Decision analysis with IDOCRIW-QUALIFLEX approach in the 2TLq-ROF environment: An application of accident prediction models in Pakistan.

In Pakistan, the assessment of road safety measures within road safety management systems is commonly seen as the most deficient part. Accident prediction models are essential for road authorities, road designers, and road safety specialists. These models facilitate the examination of safety concerns, the identification of safety improvements, and the projection of the potential impact of these modifications in terms of collision reduction. In the context described above, the goal of this paper is to utilize the 2-tuple linguistic q-rung orthopair fuzzy set (2TLq-ROFS), a new and useful decision tool with a strong ability to address uncertain or imprecise information in practical decision-making processes. In addition, for dealing with the multi-attribute group decision-making problems in road safety management, this paper proposes a new 2TLq-ROF integrated determination of objective criteria weights (IDOCRIW)-the qualitative flexible multiple criteria (QUALIFLEX) decision analysis method with a weighted power average (WPA) operator based on the 2TLq-ROF numbers. The IDOCRIW method is used to calculate the weight of attributes and the QUALIFLEX method is used to rank the options. To show the viability and superiority of the proposed approach, we also perform a case study on the evaluation of accident prediction models in road safety management. Finally, the results of the experiments and comparisons with existing methods are used to explain the benefits and superiority of the suggested approach. The findings of this study show that the proposed approach is more practical and compatible with other existing approaches.

Evaluation of the inter and intraobserver reproducibility of the "defect coverage index method", a new computed tomography assessment method of sagittal graft positioning in arthroscopic bone block procedures.

PURPOSE: To assess the reproducibility of a new 2-dimensional computed tomography (CT) method of assessing graft positioning in arthroscopic bone block procedure. METHODS: This is a prospective observational study. Twenty-seven patients, (all men, mean [Standard deviation] age at surgery 30.9 [8.49] years) were included. Vertical graft position was assessed on the sagittal view by measuring the amount of glenoid bone defect covered by the graft. The length of the bone defect and the amount of graft covering the defect were measured. Positioning of the graft on the sagittal plane was classified as accurate if the graft covered at least 90% of the defect. Intraobserver and interobserver reproducibility was analyzed using intraclass correlation coefficients (ICC) and Kappa coefficient with 95% confidence. RESULTS: Excellent intraobserver reproducibility was found, with an ICC of 0.94 (CI 95%, 0.86-0.97). Interobserver reproducibility was good, with the ICC value of 0.71, ranging from 0.45 to 0.86 (CI 95%). CONCLUSION: This new method of assessing graft positioning in arthroscopic bone block procedures on 2-dimensional computed tomography scans is reliable, with an excellent intraobserver and good interobserver reproducibility. LEVEL OF EVIDENCE: III.

Measurement of linear accelerator spectra, reconstructed from percentage depth dose curves by neural networks.

Purpose Linear accelerator (linac) spectra, used to improve the accuracy of dose calculation and to produce a complete description of beam quality, among other aspects, are relevant in radiotherapy and linear accelerator physics. Methods In this work we apply neural networks in solving an ill-conditioned system of linear equations, to indirectly measure the linear accelerator spectra via the percentage depth dose curves. The photon beam spectra are related to radiation doses through a Fredholm integral equation. To address our problem we measured the percentage depth dose curve in water and solved a discretized Fredholm equation using artificial neural network. After analysing the typology of our physical problem we selected a MultiLayer Perceptron Neural Network and designed the most suitable neural network architecture. Results The reconstructed spectra were compared with spectra from three linacs, two of them obtained by us through simulations and the third produced by another author, achieving a concordance between 92 % and 96 %. Conclusions Therefore, the spectrum of any accelerator can be quickly and easily reconstructed from measured percent depth dose curves, applying a trained artificial neural network.

[Improving the systematization of benchmarking in public health services]. / Avanzando en la sistematización del benchmarking en servicios de salud pública.

Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons.

Communication management in social responsibility programs in the mining sector / Gestión de la comunicación en programas de responsabilidad social en el sector minero

RESUMEN La responsabilidad social, como una de las respuestas a los actuales conflictos socioambientales, implica esfuerzos adicionales de las organizaciones para fortalecer su capacidad de gestión. Esto sucede, de manera especial, en las compañías mineras, cuyas actividades comprometen el uso de recursos de comunidades, entre ellos los naturales. Esta investigación analizó los aportes que la gestión de comunicaciones hace al relacionamiento con las comunidades en el marco de dos programas de responsabilidad social de los proyectos mineros Quebradona y Gramalote (ubicados en Antioquia, Colombia), adscritos a la compañía Anglogold Ashanti y ganadores del Premio Sello Social a la Minería en Antioquia, siendo dos de los proyectos con mayor exigencia y veeduría ciudadana en la región. Desde una mirada con predominancia interpretativa, y acudiendo a la revisión de documentos y entrevistas a jefes de áreas sociales, comunicadores, beneficiarios y líderes ambientales, se concluyó que el análisis del entorno, la visibilización de los programas y la mediación en los conflictos socioambientales son los principales aportes de los comunicadores en los proyectos mineros.

ABSTRACT Social responsibility, as one of the responses to current sock-environmental conflicts, implies additional efforts by organizations to strengthen their management capacity. This happens, especially, in mining companies, our activities compromise the use of community resources, including natural resources. This research analyzed the contributions that communications management makes to relations with communities within the framework of two social responsibility programs of the Quebradona and Gramalote mining projects (located in Antioquia, Colombia), attached to the company Anglogold Ashanti and winners of the Premio Sello Social a la Minería en Antioquia, being two of the projects with the highest demand and citizen oversight in the region. From an interpretive perspective and going to the review of documents and interviews with heads of social areas, communicators, beneficiaries, and environmental leaders, it was concluded that the analysis of the environment, the visibility of the programs and mediation in socio-environmental conflicts are the main contributions of communicators in mining projects.

Assessment of software-derived predictive algorithms for platelet yield and blood cell count after apheresis.

INTRODUCTION: Algorithms have been developed to predict the platelet yield after apheresis from the donor's data, as well as the effect on the blood cell count, to extract an acceptable platelet number without affecting the donor. However, the evaluation of these algorithms has not been widely reported. This study aimed to assess the accuracy of the predictive algorithms of the Trima Accel v. 6 blood collection system. METHODS: Platelet concentrates (PCs) obtained by apheresis were analyzed. Platelet count and hematocrit were compared pre- and post-apheresis. Calculated post-apheresis platelet count (CPAPC), hematocrit (CPAH), and platelet yield (CPY), and their actual values were correlated. The bias of the algorithms was assessed with Bland-Altman plots, and the prediction of the extraction of single or double platelet products was evaluated. RESULTS: Two hundred and seventy-nine PCs were analyzed. Post-apheresis platelet count (PAPC) and hematocrit were decreased. A moderate correlation was observed between CPY and the actual yield, with a negative bias, and a trend to increase alongside the magnitude of the measurements. CPAPC and CPAH were strongly correlated with their actual values without bias. Prediction of single or double platelet product extraction showed a significant agreement with the actual outcomes. CONCLUSIONS: The predictive algorithm for the platelet yield showed bias, and a trend to underestimate the actual platelet yields when they are higher. The algorithms for the prediction of the PAPC and hematocrit did not show bias, proving their accuracy. Prediction of a single or double platelet product extraction has a strong agreement with the APY.

Análisis cuantitativo, uso de Escala Braden por enfermería en el servicio de Medicina Interna del Hospital Santo Domingo / Quantitative analysis of the use of Braden Scale by nursing in the Internal Medicine service of the Hospital Santo Domingo

Resumen El objetivo de este estudio fue evaluar, mediante un análisis cuantitativo, el uso y aplicación de la Escala de Braden por el personal de enfermería en pacientes de medicina interna del Hospital Santo Domingo, año 2018. Es un estudio cuantitativo, transversal y descriptivo; la población total fue de 1017 pacientes con una muestra de 30 (12 masculinos y 18 feminas), ingresados al área de medicina interna del Hospital General Santo Domingo, provincia Santo Domingo de los Tsáchilas, de julio a agosto del 2018. Se les realizó una revisión de su historia clínica para conocer el puntaje que determinaba el riesgo de desarrollar úlceras por presión (UPP), según la valoración que recibieron mediante la escala. Durante la aplicación de la Escala de Braden, se pronosticó riesgo bajo a 15 pacientes, riesgo medio a 10 y riesgo alto a 5, quienes presentaron alteraciones neurológicas o enfermedades crónicas como: accidente cerebrovascular, diabetes mellitus, cirrosis hepática. Se concluye que el personal de enfermería no realiza una aplicación adecuada de la Escala de Braden ni desde el ingreso del paciente ni durante su reevaluación en el servicio de medicina interna, lo que trae consigo que la atención no se realice con la calidad requerida. Factor favorable para complicaciones como las UPP.

Abstract The objective of this study was to evaluate, through a quantitative analysis, the use and application of the Braden Scale by the nursing staff in internal medicine patients of the Santo Domingo Hospital, year 2018. It is a quantitative, cross-sectional and descriptive study; The total population was 1017 patients with a sample of 30 (12 males and 18 females), admitted to the internal medicine area of the Santo Domingo General Hospital, Santo Domingo de los Tsáchilas province, from July to August 2018. They underwent a review of their medical history to know the score that determined the risk of developing pressure ulcers (UPP), according to the assessment they received using the scale. During the application of the Braden Scale, low risk was predicted for 15 patients, medium risk for 10 and high risk for 5, who presented neurological disorders or chronic diseases such as: stroke, diabetes mellitus, liver cirrhosis. It is concluded that the nursing staff does not carry out an adequate application of the Braden Scale, neither since the patient's admission nor during his reevaluation in the internal medicine service, which means that the care is not performed with the required quality. Favorable factor for complications such as UPP.

Resumo O objetivo deste estudo foi avaliar, por meio de uma análise quantitativa, o uso e a aplicação da Escala de Braden pela equipe de enfermagem em pacientes de medicina interna do Hospital Santo Domingo, ano de 2018. Trata-se de um estudo quantitativo, transversal e descritivo; A população total foi de 1017 pacientes, com uma amostra de 30 (12 homens e 18 mulheres), admitidos na área de medicina interna do Hospital Geral de Santo Domingo, província de Santo Domingo de los Tsáchilas, de julho a agosto de 2018. Eles foram submetidos a uma revisão do histórico médico para conhecer o escore que determinou o risco de desenvolver úlceras por pressão (UPP), de acordo com a avaliação que receberam usando a escala. Durante a aplicação da Escala de Braden, foram previstos baixo risco para 15 pacientes, risco médio para 10 e alto risco para 5, que apresentavam distúrbios neurológicos ou doenças crônicas como: acidente vascular cerebral, diabetes mellitus, cirrose hepática. Conclui-se que a equipe de enfermagem não realiza uma aplicação adequada da Escala de Braden, nem desde a admissão do paciente nem durante sua reavaliação no serviço de medicina interna, o que significa que o cuidado não é realizado com a qualidade exigida. Fator favorável a complicações como UPP.

A novel and fast methodology to calculate doses in LDR brachytherapy.

We present the concept of a new methodology for faster simulation of the doses in brachytherapy with permanent implants, based on the knowledge of the seeds arrangement, adding previously simulated doses in an equivalent medium in terms of the atomic composition of the organ in question. To perform the doses calculations we use Monte Carlo simulations. We simulated a cylindrical I-125 seed and compared our results against published data. Our proposal is to have the doses simulated previously in different arrangement of seed-absorbents, and then, considering the spacial positions of the seeds after the implants, these doses can be directly added, obtaining a very fast computation of the total dose. Two phantoms of prostates with permanent implant seeds in 2D and 3D arrangements were simulated. The results of the proposed methodology were compared with two complete Monte Carlo simulations in 2D and 3D designs. Differences in doses were analysed, obtaining statistical discrepancies of less than 1% and reducing the simulation time by more than 4 orders of magnitude. With the proposed methodology, it is possible to perform rapid dose calculations in brachytherapy, using laptop or desktop computers.

Impact of COVID-19 outbreak by income: hitting hardest the most deprived.

BACKGROUND: The impact of the 2019 coronavirus disease (COVID-19) has many facets. This ecological study analysed age-standardized incidence rates by economic level in Barcelona. METHODS: We evaluated confirmed cases of COVID-19 in Barcelona (Spain) between 26 February 2020 and 19 April 2020. Districts were classified according to most recent (2017) mean income data. The reference for estimating age-standardized cumulative incidence rates was the 2018 European population. The association between incidence rate and mean income by district was estimated with the Spearman rho. RESULTS: The lower the mean income, the higher the COVID-19 incidence (Spearman rho = 0.83; P value = 0.003). Districts with the lowest mean income had the highest incidence of COVID-19 per 10 000 inhabitants; in contrast, those with the highest income had the lowest incidence. Specifically, the district with the lowest income had 2.5 times greater incidence of the disease, compared with the highest-income district [70 (95% confidence interval 66-73) versus 28 (25-31), respectively]. CONCLUSIONS: The incidence of COVID-19 showed an inverse socioeconomic gradient by mean income in the 10 districts of the city of Barcelona. Beyond healthcare for people with the disease, attention must focus on a health strategy for the whole population, particularly in the most deprived areas.

Cost-effectiveness of the CFTR gene-sequencing test for asymptomatic carriers in the Colombian population / [Costo-efectividad de la prueba de secuenciación del gen CFTR para portadores asintomáticos en la población colombiana].

Introduction: Cystic fibrosis is an autosomal recessive genetic disease classified as a highcost orphan disease. Objective: To determine the cost-effectiveness ratio of the diagnostic test for the CFTR gene-sequencing in asymptomatic family carriers in the first, second, and third degree of consanguinity. Materials and methods: We conducted a systematic search evaluating operative characteristics of the diagnostic test and decision-tree models in cost-effectiveness studies. A decision-tree model was elaborated taking prevention of future conceptions as a unit of analysis. We obtained the costs of the disease from the high-cost report of the Ministerio de Salud y Protección Social. The costs of the test were referenced by national laboratories. We carried out a deterministic and probabilistic sensitivity analysis with a third-payer perspective and a one-year horizon. Results: An ICER of USD$ 5051.10 was obtained as the incremental cost for obtaining 10.89% more probability of avoiding the birth of a child with cystic fibrosis per screened couple. For family members in second and third degrees, the ICER was USD$ 19,380.94 and USD$ 55,913.53, respectively, evidenced when applying the GDP per capita. This technology was cost-effective in 39%, 61.18%, and 74.36% for 1, 2, and 3 GDP per capita in first degree of consanguinity relatives. Conclusions: The genetic test for the detection of CFTR gene carriers was cost-effective depending on the threshold of availability to pay and the assumptions and limitations established in the model.

Introducción. La fibrosis quística es una enfermedad genética de carácter autosómico recesivo clasificada como enfermedad huérfana de alto costo. Objetivo. Determinar la razón de costo-efectividad de la prueba diagnóstica de secuenciación del gen CFTR para los portadores asintomáticos familiares en primer, segundo y tercer grados de consanguinidad. Materiales y métodos. Se hizo una búsqueda sistemática sobre la evaluación de las características operativas de la prueba diagnóstica y los modelos de árbol de decisiones en estudios de costo-efectividad. Se elaboró un modelo de árbol de decisiones tomando como unidad de análisis la prevención de futuras concepciones. Los costos de la enfermedad se obtuvieron del reporte de alto costo del Ministerio de Salud de Colombia. Los costos de la prueba se obtuvieron de laboratorios nacionales. Se hizo un análisis de sensibilidad, determinístico y probabilístico, con la perspectiva del tercer pagador y horizonte a un año. Resultados. Se obtuvo una razón incremental de costo-efectividad (RICE) de USD$5.051,10 por obtener 10,89 % más de probabilidades de evitar el nacimiento de un niño enfermo con fibrosis quística por pareja. Para los familiares de segundo y tercer grados, se encontró una RICE de USD$ 19.380,94 y USD$ 55.913,53, respectivamente, al aplicar el PIB per cápita. Esta tecnología fue costo-efectiva en 39 %, 61,18 % y 74,36 % para 1, 2 y 3 PIB per cápita en familiares de primer grado de consanguinidad. Conclusiones. La prueba genética de detección de portadores del gen CFTR resultó costo-efectiva dependiendo del umbral de la disponibilidad de pagar, y de los supuestos y limitaciones establecidas en el modelo.

The necessary gender perspective for the analysis of health problems.

This work begins with the difference between sex and gender, then show that the contrasts in the field of health between men and women can be explained: by the construction of gender of consultants and health service providers, by the structure of the services themselves of health (which also reflects gender constructions), and by the reproduction of gender patterns through education and research. The work shows the need to include a gender perspective in health research.

Este trabajo inicia con la diferencia entre sexo y género, para mostrar que los contrastes en el campo de la salud entre hombres y mujeres pueden explicarse por la construcción de género de consultantes y de proveedores de servicios de salud, por la estructura de los propios servicios de salud (que refleja también construcciones de género) y por la reproducción de patrones de género a través de la educación y la investigación. El trabajo muestra la necesidad de incluir la perspectiva de género en la investigación en salud.

Costo-efectividad de la prueba de secuenciación del gen CFTR para portadores asintomáticos en la población colombiana / Cost-effectiveness of the CFTR gene-sequencing test for asymptomatic carriers in the Colombian population

Introducción. La fibrosis quística es una enfermedad genética de carácter autosómico recesivo clasificada como enfermedad huérfana de alto costo. Objetivo. Determinar la razón de costo-efectividad de la prueba diagnóstica de secuenciación del gen CFTR para los portadores asintomáticos familiares en primer, segundo y tercer grados de consanguinidad. Materiales y métodos. Se hizo una búsqueda sistemática sobre la evaluación de las características operativas de la prueba diagnóstica y los modelos de árbol de decisiones en estudios de costo-efectividad. Se elaboró un modelo de árbol de decisiones tomando como unidad de análisis la prevención de futuras concepciones. Los costos de la enfermedad se obtuvieron del reporte de alto costo del Ministerio de Salud de Colombia. Los costos de la prueba se obtuvieron de laboratorios nacionales. Se hizo un análisis de sensibilidad, determinístico y probabilístico, con la perspectiva del tercer pagador y horizonte a un año. Resultados. Se obtuvo una razón incremental de costo-efectividad (RICE) de USD$ 5.051,10 por obtener 10,89 % más de probabilidades de evitar el nacimiento de un niño enfermo con fibrosis quística por pareja. Para los familiares de segundo y tercer grados, se encontró una RICE de USD$ 19.380,94 y USD$ 55.913,53, respectivamente, al aplicar el PIB per cápita. Esta tecnología fue costo-efectiva en 39 %, 61,18 % y 74,36 % para 1, 2 y 3 PIB per cápita en familiares de primer grado de consanguinidad. Conclusiones. La prueba genética de detección de portadores del gen CFTR resultó costo-efectiva dependiendo del umbral de la disponibilidad de pagar, y de los supuestos y limitaciones establecidas en el modelo.

Introduction: Cystic fibrosis is an autosomal recessive genetic disease classified as a high- cost orphan disease. Objective: To determine the cost-effectiveness ratio of the diagnostic test for the CFTR gene-sequencing in asymptomatic family carriers in the first, second, and third degree of consanguinity. Materials and methods: We conducted a systematic search evaluating operative characteristics of the diagnostic test and decision-tree models in cost-effectiveness studies. A decision-tree model was elaborated taking prevention of future conceptions as a unit of analysis. We obtained the costs of the disease from the high-cost report of the Ministerio de Salud y Protección Social. The costs of the test were referenced by national laboratories. We carried out a deterministic and probabilistic sensitivity analysis with a third-payer perspective and a one-year horizon. Results: An ICER of USD$ 5051.10 was obtained as the incremental cost for obtaining 10.89% more probability of avoiding the birth of a child with cystic fibrosis per screened couple. For family members in second and third degrees, the ICER was USD$ 19,380.94 and USD$ 55,913.53, respectively, evidenced when applying the GDP per capita. This technology was cost-effective in 39%, 61.18%, and 74.36% for 1, 2, and 3 GDP per capita in first degree of consanguinity relatives. Conclusions: The genetic test for the detection of CFTR gene carriers was cost-effective depending on the threshold of availability to pay and the assumptions and limitations established in the model.

Clinical practice guideline for the evaluation and management of patients with severe aortic stenosis for the Peruvian Social Security.

Introduction: This article summarizes the clinical practice guide (CPG) for the evaluation and management of patients with severe aortic stenosis in the Social Security of Peru (EsSalud). Objective: To provide clinical evidence-based recommendations for the evaluation and management of patients with severe aortic stenosis in the EsSalud. Methods: A local guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies, were conducted in PubMed during 2018. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of evaluation and management. Finally, the CPG was approved with Resolution N.° 47 - IETSI - ESSALUD - 2018. Results: This CPG addressed 7 clinical questions regarding two issues: the initial evaluation and the management of severe aortic stenosis. Based on these questions, 9 recommendations (1 strong recommendation and 8 weak recommendations), 16 points of good clinical practice, and 1 flowchart were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the evaluation and management of patients with severe aortic stenosis in the EsSalud.

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud basadas en evidencia científica. Métodos: Se conformó un grupo elaborador local (GEG-Local) que incluyó médicos especialistas y metodólogos. El GEG-Local formuló siete preguntas clínicas que ser respondidas en la presente GPC. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, estudios primarios en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La calidad de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG-Local usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y tratamiento. Finalmente, la GPC fue aprobada con Resolución N.° 47 ­ IETSI ­ ESSALUD ­ 2018. Resultados: La presente GPC abordó siete preguntas clínicas, respecto a dos temas: la evaluación inicial y el tratamiento de la estenosis aórtica severa. Con base en dichas preguntas se formularon nueve recomendaciones (una recomendación fuerte y ocho recomendaciones débiles), 16 puntos de buena práctica clínica y un flujograma. Conclusión: El presente artículo resume la metodología y las conclusiones de la GPC para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud.

Clinical practice guideline for the evaluation and management of patients with severe aortic stenosis for the Peruvian Social Security.

Introduction: This article summarizes the clinical practice guide (CPG) for the evaluation and management of patients with severe aortic stenosis in the Social Security of Peru (EsSalud). Objective: To provide clinical evidence-based recommendations for the evaluation and management of patients with severe aortic stenosis in the EsSalud. Methods: A local guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies, were conducted in PubMed during 2018. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of evaluation and management. Finally, the CPG was approved with Resolution N.° 47 - IETSI - ESSALUD - 2018. Results: This CPG addressed 7 clinical questions regarding two issues: the initial evaluation and the management of severe aortic stenosis. Based on these questions, 9 recommendations (1 strong recommendation and 8 weak recommendations), 16 points of good clinical practice, and 1 flowchart were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the evaluation and management of patients with severe aortic stenosis in the EsSalud.

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud basadas en evidencia científica. Métodos: Se conformó un grupo elaborador local (GEG-Local) que incluyó médicos especialistas y metodólogos. El GEG-Local formuló siete preguntas clínicas que ser respondidas en la presente GPC. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, estudios primarios en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La calidad de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG-Local usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y tratamiento. Finalmente, la GPC fue aprobada con Resolución N.° 47 ­ IETSI ­ ESSALUD ­ 2018. Resultados: La presente GPC abordó siete preguntas clínicas, respecto a dos temas: la evaluación inicial y el tratamiento de la estenosis aórtica severa. Con base en dichas preguntas se formularon nueve recomendaciones (una recomendación fuerte y ocho recomendaciones débiles), 16 puntos de buena práctica clínica y un flujograma. Conclusión: El presente artículo resume la metodología y las conclusiones de la GPC para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud.

Guía de práctica clínica para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el Seguro Social del Perú / Clinical practice guideline for the evaluation and management of patients with severe aortic stenosis for the Peruvian Social Security

Resumen Introducción: El presente artículo resume la guía de práctica clínica (GPC) para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud basadas en evidencia científica. Métodos: Se conformó un grupo elaborador local (GEG-Local) que incluyó médicos especialistas y metodólogos. El GEG-Local formuló siete preguntas clínicas que ser respondidas en la presente GPC. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, estudios primarios en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La calidad de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG-Local usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y tratamiento. Finalmente, la GPC fue aprobada con Resolución N.° 47 — IETSI — ESSALUD — 2018. Resultados: La presente GPC abordó siete preguntas clínicas, respecto a dos temas: la evaluación inicial y el tratamiento de la estenosis aórtica severa. Con base en dichas preguntas se formularon nueve recomendaciones (una recomendación fuerte y ocho recomendaciones débiles), 16 puntos de buena práctica clínica y un flujograma. Conclusión: El presente artículo resume la metodología y las conclusiones de la GPC para la evaluación y el tratamiento de pacientes con estenosis aórtica severa en el EsSalud.

Abstract Introduction: This article summarizes the clinical practice guide (CPG) for the evaluation and management of patients with severe aortic stenosis in the Social Security of Peru (EsSalud). Objective: To provide clinical evidence-based recommendations for the evaluation and management of patients with severe aortic stenosis in the EsSalud. Methods: A local guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies, were conducted in PubMed during 2018. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of evaluation and management. Finally, the CPG was approved with Resolution N.° 47 — IETSI — ESSALUD — 2018. Results: This CPG addressed 7 clinical questions regarding two issues: the initial evaluation and the management of severe aortic stenosis. Based on these questions, 9 recommendations (1 strong recommendation and 8 weak recommendations), 16 points of good clinical practice, and 1 flowchart were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the evaluation and management of patients with severe aortic stenosis in the EsSalud.

Características clínicas de los pacientes con pénfigo en la valoración dermatológica de un hospital de alta complejidad / Clinical characteristics of patients with Pemphigus in the dermatological evaluation of a high complexity hospital

Introducción y objetivo: El pénfigo es una enfermedad autoinmune dermatológica que pro-duce lesiones ampollosas por la acción de anticuerpos contra proteínas en los desmosomas, provocando pérdida de la cohesión de las células epidérmicas, generando múltiples manifesta-ciones dermatológicas. El objetivo es describir una serie de pacientes con pénfigo valorados por dermatología. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo.

Gestión por procesos del servicio de ortopedia y traumatología de un Hospital Público: estrategia, ventajas y dificultades

Este estudio pretende reflejar las experiencias, describir y analizar las dificultades en el ensayo de implementar la “gestión por procesos” en el servicio de ortopedia y traumatología de un hospital público de 140 camas como así también reconocer las ventajas y evaluar el impacto sobre la eficacia eficiencia y efectividad. La institución tiene dos pilares básicos en su gestión: brindar prestaciones de alto nivel académico, científico y humano, es decir “compromiso con la Calidad y la Excelencia”, como así también la asunción de la “Responsabilidad y Gestión Social”. Estos dos conceptos se han ido desarrollando a lo largo de la historia de nuestro hospital El objetivo central es afianzar la cultura de la excelencia en la gestión, reordenando y definiendo los procesos y a través de ello lograr: mayor compromiso de los profesionales, alinearse a las necesidades del paciente, descentralizar la gestión, estandarizar las actividades, favorecer la mejora continua, allanar la organización y mejorar la eficacia y eficiencia. Se intenta extraer conclusiones valederas, llevar a cabo una revisión sobre el desarrollo en las distintas fases y etapas de la gestión por procesos, es decir, se vuelve a mirar o “revisita” la institución, sus actores y las experiencias vividas, pasando por avances y retrocesos, aciertos y desaciertos, posibilidades y limitaciones plasmados en los resultados obtenidos. De este modo, se presenta un informe técnico y de reflexión teórica

SUMMARY: This study aims to reflect experiences, describe, and analyze the difficulties in the trial of implementing "process management" in an Orthopedics and Traumatology department of a public hospital with 140 beds as well as recognize the advantages and assess the impact on the efficacy, efficiency and effectiveness. The institution has two basic pillars in its management: to provide benefits of high academic, scientific and human level, that is to say "commitment to Quality and the Excellence", as well as the assumption of “Social Responsibility and Management ". These two concepts have been developing throughout the history of our hospital The main objective is to strengthen the culture of excellence in the management, reordering and defining the process and through this achieve: greater commitment of the professionals, align to the patient’s the needs, decentralize the management, standardize the activities, promote continuous improvements, streamline the organization and improve efficiency and effectiveness. It tries to draw valid conclusions, carry out a review on the development in the different phases and stages of the process management, that is to say, it is re-looks or "revisits " the institution, its actors and their lived experiences, passing through advances and setbacks, successes and failures, possibilities and limitations reflected in the results obtained. In this way, a technical report and theoretical reflection is presented

Prevalencia del cáncer en una aseguradora en salud en Colombia, 2013 / Cancer prevalence in a health insurance organization in Colombia, 2013

Resumen Introducción: El cáncer es una de las principales causas de muerte no violenta en el mundo, se calcula que anualmente se presentan más de 11 millones de casos nuevos, de los cuales 80% se presentan en países en vías de desarrollo. Objetivo: Conocer la prevalencia del cáncer en una población afiliada a una aseguradora en salud en Colombia. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en una cohorte de 11.500 pacientes con cáncer de una aseguradora en salud, identificados a partir de los sistemas de información de la compañía, durante los años 2010 a 2013, se analizaron los datos a través de frecuencias, tasas y razón de prevalencias. Resultados: La prevalencia general de cáncer fue de 543 por 100.000 afiliados. La mayor proporción de los casos (67%) se presentaron en mayores de 50 años. Las ciudades con mayor prevalencia fueron Manizales, Cali, Pereira y Neiva. Los tipos de cáncer más prevalentes fueron mama, otros sólidos, próstata, piel y tiroides. La prevalencia de cáncer infantil fue de 65 por 100.000 menores de 18 años afiliados. Las leucemias linfoides agudas, los tumores malignos cerebrales y los linfomas fueron las neoplasias más frecuentes en la población infantil. Conclusiones: Este es el primer estudio de prevalencia de cáncer en una población asegurada en Colombia, con lo cual se establece una herramienta que permite planear servicios, proporcionar estrategias de tamización, auditoría y evaluación de resultados en un contexto de aseguramiento y gestión del riesgo en salud.

Introduction: Cancer is one of the leading causes of non-violent death in the world. An estimated eleven million new cases occur worldwide every year, of which 80% occurred in developing countries. Objective: To determine the prevalence of cancer in a population affiliated to a health care insurance organization in Colombia. Materials and Methods: A descriptive cross-sectional study was conducted on a cohort of 11,500 patients with cancer affiliated to a health care organization. The patients were identified from the information systems of the company, during the years 2010-2013. Data were analysed using frequencies, rates, and prevalence ratio. Results: The overall prevalence of cancer was 543 per 100,000 members. The largest proportion of cases (67%) occurred in patients older than 50 years. The cities with the highest prevalence were Manizales, Cali, Pereira and Neiva. The most prevalent cancer types were breast, other solid tumours, prostate, skin, and thyroid. The prevalence of childhood cancer was 65 per 100,000 members under 18 years. Acute lymphoid leukaemia, malignant brain tumours, and lymphomas were the most common malignancies in children. Conclusions: This is the first study of the prevalence of cancer in an insured population in Colombia, becoming a tool for planning services, provide screening strategies, auditing and evaluation of results in the context of health insurance and risk management.

Economic impact of vaccination with PCV13 vs. vaccination with PCV 10 in Colombia / Impacto económico de la vacunación con PCV13 frente al PCV 10 en Colombia

We aim was to estimate the difference of costs and expected cases from serotype coverage of the 13-valent pneumococcal conjugated vaccine (PCV13) and 10-valent pneumococcal conjugated vaccine (PCV10) in the population under 5 years of age in Colombia, using a deterministic model. We considered the probabilities of incidence, mortality and sequelae from infections of pneumonia, meningitis, sepsis and acute otitis media, as well as the clinical effectiveness of PCV13 and PCV10, which were determined by a systematic review of the literature. A2 + 1 immunization schedule was considered, and a 42% herd effect and 84.09% population coverage were assumed. The perspective was the Colombian health system with a time horizon of 5-years. The model showed greater protection of PCV13 in comparison to PCV10. A difference of 98 prevented deaths was observed for meningitis, pneu monia and sepsis. The opportunity cost difference found in the 5-year follow-up between PCV13 and PCV10 vaccines was COP (Colombian pesos) 36,128,082,380 at 2012 prices, which represents COP 7,225,616,476 of difference per year. PCV13 is considered the better alternative, this is mainly due to the impact that this vaccine has on the disease burden of the infections produced by Streptococcus pneumoniae in Colombian children under five years of age.

Nuestro objetivo fue estimar la diferencia de los costos y los casos que se esperan de la cobertura de serotipos de la vacunas conjugadas 13-valente neumocócica (PCV13) y 10-valente neumocócica (PCV10), en la población menor de cinco años de edad en Colombia, mediante un modelo determinista. Se consideraron las probabilidades de incidencia, mortalidad y secuelas de las infecciones de neumonía, meningitis, sepsis y la otitis media aguda, así como la efectividad clínica de la PCV13 y la PCV10, que se determinaron mediante una revisión sistemática de la literatura. Se consideró un esquema de vacunación A2 + 1 y se supuso un efecto grupal del 42% y una cobertura de la población de 84,09%. La perspectiva fue el sistema de salud colombiano, con un horizonte temporal de cinco años. El modelo mostró una mayor protección de PCV13 en comparación con PCV10. Se observó una diferencia de 98 muertes que se evitaron por causa de la meningitis, la neumonía y la sepsis. La diferencia costooportunidad encontrada en el seguimiento de cinco años entre las vacunas PCV13 y la PCV10 fue de 36,128,082,380 pesos colombianos (COP) a precios de 2012, lo que representa una diferencia de COP 7,225,616,476 por año.

[Nosocomial infections impact in a hospital in Bogota, Colombia: effects on mortality and hospital costs]. / Impacto de la infección nosocomial en un hospital de Bogotá, Colombia: efectos en mortalidad y costos.

BACKGROUND: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. AIM: To evaluate from the health provider's perspective the costs and mortality attributable to NI. METHODS: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. RESULTS: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). CONCLUSION: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.