Caracterización del comportamiento organizacional en la Facultad de Ciencias Médicas Mayabeque / Characterization of Organizational Behavior in Mayabeque´s Faculty of Medical Sciences

Introducción: En la sociedad moderna, los sistemas organizacionales marchan a la par de los procesos de transformaciones sociales. Dentro del clima organizacional, el comportamiento organizacional permite el estudio sistemático de actos y actitudes que las personas muestran en las organizaciones. Objetivo: Caracterizar el clima organizacional desde la percepción de la dimensión comportamiento organizacional de los trabajadores de la Facultad de Ciencias Médicas de Mayabeque. Métodos: Se realizó un estudio observacional descriptivo transversal para caracterizar el comportamiento de variables socio-psicológicas que definen comportamiento organizacional y su impacto en el funcionamiento interno de la Facultad de Ciencias Médicas de Mayabeque de enero a octubre del 2017. El universo estuvo constituido por el total de trabajadores de la institución en el período estudiado. La información se recogió de una fuente primaria a través de cuestionario estructurado autoaplicado, entrevista individual y grupal y la observación de la institución, que permitió la recopilación de información imprescindible mediante la triangulación de técnicas e instrumentos para el abordaje del fenómeno organizacional. Resultados: La dimensión comportamiento organizacional muestra un valor de 5,78 según promedio de ítem, lo que muestra indicadores de riesgo. La categoría comunicación obtiene la menor puntuación con 5,50 promedio de ítem. Las relaciones interpersonales entre el jefe y los miembros del equipo de trabajo fue el ítem que obtuvo mayor promedio en la categoría, con 1,46. Conclusiones: El clima organizacional de la Facultad de Ciencias Médicas de Mayabeque clasifica con un puntaje de riesgo y los trabajadores perciben dificultades en las categorías Motivación, Comunicación y Relaciones Interpersonales que la hacen clasificar como categoría en riesgo dentro de la dimensión Comportamiento Organizacional(AU)

Introduction: In modern society, organizational systems go hand in hand with the processes of social transformations. Within the organizational ambiance, organizational behavior allows for the systematic study of acts and attitudes that people display in organizations. Objective: To characterize the organizational ambiance from the perception of the organizational behavior dimension of the workers of the Faculty of Medical Sciences of Mayabeque. Methods: A cross-sectional descriptive observational study was conducted to characterize the behavior of socio-psychological variables that define organizational behavior and their impact on the internal functioning of the Faculty of Medical Sciences of Mayabeque from January to October 2017. The universe consisted of the total number of employees of the institution in the period studied. The information was collected from a primary source through a self-administered structured questionnaire, individual and group interviews, and observation of the institution, which allowed the collection of essential information through the triangulation of techniques and instruments to address the organizational phenomenon. Results: The organizational behavior dimension shows a value of 5.78, which shows risk indicators. The communication category gets the lowest score with 5.50. The interpersonal relationships between the boss and the members of the work team were the ones that obtained the highest average in the category with 1.46. Conclusions: The organizational climate of the Faculty of Medical Sciences of Mayabeque classifies with a risk score and workers perceive difficulties in the categories of Motivation, Communication and Interpersonal Relationships that make it classified as a category at risk within the dimension of Organizational Behavior(AU)

Epidemiology of Fabry disease in patients in hemodialysis in the Madrid community.

This study screened for Fabry disease (FD) in patients in hemodialysis (HD) in the region of Madrid (CAM) with a cross-sectional design to evaluate HD-prevalent patients, followed by a three-year period prospective design to analyze HD-incident patients. INCLUSION CRITERIA: patients older than 18 years on HD in the CAM, excluding patients diagnosed with any other hereditary disease with renal involvement different from FD, that sign the Informed Consent (IC). EXCLUSION CRITERIA: underaged patients or not agreeing or not being capable of signing the IC. RESULTS: 3470 patients were included, 63% males and with an average age of 67.9±9.7 years. 2357 were HD-prevalent patients and 1113 HD-incident patients. For HD-prevalent patients, average time in HD was 45.2 months (SD 51.3), in HD-incident patients proteinuria was present in 28.4%. There were no statistical differences in plasmatic alpha-galactosidase A (α-GAL-A) activity or Lyso-GL-3 values when comparing HD-prevalent and HD-incident populations and neither between males and females. A genetic study was performed in 87 patients (2.5% of patients): 60 male patients with decreased enzymatic activity and 27 female patients either with a decreased GLA activity, increased Lyso-Gl3 levels or both. The genetic variants identified were: p.Asp313Tyr (4 patients), p.Arg220Gln (3 patients) and M290I (1 patient). None of the identified variants is pathogenic. CONCLUSIONS: 76% of HD Centers of the CAM participated in the study. This is the first publication to describe the prevalence of FD in the HD-population of a region of Spain as well as its average α-GAL-A-activity and plasmatic Lyso-Gl3 levels. It is also the first study that combines a cross-sectional design with a prospective follow-up design. This study has not identified any FD patient.

Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound. / Consulta de acceso vascular: resultados antes y después de la instauración de un programa multidisciplinar con realización de ecografía doppler de rutina.

BACKGROUND: A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU. MATERIAL AND METHODS: We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF. RESULTS: We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p=.289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p=.098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p=.015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p=.159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p=.001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p <.001), with a corresponding reduction in costs (€87,716 vs. €59,445). CONCLUSIONS: Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs.

Risk identification in haemodialysis patients by appropriate body composition assessment. / Identificar situaciones de riesgo para los pacientes en hemodiálisis mediante la adecuada valoración de su composición corporal.

INTRODUCTION: Circumstances such as gender, age, diabetes mellitus (DM) and renal failure impact on the body composition of patients. However, we use nutritional parameters such as lean and fat tissue with reference values from healthy subjects to assess the nutritional status of haemodialysis (HD) patients. AIMS: To analyse body composition by bioimpedance spectroscopy (BIS) of 6395 HD patients in order to obtain reference values of lean tissue index (LTI) and fat tissue index (FTI) from HD patients; and to confirm its validity by showing that those patients with LTI below the 10th percentile calculated for their group have greatest risk of death. MATERIAL AND METHODS: We used the BIS to determine the LTI and FTI in our cohort of HD patients in Spain. We calculated the 10th percentile and 90th percentile of LTI and FTI in each age decile for patients grouped by gender and presence of DM. We collected clinical, laboratory and demographic parameters. RESULTS: The LTI/FTI 10 and 90 percentile values varied by group (age, gender and presence of DM) and, after adjusting for other risk factors such as fluid overload, those patients with LTI lower than percentile 10 had a higher relative risk of death (OR 1.57) than those patients with higher values. CONCLUSIONS: Monitoring the LTI and FTI of patients on HD using suitable reference values may help to identify risk in this patient population.

Clinical, analytical and bioimpedance characteristics of persistently overhydrated haemodialysis patients.

BACKGROUND: Fluid overload is an important and modifiable cardiovascular risk factor for haemodialysis patients. So far, the diagnosis was based on clinical methods alone. Nowadays, we have new tools to assess more objectively the hydration status of the patients on haemodialysis, as BCM (Body Composition Monitor). A Relative Overhydration (AvROH) higher than 15% (it means, Absolute Overhydration or AWOH higher than 2.5 Litres) is associated to greater risk in haemodialysis. However, there is a group of maintained hyperhydrated patients. The aim of the present study is to identify the characteristics of patients with maintained hyperhydrated status (AvROH higher than 15% or AWOH higher than 2.5 liters). The secondary aim is to show the hemodynamic and analytical changes that are related to the reduction in hyperhydration status. METHODS: Longitudinal cohort study during six months in 2959 patients in haemodialysis (HD) that are grouped according to their hydration status by BCM. And we compare their clinical, analytical and bioimpedance spectroscopy parameters. RESULTS: The change in overhydration status is followed by a decrease in blood pressure and the need for hypotensive drugs (AHT) and erythropoiesis stimulating agents (ESA). The target hydration status is not reached by two subgroups of patients. First, in diabetic patients with a high comorbidity index and high number of hypotensive drugs (AHT) but a great positive sodium gradient during dialysis sessions; and, younger non-diabetic patients with longer time on hemodialysis and positive sodium gradient, lower fat tissue index (FTI) but similar lean tissue index (LTI) and albumin than those with a reduction in hyperhydration status. CONCLUSION: Those patients with a reduction in hyperhydration status, also show a better control in blood pressure and anemia with less number of AHT and ESA. The maintained hyperhydrated patients, diabetic patients with many comorbidities and young men patients with longer time on hemodialysis and non-adherence treatment, can profit from a constant monitoring of their hydration state as well as an individualized treatment (dialysis and drugs).