Past, present, and future of sustainable intensive care: narrative review and a large hospital system experience.

Healthcare systems are large contributors to global emissions, and intensive care units (ICUs) are a complex and resource-intensive component of these systems. Recent global movements in sustainability initiatives, led mostly by Europe and Oceania, have tried to mitigate ICUs' notable environmental impact with varying success. However, there exists a significant gap in the U.S. knowledge and published literature related to sustainability in the ICU. After a narrative review of the literature and related industry standards, we share our experience with a Green ICU initiative at a large hospital system in Texas. Our process has led to a 3-step pathway to inform similar initiatives for sustainable (green) critical care. This pathway involves (1) establishing a baseline by quantifying the status quo carbon footprint of the affected ICU as well as the cumulative footprint of all the ICUs in the healthcare system; (2) forming alliances and partnerships to target each major source of these pollutants and implement specific intervention programs that reduce the ICU-related greenhouse gas emissions and solid waste; and (3) finally to implement a systemwide Green ICU which requires the creation of multiple parallel pathways that marshal the resources at the grass-roots level to engage the ICU staff and institutionalize a mindset that recognizes and respects the impact of ICU functions on our environment. It is expected that such a systems-based multi-stakeholder approach would pave the way for improved sustainability in critical care.

Quality of hospital care and clinical outcomes: a comparison between the Lombardy Region and the Italian national data.

Background: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented reorganization and restructuring actions. This study analyzed data from the Italian National Outcomes Program to compare some volumes and outcomes of public and private accredited hospitals in the Lombardy Region with national data. Study design: Observational study. Methods: A thorough examination of hospital outcomes between 2019 and 2021 was conducted, considering 45 volume indicators and 48 process and outcome indicators, comparing Lombardy with other Italian regions and public versus private accredited hospitals. Results: In 2020, Italy and Lombardy experienced a considerable reduction in overall hospital admissions, with Lombardy showing a deeper decline (21.3% compared with 16.0% in Italy). In 2021, both experienced a partial recovery, especially marked in the Lombardy region (+7.3%, compared with national data). Focusing specifically on the private sector in Lombardy, a recovery of +9.3% in hospitalization was observed. In the analysis of clinical outcomes, Lombardy outperformed the national average for 63% of the indicators in 2020 and 83.3% in 2021. Conclusions: The study shows the continuing decline in volumes compared to 2019 (pre-COVID), the excellent performance of hospitals in Lombardy and a relevant contribution for the volumes and the quality of outcomes of private accredited hospitals.

The hospital autopsy: the importance in keeping autopsy an option

Autopsy has been one of the most powerful diagnostic tools in medicine for over a century. Despite its importance in establishing cause of death and elucidating pathophysiology of disease, rates of hospital autopsies continue to decline. In this study we aim to determine if physicians believe autopsies are essential to patient care through discussion of autopsy with families. At the same time, we analyzed whether families are more willing to consent to autopsy if physicians are involved in autopsy discussion at the time of death, and what may be the reasons for not wanting an autopsy. Our results showed a doubling in autopsy consent when autopsy was discussed by the physician. Additionally, the biggest reason for families not consenting to autopsy was because they believed they already knew what caused death. The emergence of Coronavirus 2019 (COVID-19) has re-established the value of autopsy, as seen by increased autopsy rates in the past year. This study demonstrates that physician conversation with families on autopsy leads to an increased chance of autopsy consent.

Sustentabilidad hospitalaria, calidad y seguridad del paciente en el Hospital Clínico Universidad de Chile / Hospital sustainability, quality and patient safety in Hospital Clínico Universidad de Chile

The sustainability of the Universidad de Chile Clinical Hospital must be understood comprehensively; providing higher quality and safety for our patients, ensuring highest standards of medical care. The quality of care must be understood not only in complying with the minimum standards to accredit and grant GES benefits, establish agreements with health insurers and be financially competitive; It must be incorporated into its management the dimensions of quality - effectiveness, efficiency, accessibility, safety, equity and patient-centered care- minimizing the costs of non-quality work. Our Clinical Hospital, as our country's main training center in healthcare professions, must include training at the undergraduate students' curriculum in quality and patient safety issues. (AU)

El hospital del futuro en 10 puntos / The hospital of the future in 10 points

La Sociedad Española de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals

Evaluación rápida del impacto de la crisis sanitaria generada por la epidemia de COVID-19 en los programas de cribado neonatal en la Comunidad de Madrid: programa de cribado neonatal de enfermedades endocrino-metabólicas y programa de detección precoz de hipoacusia en recién nacidas/os / Evaluation of COVID-19 emergency and state of alarm impact on Neonatal Screening Programs in Madrid: endocrine and metabolic disorders program and hearing program review

OBJETIVO: El estado de alarma decretado como medida de control de la epidemia COVID-19 supuso una amenaza en el correcto desarrollo de los programas de salud de la Comunidad de Madrid. El objetivo de este trabajo fue evaluar el impacto de la epidemia por COVID-19 y el estado de alarma decretado en los Programas de Cribado Neonatal (PCN) de Enfermedades Endocrino-Metabólicas (EEM) e hipoacusias en la Comunidad de Madrid. MÉTODOS: Se realizó un estudio descriptivo cuali-cuantitativo del 1 enero al 31 abril de 2020. Para describir las actividades desarrolladas en las etapas de los PCN se diseñaron cuestionarios semiestructurados. Para conocer las coberturas de cribado se analizaron el REgistro de CRIbado Neonatal (RECRINE) e información de los Servicios de Maternidad. Se analizaron diferencias utilizando el test de Chi2 (p valor=0,05). RESULTADOS: Las tasas de respuesta a los cuestionarios fueron mayores del 70%. Más del 80% de los hospitales dieron altas precoces entre las 24 y 48 horas de vida del recién nacido. Se diseñaron circuitos alternativos para realizar los PCN en más del 75% de los centros. Se aseguró el cribado de las diecinueve enfermedades del PCN de EEM, el RECRINE y la derivación a las Unidades Clínicas de Referencia (UCR). No se observaron incidencias importantes en confirmación diagnóstica y tratamiento en las UCR que se adaptaron a la reorganización de la asistencia sanitaria. Se observaron coberturas de cribado auditivo y de EEM superiores al 95% en el 88,5% de los hospitales. No se observaron diferencias frente al periodo preepidémico. CONCLUSIONES: Nuestro estudio demuestra la resiliencia de los profesionales que participan en el desarrollo de los PCN. Es remarcable la importancia de continuar diseñando evaluaciones periódicas para conocer y subsanar el impacto de la epidemia de COVID-19 según los estándares de calidad de atención a la población nacida en 2020 y sus madres

OBJECTIVE: Under the declaration of the state of alarm (SA) in efforts to control COVID-19, normal development of health programs was threatened. The aim of the study was the evaluation of COVID 19 emergency and SA approval impact on neonatal Endocrine and Metabolic Disorders Program (EMDP) and Neonatal Hearing Program (HP) in Madrid. METHODS: Qualitative and quantitative descriptive study was conducted. Semistructured interview was designed and developed to picture newborn screening activities taking place from January 1st to 31st of April 2020. To describe the undergo rates of newborn screening, neonatal screening information system (RECRINE) and martenity and prenatal care units were studied. Differences were analyzed using Chi2 test (p value = 0.05). RESULTS: More than 70% interviews were reported. Early hospital discharges, between 24 and 48h, were made in more than 80% hospitals. Screening programs were adapted in more than 75% health care centers. EMDP 19 diseases, RECRINE and Clinical Reference Units (RCU) referral were conducted. No significant incidences were observed in diagnostic confirmation and treatment in the RCU. RCU were adapted because of the reorganization of health care. 88.5% of the hospitals showed higher than 95% coverage rates on Hearing screening and SEM. No differences were observed compared to the pre-epidemic period. CONCLUSIONS: Our study demonstrates PCN professionals resilience. The importance of designing periodic evaluations to understand and alleviate the COVID-19 impact is remarkable. We need to assure 2020 newborns attention health care quality

Palliative care in Mozambique: Physicians' knowledge, attitudes and practices

Background Palliative care is an essential part of medical practice but it remains limited, inaccessible, or even absent in low andmiddle income countries. Objectives Toevaluate the general knowledge, attitudes, and practices of Mozambican physicians on palliative care. Methods Across­sectional observational study was conducted between August 2018 and January 2019 in the 3mainhospitals of Mozambique, in addition to the only hospital with a standalone palliative care service. Data was collected from a self-administered survey directed to physicians in services with oncology patients. Results Twohundredandsevenoutof306physicians surveyed answered the questionnaire. The median physician age was 38years. Fifty-five percent were males, and 49.8% residents. Themostcommonmedicalspecialty was surgery with 26.1%. Eighty percent of physicians answered that palliative care should be provided to patients when no curative treatments are available; 87% believed that early integration of palliative care can improve patients' quality of life; 73% regularly inform patients of a cancer diagnosis; 60% prefer to inform the diagnosis and prognosis to the family/caregivers. Fifty percent knew what a "do-not-resuscitate" order is, and 51% knew what palliative sedation is. Only 25% of the participants answered correctly all questions on palliative care general knowledge, and only 24% of the participants knew all answers about euthanasia. Conclusions Mozambican physicians in the main hospitals of Mozambique have cursory knowledge about palliative care. Paternalism and the family-centered model are the most prevalent. Moreinterventions and training of professionals are needed to improve palliative care knowledge andpractice in the country.

Nursing care provided to persons deprived of liberty in the hospital environment / Atención de enfermería a las personas privadas de libertad en el ambiente hospitalário / Assistência de enfermagem prestada às pessoas privadas de liberdade no ambiente hospitalar

ABSTRACT Objectives: To describe the nursing care provided to people deprived of liberty (PDL) in the hospital environment. Methods: An exploratory-descriptive study with a qualitative approach, conducted with 38 nursing professionals in three regional hospitals located in the Northeast of Brazil, between March and July of 2016. Content analysis was performed on the data. Results: Two categories emerged from the analysis: nursing care provided to people deprived of liberty in the hospital setting and self-evaluation of nursing care provided to PDL. Final considerations: The nursing care delivered to people deprived of liberty in the hospital environment is limited to technical procedures, revealing a fragmented work process that falls short of the standards of public policies. We found that structural deficiency, particularly regarding safety in the hospital environment, associated with lack of professional training to deal with this clientele, make nursing care difficult in this context.

RESUMEN Objetivos: Describir la atencion de enfermeria a las personas privadas de libertad (PPL) en el ambiente hospitalario. Métodos: Estudio exploratorio, descriptivo, de enfoque cualitativo, en el cual participaron 38 profesionales de enfermeria, realizado entre marzo y julio de 2016 en tres hospitales regionales situados en el Nordeste de Brasil. Se realizo el analisis de contenido de los datos. Resultados: En el analisis se encontro dos categorias: Atencion de enfermeria a las personas privadas de libertad en el contexto hospitalario y Autoevaluacion de la atencion de enfermeria a las PPL. Consideraciones finales: La atencion de enfermeria a las personasprivadas de libertad en el ambiente hospitalario se restringe a procedimientos tecnicos, lo que demuestra ser un proceso de trabajo fragmentado y por debajo del recomendado por las politicas publicas vigentes. Se identifico que la carencia estructural, sobre todo en lo que se refiere a la seguridad en el ambiente hospitalario, asociada a la falta de capacitacion de los profesionales para lidiar con esta clientela, dificulta la atencion de enfermeria en ese contexto.

RESUMO Objetivos: Descrever a assistência de enfermagem prestada às pessoas privadas de liberdade (PPL) no ambiente hospitalar. Métodos: Estudo exploratório-descritivo com abordagem qualitativa, realizado com 38 profissionais de enfermagem, entre os meses de março a julho de 2016, em três hospitais regionais localizados no Nordeste do Brasil. Realizou-se a análise de conteúdo dos dados. Resultados: Da análise emergiram duas categorias: assistência de enfermagem prestada às pessoas privadas de liberdade no contexto hospitalar e autoavaliação da assistência de enfermagem prestada às pessoas privadas de liberdade. Considerações finais: A assistência de enfermagem prestada às pessoas privadas de liberdade no ambiente hospitalar limita-se a procedimentos técnicos, demonstrando um processo-de-trabalho fragmentado e aquém do preconizado pelas políticas públicas vigentes. Identificou-se que a carência estrutural, sobretudo no tocante à segurança no ambiente hospitalar, associada à falta de capacitação dos profissionais para lidar com esta clientela dificultam a assistência de enfermagem nesse contexto.

Drug-Related Problems in the transitional care of the elderly from hospital to home / Problemas Relacionados com los Medicamentos en la transición de ancianos del hospital para casa / Problemas relacionados a medicamentos na transição de idosos do hospital para casa

ABSTRACT Objective: To identify the knowledge produced on Medication-Related Problems in the transitional care of the elderly from hospital to home. Method: Integrative review of the literature data, organized in six stages: guiding question; establishment of inclusion and exclusion criteria; extraction of data; analyze; interpretation of results; and presentation of the review. Articles were considered among 2002 and 2017, in Portuguese, English, and Spanish, in the databases LILACS, MEDLINE, CINAHL and EMBASE. Results: 10 studies were selected and analyzed. They were categorized by subject and identified in three themes: Medication Discrepancy and Reconciliation (40%); Adhesion to Medication (30%); and Adverse Drug Events (30%). Final considerations: Drug-Related Problems in the transitional care of the elderly from hospital to home, were presented as a relevant theme for nursing, involving complex issues related to care. Drug reconciliation was evidenced as a coherent and effective strategy in home care transitions for the elderly.

RESUMEN Objetivo: identificar el conocimiento producido sobre Problemas Relacionados con los Medicamentos en la transición de ancianos del hospital a casa. Método: la revisión integrativa de la literatura, organizada en seis etapas: pregunta orientadora; establecimiento de criterios de inclusión y exclusión; extracción de datos; análisis; interpretación de los resultados; y presentación de la revisión. Se consideraron los artículos entre 2002 y 2017, en portugués, inglés y español, en las bases de datos LILACS, MEDLINE, CINAHL y EMBASE. Resultados: se seleccionaron y analizaron 10 estudios. Se clasificaron por tema y se identificaron tres temas: Discrepancia y Reconciliación de Medicamentos (40%); Adhesión al Medicamento (30%); y Eventos Adversos a los Medicamentos (30%). Consideraciones finales: los Problemas Relacionados con los Medicamentos en la transición de ancianos del hospital a casa, se presentó como un tema relevante para la enfermería, involucrando cuestiones complejas relacionadas con el cuidado. La reconciliación de medicamentos fue evidenciada como estrategia coherente y eficaz en las transiciones de cuidado del anciano a casa.

RESUMO Objetivo: identificar o conhecimento produzido sobre Problemas Relacionados a Medicamentos na transição de idosos do hospital para casa. Método: revisão integrativa da literatura, organizada em seis etapas: pergunta norteadora; estabelecimento de critérios de inclusão e exclusão; extração dos dados; análise; interpretação dos resultados; e apresentação da revisão. Consideraram-se artigos entre 2002 e 2017, nos idiomas português, inglês e espanhol, nas bases de dados LILACS, MEDLINE, CINAHL e EMBASE. Resultados: foram selecionados e analisados 10 estudos. Categorizaram-se por assunto e identificaram-se três temas: Discrepância e Reconciliação de Medicamentos (40%); Adesão ao Medicamento (30%); e Eventos Adversos a Medicamentos (30%). Considerações finais: os Problemas Relacionados a Medicamentos na transição de idosos do hospital para casa, apresentou-se como um tema relevante para a Enfermagem, envolvendo questões complexas relacionadas ao cuidado. A reconciliação de medicamentos foi evidenciada como estratégia coerente e eficaz nas transições de cuidado do idoso para casa.

Care-educational technologies: an emerging concept of the praxis of nurses in a hospital context / Tecnologías cuidativo-educativas: un concepto emergente de la praxis de los enfermeros en contexto hospitalario / Tecnologias cuidativo-educacionais: um conceito emergente da práxis de enfermeiros em contexto hospitalar

ABSTRACT Objective: to know the praxis of nurses in the hospital context and, from this, to define a concept about Care-Educational Technologies. Method: qualitative, exploratory-descriptive research, developed in a university hospital in Rio Grande do Sul State, Brazil, with 21 nurses (non-probabilistic sampling), through non-participant observation and semi-structured interview, conducted from March to December 2015. Records were analyzed through content analysis. Results: the results showed that in the context of nurses' work, it is possible to deduce care-educational possibilities, based on the person-person, person-tool and/or person-universe relationship. The concept was defined based on the intertwining of caring-training and training-caring for oneself and other people. Final considerations: the reflections point to the need to develop or strengthen the autonomy of those involved in the health-disease process. This is based on the empowerment of people under their lives' conditions, in their multidimensionality, within human praxis.

RESUMEN Objetivo: conocer la praxis de los enfermeros en contexto hospitalario y, a partir de ésta, construir un concepto acerca de Tecnología Cuidativo-Educativa. Método: la investigación cualitativa, exploratoria-descriptiva, desarrollada en un hospital universitario del Rio Grande do Sul, con 21 enfermeros (muestreo no probabilístico), por medio de observación no participante y entrevista semiestructurada, realizadas durante el período de marzo a diciembre de 2015. Los registros se analizaron mediante el análisis de contenido. Resultados: los resultados expresaron que, en el contexto del trabajo del enfermero, se desprenden posibilidades cuidativo-educativas, a partir de la interrelación persona-persona, persona-herramienta y/o persona-universo. El concepto fue construido a partir del entrelazamiento del cuidar-educar y educar-cuidar de sí y del otro. Consideraciones finales: las reflexiones apuntan a la necesidad de desarrollar o fortalecer la autonomía de los involucrados en el proceso salud-enfermedad, teniendo como fundamento el empoderamiento del ser humano bajo su condición de vida en su multidimensionalidad, en el ámbito de la praxis humana.

RESUMO Objetivo: conhecer a práxis de enfermeiros em contexto hospitalar e, a partir disso, construir um conceito acerca de Tecnologia Cuidativo-Educacional. Método: pesquisa qualitativa, exploratória-descritiva, desenvolvida em um hospital universitário do Rio Grande do Sul, com 21 enfermeiros (amostragem não probabilística), por meio de observação não participante e entrevista semiestruturada, realizadas durante o período de março a dezembro de 2015. Os registros foram analisados por meio da análise de conteúdo. Resultados: os resultados expressaram que no contexto do trabalho do enfermeiro, depreendem-se possibilidades cuidativo-educativas, a partir da inter-relação pessoa-pessoa, pessoa-ferramenta e/ou pessoa-universo. O conceito foi construído a partir do entrelaçamento do cuidar-educar e educar-cuidar de si e do outro. Considerações finais: as reflexões apontam para a necessidade de desenvolver ou fortalecer a autonomia dos envolvidos no processo saúde-doença, tendo como fundamento o empoderamento do ser humano sob sua condição de vida na sua multidimensionalidade, no âmbito da práxis humana.

Assessment of the product of nursing care in specialized hospitals / Evaluación del producto del cuidar en enfermería en hospitales especializados / Avaliação do produto do cuidar em enfermagem em hospitais especializados

ABSTRACT Objective: To evaluate the product of care in units of specialized hospitals, identifying the items that most contributed to the score; to compare the product of care among hospitals, units, and shifts; to verify the association between demographic and professionals variables and the product of care. Method: Descriptive study, conducted in eight units of two specialized hospitals in the State of São Paulo. The evaluation of the product of care was performed by applying an instrument to 44 nurses. Results: "Multidisciplinary interaction and performance" obtained the lowest median in both hospitals, and the "Meeting assistance needs" and "Nursing care planning" were the better assessed ones. "Dimensioning of nursing staff" was the item that most contributed to the total score. There was a weak correlation between socio-demographic variables and score. Conclusion: The product of care, as found in both hospitals, was predominantly considered "good." The tool enabled the identification of critical aspects of the nursing work.

RESUMEN Objetivo: Evaluar el producto del cuidar en unidades de hospitales especializados identificando los ítems que más contribuyeron a la puntuación; comparar el producto del cuidar entre los hospitales, unidades y turnos; verificar la asociación entre las variables demográficas y profesionales y el producto del cuidar. Método: Estudio descriptivo conducido en ocho unidades de dos hospitales especializados del estado de São Paulo. La evaluación del producto del cuidar fue realizada mediante aplicación de instrumento por 44 enfermeros. Resultados: La "Interacción y actuación multidisciplinaria" obtuvo la menor mediana en ambos hospitales, y la "Atención de las necesidades asistenciales" y la "Planificación de la asistencia de enfermería" fueron mejor evaluados. El "Dimensionamiento de personal de enfermería" fue el elemento que más contribuyó a la puntuación total. La correlación entre variables sociodemográficas y puntuación se mostró débil. Conclusión: El producto del cuidar encontrado en ambos hospitales fue considerado predominantemente "bueno". El instrumento permitió identificar aspectos críticos del trabajo de enfermería.

RESUMO Objetivo: Avaliar o produto do cuidar em unidades de hospitais especializados identificando os itens que mais contribuíram para o escore; comparar o produto do cuidar entre os hospitais, unidades e turnos; verificar a associação entre as variáveis demográficas e profissionais e o produto do cuidar. Método: Estudo descritivo conduzido em oito unidades de dois hospitais especializados do estado de São Paulo. A avaliação do produto do cuidar foi realizada mediante aplicação de instrumento por 44 enfermeiros. Resultados: "Interação e atuação multidisciplinar" obteve a menor mediana em ambos hospitais, e "Atendimento das necessidades assistenciais" e "Planejamento da assistência de enfermagem" foram melhor avaliados. "Dimensionamento de pessoal de enfermagem" foi o item que mais contribuiu para o escore total. A correlação entre variáveis sociodemográficas e escore mostrou-se fraca. Conclusão: O produto do cuidar encontrado em ambos os hospitais foi considerado predominantemente "bom". O instrumento permitiu identificar aspectos críticos do trabalho de enfermagem.

Nutrición en el hospital / In hospital nutrition

No disponible

Hospitales del futuro. La experiencia de Dinamarca / Hospitals of the future. The experience of Denmark

Este artículo describe la experiencia de la autora, anestesióloga, durante su estancia en Dinamarca como participante del programa Europeo de intercambio HOPE, acrónimo de ‘Hospitals for Europe’. La excepcional calidad del Sistema de Salud Danés se basa en tres pilares: a) la cultura nórdica del consenso, diálogo y aparente ausencia de jerarquía; b) la relación con el paciente al que se le ofrece un ambiente lo más cercano posible al hogar y donde el médico es visto como un compañero, y c) por último, el cuidado de las condiciones de los trabajadores, con enseñanza del idioma, actividades deportivas y espacios de descanso, entre otras muchas medidas (AU)

This article describes the experience of the author, a consultant anaesthetist, during a stay in Denmark under the European Exchange Progamme ‘Hospitals for Europe’ (HOPE). The outstanding quality of the Danish system is based on a meticulous organisation that relies on three pillars: a) the Nordic paradigms of consensus, dialogue and the apparent absence of hierarchy; b) respecting the patient, bringing about a homely atmosphere where the doctor is seen as an equal; and c) last but not least, the care of the conditions of hospital workers, with teaching of languages, sports activities and spaces to relax among many other measures (AU)

Importancia del hospital para la enseñanza clínica e investigación biomédica / The importance of the hospital for the clinical teaching and biomedical research

El cometido de un hospital moderno es proveer a la población de referencia una atención de salud excelente, integrada en el ámbito social y comunitario, generándose conocimientos y potenciando la docencia, la investigación y la innovación. El hospital docente debe enseñar a los estudiantes de Medicina y Enfermería y afines, a postgraduados (formación de especialistas) y a especialistas ya formados (educación continuada). El objetivo general es mejorar de forma constante la competencia profesional del personal sanitario. La Medicina debe enseñarse en los hospitales, que constituyen, en todas las etapas del adiestramiento médico, su única escuela práctica. En este artículo, se exponen algunas reflexiones sobre el papel del hospital como centro de formación de personal médico sanitario; en concreto, a quién debe enseñar, quién debe enseñar, qué y cómo debe enseñar, así como la importancia de realizar investigación biomédica como actividad consustancial en el ámbito hospitalario

The aim of modern hospital is provide to reference population an excellent health care, integrated within social domain and community level, generating knowledge and enhancing the teaching, research and innovation. The teaching hospital should be educated to medicine, nursing and related careers students; to postgraduates (specialists training) and to specialists trained (continous training), The general objective is providing steadily the professional competence of healthcare personnel. The Medicine should be taugh in hospitals, that constitute, in all phases of medical training, their only perform school. In this article is exposed some reflections about the role of the hospitals as training center of the medical personnel; in detail, whom should be instructed, who must be taught, that and how to teach, just like the importance carry out the biomedical research as cosubstantial activity within hospital sector

Estudio prospectivo en dos hospitales / Prospective study in 2 hospitals

Objetivos. El objetivo del estudio es conocer la incidencia de los errores de conciliación en el ingreso y al alta hospitalaria en pacientes de La Rioja y mejorar la seguridad del paciente en conciliación de la medicación. Material y métodos. Estudio observacional prospectivo que forma parte del proyecto de la Acción Conjunta de la Red de la Unión Europea para la Seguridad del Paciente y la Calidad de la Asistencia Sanitaria, Paquete de Trabajo 5. Se han tenido en cuenta las definiciones del Instituto para el Uso Seguro de los Medicamentos. Cualquier discrepancia no justificada entre el tratamiento crónico y el prescrito en el hospital se consideró error de conciliación. Resultados. Se incluyeron 750 pacientes, de los cuales 9 (1,2%) presentaron al menos un error de conciliación. De las 3.156 prescripciones, 2.313 (73,4%) no mostraron discrepancias, mientras que 821 (26%) fueron discrepancias justificadas y 21 (0,6%) discrepancias no justificadas que fueron consideradas por el médico como errores de conciliación. El 1,2% de los pacientes tuvieron errores de conciliación durante su estancia en el hospital, lo que implicó al 0,6% de los medicamentos (uno de cada 166 medicamentos prescritos). Conclusiones. Se ha establecido un procedimiento en el que el médico revisa la prescripción al ingreso y al alta basado en criterios de conciliación de la medicación, utilizando como herramienta un formulario de conciliación de la medicación. La conciliación de la medicación es un objetivo estratégico prioritario para mejorar la seguridad de los pacientes (AU)

Objectives. The purpose of this study is to know the incidence rate of medication reconciliation at admission and discharge in patients of La Rioja and to improve the patient safety on medication reconciliation. Material and methods. An observational prospective study, part of the Joint Action PaSQ, Work Package 5, European Union Network for Patient Safety and Quality of Care. The study has taken into account the definitions of the Institute for Safe Medication Practices. Any unintended discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a reconciliation error. Results. A total of 750 patients were included, 9 (1.2%) of whom showed at least one discrepancy. The patients had a total of 3,156 mediations registered: 2,313 prescriptions (73.4%) showed no differences, while 821 prescriptions (26%) were intended discrepancies and 21 prescriptions (0.6%) unintended discrepancies were considered by the physician as reconciliation errors. A percentage of 1.2 of the patients, which represents 0.6% of the medicines (one in 166 medications registered) had reconciliation errors during their hospital stay. Conclusions. A proceeding has been implemented by means of the physician doing the medication reconciliation and reviewing it with the help of a medication reconciliation form. The medication reconciliation is a priority strategic objective to improve the safety of patients (AU)

A vivência do lazer em hospitais: contribuições para a atuação do profissional do lazer / The leisure experience in hospitals: contributions for professional practice at leisure

Este artigo identifica e compreende a ocorrência de manifestações de lazer de internados em hospitais, bem como reflete sobre entraves e possibilidades para o desenvolvimento das mesmas. Foi desenvolvida uma pesquisa qualitativa em três hospitais, por meio de observação participante, complementadas com entrevistas semiestruturadas. Diversas manifestações de lazer são vividas pelos internados, inclusive no próprio leito. Foram identificados projetos de lazer desenvolvidos em dois hospitais. Diversas são as barreiras econômicas, políticas, estruturais e organizacionais para a inserção do lazer no hospital, porém as características dos internados, a organização do hospital e o posicionamento dos profissionais de saúde constituem possibilidades para o lazer. O lazer no hospital assume a função de distração, mas a atuação profissional pode transformá-lo numa possibilidade de reflexão para o internado.

This paper identifies and understands the occurrence of leisure activities in hospitals. As well it reflects about barriers and possibilities for leisure development. A qualitative study was developed in three hospitals, through participant observation, complemented with semi-structured interviews. Several leisure events are experienced by the hospitalized subjects, including while they are in their beds. Leisure projects developed were identified in two hospitals. Several are the economic, political, structural and organizational barriers to leisure insertion in the hospital, but the characteristics of hospitalized subjects, hospital organization, and positioning of health professionals constitute possibilities for leisure. Leisure in the hospital assumes the function of distraction, but the professional intervention can transform it into an opportunity of reflection for the hospitalized subjects.

La reputación de los hospitales españoles. Bases para el desarrollo de un índice de reputación de los hospitales / The reputation of Spanish hospitals. Basis for developing a reputation index of hospitals

Fundamento: La reputación de los centros sanitarios se relaciona con: mayor predilección de los usuarios por obtener sus servicios, mejores resultados clínicos y mayor calidad asistencial y potencial para atraer a profesionales con talento. La reputación se ha evaluado mediante índices y escalas. El objetivo de este estudio es analizar los atributos que debería reunir un índice de reputación para los hospitales españoles. Método y materiales: Estudio basado en técnicas cualitativas de búsqueda de consenso (técnica del grupo nominal + técnica Delphi). Resultados: Se identificaron cuatro dimensiones que estructuran el índice de reputación: calidad de la asistencia, comportamiento ético, credibilidad/confianza e innovación e investigación biomédica que a su vez se subdividen en 12 componentes en total. Conclusiones: En la construcción de un índice de reputación debería considerarse la combinación de datos objetivos (p.ej. resultados en calidad y seguridad) con otros de carácter subjetivo (p.ej. satisfacción de los pacientes). Futuros estudios deberían ir en la línea de validar los estándares de referencia para construir un índice de reputación para hospitales (AU)

Background: The reputation of the health centers is associated with: greater user preference in obtaining their services, better clinical outcomes and higher care quality and potential for attracting talented professionals. Reputation was evaluated using indexes and scales. The aim of this study is to analyze the attributes that should be gathered in a reputation index for Spanish hospitals. Material and methods: Study based on qualitative techniques of consensus (nominal group technique + Delphi technique). Results: Four dimensions were identified that form the reputation index: care quality, ethical behavior, credibility/confidence and biomedical innovation and research, which in turn are subdivided into 12 components in total. Conclusions: In building a reputation index consideration must be given to the combination of objective data (e.g. quality and safety outcomes) with other data that are subjective in nature (e.g., patient satisfaction). Future studies should go online to validate the reference standards in building a reputation index for hospitals (AU)

Pacientes diabéticos sin cobertura de salud: Utilización de medicamentos, adherencia y complicaciones derivadas de su patología de base / Diabetic patients without health coverage: drug use, adherence and complications arising from their underlying disease

Objetivo: realizar un Estudio de Utilización de Medicamentos de los pacientes diabéticos atendidos en el Hospital Josefina Prieur (HJP) de la ciudad de Villa Allende (Córdoba, Argentina), determinar consumo de medicamentos antidiabéticos, grado de adherencia al tratamiento y pacientes afectados por complicaciones derivadas de la diabetes.Método: Estudio observacional, descriptivo y transversal, sobre pacientes diabéticos atendidos en el HJP que pertenecen al Programa Córdoba Diabetes (ProCorDia) durante los meses de Mayo a Diciembre de 2011.Conclusiones: Del total de medicamentos antidiabéticos dispensados, el 40,50% correspondió al subgrupo A10B (hipoglucemiantes orales) y el 59,50% al subgrupo A10A (Insulinas). Se observó una buena adherencia al tratamiento Pacientes diabéticos sin cobeRtuRa de salud: utilización de medicamentos, adheRencia y comPlicaciones deRivadas de su Patología de base Recibido: 23 de enero de 2013. Aprobado: 23 de mayo de 2013.(AU)

Objective: To carry out a drug usage study with diabetic patients treated at Josefina Prieur Hospital (HJP) Villa Allende city (Córdoba, Argentina) to determine anti-diabetic drug consumption, degree of treatment adherence, and amount of patients with complications arising from diabetes.Method: Observational, descriptive, cross-sectional study carried out on diabetic patients treated at the HJP belonging to the program ôPrograma Córdoba Diabetesö (ProCorDia), from May to December 2011. Drug consumption was determined in DDDs per 1000 inhabitants per day. Adherence was defined by the number of drug provisions for each patient during eight months. The presence of complications was obtained from records of drug delivery to patients receiving other medication besides anti-diabetic ones. Results: From 98 patients, 73 had some type of complication. The consumption of antidiabetic drugs in DDD per 1000 inhabitants per day was: Regular Insulin 1.990, NPH Insulin 6.244, Glibenclamide 2.826, Gliclazide 0.281, Metformin 2.497.Conclusions: From all anti-diabetic drugs dispensed, 40.50% belonged to subgroup A10B (oral hypoglycemic agents) and 59.50% to subgroup A10A (insulin). Good adherence to drug therapy was observed (mean = 81.63%, mode = 100%). A 74.49% of patients presented complications.(AU)