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Medical gas pipeline systems (MGPSs) are crucial for operating healthcare facilities as life-saving systems. The sustainability of MGPSs mandates optimum performance by reducing maintenance and repairs. Since faulty design is inventible, healthcare facilities endure several design-caused maintenance issues that endanger the sustainability of healthcare services and maintenance life cycle costs. These design decisions could have been avoided if proper consideration for maintenance had been applied. Eleven experts participated in semi-structured interviews guided by Staticized Group Techniques to identify and evaluate the maintenance issues. The results included identifying 52 design-related maintenance issues that pose maintainability risks. The findings primarily fall under emergency gas supply availability, future expansion readiness, and accessibility of maintenance. The most critical issue found is the excessive cutting-outs of the pipelines when upgrading the system. For new healthcare facilities, the results of this research provide practical help for designers to avoid MGPS issues. A scarcity of benchmark research and geographical factors are some limitations to this study.

Las condiciones de calidad del almacenamiento de los gases medicinales en Colombia deben cumplir una serie de requisitos y lineamientos establecidos por normas como son la Res. 4410/09(Manual de Buenas Prácticas de Manufactura de los Gases Medicinales). y Res. 2011012580 de 2011 (Guía de verificación de las BPM gases medicinales), para su correcto funcionamiento minimizando y previniendo riesgos asociados a la seguridad, de los pacientes y personal encargados de la manipulación de estos. El presente trabajo tuvo como objetivo la verificación de las condiciones de calidad del almacenamiento de la central de oxígeno de Hospital San Jerónimo de Montería, esta fue una investigación cuantitativa con un enfoque de tipo evaluativo donde se busca verificar las condiciones de calidad del área de almacenamiento. Implementando como instrumento de medición la lista de chequeo que se encuentra como anexo de la resolución 2011012580 de 2011 (Guía de verificación de las BPM de gases medicinales). Como hallazgos de esta investigación se encontraron falencias de tipo crítico y mayor como lo establece la norma, por esta razón se realizaron una serie de recomendaciones, ceñidas a la normatividad Colombina descrita anteriormente, esto con el fin de que tenga un correcto funcionamiento. RESUMEN ............................................................................................................ 12 1. INTRODUCCIÓN............................................................................................ 13 2. MARCO DE REFERENCIA ............................................................................ 15 2.1 MARCO LEGAL ........................................................................................... 15 2.2 MARCO DE ANTECEDENTES.................................................................... 22 2.3 MARCO CONCEPTUAL .............................................................................. 24 2.4 MARCO TEORICO ...................................................................................... 27 2.4.1GAS MEDICINAL.................................................................................... 27 2.4.2 OXIGENO.............................................................................................. 27 2.4.3 SISTEMA DE SUMINISTRO.................................................................. 30 2.4.4 SISTEMA DE DISTRIBUCIÓN............................................................... 31 3. OBJETIVOS.................................................................................................... 32 3.1 OBJETIVO GENERAL ................................................................................. 32 3.2 OBJETIVOS ESPECÍFICOS........................................................................ 32 4. DISEÑO METODOLÓGICO ........................................................................... 33 4.1 ENFOQUE Y TIPO DE INVESTIGACIÓN.................................................... 33 4.2 ESCENARIO DE ESTUDIO ......................................................................... 33 4.3 UNIDAD DE ANALISIS ................................................................................ 33 4.4 PRINCIPIOS DE INCLUSION Y EXCLUSIÓN............................................. 33 4.5 POBLACIÓN, TIPO DE MUESTREO Y CÁLCULO DEL TAMAÑO DE LA MUESTRA.......................................................................................................... 34 4.6 MÉTODOS E INSTRUMENTOS DE RECOLECCIÓN DE DATOS.............. 34 4.7 ANÁLISIS DE DATOS.................................................................................. 34 5. RESULTADOS Y DISCUSIÓN ....................................................................... 35 5.1 RESULTADOS ............................................................................................ 35 5.2 DISCUSIÓN................................................................................................. 36 6 CONCLUSIONES ........................................................................................... 38 7 RECOMENDACIONES................................................................................... 39 8 BIBLIOGRAFÍA............................................................................................... 40 9 ANEXOS......................................................................................................... 42 9.1 Anexo A. Plano 1 ......................................................................................... 42 9.2 Anexo B. Plano 2 ......................................................................................... 43 9.3 Anexo C. Guía de inspección de Buenas Prácticas de Manufactura ........... 44 Pregrado Tecnólogo(a) en Regencia de Farmacia Pasantías

Este trabajo trazo la linea base para la certificación en el marco de las buenas practicas de manufactura para gases medicinales en una institución prestadores de salud de cuarto nivel, estableciendo un punto de partida para ajustar los requerimientos de las normas aplicables en la fabricación de aire medicinal catalogado como medicamento. Agradecimientos 3 Dedicatoria 4 Resumen 5 Abstract 6 Introducción 7 Listado de tablas 12 Listado de figuras 13 1 Propuesta para la presentación de validaciones de producción en BPM’s en gases medicinales para una IPS. 14 2 Problema de investigación 14 2.1 Descripción del problema 14 2.2 Planteamiento del problema 15 Como orientar el cumplimiento de las buenas prácticas de manufactura de gases medicinales en una institución de salud para certificación del INVIMA. 15 2.3 Sistematización del problema 15 3 Objetivos de la Investigación 16 3.1 Objetivo general 16 Orientar las necesidades de las BPM’s en el proceso productivo de gases medicinales en una IPS. 16 3.2 Objetivos específicos 16 4 Justificación y delimitación 16 4.1 Justificación 17 4.2 Delimitación 18 4.3 Limitaciones 18 5 Marco conceptual 20 5.1 Estado del arte 20 5.1.1 Ámbito nacional 20 5.1.2 Ámbito Internacional 23 5.2 Marco Teórico 26 5.2.1 ¿Que es una USP? 26 5.3 Descripción General Proceso de Producción de Aire Medicinal en sitio por Compresión 27 5.4 Componentes del sistema 28 5.4.1 Toma de Aire 28 5.4.2 Sistema de compresión 29 5.4.3 Tanque Ecualizador o pulmón 31 5.4.4 Válvulas tanque pulmón32 5.4.5 Modo de alarma32 5.4.6 Operación manual / Test de alarma 32 5.5 Sistema de Secado 32 5.6 Sistema de Filtración36 5.7 Filtro Coalescente 37 5.8 Filtros De partículas37 5.9 Filtros de Carbón Activado 37 5.10 Filtros Microbiológicos38 5.11 Analizador de Impurezas - Punto de Rocío (DP) 39 5.12 Analizador de impurezas – Monóxido de Carbono (CO) 40 5.13 Sistema de control integrado TotalAlert Embedded41 5.14 Alarmas45 5.15 Electroválvula45 5.16 Red de suministro 46 6 Marco normativo/legal 46 7 Marco metodológico 48 7.1 Recolección de la información 48 7.1.1 Tipo de investigación 49 7.1.2 Fuentes de obtención de la información 50 7.1.3 Herramientas 52 7.1.4 Metodología 52 7.1.5 Descripción de los estándares del proceso productivo 53 7.1.6 Estructura organizacional- Personal principal 54 7.1.7 Instalaciones59 7.1.8 Equipos 60 7.1.9 Saneamiento e Higiene 60 7.1.10 Producción 61 7.1.11 Validaciones 62 7.1.12 Autoinspecciones y auditorias de calidad 63 7.1.13 Divulgación – Capacitación 64 7.1.14 Información recopilada 64 7.1.15 Instalaciones. 66 7.1.16 Red de suministro 66 7.1.17 Mantenimiento 67 7.1.18 Calificación, validación y calibración 67 7.1.19 Validación de procesos. 69 7.1.20 Auditorias y autoinspecciones 69 7.2 Análisis de la información 71 7.2.1 Estándar de garantía de calidad. Capitulo II resolución 4410 de 2009 73 7.2.2 Hallazgo. 74 7.3 Control de calidad. Capitulo III resolución 4410 de 2009. 75 7.3.1 Hallazgo 75 7.4 Validaciones. Capitulo V resolución 4410 de 2009. 75 7.4.1 Hallazgo 76 7.5 Personal. Capitulo X resolución 4410 de 2009. 76 7.5.1 Hallazgos 77 7.6 Instalación. Capitulo XI resolución 4410 de 2009. 77 7.6.1 Hallazgo 78 7.7 Equipos e instrumentos. Capitulo XI resolución 4410 de 2009. 78 7.7.1 Hallazgos 79 7.8 Producción. Capitulo VIII resolución 4410 de 2009. 80 7.9 Documentación. Capitulo XVII resolución 4410 de 2009 80 7.9.1 Hallazgos 81 7.10 Propuesta(s) de solución 81 8 Impactos esperados/generados 84 8.1 Manuales 84 8.2 Protocolos 85 8.3 Instructivos 86 8.4 Planes 87 8.5 Planos, formato y anexos 88 9 Análisis financiero 90 9.1 Análisis costo beneficio 90 9.1.1 Retorno a la inversión 92 9.1.2 Multas y sanciones 92 10 Conclusiones y recomendaciones 94 10.1 Conclusiones 94 10.2 Recomendaciones 95 11 Bibliografía 96 1th ed Especialización Especialista en Gerencia de Ingeniero Hospitalaria Especialización en Gerencia de Ingeniería Hospitalaria

Die Arbeit behandelt die Planung und Konzeptionierung eines Teilbereichs des Instituts für Radiologie in eine Schwerpunktkrankenanstalt mit einem MRT und zwei CT. Der Verfasser betreibt eigenständig die Behandlung einer Problemstellung des Studiums mit Praxisbezug, und methodisch korrekte Auseinandersetzung mit wissenschaftlichen Erkenntnissen in einem vorgegebenen Zeitraum. Die durch das Studium erworbenen Kenntnisse und Fähigkeiten sind anzuwenden, um das Fundament für das Technische Projekt zu bilden. Folgende Lehrinhalte werden insbesondere berücksichtigt: • Räumliche Planung • Planung des Workflows • Planung der Medizintechnik • Planung der Installationstechnik (Elektro- und Kommunikationstechnik) • Planung der HKLS-Technik Unter Berücksichtigung dieser Aspekte wird die Abteilung der Schwerpunktanstalt in der relevanten Dimension geplant. The thesis deals with the planning and conceptual design of a subarea of the Institute of Radiology into a focus hospital with one MRI and two CT. The author independently carries out the treatment of a problem of the study with practical relevance, and methodically correct examination of scientific findings in a specified period. The knowledge and skills acquired through the study are to be applied to form the foundation for the technical project. The following teaching contents are considered in particular: - Spatial planning - Workflow planning - Planning of medical technology - Planning of installation technology (electrical and communication technology) - Planning of the HVAC technology Taking these aspects into account, the department of the focal institution is planned in the relevant dimension.

Background: In healthcare, it is common that personnel handle medical gases. Medical gases can be hazardous if they are handled the wrong way. The healthcare personnel needs knowledge within gas handling to eliminate the risks of mix-ups, inaccurate transportation, inaccurate change of regulators and further on. Therefore, it is essential to educate healthcare personnel in how to handle medical gases in a safe manner. Region Uppsala has been responsible for educations on-site. To make the education more accessible it is desirable to make an interactive online course, with personnel responsible for medical gases as the target group. Aim: To design a digital interactive education, with personnel responsible for medical gases as the target group. Method: Revise material from earlier education plans within gas handling, designing an interactive online course using Articulate 360 storyline and evaluate the pedagogical layout and the information in the first version of the online course. Result: It was found that an interactive online course, with personnel responsible for medical gases within Region Uppsala as the target group should contain general information about gas, medical gases with associated bottles, information about gas cylinder, regulators and their handling and security and management processes. Focus during the making of the online course was to include interactive parts and to follow the principles “Meaningful”, “Engaging” and “Accessible”. The result from the evaluation made on the first version of the education generated about ten points of improvement. Two examples of changes applied to the final version of the education was a change of color from black to white on the icons at the bottom of the layout and addition of a section about emergency shut-off valves. Conclusion: An interactive online course was produced with the purpose to educate personnel responsible for medical gases within Region Uppsala. The created online course is more accessible than the previous education available on-site and with some complementary practical elements, the online course can permanently replace the previous on-site education.

Eine Intensivstation gilt als einer der anspruchsvollsten Bereiche einer Krankenanstalt und ermöglicht die Behandlung von sowohl kardiologischen als auch allen anderen Erkrankungen, deren Therapie und Genesung an einer regulären Bettenstation nicht mehr ausreichend gewährleistet werden kann. Da sich auf einer derartigen Station PatientInnen befinden, welche oft schwere Eingriffe hinter sich haben, oder an einer schweren Erkrankung leiden und dadurch eine massive Immuninsuffizienz haben, werden an diese Räume besonders hohe Ansprüche in Sachen Hygiene, Verfügbarkeit und technische Infrastruktur gestellt. An intensive care unit is considered one of the most demanding areas of a hospital and allows the treatment of cardiological, as well as all other diseases, whose therapy and recovery at a regular ward can no longer be adequately ensured. Since there are patients on such a ward, who often have severe procedures behind them, or who suffer from a serious illness and thus have massive immune deficiency, these rooms are subject to particularly high demands in terms of hygiene, availability and technical infrastructure.

Seit mehr als 5 Jahren ist der Autor dieser Arbeit bei einem medizintechnischen Unternehmen tätig, welches speziell im Bereich der medizinischen Gasanlagen eine beachtliche Anzahl an Krankenanstalten in Österreich betreut. Neben der elektrischen Versorgung nimmt die Versorgung mit lebenserhaltenden medizinischen Gasen eine zentrale Rolle im intramuralen Bereich ein. Sauerstoff und medizinische Druckluft in medizinischen Anwendung müssen stets in ausreichender Menge zur benötigten Zeit am richtigen Ort zur Verfügung stehen. Im Laufe von Jahrzehnten entwickelten sich vielfältige Normen und Regularien, um den geforderten medizinischen Bedürfnissen gerecht zu werden und um die Versorgung bewerkstelligen zu können. For over 5 years the author of this thesis has been working for a company, which is specialized in the field of medical gases and maintains a huge number of hospitals in Austria. Besides the electrical supply, the provision of life-sustaining medical gases, plays an important role in the intramural field. Oxygen and medicinal air for medical purposes must always be available to any patient at any time. There has been an extraordinal amount of new and improved relevant standards over the last four decades aiming to satisfy all upcoming medical needs and make sure that medical supply is always sufficiently provided.

Medical gases are known to show a great environmental impact and also to consume relevant resources in terms of hospital management. The present work reports on a study performed between 2008 and 2016 in a target set of 12 Spanish hospitals with floor area and number of beds ranging 2314–23,300 m2 and 20–194, respectively, for which the average annual consumption rates of oxygen, nitrogen, medicinal air, carbon dioxide and nitrogen protoxide were analysed. The annual consumption of medical gases in a hospital was proved to be correlated with the number of hospital discharges, the number of surgeries, the number of emergency interventions, the number of hospitalisations, the number of hospital beds, the useful floor area of the building and the number of workers. In particular, the annual consumption per hospital bed was computed as 350 m3 for oxygen, 325 m3 for medicinal air, 9 m3 for nitrogen protoxide and 3 m3 for carbon dioxide. It is shown that healthcare activity appears as an adequate variable to quantify and to monitor medical gases consumption in hospitals, to assess the size of their facilities as well as to optimise maintenance management.

Cilj istraživanja Premda medicinski plinovi čine mali udio u ukupnom zdravstvu Republike Hrvatske, njihova upotreba je neophodna, a važnost neprocjenjiva. Kao i svaka druga farmaceutska industrija, tako i proizvođač medicinskih plinova posjeduje farmaceutski sustav kakvoće koji je temeljen na propisima kojima su strogo definirani postupci od proizvodnje pa sve do isporuke prema zdravstvenim ustanovama. Cilj ovog rada je opisati glavne indikacije najčešće korištenih medicinskih plinova, način njihove proizvodnje te pakiranja. Također, cilj rada je i istaknuti osnovne zahtjeve dobre proizvođačke prakse koje proizvođač mora zadovoljiti s ciljem dobivanja proizvodne dozvole te osnovne prinicipe registracije lijekova i medicinskih proizvoda. Materijali i metode Literatura je pretraživana prema temi i predmetu istraživanja. Ciljana pretraga provedena je na bazama PubMed, Google pretraživaču, na stranicama Agencije za lijekove i medicinske proizvode, putem znanstvenih članaka te dostupnim dokumentima proizvođača. U ovom se radu raspravlja o posebnostima proizvodnje i registracije medicinskih plinova te se metodama deskriptivne analize i kompilacije opisuju specifičnosti vezane uz medicinske plinove. Rezultati Iznesene su osnovne indikacije upotrebe medicinskih plinova te je ukratko opisana upotreba takvih plinova izvan zdravstvenog sustava. U osnovnim crtama objašnjeni su postupci proizvodnje tekućih plinova. Opisana je klasifikacija medicinskih plinova sukladno Direktivi 2001/83 te Direktivi za medicinske proizvode (MEDDEV), a približena je i razlika između Kroz poglavlja: osoblje, prostori i oprema, dokumentacija, proizvodnja, kontrola kakvoće i transport prikazani su zahtjevi dobre proizvođačke prakse koje je proizvođač dužan zadovoljiti s ciljem pribavljanja proizvodne dozvole, ali i osiguranja da je gotov proizvod siguran i kvalitetan za kliničku primjenu. Kao važan segment vezan uz fizička svojstva plinova opisani su i zahtjevi za sigurnosno rukovanje. Također rad daje pregled osnovnih postupaka registracije lijekova i medicinskih proizvoda s ciljem dobivanja odobrenja za stavljanje u promet. Zaključak Medicinski plinovi su plinovi korišteni u zdravstvenom sustavu te kao takvi predstavljaju mali udio u ukupnom zdravstvu. Radi se o vrlo jednostavnim i dugo poznatim molekulama proizvedenim u postrojenjima koja na istom principu rade dulje od 100 godina. Premda su dugo vremena isporučivani u bolnice kao proizvodi bez posebnog statusa, razvojem farmaceutske regulative bivaju prepoznati te u konačnici i registrirani kao lijekovi i medicinski proizvodi. Upravo zbog statusa kojeg su dobili, plinska industrija je dobila status proizvođača lijeka i medicinskih proizvoda. Kroz godine rada nekada samo proizvođači tehničkih plinova, a danas proizvođači lijekova i medicinskih proizvoda ustrojili su snažne farmaceutske sustave kvalitete kojima reguliraju proizvodnju, provjeru kakvoće, puštanje u promet te u konačnici i distribuciju prema zdravstvenim ustanovama. Objectives Although medical gases make a small share in the total healthcare in Republic of Croatia, their use is necessary and the importance is essential. Like any other pharmaceutical manufacturer, manufacturer of medical gases has an organized pharmaceutical quality system based on laws and regulations by which all processes from production to distribution to healthcare institutions are strictly defined. The aim of this paper is to describe the main indications of the most commonly used medical gases, how they are produced and packaged. Also, the aim of the paper is to highlight the basic requirements of good manufacturing practice that the manufacturer is required to meet with the aim of obtaining a manufacturing licence and the basic principles of the registration of medicines and medical devices. Materials and methods Targeted literature search was done on PubMed, Google search engine, website of Croatian Agency of Medicinal Products and Medical Devices, articles in the research journals and available documents of manufacturers. This paper discusses the specificities of the production and registration of medical gases and by methods of descriptive analyzes and compilations specificities associated with medical gases are described. Results Basic indications of the use of medical gases have been described and the use of these same gases outside the health system is also briefly described. In the basic lines, the processes of production of liquid gases are explained. The classification of medical gases according to the Directive 2001/83 and the Medical Devices Directive (MEDDEV) is also described, and the difference between the medicine and the medical device is approximated. Through the chapters: staff, premises and equipment, documentation, production, quality control and distribution, the requirements of good manufacturing practice that the manufacturer is required to meet with the aim of obtaining a production license are also presented, as well as ensuring that the finished product is safe and of high quality for use on patients. As an important segment related to the physical properties of gases, safety management requirements are also described. This paper also provides an overview of the basic procedures for registering medicines and medical devices with a view to obtaining a marketing authorization. Conclusion Medical gases are gases used in the health system and as such the represent a small share in overall health care. These are very simple and long-known molecules produced in plants that work on the same principle for more than 100 years. Although they have been delivered to hospitals for a long time as products without special status, the development of pharmaceutical regulation they are beeing recognized and ultimately registered as medicines and medical devices. Because of the status the received, the gas industry has gained the status of medicine and medical device producers. Throughout the years, only manufacturers of medicine and medical devices have established strong pharmaceutical quality systems by which they regulate production, quality control, release on the market and ultimately, distribution to health facilities.

V diplomski nalogi smo raziskovali skladiščno poslovanje. V teoretičnem delu smo se osredotočili na skladiščenje, osnovne funkcije in cilje skladiščenja, delitev skladišč, pomembnost lokacije skladišča, embalažo ter skladiščno dokumentacijo in evidenco. Nadaljevali smo s predstavitvijo izbranega podjetja Linde plin d.o.o. Diplomska naloga se nadaljuje z opisovanjem skladiščenja medicinskih plinov v izbranem podjetju, označevanjem in vzdrževanjem jeklenk, evidentiranjem embalaže ter procesom sledljivosti jeklenk. Prav tako smo predstavili minimalne zahteve skladiščenja in označevanje. Opisali smo problem v procesu sledljivosti jeklenk in na koncu diplomskega dela navedli tudi rešitev za odpravo le tega. In the theoretical part we focused on warehouse, basic functions and objectives of the storage division warehouse, the importane od the storage location, packaging and warehouse documentation and records. We continued with the presentation of the selected company Ling plin d.o.o. The degree paper continues by describing the storage of medical gases in the selected company, marking and maintenance of cylinders, recording of packaging and process traceability cylinders. We also introduced the minimum requirements of warehousing and labeling. We describe the problem in the process of traceability of cylinders and at the end of the degree paper provided a solution for the elimination of the problem.

V magistrskem delu smo predstavili družbo Messer Slovenija, d. o. o., ki je del mednarodno priznane korporacije Messer Group GmbH in Nemčije, ki posluje na različnih svetovnih trgih. Podjetje Messer Slovenija oskrbuje preko 3.000 kupcev in v Sloveniji pokriva 40 odstotkov potreb slovenskega tržišča za področje tehničnih in specialnih plinov. V magistrskem delu smo se osredotočili na področje medicinskih plinov in medicinske opreme, iz tega izhajajo tudi ključne ugotovitve. Pri preverjanju prve raziskovalne hipoteze smo se osredotočili na instrumente marketinškega komuniciranja, ki se jih poslužuje podjetje Messer Slovenija, ti so: oglaševanje, pospeševanje prodaje, osebna prodaja, odnosi z javnostmi in publiciteta, priporočila in posebne oblike marketinškega komuniciranja. Tako smo skozi prikaz vseh uporabljenih instrumentov za področje medicinskih plinov in medicinske opreme prikazali način marketinškega komuniciranja. Ugotovili smo, da je za podjetje najpomembnejše, da se pri marketinškem komuniciranju osredotoči na udeležence oz. ciljno skupino, ki jih zanima izdelek in storitev, ki ga podjetje ponuja, saj lahko tako usmeri vso delovanje le na njih. V ta namen je bilo za podjetje Messer Slovenija potrebno opredeliti ciljne skupine za medicinske pline in medicinsko opremo. Ugotovili smo, da podjetje Messer Slovenija uspešno izkorišča vsakega od navedenih instrumentov marketinškega komuniciranja, pri čemer daje velik poudarek osebni prodaji. Osebna prodaja velja za podjetje Messer Slovenija za najpomembnejši komunikacijski instrument, kar je predpostavka druge raziskovalne hipoteze. Razlika, ki jo predstavlja osebna prodaja glede na druge instrumente marketinškega komuniciranja, je dvostranska in osebna komunikacija. Na tak način komuniciranja se gradi dolgoročno sodelovanje s strankami in ponudba se prilagodi povpraševanju stranke. Prodajno osebje se lahko z vsako stranko posebej dogovarja o nakupnih pogojih in le tako pridejo do ustrezne rešitve, ki je sprejemljiva za obe strani. Podjetje Messer Slovenija posveča velik pomen izobraževanju prodajnega osebja. To se vsakoletno izobražuje z različnih področij, kot so: vloga prodajalca, različne tehnike prodaje, uspešna komunikacija s strankami, uspešna predstavitev ponudbe, uspešno reševanje ugovorov, ocena konkurence in drugo. Za področje medicinskih plinov in medicinske opreme se prodajno osebje srečuje z medicinskim osebjem, kot so medicinske sestre in zdravniki. Za usmerjanje prodajnega osebja je dobro poznati priporočila, ki zagotavljajo prodajnemu osebju lažjo pot do uspešne prodaje. Kot primer nekaterih napotkov za boljše sodelovanje z zdravniki lahko navedemo naslednje: zdravniki ne potrebujejo poglobljenega informiranja o izdelkih, ampak usmerjeno diskusijo o bolezni oz. terapiji, v pogovoru ne želijo standardnih opisov ali definicij, temveč prilagojene informacije, ki veljajo za njihovo področje dela. Od prodajnega osebja cenijo vse relevantne vire informiranja, prednost pred številom obiskov dajejo njihovi kakovosti. Če predpostavljamo, da ima prodajno osebje določene osebnostne lastnosti, kot so zanesljivost, poštenost, inovativnost, dinamičnost lahko v povezavi z ostalimi znanji, ki jih pridobijo skozi različna izobraževanja, zelo uspešno vodijo prodajni proces. Tako se še enkrat poudarja vloga in pomen osebne prodaje, ki velja za vsa prodajna področja v podjetju Messer Slovenija za najpomembnejši instrument marketinškega komuniciranja. V magistrskem delu smo prav tako prikazali razliko med prodajnima področjema medicinskih plinov in medicinske opreme, hkrati pa smo prikazali tudi njuno povezanost in prekrivanje. Področje medicinskih plinov zajema segment uporabnikov, ki so splošne bolnišnice, psihiatrične bolnišnice, zdravstveni domovi, kirurški centri, veterinarske ambulante in ostali. Za področje prodaje medicinskih plinov se podjetje ne posveča v tako veliki meri instrumentom marketinškega komuniciranja kot za področje medicinske opreme. V našem primeru so medicin In this master's thesis we have presented the company Messer Slovenia d. o. o., which is part of the internationally recognized cooperation Messer Group GmbH from Germany, which operates in various global markets. The company Messer Slovenia supplies over 3,000 customers and covers 40% of the needs of the Slovenian market in the field of technical and specialty gases. In this master's thesis we have focused on the field of medical gases and medical equipment, and the results and key findings are presented below. When checking the first research hypothesis we focused on marketing communication instruments that Messer Slovenia uses, such as: advertising, sales promotion, personal selling, public relations and publicity, recommendations and specific forms of marketing communication. Therefore, with all of the instruments used in the field of medical gases and medical equipment we have shown the method of marketing communication. We found that the most important factor for the company is that the focus of marketing communication is on the participants or target group who are interested in the product or service that the company offers. Thereby it can focus all the operations on them. For this purpose it was necessary for Messer Slovenia to define the target groups for medical gases and medical equipment. We found that Messer Slovenia successfully uses all of the mentioned instruments of marketing communication, from which it gives great emphasis on personal sales. Personal selling is the most important communication instrument for Messer Slovenia, which is the assumption for the other hypothesis. The differentiation between personal selling and the other instruments of marketing communication is the two-way and personal communication involved. In this method of communication a long-term cooperation with the customers is built up and an offer can be tailored to the customer’s inquiry. The sales staff can agree on purchase conditions with each customer individually, and only in this way can a solution that is acceptable for both sides be found. Messer Slovenia pays attention to educating its sales team. Every year this consists of carrying out training in various fields, such as: the role of the seller, different selling techniques, effective communication with clients, successful presentation of the offer, successful solution of conflicts, appraisal of the competitors. In the field of medical gases and medical equipment the sales staff meets with medical staff such as nurses and doctors. To direct the sales staff it is good to know the recommendations, which provide the sales staff with an easy route to a successful sale. As an example of some guidance for better collaboration with doctors we indicate the following: doctors do not need in-depth information about the products, but focused discussion about the disease or therapy in conversation they do not want standard descriptions and definitions, but tailored information that is available for their field of work. From the sales staff they appreciate all relevant sources of information. For doctors the quality of information they get from a single visit is more important than the quantity of visits. If we assume that sales staffs have particular personal characteristics such as reliability, honesty, innovation and dynamics, then in connection with other knowledge, which can be acquired through education, they could run the sales process very successfully. The role and importance of personal sales is again emphasised as the most important instrument of marketing communication, which is valid for all sales areas at Messer Slovenia. In this master's thesis, as well as showing the difference between the sales areas of medical gases and medical equipment, we have also shown their connection and coverage. The field of medical gases includes the segment of end users that are made up of general hospitals, psychiatric hospitals, health centres, surgical centres, veterinary clinics and others. In the sales field of medical gases the company does not focus as str

Objetivos: Analizar la evolución en la adecuación clínica de la prescripción de Oxigenoterapia Continua Domiciliaria a la normativa vigente en el Servicio Andaluz de Salud. Metodología: Se revisaron en un estudio previo las prescripciones nuevas y de continuación de oxigenoterapia continua domiciliaria realizadas desde Enero 2008 a Diciembre 2009. Se constituyó una Comisión de Seguimiento Multidisciplinar y se volvió a analizar la adecuación de la prescripción tras dos intervenciones farmacéuticas desde Abril 2011 a Marzo 2012. Se realizó análisis estadístico, mediante programa SPSS 15,0 para Windows, siendo la variable dependiente la adecuación a la hoja correcta de primera prescripción y continuación; y como independiente, las distintas unidades prescriptoras. En los casos en que se realizó la prescripción en hoja correcta, se analizaron las variables de cumplimentación obligatoria. Resultados: Se revisaron manualmente 163 prescripciones, con un porcentaje de adecuación a la normativa del 66,30%, algo superior a los resultados del estudio previo (55,72% en 2008; 47,70% en 2009). La intervención realizada no alcanzó en mayor grado las perspectivas por falta de recursos económicos y materiales, afectando a uno de los objetivos fundamentales que eran las revisiones de pacientes. Conclusiones: La intervención farmacéutica ha conseguido que la prescripción se adecue en mayor proporción a la normativa y se realice mejor, pero no se ha podido controlar el tema de las revisiones al depender de otras especialidades médicas y unidades administrativas que solicitaban aumento de recursos tecnológicos y humanos que facilitaran el control. Objectives: Analyze developments in the clinical adequacy of prescribing continuous home oxygen therapy to current regulations in the Andalusian Health Service. Methodology: Were reviewed in a previous study requirements and continuing new domiciliary oxygen therapy conducted from January 2008 to December 2009. It constituted a Monitoring Committee Multidisciplinary and turned to analyzing the appropriateness of prescribing after two pharmaceutical interventions from April 2011 to March 2012. Statistical analysis was performed by SPSS 15.0 for Windows, the dependent variable being the correct blade adjustment to the first prescription and then, and as independent prescribing different units. In cases in which the prescribing correct sheet, variables were analyzed mandatory. Results: 163 prescriptions were checked manually with a rate of compliance with the regulations of 66.30%, slightly higher than the results of the previous study (55.72% in 2008, 47.70% in 2009). The intervention did not achieve a greater degree the outlook for lack of financial and material resources, affecting one of the fundamental objectives were patient reviews. Conclusions: Pharmaceutical intervention has ensured that the prescription conforms to the rules and perform better, but has not been able to control the issue of revisions to rely on other medical and administrative units requesting increased technological and human resources to facilitate control.

Medical gases are pharmaceutical molecules which offer solutions to a wide array of medical needs. This can range from use in burn and stroke victims to hypoxia therapy in children. More specifically however, gases such as oxygen, helium, xenon, and hydrogen have recently come under increased exploration for their potential theraputic use with various brain disease states including hypoxia-ischemia, cerebral hemorrhages, and traumatic brain injuries. As a result, this article will review the various advances in medical gas research and discuss the potential therapeutic applications and mechanisms with regards to the field of neurobiology.