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INTRODUCCIÓN: las actividades asistenciales relacionadas con la atención de pacientes en servicios clínicos tienen diferentes grados de riesgos para las personas que los reciben, el error en la atención sanitaria se denomina evento adverso y/o centinelas los que, según su gravedad, pueden llegar a causar la muerte de los usuarios. OBJETIVO: determinar los costos totales de úlceras por presión y caídas ocurridos en los usuarios de los servicios clínicos de cirugía y medicina en un establecimiento de alta complejidad durante el primer semestre del 2017 y primer semestre del 2018, en Chile. MÉTODO: estudio descriptivo retrospectivo. La ocurrencia de eventos relacionados a úlceras por presión y caídas son notificados a través del sistema informático Phoenix y son recepcionados por el Departamento de Calidad y Seguridad del Paciente del establecimiento, los datos económicos fueron proporcionados por el departamento de Finanzas. Los datos fueron procesados por programa computacional Excel. RESULTADOS: los costos totales asociado a úlceras por presión y caídas:ï¼Servicio de Cirugía, primer semestre del 2017:-Ulceras por presión $44.086.872 (U$ 57.557 dólares)-Caídas $39.630.517 (U$51.739 dólares)-Costo total $ 83.717.389 (U$109.297 dólares)ï¼Servicio de Medicina, primer semestre del 2017:-Úlceras por presión $22.654.894 (U$29.803 dólares)-Caídas $32.023.185 (U$41.807 dólares)-Costo total $ 54.678.079 (U$71.385 dólares)ï¼Servicio de Cirugía, primer semestre del 2018:-Ulceras por presión $76.979.440 (U$100.500 dólares)-Caídas $18.522.927 (U$24.182 dólares)-Costo total $ 95.502.367 (U$124.683 dólares)ï¼Servicio de Medicina, primer semestre del 2018:-Ulceras por presión $14.981.255 (U$19.558 dólares)-Caídas $55.258.625 (U$72.142 dólares)-Costo total $ 70.239.880 (U$91.701 dólares) CONCLUSIÓN: se logró levantar información actual sobre los recursos financieros y clínicos que determinan el impacto económico que generan los eventos adversos en los pacientes atendidos en un centro asistencial público. Es por esto, que el presente estudio, permitió cuantificar y evidenciar el impacto económico de dos eventos ocurridos en los servicios clínicos de un hospital de alta complejidad de Chile.
INTRODUCTION: healthcare activities related to the care of patients in clinical services, have different degrees of risks for the people who receive them, the error in health care is called an adverse event and / or sentinels which, depending on their severity, can arrive to cause the death of users. OBJECTIVE: to determine the total costs of pressure ulcers and falls that occurred in users of clinical services of surgery and medicine in a highly complex establishment during the first half of 2017 and the first half of 2018, in Chile. METHOD: retrospective descriptive study. The occurrence of events related to pressure ulcers and falls are notified through the Phoenix computer system and are received by the Department of Quality and Patient Safety of the establishment, the economic data were provided by the Department of Finance. The data were processed by Excel computer program. RESULTS: the total costs associated with pressure ulcers and falls:Surgery Service, first semester of 2017: -Pressure ulcers $ 44,086,872 (U$ 57,557)-Falls $ 39,630,517 (U$ 51,739) -Total cost$ 83,717,389 (U$ 109,297)Medicine Service, first semester of 2017: -Pressure ulcers $ 22,654,894 (U$29,803 dollars) -Falls $ 32,023,185 (U$41,807 dollars) -Total cost $ 54,678,079 (U$71,385 dollars)Surgery Service, first semester of 2018: -Pressure ulcers $ 76,979,440 (U$100,500 dollars) -Falls $ 18,522,927 (U$24,182 dollars) -Total cost $ 95,502,367 (U$124,683 dollars)Medicine Service, first semester of 2018: -Pressure ulcers $ 14,981,255 (U$19,558 dollars) -Falls $ 55,258,625 (U$72,142dollars) -Total cost $ 70,239,880 (U$91,701 dollars) CONCLUSIONS: it was possible to collect current information on financial and clinical resources that determine the economic impact generated by adverse events in patients treated in a public healthcare center. This is why the present study made it possible to quantify and demonstrate the economic impact of two events that occurred in the clinical services of a highly complex hospital in Chile.
Subject(s)
Humans , Database Management Systems/instrumentation , Pressure Ulcer/diagnosis , Pressure Ulcer/etiology , Research Design , Software , Chile , Retrospective Studies , Risk Factors , Statistics as Topic , Health Care Costs , Cost of Illness , Risk Assessment , Pressure Ulcer/economics , Emergency Medical Services/statistics & numerical data , Patient SafetyABSTRACT
s reconocida la etiología multifactorial de la periodontitis, donde factores genéticos y ambientales interactúan para producir la enfermedad y modificar su expresión clínica. El objetivo de este estudio fue determinar la asociación entre la presencia del polimorfismo para el receptor de IgG subclase III A (FCYRIIIA-158V-F) y la periodontitis severa. Se estudiaron 150 pacientes: 32 pacientes con periodontitis agresiva, 71 pacientes con periodontitis crónica, y 47 voluntarios clínicamente sanos sin periodontitis. Se obtuvieron muestras de sangre periférica, aproximadamente 20µl. La extracción de ADN se llevó a cabo desde las microtarjetas FTAelute. Los polimorfismos seleccionados fueron amplificados por PCR. Resultados: Las frecuencias genotípicas de los tres grupos evaluados cumplieron con el equilibrio Hardy-Weinberg (Test Chi cuadrado, valor-p >0.05, IC 95 %). La diferencia entre la condición de enfermo (peridontitis crónica y agresiva) y el grupo de individuos sanos fue estadísticamente significativa para la presencia del alelo T (p≤0,004), con un OR de 4,03 (IC 95%), la sensibilidad correspondió al 93% y la especificidad al 23%, con un valor predictivo positivo del 72% y un valor predictivo negativo del 61%. Conclusiones: Se determinó una asociación estadísticamente significativa entre la presencia del alelo T en el polimorfismo de FCYRIIIA-158V-F y la condición de enfermo, de manera que el poseer el alelo T presenta una mayor probabilidad de desarrollar periodontitis severa. Debido a la importancia de identificar sujetos suceptibles a la periodontitis recomendamos realizar más estudios.
he multifactorial etiology of periodontitis is recognized, where genetic and environmental factors interact to produce the disease and modify its clinical expression The aim of this study is to determine the association between the presence of the polymorphism for IgG subclass III A receptor (FCYRIIIA-158V-F) and severe periodontitis. Materials and Methods: The study sample was composed of 150 patients: 32 patients with aggressive periodontitis, 71 patients with chronic periodontitis, and 47 clinically healthy volunteers without periodontitis. Peripheral blood samples, approximately 20μl, were obtained. DNA extraction was carried out from the FTAelute micro-cards. The selected polymorphisms were amplified by PCR. Results: The genotypic frequencies of the three groups evaluated met the Hardy-Weinberg equilibrium (Chi-square test, p-value> 0.05, 95% CI). The difference between the periodontitis (chronic and aggressive peridontitis) group and the group of healthy individuals was statistically significant for the presence of the T allele (p≤0.004), with an OR of 4.03 (95% CI), the sensitivity to 93% and specificity to 23%, with a positive predictive value of 72% and a negative predictive value of 61%. Conclusions: A statistically significant association was found between the presence of the T allele in the polymorphism of FCYRIIIA-158V-F and the diseased condition (periodontitis group), suggesting that the T allele possesses a higher probability of developing severe periodontitis. Due to the importance of identifying subjects susceptible to periodontitis we recommend further studies.
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ABSTRACT: This study aimed to evaluate the inbreeding depression and average genetic components in seven hybrids and two open pollinated cultivars for green corn production, as well as to select the best genotypes in order to obtain base populations for inbred lines extraction. The experiment was carried out in a randomized complete block design with four replications, in a split plot design, with inbreeding levels arranged in the plots and the different genotypes distributed over the subplots, in the municipality of Sabáudia - PR, during the 2014/15 crop season. Higher values of dominance and inbreeding depression were observed for yield of both unhusked and commercial ears. Higher additive effects were detected on length and diameter of commercial ears. The genotypes AM811, Cativerde 02 and AG4051 showed greater probability of obtaining highly productive and higher quality green corn inbred lines.
RESUMO: O trabalho teve por objetivo avaliar a depressão por endogamia e os componentes genéticos de médias em sete híbridos e em duas variedades de polinização aberta para uso como milho verde, para seleção de genótipos visando à formação de populações-base para a extração de linhagens. Para a realização do estudo, foi instalado um experimento no município de Sabáudia - PR, no ano agrícola de 2014/15. O experimento foi delineado em blocos completos ao acaso, com quatro repetições, em arranjo de parcelas subdivididas, com as gerações de endogamia e os diferentes genótipos ocupando as parcelas e as subparcelas, respectivamente. As maiores estimativas de dominância e de depressão endogâmica foram observadas na produtividade de espigas empalhadas e comerciais. Os efeitos aditivos foram mais expressivos na herança do comprimento e do diâmetro de espigas comerciais. Os genótipos AM811, Cativerde 02 e AG4051 apresentaram maiores probabilidades no sucesso de extração de linhagens destinadas à produtividade e qualidade de milho verde.
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Pulmonary rehabilitation (PR) is an essential tool in the management of chronic respiratory diseases in childhood. PR improve symptoms, physical performance, quality of life and social integration in children who have limitations in their daily activities. Health professionals have a key role in identifying those children who are candidates for pulmonary rehabilitation programs, in the initial evaluation and in the implementation of therapeutic strategies for training and education. This document is intended as a reference guide for all those professionals who are dedicated to the care of children with chronic respiratory diseases.
La rehabilitación respiratoria (RR) es un componente esencial en el manejo de las enfermedades respiratorias crónicas en la infancia. La RR ha demostrado mejorar los síntomas, el rendimiento físico, la calidad de vida y su participación social en aquellos niños que tienen limitaciones en el desarrollo de sus actividades de la vida diaria. Los profesionales de la salud tienen un rol fundamental en identificar aquellos niños que son candidatos para los programas de rehabilitación respiratoria, en la evaluación inicial y en la implementación de estrategias terapéuticas de entrenamiento y de educación. Este documento pretende ser una guía de consulta para todos aquellos profesionales que se dedican a la atención de niños con enfermedades respiratorias crónicas.
Subject(s)
Humans , Child , Exercise , Respiratory Tract Diseases/rehabilitation , Quality of Life , Chronic DiseaseABSTRACT
Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.
La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.
Subject(s)
Female , Humans , Middle Aged , Coccidioidomycosis , Lung Diseases, Fungal , Antifungal Agents/therapeutic use , Chile , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Diagnosis, Differential , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Mexico , Pneumonia/diagnosis , Travel , Treatment FailureABSTRACT
En la primera pandemia del siglo XXI por virus influenza A/H1N1, una importante proporción de paciente que desarrollaron neumonía y Falla Respiratoria Aguda (FRA) eran obesos. La obesidad ha sido propuesta como un factor de riesgo que aumenta la morbimortalidad; sin embargo, hay controversia al respecto. Objetivo: evaluar el impacto de la obesidad en complicaciones, estadía y/o mortalidad en pacientes adultos graves por virus influenza A/H1N1. Estudio observacional y multicéntrico realizado en 17 UCIs de Chile durante el periodo mayo-agosto 2009. Fueron incluidos en el estudio solo paciente con infección por virus Influenza A/H1N1 confirmada o probable. Los paciente obesos (IMC>30) fueron comparados con pacientes no obesos. Resultados: De un total de 136 pacientes incluidos en el estudio, 64 (47 por ciento) fueron obesos y de estos 13 obesos mórbidos (BMI >40). Los pacientes obesos tienen mayor frecuencia de: comorbilidades, ventilación mecánica y complicaciones. La estadía en UCI y en el hospital fue más prolongada en pacientes obesos (18,1+/-15 vs. 10,9+/-10,2, p=0,002 y 27,2+/-24,7 vs17,7 +/- 14,6, p=0,01 respectivamente). La mortalidad fue mayor en pacientes obesos (36 por ciento vs. 19,4 por ciento; OR 2,32; IC95 por ciento 1,07-5,05, p=0.035). El estudio de regresión logística encuentra que la FOM es un factor pronóstico independiente de mortalidad en pacientes obesos. Conclusiones: Los pacientes obesos con neumonía grave por virus influenza A/H1N1 tienen una mayor morbi-mortalidad y prolongación de su estadía en UCI y en el hospital. El desarrollo de FOM en pacientes obesos es un factor de mal pronóstico.
In the first pandemic of the 21st century due to influenza A/H1N1 virus, a significant proportion of patients who developed pneumonia and acute respiratory failure (ARF) were obese. Obesity has been proposed as a risk factor that increases morbidity and mortality, however, there is controversy about it. Objective: To determine the impact of obesity on complications, stay and / or mortality in adult patients with severe influenza A/H1N1 virus. Multicenter observational study conducted in 17 ICUs of Chile during the period May to August 2009. Were included only patients with influenza A/H1N1 virus infection confirmed or probable. Obese patients (BMI> 30) were compared with non obese patients. The results: Of a total of 136 patients included in the study, 64 (47 percent) were obese and of these 13 morbidly obese (BMI> 40). Obese patients have a higher frequency of: comorbidities, mechanical ventilation and complications. The stay in ICU and hospital was longer in obese patients (18.1 +/- 15 vs. 10.9 +/- 10.2, p = 0.002 and 27.2 +/- 24.7 vs17, 7 +/- 14.6, p = 0.01 respectively). Mortality was higher in obese patients (36 percent vs. 19.4 percent, OR 2.32, 95 percent CI 1.07 to 5.05, p = 0,035). The logistic regression analysis found that the MOF is an independent predictor of mortality in obese patients. Conclusions: Obese patients with severe pneumonia due to the influenza A/H1N1 virus have a high morbidity and mortality and prolonged stay in ICU and hospital. MOF development in obese patients is a poor prognostic factor.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Influenza, Human/epidemiology , Pneumonia, Viral/epidemiology , Obesity/epidemiology , Body Mass Index , Comorbidity , Chile/epidemiology , Influenza, Human/mortality , Influenza, Human/virology , Intensive Care Units , Length of Stay , Logistic Models , Multicenter Studies as Topic , Pneumonia, Viral/mortality , Obesity/complications , Obesity/mortality , Survival Analysis , Influenza A Virus, H1N1 Subtype/isolation & purificationABSTRACT
Background: Physical activity (PA) has a protective role in cardiovascular diseases. Aim: To quantify PA in young adults and to correlate it with cardiovascular risk factors. Material and Methods: A cross-sectional study was performed employing the international physical activity questionnaire (IPAQ), to measure the PA of 983 randomly selected young adults from Valparaiso region born between 1974 and 1978. Its results were associated with levels of obesity, insulin resistance and cardiovascular risk factors defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) Results: Mean physical activity among men and women was 3731 ± 3923 and 1360 ± 2303 METs-minutes/week, respectively (p < 0.001). Fifty percent of women and 21.5 percent of men had an insuffcient level of physical activity (p < 0.001). Sixty percent of men and 23.4 percent of women had an intense level of physical activity (p < 0.001). There was an inverse association of physical activity and insulin resistance. A high physical activity was protective, specially among men, against a low HDL cholesterol level and high triglyceride levels with Odds Ratios of 0.59 (confdence interval (CI): 0,35-0.98) and 0.49 (CI: 0,27-0,87) respectively, after adjusting for body mass index and age. Conclusions: In this sample, men had higher levels of physical activity, that was protective against insulin resistance and the presence of cardiovascular risk factors.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Cardiovascular Diseases/prevention & control , Motor Activity , Body Mass Index , Cholesterol, HDL/blood , Cross-Sectional Studies , Insulin Resistance/physiology , Surveys and Questionnaires , Risk Factors , Sex Factors , Waist CircumferenceABSTRACT
Las enfermedades musculoesqueléticas generan impotencia funcional y dolor crónico. El sistema de salud público concentra gran parte de su resolución en el nivel secundario de atención, con largas listas de espera. El presente trabajo señala los primeros resultados del funcionamiento de un Programa Piloto de Atención Musculoesquelética (PAME).Con especialistas del nivel secundario, se desarrollaron guías de manejo y derivación de los principales problemas musculoesqueléticos en lista de espera. En su desarrollo se consideró la existencia de salas de manejo kinésico en atención primaria. Se seleccionó un consultorio perteneciente al Servicio de Salud Metropolitano Sur, donde se implementó una sala piloto más kinesiólogo. Se capacitó a los médicos del consultorio en la correcta derivación de pacientes, ajustada a cartera de servicio. En cada paciente atendido en la sala, se evaluó dolor (EVA) y capacidad funcional (HAQ-8) al momento de ingreso y egreso. Además, se realizó conteo de lista de espera en todos los consultorios del Servicio de Salud. El costo de implementación del PAME fue $7.086.925. En sus primeros 6 meses fueron atendidos 301 pacientes (81 por ciento mujeres, x igual 60 años). La evaluación de los pacientes en condición de alta evidenció mejoría significativa del dolor y funcionalidad en todas las patologías. La tasa de generación de interconsultas al nivel secundario del consultorio correspondió a 4,2x10.000 inscritos-año, la menor del servicio de salud. El PAME, constituye una estrategia factible, mejorando el dolor, funcionalidad y acceso, de la enfermedad musculoesquelética, aumentando la resolutividad de atención primaria y el trabajo coordinado de la red asistencial
Musculoskeletal diseases result in functional impairment and chronic pain. The public health system concentrates a great part of its resolutions for the secondary health care level, thus generating long waiting lists. The present work reports the first results from the operation of a Musculoskeletal Care Pilot Program (PAME).Management and referral guidelines for the main musculoskeletal conditions in waiting list were developed with specialists from the secondary care level. While being developed, the existence of primary care physical therapy wards was considered. An outpatient clinic belonging to the Southern Metropolitan Health Service was selected, and a to implement a pilot ward with a physical therapist. The physicians from the outpatient clinic were trained in the adequate patient referral, adjusted to the service portfolio. Each patient receiving care at the floor, was assessed for pain (VAS) and functional capacity (HAQ-8) upon admission and discharge. Moreover, a waiting list count was performed at all the outpatient clinics from the Health Service. The cost of the implementation of PAME was $7.086.925. During the first 6 months, 301patients received health care (81percent females, x igual 60 years). The assessment of patients in conditions for discharge evidenced a significant improvement of pain and functionality in all pathologies. The rate of referrals to the secondary level was 4,2 x 10.000 registered-year, the lowest in the Health Service. The PAME constitutes a viable strategy, improving pain, functionality and access of musculoskeletal disease, and increasing the capacity of resolution of the primary care levels and the coordinated work of the care network