The economic impact of anastomotic leak after colorectal cancer surgery.

OBJECTIVE: To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system. METHOD: This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL. RESULTS: The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL. CONCLUSIONS: The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. INTEREST OF THE STUDY: it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days.

Routine assessment of kidney urea clearance, dialysis dose and protein catabolic rate in the once-weekly haemodialysis regimen.

BACKGROUND: The dialysis dose (Kt/V) and normalized protein catabolic rate (PCRn) are the most useful indices derived from the urea kinetic model (UKM) in haemodialysis (HD) patients. The kidney urea clearance (Kru) is another important UKM parameter which plays a key role in the prescription of incremental HD. Ideally, the three kinetic parameters should be assessed using the complex software Solute Solver based on the double pool UKM. In the clinical setting, however, the three indices are estimated with simplified formulae. The recently introduced software SPEEDY assembles the aforementioned equations in a plain spreadsheet, to produce quite accurate results of Kru, Kt/V and PCRn. Unfortunately, specific equations to compute Kt/V and PCRn for patients on a once-weekly HD regimen (1HD/wk) were not available at the time SPEEDY was built-up. We devised a new version of SPEEDY (SPEEDY-1) and an even simpler variant (SPEEDY-1S), using two recently published equations for the 1HD/wk schedule . Moreover, we also added a published equation to estimate the equivalent renal clearance (EKR) normalized to urea distribution volume (V) of 35 L (EKR35) from Kru and Kt/V . Aim of the present study was to compare the results obtained using the new methods (SPEEDY-1 and SPEEDY-1S) with those provided by the reference method Solute Solver. SUBJECTS AND METHODS: One hundred historical patients being treated with the once-weekly HD regimen were enrolled. A total of 500 HD sessions associated to the availability of monthly UKM studies were analysed in order to obtain Kru, single pool Kt/V (spKt/V), equilibrated Kt/V (eKt/V), V, PCRn and EKR35 values by using Solute Solver, SPEEDY-1 and SPEEDY-1S. RESULTS: When comparing the paired values of the above UKM parameters, as computed by SPEEDY-1 and Solute Solver, respectively, all differences but one were statistically significant at the one-sample t-test; however, the agreement limits at Bland-Altman analysis showed that all differences were negligible. When comparing the paired values of the above UKM parameters, as computed by SPEEDY-1S and Solute Solver, respectively, all differences were statistically significant; however, the agreement limits showed that the differences were negligible as far as Kru, spKt/V and eKt/V are concerned, though much larger regarding V, PCRn and EKR35. CONCLUSIONS: We implemented SPEEDY with a new version specific for the once-weekly HD regimen, SPEEDY-1. It provides accurate results and is presently the best alternative to Solute Solver. Using SPEEDY-1S led to a larger difference in PCRn and EKR35, which could be acceptable for clinical practice if SPEEDY-1 is not available.

Management of the COPD Patient with Comorbidities: An Experts Recommendation Document.

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

Breast cancer detection in Mexico City during 2017. / Detección del cáncer de mama en la Ciudad de México durante 2017.

BACKGROUND: Breast cancer is the leading cause of death of women in Mexico; its detection is among the priorities of Mexico City's (CDMX) Southern Local Office from the Instituto Mexicano del Seguro Social (IMSS: Mexican Institute for Social Security). OBJECTIVE: To describe the incidence and mortality related to breast cancer detection in the CDMX's Southern Local Office units from IMSS in 2017. MATERIAL AND METHODS: Databases from the Coordination of Prevention and Health Care (CPAS), Information and Strategic Analysis (CIAE) and the Breast Clinic (UDDC Mama) were analyzed. Among data, it was included age, study (mastography, ultrasound and biopsy), and histological type, incidence and mortality. For statistical analysis it was used Student's t, and Spearman correlation (p < 0.05). RESULTS: In a population of 589,683 women (40-69 years), 97,779 mastographs were performed. Out of these, there were 94,883 normal (BI-RADS 1) and 1933 suspicious (BIRADS 3-5). In 436 biopsies, infiltrating ductal carcinoma was the most frequent. The incidence rate was 39.3/100,000 and the mortality rate was 3.54/100,000 inhabitants (in 2015 and 2016 it was 6.84 and 7.02/100,000, respectively). CONCLUSIONS: An increase in the incidence and a decrease in breast cancer mortality has been observed, which is related to improvements in screening programs in 2017. It is important to maintain and optimize screening programs.

INTRODUCCIÓN: El cáncer de mama es la principal causa de muerte de mujeres en México; su detección se ubica entre las prioridades de la Delegación Sur de la Ciudad de México del Instituto Mexicano del Seguro Social (IMSS). OBJETIVO: Describir la incidencia y la mortalidad relacionadas con la detección del cáncer de mama en las unidades de la Delegación Sur de la Ciudad de México del IMSS en 2017. MATERIAL Y MÉTODOS: Se analizaron las bases de datos de las Coordinaciones de Prevención y Atención a la Salud (CPAS), de Información y Análisis Estratégico (CIAE) y de la Clínica de Mama (UDDC Mama). Entre los datos se incluyó edad, estudio (mastografía, ultrasonido y biopsia) y tipo histológico, incidencia y mortalidad. Para el análisis estadístico se empleó t de Student y correlación de Spearman (p ≤ 0.05). RESULTADOS: En una población de 589 683 mujeres (40-69 años), se realizaron 97 779 mastografías. De estas hubo 94 883 normales (BIRADS 1) y 1933 sospechosas (BIRADS 3-5). En 436 biopsias, el carcinoma ductal infiltrante fue el más frecuente. La tasa de incidencia fue 39.3/100 000 y de mortalidad de 3.54/100 000 habitantes (en 2015 y 2016 fue de 6.84 y 7.02/100 000, respectivamente). CONCLUSIONES: Se ha observado un incremento en la incidencia y disminución de mortalidad por cáncer de mama, el cual está relacionado con mejoras en programas de detección en 2017. Es importante mantener y optimizar los programas de detección.

Factors Limiting Formation of Community Forestry Enterprises in the Southern Mixteca Region of Oaxaca, Mexico.

Many studies have considered community-based forestry enterprises to be the best option for development of rural Mexican communities with forests. While some of Mexico's rural communities with forests receive significant economic and social benefits from having a community forestry enterprise, the majority have not formed such enterprises. The purpose of this article is to identify and describe factors limiting the formation of community forestry enterprise in rural communities with temperate forests in the Southern Mixteca region of Oaxaca, Mexico. The study involved fieldwork, surveys applied to Community Board members, and maps developed from satellite images in order to calculate the forested surface area. It was found that the majority of Southern Mixteca communities lack the natural and social conditions necessary for developing community forestry enterprise; in this region, commercial forestry is limited due to insufficient precipitation, scarcity of land or timber species, community members' wariness of commercial timber extraction projects, ineffective local governance, lack of capital, and certain cultural beliefs. Only three of the 25 communities surveyed have a community forestry enterprise; however, several communities have developed other ways of profiting from their forests, including pine resin extraction, payment for environmental services (PES), sale of spring water, and ecotourism. We conclude that community forestry enterprise are not the only option for rural communities to generate income from their forests; in recent years a variety of forest-related economic opportunities have arisen which are less demanding of communities' physical and social resources.

Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence.

AIMS: Despite the increasing prevalence of hospitalized diabetic patients, there are few studies that evaluate the glycemic control and the rate of adherence to clinical practice guidelines for glucose monitoring and management in the hospital setting. METHODS: Crossover study using one-day surveys of all inpatients admitted to internal medicine wards from voluntary participating hospitals across Spain. Retrospective review of medical records was used to identify patients with hyperglycemia, causes for hospitalization, patients' demographic characteristics, appropriateness of glycemic monitoring and treatment during hospitalization. RESULTS: Among 5439 hospitalized patients studied there were 1000 (18.4%) with hyperglycemia in 111 participating hospitals. Patients mean age was 76.0±8.5 years (51.6% male). On admission, 91% had known diabetes (disease duration of 10.9±8.5 years), 5% had unknown diabetes and 4% had stress hyperglycemia. The comorbidity index (Charslon score) was 4 (interquartile range: 2 to 6) and 31% showed a high level of disability (Rankin scale). Main infringement in the process of care included lack of a recent HbA1c value (43.7%), use of sliding scale insulin therapy (20.7%), use of oral antidiabetic agents (8.9%), and less than three bedside point-of-care (POC) blood glucose test per day (17%). Glycemic target pre-meal and bedtime were achieved in 47% to 79.5% of POC. The rates of hypoglycemia (<70 mg/dL and <50mg/dL) were 10.3% and 2.4%, respectively. CONCLUSIONS: Our results suggest that there is an important gap between the clinical guidelines and both the management and the grade of glycemic control of diabetic inpatients.

Female farmworkers' perceptions of heat-related illness and pregnancy health.

Although agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women's perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack control over workplace conditions and that they lack training about these specific risks. These data are being used to develop culturally appropriate educational materials emphasizing health promoting and protective behaviors during pregnancy.

Theoretical and computational protein design.

From exponentially large numbers of possible sequences, protein design seeks to identify the properties of those that fold to predetermined structures and have targeted structural and functional properties. The interactions that confer structure and function involve intermolecular forces and large numbers of interacting amino acids. As a result, the identification of sequences can be subtle and complex. Sophisticated methods for characterizing sequences consistent with a particular structure have been developed, assisting the design of novel proteins. Developments in such computational protein design are discussed, along with recent accomplishments, ranging from the redesign of existing proteins to the design of new functionalities and nonbiological applications.

Metodología para la elaboración de un modelo de gestión en una institución pública venezolana: FUNDACITE-Merida / Methodology for the development of a management model for a public institution in venezuelan: FUNDACITE-Merida

Se propone una metodología para obtener un Modelo de gestión en una Institución pública. El modelo está basado en los procesos que intervienen en la Institución. La metodología propuesta se divide en varias fases de trabajo y está basada en una matriz que considera los diferentes requerimientos que llegan a la institución y las unidades que intervienen en las actividades ofrecidas por la institución. La primera fase levanta la información sobre la organización; la siguiente fase redefine aspectos claves de la organización, como son misión y objetivos. La tercera fase decribe los procesos implícitos en el modelo de gestión, para pasar a describir los requerimientos necesarios para la implementación. Finalmente, está la fase de implantación del modelo en la organización. Existen tres niveles de funcionamiento de la institución: dirección, servicios operativos y servicios de apoyo. La metodología propuesta ha sido implementada en la Fundación para el Desarrollo de Ciencia y tecnología en el Estado Mérida (FUNDACITE-Mérida) tomando en cuenta los lineamientos establecidos por el Ministerio de Ciencia y Tecnología. La metodología propuesta es general, por lo que puede ser usada por cualquier organización y de manera repetida por una misma organización, cada vez que las condiciones de su entorno y de ella misma lo ameriten

educacion en la quinta dimension del sujeto en la asignatura gabinete contable Carrera de Contaduria Publica / sss

La investigacion se realizo en la asignatura Gabinete Contable de sexto semestre de la carrera de contaduria publica, en el cual se detecto como problema, alto indice de reprobados, segun el diagnostico interno y externo se determino que la causa es el proceso docente educativo (PDE) para lo cual se analizo el plan global actual como tambien de otras universidades nacionales y extranjeras ninguno de los planes de estudio fue suficiente para el contexto social con un enfoque epistemologico dialectico holistico sistematico y generico dentro de los procesos concientes, aplicando en cada uno de los componentes de la pedagogia para que el PDE sea mas significativo, cognitivo y socializado a fin de resolver los problemas de la sociedad...

Mortalidad materna en el Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Revisión de 5 años / Maternal mortality at Hospital de Ginecobstetricia, Centro Médico de Occidente IMSS. Five years review

El objetivo del presente trabajo fue conocer la mortalidad y aspectos relacionados, en el Hospital de Ginecobstetricia del Centro Médico de Occidente IMSS y hacer un análisis de la problemática y proponer alternativas de solución. Se revisaron los expedientes e informes del Comité de Mortalidad Materna de 74 muertes ocurridas en un lapso de cinco años. Se emplearon las definiciones y criterios de clasificación propuestos por la Federación Internacional de Ginecología y Obstetricia. La tasa de muerte materna promedio fue de 8.01 X 10,000 nacidos vivos. Las principales causas de muerte fueron hemorragia, hipertensión arterial, probable tromboembolia pulmonar y sepsis. 82.4%fueron muertes directas, 66.2%fueron previsibles, y al ingreso al hospital, 39.1%. La responsabilidad profesional existió en 66.2%y la hospitalaria en 25.6%. Se hace el análisis de éstos y otros datos y se plantean posibles estrategias para disminuir la mortalidad materna.