Desarrollo local: la informática al servicio de la gestión en salud: entrega de turnos del Servicio de la Mujer y Recién Nacido HCSBA / Local developoment: informatics at the service of health management: delivery of shifts of the HCSBA woman and newborn service

INTRODUCCIÓN: La entrega de turnos de los diferentes equipos clínicos de atención al paciente es un acto de suma importancia en el día a día, apunta al óptimo y continuo cuidado del paciente. En el continuo de atención por diferentes Unidades Clínicas, se debe cumplir un protocolo definido por las Unidades de Calidad de Establecimientos y Servicios Clínicos como parte del Sistema de Acreditación en Salud, apuntando a mejorar la seguridad de atención al paciente. Se planteó reemplazar antiguos informes en papel por bases de datos digitales acumulativas, de fácil llenado, con alternativa de pre-informes y análisis rápido de series, permitiendo tomar decisiones mejor fundamentadas en el futuro. Esta herramienta como se describe al inicio considera el continuo desde el ingreso de la paciente a la Unidad de Urgencia de nuestra maternidad hasta la resolución de esta madre en nuestro Servicio o el traslado de ella o su recién nacido dentro de la Red Pública como primera instancia o privada acorde a protocolos establecidos. MATERALES Y MÉTODOS: Desarrollo de aplicación a través de programas Microsoft Acces y MySQL. Parametrización de variables según Guia perinatal MINSAL y recomendaciones de expertos empleados en Unidad Ginecoobstétrica del establecimiento. RESULTADOS: Creación de aplicación propia ¨Sistema de entrega de turno¨ (SET). Implementación mediante marcha blanca a partir de Agosto de 2019. Adecuada acogida por personal de Servicio de la Mujer y Recién Nacido HCSBA. CONCLUSIÓN: La informática médica permite avanzar y agilizar procesos de gestión clinica. Es posible implementar sistemas de creación propios en la atención de salud pública chilena. La herramienta SET permitirá obtener resultados precisos y rápido análisis de series obtenidas.

INTRODUCTION: The delivery of shifts of the different clinical teams of patient care is an act of utmost importance in the day to day, it points to the optimal and continuous care of the patient. In the continuum of care by different Clinical Units, a protocol defined by the Quality Units of Establishments and Clinical Services as part of the Health Accreditation System must be complied with, aiming at improving the safety of patient care. It was proposed to replace old paper reports with cumulative digital databases, easy to fill, with alternative pre-reports and quick series analysis, allowing better informed decisions in the future. This tool as described at the beginning considers the continuum from the patient's admission to the Emergency Unit of our motherhood until the resolution of this mother in our Service or the transfer of this or her newborn within the Public Network as the first instance or private according to established protocols. MATERIALS AND METHODS: Application development through Microsoft access and MySQL programs. Parameterization of variables according to the MINSAL perinatal guide and recommendations of experts employed in the Obstetric Gynecology Unit of the establishment. RESULTS: Creation of own application "Shift Delivery System" (SET). Implementation through white march as of August 2019. Adequate reception by women service personnel and newborn HCSBA. CONCLUSION: Medical informatics allows progress and speed up clinical management processes. It is possible to implement own creation systems in Chilean public health care. The SET tool will allow obtaining accurate results and rapid analysis of series obtained.

Adaptación transcultural del cuestionario POSAS (Patient and Observer Scar Assessment) para valoración de cicatrices / Transcultural adaptation of the POSAS questionnaire (Patient and Observer Scar Assessment) to assess scars

Resumen Introducción: La escala POSAS para evaluación de cicatrices está validada y muestra ventajas sobre otras escalas por integrar parámetros cualitativos y la opinión del paciente. Tiene un uso creciente en la práctica clínica, pero hace falta su adaptación transcultural para su aplicación local. Objetivo: Realizar una adaptación transcultural de la escala POSAS 2.0 original. Materiales y Método: Con técnica de traducción dinámica se efectuó traducción de POSAS en inglés, comparación de traducciones, traducción inversa y prueba piloto en observadores y pacientes. Resultados: Se obtuvo buena correlación de traducciones, los observadores y pacientes lograron comprender el instrumento adaptado en un estudio piloto. Conclusión: Obtuvimos una versión adaptada de la escala POSAS, aplicable a población local para valoración de diferentes tipos de cicatrices. Se puede someter la escala adaptada a procesos de validación.

Introduction: The POSAS scale for the evaluation of scars is validated and shows advantages over other scales by integrating qualitative parameters and the opinion of the patient. It has a growing use in clinical practice, but its transcultural adaptation is needed for its local application. Aim: To carry out a transcultural adaptation of the original POSAS 2.0 scale. Materials and Method: With dynamic translation technique, translation of POSAS in english, comparison of translations, inverse translation and pilot test in observers and patients. Results: Good correlation of translations was obtained, observers and patients were able to understand the instrument adapted in a pilot study. Conclusion: We obtained an adapted version of the POSAS scale, applicable to the local population for assessment of different types of scars. The adapted scale can be submitted to validation processes.

Environmental risk assessment of triclosan and ibuprofen in marine sediments using individual and sub-individual endpoints.

The guidelines for the Environmental Risk Assessment (ERA) of pharmaceuticals and personal care products (PPCP) recommend the use of standard ecotoxicity assays and the assessment of endpoints at the individual level to evaluate potential effects of PPCP on biota. However, effects at the sub-individual level can also affect the ecological fitness of marine organisms chronically exposed to PPCP. The aim of the current study was to evaluate the environmental risk of two PPCP in marine sediments: triclosan (TCS) and ibuprofen (IBU), using sub-individual and developmental endpoints. The environmental levels of TCS and IBU were quantified in marine sediments from the vicinities of the Santos submarine sewage outfall (Santos Bay, São Paulo, Brazil) at 15.14 and 49.0 ng g-1, respectively. A battery (n = 3) of chronic bioassays (embryo-larval development) with a sea urchin (Lytechinus variegatus) and a bivalve (Perna perna) were performed using two exposure conditions: sediment-water interface and elutriates. Moreover, physiological stress through the Neutral Red Retention Time Assay (NRRT) was assessed in the estuarine bivalve Mytella charruana exposed to TCS and IBU spiked sediments. These compounds affected the development of L. variegatus and P. perna (75 ng g-1 for TCS and 15 ng g-1 for IBU), and caused a significant decrease in M. charruana lysosomal membrane stability at environmentally relevant concentrations (0.08 ng g-1 for TCS and 0.15 ng g-1 for IBU). Chemical and ecotoxicological data were integrated and the risk quotient estimated for TCS and IBU were higher than 1.0, indicating a high environmental risk of these compounds in sediments. These are the first data of sediment risk assessment of pharmaceuticals and personal care products of Latin America. In addition, the results suggest that the ERA based only on individual-level and standard toxicity tests may overlook other biological effects that can affect the health of marine organisms exposed to PPCP.

CHARACTERIZATION OF FLUORESCENT NUCLEAR TRACK DETECTORS AS CRITICALITY DOSIMETERS II.

Fluorescent nuclear track detectors (FNTDs) as criticality dosimeters for both neutrons and gamma are further characterized in terms of angular dependence and quick dose assessment. The power spectrum integral depth profiles obtained from stacks of fluorescent images acquired within FNTDs exposed to a broad spectrum neutron field at various angles are analyzed to determine a calibration curve for angular dependence. MCNPX simulations were shown to be in good agreement with experimental results. A prototype triage reader was also designed and tested for quick assessment of dose. An unfolding technique incorporating both energy dependence and angular dependence is discussed. The advantages and shortcomings of using FNTDs in the event of a criticality excursion accident are analyzed.

ENERGY RESPONSE OF FLUORESCENT NUCLEAR TRACK DETECTORS OF VARIOUS COLORATIONS TO MONOENERGETIC NEUTRONS.

The neutron-energy dependence of the track-counting sensitivity of fluorescent nuclear track detectors (FNTDs) at two ranges of Mg doping, resulting in different crystal colorations, was investigated. The performance of FNTDs was studied with the following converters: Li-glass for thermal to intermediate-energy neutrons, polyethylene for fast neutrons, and polytetrafluoroethylene (Teflon™) for photon- and radon-background subtraction. The irradiations with monoenergetic neutrons were performed at the National Physics Laboratory (NPL), UK. The energy range was varied from 144 keV to 16.5 MeV in the personal dose equivalent range from 1 to 3 mSv. Monte Carlo simulations were performed to model the response of FNTDs to monoenergetic neutrons. A good agreement with the experimental data was observed suggesting the development of a basic model for future MC studies. Further work will focus on increasing FNTD sensitivity to low-energy neutrons and developing a faster imaging technique for scanning larger areas to improve counting statistics.

[Description of assessment processes at the Medical School of the Pontificia Universidad Católica de Chile: a ten year experience]. / Descripción de los Procesos de Evaluación en la Escuela de Medicina de la Pontificia Universidad Católica de Chile: Experiencia de 10 años.

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.

Descripción de los Procesos de Evaluación en la Escuela de Medicina de la Pontificia Universidad Católica de Chile: Experiencia de 10 años / Description of Assessment Processes at the Medical School of the Pontificia Universidad Católica de Chile: A Ten year experience

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.

Understanding international postgraduate studies. Drivers from the supply and the demand side.

Changes in the global political and socioeconomic scenario are fostering the internationalization of master and doctoral programme as one of the current priorities for Universities. Changes in European higher education such as those stimulated by the Bologna process and the introduction of double, multiple or joint Master degree programmes together with the Erasmus Mundus programme are enhancing the competition of European universities in the global education market place. Universities compete to attract the best students, both national and international, to their postgraduate programmes. However, the design and launch of international masters or doctorates imply working with a different logic to the one used in national programmes. Complexity, diversity and differentiation are drivers of international education and as happens in complex systems the properties and features of the final products are different from the existing in the individual components. The aim of this paper is to understand international studies as complex systems and to analyze and identify factors affecting to the different components involved in the implementation of these programmes. The new approaches and the interrelations in aspects such as academic, administrative or economic management, quality assurance and marketing issues are examined and drivers, challenges and good practices where possible are identified. The analysis has been carried out considering the point of view of both Universities (supply-led approach) and students and employers (demand-led approach). From the analysis have emerged important questions that show the interrelation pattern and that can be useful when designing and implementing international postgraduate studies. Universities and students tend to agree about many issues however, some divergences have also been identified which make the results of the research more valuable.

Avaliação clínica e da qualidade de vida de indivíduos com disfunção temporomandibular / Clinical and quality-of-life assessment among women with temporomandibular disorder

OBJETIVOS: Este estudo teve como objetivo avaliar sintomas de dor, apertamento dos dentes, qualidade do sono e sensibilidade dolorosa nos principais músculos mastigatórios e estabilizadores cervicais e qualidade de vida de mulheres com Disfunção Temporomandibular (DTM). MÉTODOS: Foram avaliadas 45 mulheres, divididas em dois grupos. O grupo I, composto por 27 mulheres (30,1±5,8anos) com diagnóstico de DTM e o grupo II, controle, composto por 18 mulheres saudáveis (23,4±2,3 anos). A intensidade dos sintomas de dor, cefaleia, cervicalgia, de apertamento dos dentes e dificuldade de dormir foram avaliados por escala visual analógica (EVA), o limiar de dor dos músculos masseter, temporal anterior, trapézio superior e esternocleidomastoideo, com dolorímetro e a qualidade de vida, pelo SF-36. Foi realizada análise estatística e o nível de significância foi α=0,05. RESULTADOS: Os resultados mostram que mulheres com DTM têm sintomas mais intensos de cefaleia (p<0,001), cervicalgia (p<0,001), intensidade de apertamento dos dentes (p<0,001) e dificuldade de dormir (p<0,001). Também apresentam limiar de dor mais baixo nos músculos masseter (p<0,001), temporal anterior (p<0,001), trapézio superior (p<0,001), esternocleidomastoideo (p<0,001) e pior qualidade de vida em todos os domínios avaliados (p<0,05), quando comparados com o grupo controle. CONCLUSÕES: Mulheres com DTM têm maior intensidade dos sintomas de dor, apertamento dos dentes, dificuldade de dormir, maior sensibilidade dolorosa em músculos mastigatórios e cervicais e pior qualidade de vida quando comparadas com mulheres sem DTM.

OBJECTIVES: The aim of this study was to evaluate pain symptoms, teeth clenching, quality of sleep, sensitivity to pain in the main masticatory and stabilizer muscles, and quality of life among women with temporomandibular disorder (TMD). METHODS: Forty-five women were evaluated and divided into two groups. Group I included 27 women (mean age 30.1±5.8 years) with a diagnosis of TMD and Group II (control) included 18 healthy women (mean age 23.4±2.3 years). The intensity of pain symptoms (headache, neck pain), teeth clenching and trouble sleeping was evaluated using a visual analog scale (VAS). The pain thresholds of the masseter, anterior temporalis, upper trapezius and sternocleidomastoid muscles were evaluated using a dolorimeter. Quality of life was evaluated using SF-36. Statistical analysis was performed and the significance level was α<0.05. RESULTS: The results showed that the women with TMD presented more intense headache (p<0.001), neck pain (p<0.001), teeth clenching (p<0.001) and trouble sleeping (p<0.001). They also presented lower pain threshold in the masseter (p<0.001), anterior temporalis (p<0.001), upper trapezius (p<0.001) and sternocleidomastoid (p<0.001) muscles and lower quality of life in all evaluated domains (p<0.05) when compared with the control group. CONCLUSIONS:Women with TMD had greater intensity of pain symptoms, teeth clenching, trouble sleeping, sensitivity to pain in the masticatory and neck muscles and lower quality of life, compared with women without TMD.

Critical assessment of the current guidelines for the management and treatment of morbidly obese patients.

An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.

Pattern of care for schizophrenia patients in Granada (Spain): a case register study.

AIMS: This study sets out to explore the use flow of mental health services by a cohort of patients with schizophrenia located in Granada (Spain). METHODS: All cases (N = 844) included in the analysis were users of the community mental healthcare public service provided in the area. The Markov chain model was used to calculate the probability of transition from one type of contact with mental health services resources to another type of contact in the next month, over a three-year follow-up. RESULTS: For a given one-month period, for each level of service contact, most patients continued to use the same level of care. CONCLUSIONS: Our results can be interpreted as a reflection of adequate continuity of mental health care provided by the Andalusian community service.

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study.

OBJECTIVE: The objective is to describe and characterize patterns of service use by out-patients with schizophrenia in Spain. METHOD: A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods. RESULTS: A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out-patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas. CONCLUSION: Development and organization of mental health services should take into account the combinations of services patients most frequently use.

Evaluation of the spiral plating system for the routine assessment of indicator microorganisms in raw ewe's milk.

The numbers of members of different microbial groups in bulk raw ewe's milk used for cheesemaking (46 samples, taken on receipt at the dairy over 1 year) were assayed by the spiral plating system to determine the effectiveness of this method compared with that of widely accepted conventional methods in providing counts. The results indicated that for ewe's milk, the suitability of the spiral plating system depends to a great extent on the microbial group studied. Although "spiral" counts of mesophiles, psychrotrophs, coliforms, and Enterobacteriaceae could be considered equivalent to those obtained by conventional techniques (r > or = 0.90; variance between replicate platings approximately 0.005), the automated method was found not to be suitable for the assessment of other groups of indicator bacteria (thermodurics and enterococci). Counts of lactic acid bacteria and yeasts and molds were affected significantly (P < 0.05) by the plating method, although other statistical parameters were more favorable (r = 0.88 and r = 0.82, respectively; 95% confidence limits within 0.5 log units). Finally, counts of staphylococci, particularly on Baird-Parker medium, showed less variation and higher reproducibility with the spiral method. Nevertheless, for the routine microbiological analysis of ewe's milk, the spiral plating system, with its time-, effort-, and material-saving advantages, is preferred over the conventional method.

[Development on a rice-based food product, for children]. / Desarrollo de un producto alimenticio a base de arroz, para uso infantil.

An infant dehydrated rice-based food product, complemented with soybean flour, was developed. To improve its nutritional and organoleptic characteristics, fruits were also added. Ingredients were first precooked and dried in a drum-dryer, obtaining a final product, as flakes, with a 2 to 3% water content. This rehydrates easily with liquids such as milk, water or "panela" (refined and concentrated sugar cane syrup). The sensory panel did not detect any difference between formulations containing 10, 15 and 20% soybean, respectively.

El servicio de vacunacion antirrabica en los Centros de Salud 2 y 3 de Guadalajara, Jalisco / The service of antirabies vaccination in the health centers 2 and 3 of Guadalajara, Jalisco

Se analizan 3,824 historias clinicas de otras tantas personas mordidas por alguna especie animal, que acudieron a los servicios antirrabicos de los Centros de Salud 2 y 3 de Guadalajara en el lapso comprendido entre 1976-1977. Se pretende presentar un perfil epidemiologico de estos casos, en relacion con la necesidad de aplicar la proteccion especifica. Se sugiere el uso rutinario de una hoja clinica