role in PCOS pathophysiology. (Endokrynol Pol 2012; 63 (5): 356-361)Wstęp: Celem pracy była analiza zależności między stężeniem insulinopodobnego czynnika 3 a stężeniami androgenów: androstendionu
(A), wolnego testosteronu (fT) oraz całkowitego testosteronu (T) u kobiet z zespołem policystycznych jajników (PCOS), z uwzględnieniem
wskaźnika masy ciała (BMI). Przedmiotem badania był także związek między INSL3 a hormonem luteotropowym (LH), folikulotropowym
(FSH), siarczanem dehydroepiandrosteronu (DHEA-S), białkiem wiążącym hormony płciowe (SHBG) oraz stężeniami glukozy i insuliny.
Materiał i metody: Badaną grupę stanowiło 37 kobiet z PCOS, średnia wieku 27 ± 4 lat. Grupę kontrolną stanowiły 34 zdrowe kobiety
(średnia wieku 24,2 ± 1,2 roku) z regularnymi miesiączkami, bez objawów hiperandrogenizacji. Kobiety z PCOS podzielono na grupy
pod względem masy ciała; grupę z prawidłową masą ciała tworzyło 27 kobiet, natomiast z nadwagą i otyłością - 10 badanych. Analizie
poddano także zależności między stężeniem INSL3 i stężeniami LH, FSH, T, fT, A, DHEA-S, SHBG, glukozy i insuliny oraz wskaźniki
antropometryczne (wzrost, masa ciała, wskaźnik talia-biodra).
Wyniki: U kobiet z PCOS wykazano wyższe stężenie INSL3 w porównaniu z grupą kontrolną (64,6 ± 27,7 i 62,7 ± 20,0 ng/mL, odpowiednio).
Wykazano silną zależność między stężeniem INSL3 a stężeniem androstendionu (r = 0,48; p = 0,0115), wolnego (r = 0,44; p = 0,0108)
i całkowitego testosteronu (r = 0,46; p = 0,0057) w grupie kobiet z PCOS o prawidłowej masie ciała. Nie wykazano zależności między
stężeniem INSL3 a stężeniami LH, FSH, DHEA-S, stężeniem glukozy, insuliny oraz wskaźnikiem insulinooporności HOMA.
Wnioski: Wykazano związek między stężeniem INSL3 a androgenemią u kobiet z PCOS, szczególnie silnie wyrażoną u kobiet z prawidłową
masą ciała, co może być istotne w patofizjologii PCOS. (Endokrynol Pol 2012; 63 (5): 356-361
Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease
No full textOBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease. METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country). RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate. CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome
