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OBJECTIVE: To compare static compliance of the respiratory system (CstRS) and the ratio of partial pressure of end-tidal to arterial carbon dioxide (Pe'CO2/PaCO2), in healthy dogs using two approaches for tidal volume (VT) selection during volume-controlled ventilation: body mass based and driving pressure (ΔPaw) guided. STUDY DESIGN: Randomized, nonblinded, crossover, clinical trial. ANIMALS: A total of 19 client-owned dogs anesthetized for castration and ovariohysterectomy. METHODS: After a stable 10 minute baseline, each dog was mechanically ventilated with a VT selection strategy, randomized to a constant VT of 15 mL kg-1 of actual body mass (VTBW) or ΔPaw-guided VT (VTΔP) of 7-8 cmH2O. Both strategies used an inspiratory time of 1 second, 20% end-inspiratory pause, 4 cmH2O positive end-expiratory pressure and fraction of inspired oxygen of 0.4. Respiratory frequency was adjusted to maintain Pe'CO2 between 35 and 40 mmHg. Respiratory mechanics, arterial blood gases and Pe'CO2/PaCO2 were assessed. Continuous variables are presented as mean ± SD or median (interquartile range; quartiles 1-3), depending on distribution, and compared with Wilcoxon signed-rank tests. RESULTS: The VT was significantly higher in dogs ventilated with VTΔP than with VTBW strategy (17.20 ± 4.04 versus 15.03 ± 0.60 mL kg-1, p = 0.036). CstRS was significantly higher with VTΔP than with VTBW strategy [2.47 (1.86-2.86) versus 2.25 (1.79-2.58) mL cmH2O-1 kg-1, p = 0.011]. There were no differences in Pe'CO2/PaCO2 between VTΔP and VTBW strategies (0.94 ± 0.06 versus 0.92 ± 0.06, p = 0.094). No discernible difference in ΔPaw was noted between the strategies. CONCLUSIONS AND CLINICAL RELEVANCE: While no apparent difference was observed in the Pe'CO2/PaCO2 between the VT selection strategies employed, CstRS significantly increased during the VTΔP approach. A future trial should explore if VTΔP improves perioperative gas exchange and prevents lung damage.
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Peso Corporal , Estudios Cruzados , Respiración Artificial , Volumen de Ventilación Pulmonar , Animales , Perros , Femenino , Respiración Artificial/veterinaria , Masculino , Histerectomía/veterinaria , Ovariectomía/veterinaria , Dióxido de Carbono/sangre , Orquiectomía/veterinaria , Orquiectomía/métodos , Respiración con Presión Positiva/veterinariaRESUMEN
Trypanosomatids are an important group of parasites that predominate in tropical and subtropical areas of the planet, which cause diseases that are classified as forgotten and neglected by the world health organization. In this group of parasites, we find Trypanosoma cruzi, Trypanosoma brucei, Trypanosoma brucei rhodesiense and Leishmania spp, for which there is no vaccine available, and its control has focused mainly on pharmacological treatment. Due to the poverty situation where these diseases are found and the biological complexity of these parasites, there are multiple variables to control, including the diversity of species, the complexity of their life cycles, drug resistance, cytotoxicity, the limited use in pregnant women, the high costs of treatment and the little-known pharmacological mechanisms of action, among others. It is therefore necessary to find new strategies and approaches for the treatment of these parasitic diseases. Among these new approaches is the rational search for new targets based on the allosteric inhibition of protein kinases, which have been little studied in trypanosomatids. Among these kinases, we find Glycogen Synthase Kinase-3 (GSK-3), a kinase of great pharmacological interest, which is under intense basic and clinical research by pharmaceutical companies for the treatment of cancer. This kinase, highly studied in the PI3K/AKT/mTOR pathway signaling in humans, has an orthologous gene in these parasites (GSK-3 s), which has proven to be essential for them in response to different challenges; Therefore, it is notable to increase research in this kinase in order to achieve a broad structural and functional characterization in the different species of trypanosomatids.
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Glucógeno Sintasa Quinasa 3 , Glucógeno Sintasa Quinasa 3/antagonistas & inhibidores , Humanos , Animales , Trypanosomatina/enzimología , Trypanosomatina/efectos de los fármacos , Trypanosomatina/genéticaRESUMEN
OBJECTIVE: To develop an ultrasound-guided caudal quadratus lumborum block (C-QLB) technique in canine cadavers and to compare sensory and motor blockade resulting from the combination of ultrasound-guided greater ischiatic notch (GIN) plane and C-QLB approaches (GIN-CQLB group) versus a lumbosacral plexus (LSP group) approach [combination of lateral pre-iliac (LPI) and parasacral (PS) techniques] in dogs. STUDY DESIGN: Descriptive anatomical study and prospective randomized, blinded, experimental crossover trial. ANIMALS: A total of six canine cadavers and six adult Beagle dogs. METHODS: Phase I: following ultrasound-guided C-QLB injections of 0.3 mL kg-1 of dye, using the interfascial plane located lateral to the quadratus lumborum muscle at the level of the sixth lumbar vertebra (L6) as injection point, the spread of injectate and nerve staining was evaluated using gross anatomical dissection. PHASE II: sensory and motor blockade achieved with the GIN-CQLB or LSP blocks in Beagle dogs were evaluated and compared. The assigned technique was performed with 2% lidocaine: 0.2 mL kg-1 for the GIN and PS approaches and 0.3 mL kg-1 for the C-QLB and LPI approaches. RESULTS: Dissection revealed distribution of dye around the lumbar hypaxial musculature, extending into the paravertebral spaces, with staining of 3 (2-4) [median (interquartile range)] spinal nerves, spanning L3 to L6. The median motor blockade in the GIN-CQLB and LSP groups was 7 (7-8) versus 16 (10-16) (p = 0.026), whereas the median sensory blockade was 5 (4-5) versus 3 (3-3) (p = 0.025), respectively. CONCLUSION AND CLINICAL SIGNIFICANCE: The GIN-CQLB approach desensitized the thigh dermatomes effectively. Compared with the LSP approaches, GIN-CQLB exhibits a motor-protective effect by preserving tonic muscle function.
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Analgesia , Enfermedades de los Perros , Animales , Perros , Analgesia/veterinaria , Cadáver , Dolor Postoperatorio/veterinaria , Estudios Prospectivos , Ultrasonografía , Ultrasonografía Intervencional/veterinaria , Ultrasonografía Intervencional/métodos , Estudios CruzadosRESUMEN
ABSTRACT Trypanosomatids are an important group of parasites that predominate in tropical and subtropical areas of the planet, which cause diseases that are classified as forgotten and neglected by the world health organization. In this group of parasites, we find Trypanosoma cruzi, Trypanosoma brucei, Trypanosoma brucei rhodesiense and Leishmania spp, for which there is no vaccine available, and its control has focused mainly on pharmacological treatment. Due to the poverty situation where these diseases are found and the biological complexity of these parasites, there are multiple variables to control, including the diversity of species, the complexity of their life cycles, drug resistance, cytotoxicity, the limited use in pregnant women, the high costs of treatment and the little-known pharmacological mechanisms of action, among others. It is therefore necessary to find new strategies and approaches for the treatment of these parasitic diseases. Among these new approaches is the rational search for new targets based on the allosteric inhibition of protein kinases, which have been little studied in trypanosomatids. Among these kinases, we find Glycogen Synthase Kinase-3 (GSK-3), a kinase of great pharmacological interest, which is under intense basic and clinical research by pharmaceutical companies for the treatment of cancer. This kinase, highly studied in the PI3K/AKT/mTOR pathway signaling in humans, has an orthologous gene in these parasites (GSK-3 s), which has proven to be essential for them in response to different challenges; Therefore, it is notable to increase research in this kinase in order to achieve a broad structural and functional characterization in the different species of trypanosomatids.
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OBJECTIVE: To develop and assess the feasibility, as a diagnostic block, of an ultrasound-guided lateral pericapsular hip desensitization (L-PHD) technique in dogs. STUDY DESIGN: Prospective, randomized, anatomical and feasibility study. ANIMALS: A total of 11 canine cadavers and eight adult dogs scheduled for acetabular surgical denervation. METHODS: After studying the ultrasound anatomy of the lateral aspect of the gluteal region and determining an acoustic window to perform an ultrasound-guided L-PHD in three canine cadavers, the right and left hemipelves of eight canine cadavers were injected in the interfascial plane located lateral (LL-PHD group) or medial (LM-PHD group) to the deep gluteal muscle, with 0.05 mL kg-1 of dye per hip on each cadaver. The staining of the pericapsular nerves was assessed by anatomical dissection. Then, the LM-PHD was performed using 2% lidocaine as a diagnostic block in dogs scheduled for acetabular surgical denervation. Positive predictive value (PPV) was calculated for those animals who had favorable outcomes after acetabular surgical denervation. RESULTS: The ultrasound-guided LL-PHD and LM-PHD could be performed by inserting the needle lateral and medial to the deep gluteal muscle. Ultrasound-guided LL-PHD stained the cranial gluteal nerve and its muscular branches in all injections and partially stained the lumbosacral trunk in two out of eight cadavers. The LM-PHD selectively stained the articular branches of the cranial gluteal nerve in all but one cadaver. The PPV for LM-PHD successful test prediction was 85.7% (95% confidence interval: 48.6% to 98.6%). CONCLUSIONS: and clinical significance Ultrasound-guided LM-PHD using 0.05 mL kg-1 of dye selectively stained the articular branches of the cranial gluteal nerve in canine cadavers. The LM-PHD technique is feasible and could be used as a diagnostic block before acetabular surgical denervation in dogs.
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Enfermedades de los Perros , Ultrasonografía Intervencional , Animales , Perros , Cadáver , Estudios de Factibilidad , Estudios Prospectivos , Ultrasonografía , Ultrasonografía Intervencional/veterinaria , Ultrasonografía Intervencional/métodosRESUMEN
OBJETIVE: To determine the utility of the electrically evoked stapedial reflex test (ESRT) and behavioral method in the CIs programming as an objective method to identify MCL levels in the CIs programming in pediatric patients. METHOD: Cross-sectional cohort study that included 20 pediatric patients with postlingual deafness and CI unilateral. They were performed clinical history, tympanometry, ESRT and by free field audiometry, before and after programming modifications according to MCL levels obtained by ESRT were performed. ESRT threshold was assessed with individual 300 ms stimuli on the 12 electrodes and recorded through manual decay. Likewise, the maximum comfort threshold (MCL) of each electrode was obtained through a behavioral analysis. RESULTS: No significant differences were found between the ESRT and behavioral method in MCLs levels in each of the electrodes evaluated. In addition, the correlation coefficients were significant and located in a range of 0.55-0.81, higher in electrodes 7, 8, and 9 (r = 0.77, 0.76, and 0.81, respectively). However, the median hearing threshold established by the ESRT was significantly lower compared to the behavioral threshold (36.0 vs. 47.0 dB, p < 0.0001), regardless of age (p = 0.249) or the etiology of hearing loss (p = 0.292). The difference between the tests was in the number of times to do it, the ESRT was done once and the behavioral on average 4 ± 1 times. CONCLUSION: Similar MCL thresholds were obtained in both ESRT and behavioral test, establishing that both methods are reliable for use in pediatric patients; however, ESRT allows shortening the time to achieve normal hearing and language acquisition thresholds in a more optimal time.
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Implantación Coclear , Implantes Cocleares , Pérdida Auditiva , Niño , Humanos , Adulto , Estudios Transversales , Implantación Coclear/métodos , Reflejo , Umbral Auditivo/fisiología , Estimulación EléctricaRESUMEN
Paul Pfurtscheller fue uno de los creadores de material didáctico más universales y re-conocidos dentro de la enseñanza de la Historia Natural, sus láminas de pared de zoología tuvieron presencia a nivel internacional en escuelas normales, institutos de segunda enseñanza e incluso en gabinetes y laboratorios universitarios. Doctor por la Universidad de Viena con una tesis de Botá-nica desarrolló una carrera prominente como profesor de secundaria de la asignatura de Historia Natural en el Gymnasium (Instituto) Franz Josef de Viena, desarrollando un gabinete museo para su asignatura y creando 39 láminas zootómicas como apoyo a su docencia personal. La edición de sus láminas a través de prestigiosa casa editorial vienesa A. Pichlers Witwe & Sohn y posteriormente por la holandesa Martinus Nijhoff permitió la difusión de su trabajo a través de Europa y América. Tras una aproximación biográfica del personaje basada en los documentos encontrados en la Biblioteca Nacional de Austria y en los de la Universidad de Viena, se ha indagado en su papel como docente y en la génesis de su colección, en su éxito pedagógico y el papel que tuvieron en las aulas espa-ñolas de principios de siglo XX. Dentro de las fuentes a considerar destacan las propias láminas, los catálogos comerciales, las leyendas explicativas, los manuales de clase, memorias anuales de los centros estudiados y las imágenes de las aulas, no como meras ilustraciones, sino como objeto de estudio para analizar el espacio escolar y el papel didáctico de las láminas. (AU)
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Humanos , Historia del Siglo XX , Zoología/historia , Zoología/instrumentación , /historia , España/etnologíaRESUMEN
The automotive industry has used plastics almost since the beginning. The lightness, flexibility, and many qualities of plastics make them ideal for the automotive industry, reducing cars' overall weight and fuel consumption. Engineering plastics in this industry belong to the high-performance segment of non-renewable resources. These plastics exhibit higher properties than commodity plastics. Fortunately, unlike recycled commodity plastics, the super properties and high-performance characteristics make engineering plastics effectively reused after recycling. The substitution of these fossil-fuel-derived plastics adds to the solution of lightweighting, a much-needed solution to waste management, and solves industrial and ecological issues surrounding plastic disposal. All major vehicle manufacturers worldwide use bioplastics and bio-based plastics, including natural-fiber composites and engineering plastics reinforced with natural fibers. Changing the source of plastics to raw materials from renewable resources is the logical approach to sustainability. Thus, high-quality plastics, recycled plastics, bio-based plastics, and biodegradable plastics could be exploited from design, making sustainability an integral concept of mobility development. This review analyzes that switching from fossil-fuel- to renewable-sources-derived plastics is a step toward meeting the current environmental goals for the automotive industry, including electric cars.
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The use of the Internet to develop new technologies has generated a considerable change in teaching and student learning in higher education. The pandemic caused by COVID-19 has forced universities to switch from face-to-face to online instruction. Furthermore, this transfer process was planned and executed quickly, with urgent redesigns of courses originally conceived for live teaching. The aim of this work is to measure the service quality of online teaching delivered during the COVID-19 period. The methodology was based on an importance-performance analysis using a structural equations model. The data were obtained from a sample of 467 students attending a university in southern Spain. The results reveal five priority attributes of online teaching that need to be improved in order to enhance the service quality of the virtual instruction provided to students. Universities need to redefine their online format by integrating methodological and technological decisions and involving collaboration between teachers, students and administration staff and services. The results do not apply to educational institutions that exclusively teach courses online, but to those institutions that had to rapidly adapt, and shift course material originally designed for face-to-face training.
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COVID-19 , Educación a Distancia , Humanos , SARS-CoV-2 , España , Enseñanza , UniversidadesRESUMEN
OBJECTIVE: To evaluate the evidence of analgesic efficacy of tramadol for the management of postoperative pain and the presence of associated adverse events in dogs. DATABASES USED: A comprehensive search using PubMed/MEDLINE, LILACS, Google Scholar and CAB databases with no restrictions on language and following a prespecified protocol was performed from June 2019 to July 2020. Included were randomized controlled trials (RCTs) performed in dogs that had undergone general anesthesia for any type of surgery. Two authors independently classified the studies, extracted data and assessed their risk of bias using Cochrane's tool. RevMan and GRADE methods were used to rate the certainty of evidence (CoE). CONCLUSIONS: Overall 26 RCTs involving 848 dogs were included. Tramadol administration probably results in a lower need for rescue analgesia versus no treatment or placebo [moderate CoE; relative risk (RR): 0.47; 95% confidence interval (CI): 0.26-0.85; I2 = 0%], and may result in a lower need for rescue analgesia versus buprenorphine (low CoE; RR: 0.50; 95% CI: 0.20-1.24), codeine (low CoE; RR: 0.75; 95% CI: 0.16-3.41) and nalbuphine (low CoE; RR: 0.05; 95% CI: 0.00-0.72). However, tramadol administration may result in an increased requirement for rescue analgesia versus methadone (low CoE; RR: 3.45; 95% CI: 0.66-18.08; I2 = 43%) and COX inhibitors (low CoE; RR: 2.27; 95% CI: 0.68-7.60; I2 = 45%). Compared with multimodal therapy, tramadol administration may make minimal to no difference in the requirement for rescue analgesia (low CoE; RR: 1.12; 95% CI: 0.48-2.60; I2 = 0%). Adverse events were inconsistently reported and the CoE was very low. The overall CoE of the analgesic efficacy of tramadol for postoperative pain management in dogs was low or very low, and the main reasons for downgrading the evidence were risk of bias and imprecision.
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Analgesia , Enfermedades de los Perros , Nalbufina , Tramadol , Analgesia/veterinaria , Animales , Enfermedades de los Perros/tratamiento farmacológico , Perros , Manejo del Dolor/veterinaria , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/veterinaria , Tramadol/uso terapéuticoRESUMEN
During the early 20th century, a neurobiological research school combining diverse scientific approaches (basic neurohistology, anatomical pathology, neurology, and psychiatry) emerged around the figure of Santiago Ramón y Cajal (1852-1934). In the 1920s, a new building was erected and it was to become the major Spanish neurobiological research center. It was an oversized project that, unfortunately, did not facilitate the definitive consolidation of a Spanish neurohistological school. Later, the Civil War and the early years of Franco's dictatorship brought about the slow decline of this research group. Anat Rec, 303:1242-1251, 2020. © 2019 American Association for Anatomy.
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Histología/historia , Neurociencias/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , EspañaRESUMEN
Introducción: Envejecer implica cambios físicos, biológicos, psicosociales y económicos que predisponen al adulto mayor (AM) a vulnerabilidad alimentaria (VA) influyendo en su estado de nutrición y fragilidad, trayendo como consecuencia un alto riesgo de discapacidad, hospitalización y mortalidad. Objetivo: Determinar la relación de la vulnerabilidad alimentaria con el estado de nutrición y fragilidad en una población de adultos mayores mexicanos. Métodos: Se realizó un estudio observacional analítico en adultos de 60 años o más de ambos sexos que se encontraban institucionalizados en el Centro Gerontológico Integral de Pachuca, México; los cuales dieron su consentimiento para realizar la Escala de Vulnerabilidad Alimentaria Nutricional, el cuestionario Mini Nutritional Assessment MNA(R) y el cuestionario Frail de cribado para identificar personas frágiles. Resultados: Se incluyeron 80 AM de 60-64 años (n=19), 65-74 años (n=37) y ≥ 75 (n=24) años; encontrando proporciones de VA leve de 92.5% y VA moderada de 7.5%; y el 50% de AM se encontró con riesgo de malnutrición de acuerdo con MNA(R), y 65% se encontró con riesgo de fragilidad de acuerdo con la escala Frail. Se encontró correlación negativa entre el puntaje obtenido en MNA y puntaje de VA (r= -0.56, p <0.001), y no se encontró asociación entre VA y fragilidad (CHI2, p =0.062). Conclusión: Una mayor vulnerabilidad alimentaria se asoció con incrementó del riesgo de malnutrición en los adultos mayores, pero no se encontró relación entre vulnerabilidad alimentaria con la fragilidad. Una alta proporción de adultos mayores presentó algún indicador de fragilidad, lo que en el corto plazo podría afectar su calidad de vida
Introduction: Aging implies physical, biological, psychosocial and economic changes that predispose the elderly (AM) to food vulnerability (VA) influencing their nutritional status and fragility, resulting in a high risk of disability, hospitalization and mortality. Objective: To determine the relationship of food vulnerability with the state of nutrition and frailty in an elderly Mexican population. Methods: An analytical observational study was conducted in adults of 60 years or older of both sexes who were institutionalized in the Comprehensive Gerontological Center of Pachuca, Mexico; who gave their consent to carry out the Nutritional Food Vulnerability Scale, the Mini Nutritional Assessment MNA(R) questionnaire and the Frail screening questionnaire to identify frail people.Results: 80 AM of 60-64 years (n = 19), 65-74 years (n = 37) and ≥75 (n = 24) years were included; finding proportions of mild VA of 92.5% and moderate VA of 7.5%; and 50% of AM was at risk of malnutrition according to MNA(R), and 65% was found to be at risk of frailty according to the Frail scale. A negative correlation was found between the score obtained in MNA and the VA score (r = -0.56, p <0.001), and no association was found between VA and fragility (CHI2, p = 0.062). Conclusion: Greater food vulnerability was associated with increased risk of malnutrition in older adults, but no relationship was found between food vulnerability and frailty. A high proportion of older adults presented some indicator of frailty, which in the short term could affect their quality of life
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Evaluación Nutricional , Estado Nutricional , Nutricion del Anciano , Fragilidad/epidemiología , Desnutrición/epidemiología , Poblaciones Vulnerables/estadística & datos numéricos , Nutrición de los Grupos Vulnerables , México/epidemiología , Anciano Frágil/estadística & datos numéricos , Evaluación Geriátrica/métodosRESUMEN
OBJECTIVE: The financial crisis that begun in 2008 significantly decreased the budget of the public health system on Spain. The aim of this study was to evaluate the impact of the financial crisis on the activity, quality and efficiency of a high-technology university hospital. METHODS: We retrospectively analyzed the outcomes of four sets of hospital management indicators between 2007 and 2016 (A: activity; B: quality and complexity of inpatientcare; C: staff, global production and budget expenses; D: patients satisfaction survey). The data were obtained from the center's information systems and treated as longitudinal series of descriptive type. The impact of the crisis was assessed by analyzing the percentage deviations of the different indicators in relation to the values of the year 2009, the year before initial budget adjustments. RESULTS: The overall activity of the hospital, adjusted for complexity, decreased 9% during the first two years of the crisis and recovered later. Inpatient complexity increased 14%. Quality set indicators did not deteriorate. Expenses decreased 16% between the years 2009 and 2014, and efficiency and global productivity improved by 13%. Patient satisfaction survey results did not change. CONCLUSIONS: The financial crisis and the subsequent decrease of budget provoked an initial reduction of hospital activity, associated with a complexity increase. It was progressively made up for with increased efficiency and global productivity. The financial crisis did not have negative effects on quality of care or patient satisfaction.
OBJETIVO: La crisis económica iniciada el año 2008 provocó una caída importante del gasto sanitario público en España. El objetivo del estudio fue evaluar el impacto de la crisis en la actividad, calidad y eficiencia de un hospital terciario universitario de alta complejidad. METODOS: Se analizó retrospectivamente la evolución entre los años 2007 y 2016 de cuatro grupos de indicadores de gestión (A: actividad asistencial; B: calidad y complejidad de las altas; C: plantilla, producción global y gasto; D: satisfacción de los pacientes hospitalizados). Los datos se obtuvieron de los sistemas de información del centro y se trataron como series longitudinales de tipo descriptivo. El impacto de la crisis se valoró analizando las desviaciones porcentuales de los diferentes indicadores en relación a los valores del año 2009, el año previo al inicio de los ajustes presupuestarios. RESULTADOS: La actividad global ajustada por complejidad disminuyó un 9% los dos primeros años de la crisis, y se recuperó en los años posteriores. La complejidad de los pacientes hospitalizados se incrementó en un 14%. Los indicadores de calidad no se deterioraron. El gasto ejecutado anual disminuyó un 16% entre el 2009 y el 2014, y la eficiencia y la productividad global aumentaron un 13%. Los indicadores de satisfacción no se modificaron. CONCLUSIONES: La crisis económica y la consecuente reducción del presupuesto y del gasto provocaron una disminución inicial de la actividad del centro, asociada a un incremento de la complejidad, que fue compensada progresivamente gracias a una mejora en la eficiencia y en la productividad global. La crisis no impactó negativamente ni en la calidad ni en la satisfacción de los pacientes atendidos en régimen de hospitalización.
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Recesión Económica , Eficiencia Organizacional/economía , Hospitales Universitarios/economía , Programas Nacionales de Salud/economía , Calidad de la Atención de Salud/economía , Presupuestos , Eficiencia Organizacional/estadística & datos numéricos , Hospitales Universitarios/organización & administración , Hospitales Universitarios/estadística & datos numéricos , Humanos , Programas Nacionales de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , EspañaRESUMEN
[RESUMEN]. Se exponen los logros y los desafíos que provienen de la aplicación de la eSalud en el contexto cubano para apoyar la salud universal. El Ministerio de Salud Pública definió la Estrategia de Informatización, cuyas líneas de trabajo se sustentan en los componentes declarados en la Estrategia y Plan de Acción sobre eSalud de la Organización Panamericana de la Salud, y en la Política para la Informatización de la Sociedad, aprobada por el Gobierno cubano. Se especifican las acciones de la estrategia cubana elaboradas para solventar las limitaciones en la infraestructura tecnológica, desarrollar las plataformas, las herramientas y las aplicaciones que requieran los servicios de salud, y estimular en los profesionales las habilidades para emplearlas. Los resultados de la eSalud en Cuba son producto de la aplicación y la evaluación de la estrategia aplicada en el marco del perfeccionamiento del sector de la salud, mediante proyectos como el registro médico electrónico denominado Galen Clínicas, la preparación del capital humano y los recursos de información y educación a distancia de la Red Telemática de Salud Infomed. Estos son modelos de solidaridad y trabajo colaborativo en redes, que han contribuido a la salud universal e impactado positivamente en el sistema de salud, más allá de las fronteras. Los desafíos de la eSalud consisten en el desarrollo de iniciativas en salud móvil, en lo que existe poca experiencia; la telemedicina, cuyo proyecto quedó detenido; la integración e interoperabilidad de las aplicaciones; la sostenibilidad de las soluciones implementadas; la insuficiente infraestructura tecnológica; y el fortalecimiento del marco legal.
[ABSTRACT]. The achievements and challenges arising from the application of eHealth in the Cuban context to support universal health are presented. The Ministry of Public Health defined the Computerization Strategy, whose lines of work are based on the components declared in the Strategy and Plan of Action on eHealth of the Pan American Health Organization, and in the Policy for the Computerization of the Society, approved by the Cuban Government. The paper describes the actions of the Cuban strategy elaborated to solve the limitations in the technological infrastructure, to develop the platforms, the tools and the applications required by the health services, and to stimulate the professionals’ abilities to use them. The results of eHealth in Cuba are based on the application and evaluation of the strategy implemented in the framework of the improvement of the health sector through projects such as the electronic medical record called Galen Clínicas, the training of human resources and the resources for information and education from the Infomed Health Telematics Network. These models of solidarity and collaborative networking have contributed to universal health and positively impacted on the health system beyond the borders. The challenges of eHealth are the development of initiatives in mobile health —in which there is little experience—; telemedicine —a project that is stopped—; integration and interoperability among applications; the sustainability of the implemented solutions; insufficient technological infrastructure; and strengthening of the legal framework.
[RESUMO]. As descobertas e desafios decorrentes da aplicação da eSaúde no contexto cubano para apoiar a saúde universal são expostos. O Ministério da Saúde Pública definiu a Estratégia de informatização, cujas linhas de trabalho são baseadas nos componentes declarados na Estratégia e Plano de Ação da eSaúde da Organização Pan-Americana da Saúde e na Política de Informatização da Sociedade aprovada pelo governo cubano. O artigo especifica as ações da estratégia cubana para resolver as limitações da infra-estrutura tecnológica, desenvolver plataformas, ferramentas e aplicações que exigem serviços de saúde, e estimular nos profissionais as habilidades para usá-los. Os resultados da eSaúde em Cuba são o produto da aplicação e avaliação da estratégia aplicada no âmbito da melhoria do setor da saúde, através de projetos como o registro médico eletrônico chamado Galen Clínicas, a preparação do capital humano e os recursos de informação e educação a distância da Rede Telémática de Saúde Infomed. Estes modelos de solidariedade e trabalho colaborativo em redes contribuíram para a saúde universal e impactaram positivamente no sistema de saúde, além das fronteiras. Os desafios da eSaúde consistem no desenvolvimento de iniciativas em saúde móvel, em que há pouca experiência; telemedicina, cujo projeto foi interrompido; a integração e interoperabilidade das aplicações; a sustentabilidade das soluções implementadas; a infra-estrutura tecnológica insuficiente; e o fortalecimento do quadro legal.
Asunto(s)
Registros Electrónicos de Salud , Telemedicina , Cobertura Universal del Seguro de Salud , Cuba , Registros Electrónicos de Salud , Telemedicina , Cobertura Universal del Seguro de Salud , Proyectos de Tecnologías de Información y Comunicación , Proyectos de Tecnologías de Información y Comunicación , Registros Electrónicos de Salud , Proyectos de Tecnologías de Información y ComunicaciónRESUMEN
The achievements and challenges arising from the application of eHealth in the Cuban context to support universal health are presented. The Ministry of Public Health defined the Computerization Strategy, whose lines of work are based on the components declared in the Strategy and Plan of Action on eHealth of the Pan American Health Organization, and in the Policy for the Computerization of the Society, approved by the Cuban Government. The paper describes the actions of the Cuban strategy elaborated to solve the limitations in the technological infrastructure, to develop the platforms, the tools and the applications required by the health services, and to stimulate the professionals' abilities to use them. The results of eHealth in Cuba are based on the application and evaluation of the strategy implemented in the framework of the improvement of the health sector through projects such as the electronic medical record called Galen Clínicas, the training of human resources and the resources for information and education from the Infomed Health Telematics Network. These models of solidarity and collaborative networking have contributed to universal health and positively impacted on the health system beyond the borders. The challenges of eHealth are the development of initiatives in mobile health -in which there is little experience-; telemedicine -a project that is stopped-; integration and interoperability among applications; the sustainability of the implemented solutions; insufficient technological infrastructure; and strengthening of the legal framework.
As descobertas e desafios decorrentes da aplicação da eSaúde no contexto cubano para apoiar a saúde universal são expostos. O Ministério da Saúde Pública definiu a Estratégia de informatização, cujas linhas de trabalho são baseadas nos componentes declarados na Estratégia e Plano de Ação da eSaúde da Organização Pan-Americana da Saúde e na Política de Informatização da Sociedade aprovada pelo governo cubano. O artigo especifica as ações da estratégia cubana para resolver as limitações da infra- estrutura tecnológica, desenvolver plataformas, ferramentas e aplicações que exigem serviços de saúde, e estimular nos profissionais as habilidades para usá-los. Os resultados da eSaúde em Cuba são o produto da aplicação e avaliação da estratégia aplicada no âmbito da melhoria do setor da saúde, através de projetos como o registro médico eletrônico chamado Galen Clínicas, a preparação do capital humano e os recursos de informação e educação a distância da Rede Telémática de Saúde Infomed. Estes modelos de solidariedade e trabalho colaborativo em redes contribuíram para a saúde universal e impactaram positivamente no sistema de saúde, além das fronteiras. Os desafios da eSaúde consistem no desenvolvimento de iniciativas em saúde móvel, em que há pouca experiência; telemedicina, cujo projeto foi interrompido; a integração e interoperabilidade das aplicações; a sustentabilidade das soluções implementadas; a infra-estrutura tecnológica insuficiente; e o fortalecimento do quadro legal.
RESUMEN
Fundamentos: La crisis económica iniciada el año 2008 provocó una caída importante del gasto sanitario público en España. El objetivo del estudio fue evaluar el impacto de la crisis en la actividad, calidad y eficiencia de un hospital terciario universitario de alta complejidad. Métodos: Se analizó retrospectivamente la evolución entre los años 2007 y 2016 de cuatro grupos de indicadores de gestión (A: actividad asistencial; B: calidad y complejidad de las altas; C: plantilla, producción global y gasto; D: satisfacción de los pacientes hospitalizados). Los datos se obtuvieron de los sistemas de información del centro y se trataron como series longitudinales de tipo descriptivo. El impacto de la crisis se valoró analizando las desviaciones porcentuales de los diferentes indicadores en relación a los valores del año 2009, el año previo al inicio de los ajustes presupuestarios. Resultados: La actividad global ajustada por complejidad disminuyó un 9% los dos primeros años de la crisis, y se recuperó en los años posteriores. La complejidad de los pacientes hospitalizados se incrementó en un 14%. Los indicadores de calidad no se deterioraron. El gasto ejecutado anual disminuyó un 16% entre el 2009 y el 2014, y la eficiencia y la productividad global aumentaron un 13%. Los indicadores de satisfacción no se modificaron. Conclusiones: La crisis económica y la consecuente reducción del presupuesto y del gasto provocaron una disminución inicial de la actividad del centro, asociada a un incremento de la complejidad, que fue compensada progresivamente gracias a una mejora en la eficiencia y en la productividad global. La crisis no impactó negativamente ni en la calidad ni en la satisfacción de los pacientes atendidos en régimen de hospitalización
Background: The financial crisis that begun in 2008 significantly decreased the budget of the public health system on Spain. The aim of this study was to evaluate the impact of the financial crisis on the activity, quality and efficiency of a high-technology university hospital. Methods: We retrospectively analyzed the outcomes of four sets of hospital management indicators between 2007 and 2016 (A: activity; B: quality and complexity of inpatientcare; C: staff, global production and budget expenses; D: patients satisfaction survey). The data were obtained from the center's information systems and treated as longitudinal series of descriptive type. The impact of the crisis was assessed by analyzing the percentage deviations of the different indicators in relation to the values of the year 2009, the year before initial budget adjustments. Results: The overall activity of the hospital, adjusted for complexity, decreased 9% during the first two years of the crisis and recovered later. Inpatient complexity increased 14%. Quality set indicators did not deteriorate. Expenses decreased 16% between the years 2009 and 2014, and efficiency and global productivity improved by 13%. Patient satisfaction survey results did not change. Conclusions: The financial crisis and the subsequent decrease of budget provoked an initial reduction of hospital activity, associated with a complexity increase. It was progressively made up for with increased efficiency and global productivity. The financial crisis did not have negative effects on quality of care or patient satisfaction
Asunto(s)
Humanos , Atención Terciaria de Salud/organización & administración , Financiación de la Atención de la Salud , Eficiencia Organizacional/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Recursos Financieros en Salud/provisión & distribución , Recesión Económica/estadística & datos numéricos , Presupuestos/organización & administración , Calidad de la Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
RESUMEN Se exponen los logros y los desafíos que provienen de la aplicación de la eSalud en el contexto cubano para apoyar la salud universal. El Ministerio de Salud Pública definió la Estrategia de Informatización, cuyas líneas de trabajo se sustentan en los componentes declarados en la Estrategia y Plan de Acción sobre eSalud de la Organización Panamericana de la Salud, y en la Política para la Informatización de la Sociedad, aprobada por el Gobierno cubano. Se especifican las acciones de la estrategia cubana elaboradas para solventar las limitaciones en la infraestructura tecnológica, desarrollar las plataformas, las herramientas y las aplicaciones que requieran los servicios de salud, y estimular en los profesionales las habilidades para emplearlas. Los resultados de la eSalud en Cuba son producto de la aplicación y la evaluación de la estrategia aplicada en el marco del perfeccionamiento del sector de la salud, mediante proyectos como el registro médico electrónico denominado Galen Clínicas, la preparación del capital humano y los recursos de información y educación a distancia de la Red Telemática de Salud Infomed. Estos son modelos de solidaridad y trabajo colaborativo en redes, que han contribuido a la salud universal e impactado positivamente en el sistema de salud, más allá de las fronteras. Los desafíos de la eSalud consisten en el desarrollo de iniciativas en salud móvil, en lo que existe poca experiencia; la telemedicina, cuyo proyecto quedó detenido; la integración e interoperabilidad de las aplicaciones; la sostenibilidad de las soluciones implementadas; la insuficiente infraestructura tecnológica; y el fortalecimiento del marco legal.
ABSTRACT The achievements and challenges arising from the application of eHealth in the Cuban context to support universal health are presented. The Ministry of Public Health defined the Computerization Strategy, whose lines of work are based on the components declared in the Strategy and Plan of Action on eHealth of the Pan American Health Organization, and in the Policy for the Computerization of the Society, approved by the Cuban Government. The paper describes the actions of the Cuban strategy elaborated to solve the limitations in the technological infrastructure, to develop the platforms, the tools and the applications required by the health services, and to stimulate the professionals' abilities to use them. The results of eHealth in Cuba are based on the application and evaluation of the strategy implemented in the framework of the improvement of the health sector through projects such as the electronic medical record called Galen Clínicas, the training of human resources and the resources for information and education from the Infomed Health Telematics Network. These models of solidarity and collaborative networking have contributed to universal health and positively impacted on the health system beyond the borders. The challenges of eHealth are the development of initiatives in mobile health —in which there is little experience—; telemedicine —a project that is stopped—; integration and interoperability among applications; the sustainability of the implemented solutions; insufficient technological infrastructure; and strengthening of the legal framework.
RESUMO As descobertas e desafios decorrentes da aplicação da eSaúde no contexto cubano para apoiar a saúde universal são expostos. O Ministério da Saúde Pública definiu a Estratégia de informatização, cujas linhas de trabalho são baseadas nos componentes declarados na Estratégia e Plano de Ação da eSaúde da Organização Pan-Americana da Saúde e na Política de Informatização da Sociedade aprovada pelo governo cubano. O artigo especifica as ações da estratégia cubana para resolver as limitações da infra- estrutura tecnológica, desenvolver plataformas, ferramentas e aplicações que exigem serviços de saúde, e estimular nos profissionais as habilidades para usá-los. Os resultados da eSaúde em Cuba são o produto da aplicação e avaliação da estratégia aplicada no âmbito da melhoria do setor da saúde, através de projetos como o registro médico eletrônico chamado Galen Clínicas, a preparação do capital humano e os recursos de informação e educação a distância da Rede Telémática de Saúde Infomed. Estes modelos de solidariedade e trabalho colaborativo em redes contribuíram para a saúde universal e impactaram positivamente no sistema de saúde, além das fronteiras. Os desafios da eSaúde consistem no desenvolvimento de iniciativas em saúde móvel, em que há pouca experiência; telemedicina, cujo projeto foi interrompido; a integração e interoperabilidade das aplicações; a sustentabilidade das soluções implementadas; a infra-estrutura tecnológica insuficiente; e o fortalecimento do quadro legal.