Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Percepción de riesgo ante el covid-19 en estudiantes de la carrera de psicología de la "Universidad Mayor de San Andrés"

La presente investigación tuvo como objetivo determinar los niveles de percepción de riesgo frente al virus del Covid-19. El estudio se realizó con una muestra de 148 estudiantes de la carrera de psicología de la Universidad Mayor de San Andrés (UMSA) La Paz-Bolivia. Se aplicó una escala: Percepción de Riesgo frente al covid-19, el cual se sometió a un análisis estadístico del tipo descriptivo. Los resultados muestran que la mayoría de los participantes presentan una percepción del riesgo, alta y media, frente a la enfermedad y sus consecuencias, destacándose el temor a la muerte de un familiar o enfermad gravemente. Se concluye que existe una tendencia a percibir el covid-19 como una enfermad que pone en riesgo la vida propia y los demás, sin embargo, se presentan dificultades relacionadas con conductas de protección que reduzcan la probabilidad de contagio.

The objective of this research was to determine the levels of risk perception of the covid-19 virus. The study was carried out with a sample of 148 psychology students of the Universidad Mayor de San Andrés (UMSA) La Paz-Bolivia. A scale was applied: Risk Perception against covid-19, which was subjected to a descriptive statistical analysis. The results show that most of the participants have a high and medium risk perception of the disease and its consequences, especially the fear of death of a family member or serious illness. It is concluded that there is a tendency to perceive covid-19 as a disease that puts one's own life and the lives of others at risk; however, there are difficulties related to protective behaviors that reduce the probability of contagion.

O objectivo desta investigação era determinar os níveis de percepção de risco em relação ao vírus covid-19. O estudo foi realizado com uma amostra de 148 estudantes de psicologia da Universidad Mayor de San Andrés (UMSA) La Paz-Bolívia. Foi aplicada uma escala: Percepção do Risco em frente da covid-19, que foi sujeita a uma análise estatística descritiva. Os resultados mostram que a maioria dos participantes tem uma percepção de risco elevado e médio da doença e das suas consequências, destacando-se o medo da morte de um membro da família ou de uma doença grave. Conclui-se que existe uma tendência para perceber a covid-19 como uma doença que coloca a própria vida e a vida dos outros em risco; contudo, existem dificuldades relacionadas com comportamentos protectores que reduzem a probabilidade de contágio.

Percepción de riesgo ante el covid-19 en estudiantes de la carrera de psicología de la Universidad Mayor de San Andrés / Perception of the risk to covid-19 in students of the psychology career of the Universidad Mayor de San Andrés / Percepção do risco para covid-19 em alunos da carreira de psicologia da Universidad Mayor de San Andrés

Resumen La presente investigación tuvo como objetivo determinar los niveles de percepción de riesgo frente al virus del Covid-19. El estudio se realizó con una muestra de 148 estudiantes de la carrera de psicología de la Universidad Mayor de San Andrés (UMSA) La Paz-Bolivia. Se aplicó una escala: Percepción de Riesgo frente al covid-19, el cual se sometió a un análisis estadístico del tipo descriptivo. Los resultados muestran que la mayoría de los participantes presentan una percepción del riesgo, alta y media, frente a la enfermedad y sus consecuencias, destacándose el temor a la muerte de un familiar o enfermad gravemente. Se concluye que existe una tendencia a percibir el covid-19 como una enfermad que pone en riesgo la vida propia y los demás, sin embargo, se presentan dificultades relacionadas con conductas de protección que reduzcan la probabilidad de contagio.

Abstract The objective of this research was to determine the levels of risk perception of the covid-19 virus. The study was carried out with a sample of 148 psychology students of the Universidad Mayor de San Andrés (UMSA) La Paz-Bolivia. A scale was applied: Risk Perception against covid-19, which was subjected to a descriptive statistical analysis. The results show that most of the participants have a high and medium risk perception of the disease and its consequences, especially the fear of death of a family member or serious illness. It is concluded that there is a tendency to perceive covid-19 as a disease that puts one's own life and the lives of others at risk; however, there are difficulties related to protective behaviors that reduce the probability of contagion.

Resumo O objectivo desta investigação era determinar os níveis de percepção de risco em relação ao vírus covid-19. O estudo foi realizado com uma amostra de 148 estudantes de psicologia da Universidad Mayor de San Andrés (UMSA) La Paz-Bolívia. Foi aplicada uma escala: Percepção do Risco em frente da covid-19, que foi sujeita a uma análise estatística descritiva. Os resultados mostram que a maioria dos participantes tem uma percepção de risco elevado e médio da doença e das suas consequências, destacando-se o medo da morte de um membro da família ou de uma doença grave. Conclui-se que existe uma tendência para perceber a covid-19 como uma doença que coloca a própria vida e a vida dos outros em risco; contudo, existem dificuldades relacionadas com comportamentos protectores que reduzem a probabilidade de contágio.

Surgical correction of juvenile idiopathic scoliosis. our patients' perception of their quality of life / Correção cirúrgica da escoliose idiopática juvenil - percepção de nossos pacientes sobre sua qualidade de vida / Corrección quirúrgica de escoliosis idiopática juvenil - percepción de nuestros pacientes sobre su calidad de vida

ABSTRACT Objective: To report the results of our patients who underwent scoliosis correction surgery in relation to their quality of life. Introduction: Juvenile idiopathic scoliosis affects between 1 and 3% of the population during puberty. Treatment will be conservative in most cases. The goal of surgical treatment is to improve coronal and sagittal alignment. The SRS 22 questionnaire is a useful tool for assessing quality of life in these patients. Methods: A retrospective study of 22 patients submitted to corrective surgery for juvenile idiopathic scoliosis between October 2017 and January 2020 was conducted. All of them had curves greater than 45 degrees managed through instrumentation and arthrodesis. Post-surgical quality of life was assessed using the SRS 22 questionnaire. Results: The average age of our patients at the time of the intervention was 15.5 years with a predominance of female patients. The application of the SRS 22 questionnaire generated the following mean scores: pain 4.6, function 4.3, self-image 4.41, mental health 4.89, and satisfaction 5.0. Conclusions: The development of surgical techniques has allowed good results to be achieved in the treatment of scoliosis. The evaluation of our patients using the SRS 22 questionnaire reflects a good quality of life in the 5 parameters evaluated. The main limitations of this study were the small sample size and its retrospective nature. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

RESUMO Objetivo: Relatar os resultados de nossos pacientes operados para correção de escoliose com relação à sua qualidade de vida. Introdução: A escoliose idiopática juvenil afeta entre 1% e 3% da população durante a puberdade. O tratamento será conservador na maioria dos casos. O tratamento cirúrgico terá como objetivo melhorar o alinhamento coronal e sagital. O questionário SRS 22 é uma ferramenta útil para avaliar a qualidade de vida desses pacientes. Métodos: Foi realizado um estudo retrospectivo de 22 pacientes operados entre outubro de 2017 e janeiro de 2020 devido à escoliose idiopática juvenil. Todos tinham curvas superiores a 45 graus tratadas com instrumentação e artrodese. A qualidade de vida pós-operatória foi avaliada por meio do questionário SRS-22. Resultados: A média de idade dos nossos pacientes no momento da intervenção foi 15,5 anos, com predominância do sexo feminino. A aplicação do questionário SRS-22 gerou os seguintes escores médios: dor 4,6; função 4,3; autoimagem 4,41; saúde mental 4,89 e satisfação 5,0. Conclusões: O desenvolvimento das técnicas cirúrgicas permitiu obter bons resultados no tratamento da escoliose. A avaliação de nossos pacientes por intermédio do questionário SRS 22 reflete boa qualidade de vida nos cinco parâmetros avaliados. As principais limitações deste estudo foram o pequeno tamanho da amostra e seu caráter retrospectivo. Nível de Evidência III; Estudo retrospectivo, longitudinal, descritivo, observacional.

RESUMEN Objetivo: Reportar los resultados de nuestros pacientes operados para corrección de escoliosis en relación a su calidad de vida. Introducción: La escoliosis idiopática juvenil afecta entre el 1% y 3% de la población durante la pubertad. El tratamiento será, en la mayoría, de los casos conservador. El tratamiento quirúrgico tendrá como objetivo mejorar la alineación coronal y sagital. El cuestionario SRS 22 es una herramienta útil para la valoración de la calidad de vida en estos pacientes. Métodos: Se realizó un estudio retrospectivo de 22 pacientes intervenidos entre octubre de 2017 y enero de 2020 debido a la escoliosis idiopática juvenil. Todos tenían curvas mayores de 45 grados manejadas mediante instrumentación y artrodesis. Se realizó la evaluación de la calidad de vida posquirúrgica mediante el cuestionario SRS-22. Resultados: La edad promedio de nuestros pacientes en el momento de la intervención fue de 15,5 años con predominio de pacientes del sexo femenino. La aplicación del cuestionario SRS-22 generó las siguientes puntuaciones medias: dolor 4,6; función 4,3; autoimagen 4,41; salud mental 4,89 y satisfacción 5,0. Conclusiones: El desarrollo de las técnicas quirúrgicas ha permitido obtener buenos resultados en el tratamiento de la escoliosis. La evaluación de nuestros pacientes mediante el cuestionario SRS 22 refleja una buena calidad de vida en los 5 parámetros evaluados. Las limitaciones principales de este estudio han sido el pequeño tamaño de la muestra y su carácter retrospectivo. Nivel de Evidencia III; Estudio retrospectivo, longitudinal, descriptivo, observacional.

Prevalence and characteristics of upper lumbar disc herniations in our practice: a retrospective analysis / Prevalência e características das hérnias lombares superiores em nosso meio: análise retrospectiva / Prevalencia y características de las hernias lumbares altas en nuestro medio: analisis retrospectivo

ABSTRACT Introduction: Upper lumbar disc herniations (ULDH) are considered infrequent injuries (1-11%). They present, most often in older adults, with special clinical features that make diagnosis and therapeutic decision-making difficult. The prevalence, location, and management of these herniations and the medical history of our patients were analyzed. Methods: Sex, age, injury level, previous surgery, and patient treatment data from July 2018 to May 2021 were collected retrospectively. During this period, 179 patients underwent surgery, 33 of whom patients presented ULDH. Results: Thirty-three patients were included in the study (18 male and 15 female). Ages ranged from 39 to 85 years, with a predominance of elderly patients. The levels operated were L1-L2 in seven patients, L2-L3 in ten patients, L3-L4 in fourteen patients, and surgery in two levels (L2-L3, L3-L4) in two patients. In our practice, microdiscectomy is the preferred approach and was performed in all cases, with the addition of fusion in four of the 33 patients. Finally, a history of low lumbar disc herniation (LLDH) surgery was found in 16 patients. Conclusions: In our population, ULDHs are a rare entity with lower prevalence at the higher lumbar levels. They occur more frequently in elderly patients and clinical presentation can vary, which is a challenge for surgeons. In older adults, the development of lumbar kyphosis due to vertebral wedging is considered a risk factor for the development of ULDH. Surgical management by microdiscectomy is considered a technique with good results for this pathology. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

RESUMO Introdução: As hérnias de disco lombares altas (ULDH) são consideradas lesões infrequentes (1% a 11%). Ocorrem principalmente em idosos com características clínicas especiais que dificultam o diagnóstico e a decisão terapêutica. A prevalência, localização, o tratamento e a história de nossos pacientes foram analisados. Métodos: Dados sobre sexo, idade, nível das lesões, história cirúrgica e tratamento de nossos pacientes foram coletados retrospectivamente de julho de 2018 a maio de 2021. Nesse período, 179 pacientes foram operados, dos quais 33 apresentavam ULDH. Resultados: Trinta e três pacientes foram incluídos neste estudo, sendo 18 homens e 15 mulheres. A faixa etária variou de 39 a 85 anos, predominando os pacientes idosos. Os níveis operados foram L1-L2 em sete pacientes, L2-L3 em dez pacientes, L3-L4 em catorze pacientes e cirurgia em 2 níveis (L2-L3, L3-L4) em dois pacientes. Em nosso meio, a microdiscectomia é o tratamento de escolha, que foi realizado em todos os casos, adicionando fusão em 4 dos 33 pacientes. Finalmente, encontrou-se o antecedente de cirurgia de hérnia de disco lombar baixa (LLDH) em 16 pacientes. Conclusões: Em nosso meio, a ULDH é uma entidade rara e com menor prevalência em níveis lombares mais altos. Ocorrem com maior frequência em idosos e seu quadro clínico pode ser variado, o que representa um desafio para o cirurgião. Em idosos, o desenvolvimento de cifose lombar devido ao acunhamento vertebral é considerado um fator de risco para o desenvolvimento de ULDH. A cirurgia de microdiscectomia é considerada uma técnica com bons resultados nessa patologia. Nível de Evidência III; Estudo retrospectivo, transversal, descritivo, observacional.

RESUMEN Introducción: Las hernias discales lumbares altas (ULDH) son consideradas lesiones infrecuentes (1-11%). Se presentan principalmente en adultos mayores con características clínicas especiales que dificultan su diagnóstico y decisión terapéutica. La prevalencia, localización, manejo y antecedentes de nuestros pacientes fueron analizados. Métodos: Los datos con respecto a sexo, edad, nivel de lesión, antecedentes quirúrgicos y manejo de nuestros pacientes fueron recolectados retrospectivamente desde julio del 2018 hasta mayo del 2021. Durante este periodo 179 pacientes fueron operados, de los cuales 33 presentaron ULDH. Resultados: Treinta y tres pacientes fueron incluidos en éste estudio, de los cuales 18 eran hombres y 15 mujeres. Los rangos de edad variaron entre 39 y 85 años, predominando pacientes de la tercera edad. Los niveles intervenidos fueron L1-L2 en siete pacientes, L2-L3 en diez pacientes, L3-L4 en catorce pacientes y cirugía en 2 niveles (L2-L3, L3-L4) en dos pacientes. En nuestro medio, la microdiscectomía es el manejo preferido, el cual se realizó en todos los casos, agregando fusión en 4 de los 33 pacientes. Finalmente se encontró antecedente de cirugía por hernias discales lumbares bajas (LLDH) en 16 pacientes. Conclusiones: En nuestro medio, las ULDH son una entidad rara con menor prevalencia en niveles lumbares más altos. Se presentan con mayor frecuencia en personas de edad avanzada y su cuadro clínico puede ser variado, lo cual representa un reto para cirujano. En adultos mayores el desarrollo de cifosis lumbar por acuñamientos vertebrales se considera un factor de riesgo para el desarrollo de ULDH. El manejo quirúrgico mediante microdiscectomía se considera una técnica con buenos resultados en ésta patología. Nivel de Evidencia III; Estudio retrospectivo, transversal, descriptivo, observacional.

Macrovascular Networks on Contrast-Enhanced Magnetic Resonance Imaging Improves Survival Prediction in Newly Diagnosed Glioblastoma.

A higher degree of angiogenesis is associated with shortened survival in glioblastoma. Feasible morphometric parameters for analyzing vascular networks in brain tumors in clinical practice are lacking. We investigated whether the macrovascular network classified by the number of vessel-like structures (nVS) visible on three-dimensional T1-weighted contrast⁻enhanced (3D-T1CE) magnetic resonance imaging (MRI) could improve survival prediction models for newly diagnosed glioblastoma based on clinical and other imaging features. Ninety-seven consecutive patients (62 men; mean age, 58 ± 15 years) with histologically proven glioblastoma underwent 1.5T-MRI, including anatomical, diffusion-weighted, dynamic susceptibility contrast perfusion, and 3D-T1CE sequences after 0.1 mmol/kg gadobutrol. We assessed nVS related to the tumor on 1-mm isovoxel 3D-T1CE images, and relative cerebral blood volume, relative cerebral flow volume (rCBF), delay mean time, and apparent diffusion coefficient in volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter. We also assessed Visually Accessible Rembrandt Images scoring system features. We used ROC curves to determine the cutoff for nVS and univariate and multivariate cox proportional hazards regression for overall survival. Prognostic factors were evaluated by Kaplan-Meier survival and ROC analyses. Lesions with nVS > 5 were classified as having highly developed macrovascular network; 58 (60.4%) tumors had highly developed macrovascular network. Patients with highly developed macrovascular network were older, had higher volumeCEL, increased rCBFCEL, and poor survival; nVS correlated negatively with survival (r = -0.286; p = 0.008). On multivariate analysis, standard treatment, age at diagnosis, and macrovascular network best predicted survival at 1 year (AUC 0.901, 83.3% sensitivity, 93.3% specificity, 96.2% PPV, 73.7% NPV). Contrast-enhanced MRI macrovascular network improves survival prediction in newly diagnosed glioblastoma.

Effects of a 10-week in-season eccentric-overload training program on muscle-injury prevention and performance in junior elite soccer players.

PURPOSE: To analyze the effect of an eccentric-overload training program (ie, half-squat and leg-curl exercises using flywheel ergometers) with individualized load on muscle-injury incidence and severity and performance in junior elite soccer players. METHODS: Thirty-six young players (U-17 to U-19) were recruited and assigned to an experimental (EXP) or control group (CON). The training program consisted of 1 or 2 sessions/wk (3-6 sets with 6 repetitions) during 10 wk. The outcome measured included muscle injury (incidence per 1000 h of exposure and injury severity) and performance tests (countermovement jump [CMJ], 10-m and 20-m sprint test). RESULTS: Between-groups results showed a likely (ES: 0.94) lower number of days of absence per injury and a possible decrement of incidence per 1000 h of match play in EXP than in CON. Regarding muscle performance, a substantial better improvement (likely to very likely) was found in 20-m sprint time (ES: 0.37), 10-m flying-sprint time (ES: 0.77), and CMJ (ES: 0.79) for EXP than for CON. Within-group analysis showed an unclear effect in each variable in CON. Conversely, substantial improvements were obtained in CMJ (ES: 0.58), 20-m sprint time (ES: 0.32), 10-m flying-sprint time (ES: 0.95), and injury severity (ES: 0.59) in EXP. Furthermore, a possible decrement in total injury incidence was also reported in EXP. CONCLUSIONS: The eccentric-based program led to a reduction in muscle-injury incidence and severity and showed improvements in common soccer tasks such as jumping ability and linear-sprinting speed.

Análisis colorimétrico computarizado del color de la piel palpebral: un potencial método No Invasivo para monitorizar el cumplimiento de la terapia con parche en ambliopía / Computerized colorimetric analysis of skin palpebral color. A potential non invasive method for monitoring patch Compliance in the Treatment of amblyopia

Objetivo: evaluar el análisis colorimétrico computarizado del color de la piel del párpado antes y después de realizar oclusión, con el fin de determinar qué cambios en el color de la piel permiten conocer el cumplimiento de la terapia oclusiva en el tratamiento de la ambliopía. Métodos: se analizó el cambio de coloración de la piel tomando fotografías estandarizadas, antes y después de 48 horas de aplicación del parche. Los análisis se hicieron con el programa PS CS2 de Adobe Systems que proporciona discriminación de los colores primarios en una imagen determinada y permite analizar y comparar numéricamente las intensidades. Resultados: el promedio basal de intensidades fue de 52.50 con un rango entre 42.11 y 72.87. La desviación estándar fue de 37.34. El promedio después de 48 horas oclusión fue de 102.33 con un rango de entre 96.32 y 109.28 y una desviación estándar de 62.49. (P≤0.05). Al comparar el cambio de la piel ocluida en los párpados con la piel de la mejilla, expuesta a la luz pero no ocluida, se demostraron cambios igualmente significativos. Conclusiones: el análisis colorimétrico computarizado no invasivo de los cambios en la coloración de la piel de los pacientes en tratamiento con ambliopía puede convertirse en un método estándar para monitorizar el cumplimiento de la terapia con oclusión. Los resultados del presente trabajo son claros en evidenciar que tan rápidamente se inducen cambios colorimétricos en la piel, incluso antes de que éstos sean detectables a simple vista. Saber qué tan disciplinado ha sido el tratamiento da la posibilidad de conocer exactamente en qué situación está el paciente y estimulará a padres y pacientes para cumplir la terapia.

Objective: to evaluate the colorimetric computerized analysis of palpebral skin color before and after occluding the eye, in order to determine what changes in skin color allow to understand the compliance with patching treatment while treating amblyopia. Methods: skin color change was analyzed taking standardized pictures before and after 48 hours occlusion. Analysis was done with the program PS CS2 from Adobe Systems that gives color discrimination from an image and allows numerical comparison between intensities. Results: palpebral skin mean basal intensity was 52.50 (between 42-11 and 72-87). SD was 37.34. Average after 48 hours occlusion was 102.33 (96.32 to 109.28) and SD of 62.49 (P≤0.05). When comparing occluded skin color with cheek color, exposed to light but not occluded, there were also significant changes. Conclusions: Noninvasive colorimetric computerized analysis from changes in skin color in amblyopic patients treated with patching, could become a standard method for monitoring compliance with occlusion therapy. Results of this experiment are clear and evidence that changes in skin color occur quickly after starting the patch, even before they are visible to the bare eye. Knowing how disciplined has been the patient with his treatment gives the opportunity of knowing the exact situation of the patient and will stimulate parents and patients to improve patch compliance.

Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains.

BACKGROUND: Studies on the implantation of care routines showed reduction on EVD catheter-related infections rates; however zero tolerance is difficult to be achieved. The objective of this study was to assess the impact of an educational intervention on the maximal reduction on rates of EVD-related infections. METHODOLOGY/PRINCIPAL FINDINGS: The quasi-experimental (before-after intervention) study occurred in two phases: pre-intervention, from April 2007 to July 2008, and intervention, from August 2008 to July 2010. Patients were followed for 30 days after the removal of the EVD, and EVD-related infections were considered as only those with laboratorial confirmation in the CSF. Observations were made of the care of the EVD and compliance with Hygiene of the Hands (HH), a routine of care was drawn up, training was given, and intervention was made to reduce the time the EVD catheter remained in place. RESULTS: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 EVD catheters-day. Gram-negative agents were identified in 71.4% of the infections during the pre-intervention period and in 60% during the intervention period. During the study, EVD-related infection rates were reduced from 9.5% to 4.8% per patient, from 8.8% to 4.4% per procedure, and the incidence density dropped from 14.0 to 6.9 infections per 1000 catheters-day (p = 0.027). The mortality reduced 12% (from 42% to 30%). CONCLUSIONS/SIGNIFICANCE: During one year after the fourth intervention, no microbiologically identified infection was documented. In light of these results, educational intervention proved to be a useful tool in reducing these rates and showed also impact on mortality.

Análisis y minimización del riesgo de rotura de stock aplicado a la gestión en farmacia hospitalaria / Stockout risk analysis and minimization applied to hospital pharmacy management

Objetivo Determinar el valor que debería tomar el stock de seguridad de los fármacos dispensados en un hospital de tercer nivel en función del nivel de riesgo y del número de días que se desee resistir sin rotura de stock. Método Se ha analizado estadísticamente la demanda registrada durante 120 días consecutivos de infliximab, un fármaco que, por su alto coste y la inmediatez de abastecimiento esperada en la clínica, tiene un adecuado perfil para el estudio. A partir del histórico de datos de adquisición y dispensación existentes en nuestro servicio, se generó una tabla para relacionar el nivel de riesgo asumido con el número de unidades en stock y el número de días que debe durar el stock de seguridad. Adicionalmente, se calcula en el artículo el valor que debería tomar dicho stock conforme a diferentes reglas heurísticas utilizadas por los Servicios de Farmacia. Resultados En el periodo analizado, la demanda diaria fue de 11,4±14,8 unidades de infliximab. Utilizando la metodología propuesta se debería fijar un stock de seguridad de 79 unidades. Este valor es comparado con las 47 y 119 unidades que ofrecen otras reglas utilizadas en el ámbito hospitalario. Conclusiones El método propuesto permite conocer el nivel de riesgo que se asume en la elección del stock de seguridad. Por tanto, permite diseñar una política de stocks de seguridad coherente con el nivel de riesgo adoptado. Bajo ciertas asunciones sería posible reducir la cota del stock de seguridad proporcionada por el método. Finalmente, es destacable la notable diferencia que puede llegar a existir entre los valores de stock de seguridad sugeridos por distintas reglas, tal y como se demuestra en el artículo (AU)

Objective To determine how many dispensary drugs should be in the safety stock in a tertiary hospital in accordance with the risk level and the number of days that the hospital is able to withstand a stockout. Methods We statistically analysed the infliximab order recorded over a period of 120 days. This drug is relevant for this study as it is costly and is immediately supplied to the clinic. Using the data records for purchasing and dispensing in our department, we created a table to compare the level of risk assumed with the number of units in stock and the number of days that the safety stock should last. In addition, we calculated how much stock there should be in accordance with different heuristic rules used by pharmacy departments. Results In the period being studied, the daily order was 11.4±14.8 units of infliximab. Using the methodology proposed, we discovered that there should be 79 units in the safety stock. Other hospital rules determine values of 47 and 119 units. Conclusions The method proposed allows us to discover the risk level that is assumed when selecting the safety stock. Therefore, we are able to design a safety stock policy consistent with the risk level adopted. Under certain assumptions the safety stock quota provided by this method could be reduced. Lastly, there is a notable difference between the safety stock values suggested by different rules, as it has been shown in this article (AU)

Stockout risk analysis and minimization applied to hospital pharmacy management.

OBJECTIVE: To determine how many dispensary drugs should be in the safety stock in a tertiary hospital in accordance with the risk level and the number of days that the hospital is able to withstand a stockout. METHODS: We statistically analysed the infliximab order recorded over a period of 120 days. This drug is relevant for this study as it is costly and is immediately supplied to the clinic. Using the data records for purchasing and dispensing in our department, we created a table to compare the level of risk assumed with the number of units in stock and the number of days that the safety stock should last. In addition, we calculated how much stock there should be in accordance with different heuristic rules used by pharmacy departments. RESULTS: In the period being studied, the daily order was 11.4±14.8 units of infliximab. Using the methodology proposed, we discovered that there should be 79 units in the safety stock. Other hospital rules determine values of 47 and 119 units. CONCLUSIONS: The method proposed allows us to discover the risk level that is assumed when selecting the safety stock. Therefore, we are able to design a safety stock policy consistent with the risk level adopted. Under certain assumptions the safety stock quota provided by this method could be reduced. Lastly, there is a notable difference between the safety stock values suggested by different rules, as it has been shown in this article.

Plan de formación continuada en una unidad de gestión clínica / Continuing training plan in a clinical management unit

La Unidad de Continuidad Asistencial está orientada a la atención de pacientes frágiles, pluripatológicos y de cuidados paliativos. Atiende a pacientes en domicilio, consulta, unidad de día, consultoría telefónica y en dos hospitales de la misma área sanitaria. Desde su inicio en 2002 como unidad de gestión, la formación ha sido un elemento prioritario de desarrollo. Los elementos clave son acercar la formación al lugar de trabajo, incluir aspectos fundamentales de los problemas asistenciales más prevalentes en el trabajo diario, orientar la formación a todo el personal incluyendo aspectos organizativos, de seguridad del paciente y su entorno, mejora del clima laboral, desarrollo de nuevas habilidades y conocimientos apoyados en la asistencia basada en la evidencia para el desarrollo de las diferentes competencias profesionales. La unidad puede ser el escenario idóneo para acometer las necesarias reformas conceptuales de la formación de los profesionales que permitan mejorar la calidad asistencial (AU)

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care(AU)

A Risk-based Model Predictive Control Approach to Adaptive Interventions in Behavioral Health.

This paper examines how control engineering and risk management techniques can be applied in the field of behavioral health through their use in the design and implementation of adaptive behavioral interventions. Adaptive interventions are gaining increasing acceptance as a means to improve prevention and treatment of chronic, relapsing disorders, such as abuse of alcohol, tobacco, and other drugs, mental illness, and obesity. A risk-based Model Predictive Control (MPC) algorithm is developed for a hypothetical intervention inspired by Fast Track, a real-life program whose long-term goal is the prevention of conduct disorders in at-risk children. The MPC-based algorithm decides on the appropriate frequency of counselor home visits, mentoring sessions, and the availability of after-school recreation activities by relying on a model that includes identifiable risks, their costs, and the cost/benefit assessment of mitigating actions. MPC is particularly suited for the problem because of its constraint-handling capabilities, and its ability to scale to interventions involving multiple tailoring variables. By systematically accounting for risks and adapting treatment components over time, an MPC approach as described in this paper can increase intervention effectiveness and adherence while reducing waste, resulting in advantages over conventional fixed treatment. A series of simulations are conducted under varying conditions to demonstrate the effectiveness of the algorithm.

[Continuing training plan in a clinical management unit]. / Plan de formación continuada en una unidad de gestión clínica.

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From 2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care.

Elevada mortalidad temprana en una unidad de cuidados paliativos de pacientes traqueostomizados procedentes de una unidad de cuidados intensivos / High early mortality in a palliative care unit among patients with tracheostomy discharged from an intensive care units

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Microwave Fixation in Rat Fetuses Tissues: Histological and Immunohistochemical Analysis / Fijación de tejidos de Fetos de Ratas por Microondas: Análisis Histológico e Inmunohistoquímico

The aim of this study was to show the microwaves action in fixation of rat fetuses, dermal and cartilaginous tissues, using histological and immunohistochemistry methods for analysis. It was possible to conclude in this study using the rat as experimental model that the two methods for antibody retrieval, presented an excellent ways for the use of Ki67 antibody in the immunohistochemical analysis.

El objetivo de este estudio fue evaluar la acción de las microondas en la fijación de los tejidos dérmico y cartilaginoso de fetos de ratas, usando para el análisis métodos histológico e inmunohistoquímico. Fue posible concluir en este estudio usando la rata como modelo experimental, que los dos métodos empleados para la recuperación antigénica representan excelentes medios para el uso del anticuerpo Ki67, en el análisis inmunohistoquímico.

Development of a GPC-based sliding mode controller.

This article presents a sliding mode controller that uses a generalized predictive controller in the reaching mode. The proposed predictive sliding mode controller is developed from a first-order-plus-deadtime model that represents a good approximation to many chemical processes. The predictive sliding mode controller has six tuning parameters and the tuning rules are given in the paper. Four simulation examples show the features of the proposed controller, which overcomes some of the disadvantages of sliding mode control and generalized predictive control strategies.