This article presents the state of the art of Lean principles applied in Emergency Departments through a systematic literature review. Our article extends previous work found in the literature to respond to the following questions: (i) What research problems in emergency departments can Lean principles help overcome? (ii) What Lean approaches and tools are used most often in this environment? (iii) What are the results and benefits obtained by these practices? and (iv) What research opportunities appear as gaps in the current state of the art on the subject? A six-step systematic review was performed following the guidance of the PRISMA method. The review analysis identified six main research problems where Lean was applied in Emergency Departments: (i) High Waiting Time and High Length of Hospital Stay; (ii) Health Safety; (iii) Process redesign; (iv) Management and Lessons Learned; (v) High Patient Flow; (vi) Cost Analysis. The six research problems’ main approaches identified were Lean Thinking, Multidisciplinary, Statistics, and Six Sigma. The leading Lean tools and methodologies were VSM, Teamwork, DMAIC, and Kaizen. The main benefits of applying Lean Principles were (a) reductions in waiting time, costs, length of hospital stay, patient flow, and procedure times; and (b) improvements in patient satisfaction, efficiency, productivity, standardization, relationships, safety, quality, and cost savings. Multidisciplinary integration of managers and work teams often yields good results. Finally, this study identifies knowledge gaps and new opportunities to study Lean best practices in healthcare organizations.

Rtion (PE) and different loads in strength exercises (SEs), in sedentary, active, and trained adult subjects. Thirty young men (18-34 years) were divided into 3 groups (experimental group [EG]): sedentary EG (SEG), physically active group (PAG), and the strength trained group (STG). Maximum strength was established using the 1 repetition maximum test (1RM). Using series of 12 repetitions, different loads were applied until the 4 ratings of PE (RPEs) (11, 13, 15, and 17) from 15 category Borg Perceived Exertion Scale (RPE 6-20). The pace of the repetitions and the intervals between the sets were controlled, the loads were blind, the order of the RPE randomized, whereas the PE was localized and determined after completion of the series. Strength correlations between the RPE and the %1RM, according to the EGs and SEs (0.826-0.922, p < 0.001), were observed. Similar behavior was seen in the SEs. Higher loads are related to higher RPEs and are differentiated between the EGs. The STG used higher %1RM when compared to the SEG, whereas the PAG, displayed an intermediary behavior in relation to the other groups. The use of PE represents a reliable instrument for the measurement of intensity in strength training....

The purpose of this article is to analyze the performance of small and medium-sized enterprises (SMEs) manufacturing, aiming to identify the main practices of sustainability, including the values and transparency, internal audience, environment, supplier relationships, customer and/or consumer relationships, and community relationships. In order to develop this research, a questionnaire was applied on the subject in question, through which the companies were classified as to their reality in relation to corporate social responsibility. Based on the analysis, it was observed that five of these companies obtained a score that indicates that the companies have already assimilated the associated concepts and are clear of the necessary commitments for a socially responsible action. However, given the results obtained, it is possible to conclude that there is a need to strengthen the actions to be taken with regard to corporate social responsibility, since no company has positioned itself in excellence. In addition, some suggestions for new research were identified and discussed in the analysis of the results.