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1.
Drug Metab Pers Ther ; 30(2): 121-8, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26036226

RESUMEN

Developments in "-omics" are creating a paradigm shift in laboratory medicine leading to personalized medicine. This allows the increase in diagnostics and therapeutics focused on individuals rather than populations. In order to investigate whether laboratory medicine is ready to play a key role in the integration of personalized medicine in routine health care and set the state-of-the-art knowledge about personalized medicine and laboratory medicine in Europe, a questionnaire was constructed under the auspices of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and the European Society of Pharmacogenomics and Personalised Therapy (ESPT). The answers of the participating laboratory medicine professionals indicate that they are aware that personalized medicine can represent a new and promising health model, and that laboratory medicine should play a key role in supporting the implementation of personalized medicine in the clinical setting. Participants think that the current organization of laboratory medicine needs additional/relevant implementations such as (i) new technological facilities in -omics; (ii) additional training for the current personnel focused on the new methodologies; (iii) incorporation in the laboratory of new competencies in data interpretation and counseling; and (iv) cooperation and collaboration among professionals of different disciplines to integrate information according to a personalized medicine approach.


Asunto(s)
Ciencia del Laboratorio Clínico/educación , Medicina de Precisión , Centros Médicos Académicos , Química Clínica/educación , Europa (Continente) , Instituciones de Salud/normas , Instituciones de Salud/provisión & distribución , Humanos , Laboratorios de Hospital/normas , Laboratorios de Hospital/provisión & distribución , Rol Profesional , Facultades de Medicina , Sociedades Médicas , Encuestas y Cuestionarios , Enseñanza
2.
Arch Bronconeumol ; 49(9): 371-7, 2013 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-23414603

RESUMEN

BACKGROUND: Underdiagnosis is one of the problems with the greatest impact on respiratory disease management and requires specific interventions. Access to quality spirometry is especially important and is an objective of the Master Plan for Respiratory Diseases of the Department of Health of the Generalitat de Catalunya. OBJECTIVE: To determine the current use of spirometry at public hospitals in Catalonia, possible deficiencies and options for improvement. METHODS: A cross-sectional survey of 65 public hospitals in Catalonia in 2009. Descriptive analyses were developed for each public health-care region. RESULTS: A lack of uniformity was observed in the use of spirometry at the regional level (between 0,98 and 1.50 spirometries per 100 inhabitants). We identified two factors associated with a higher rate of spirometry: i) the existence of a Respiratory Medicine Department at the hospital, and ii) the existence of a set location to carry out spirometries. Several areas for improvement also were identified: quality control of the test itself, the inclusion of spirometry in electronic health-care records and continuing education programs. CONCLUSIONS: The results of this study have identified areas for improvement in spirometry programs.


Asunto(s)
Encuestas de Atención de la Salud , Hospitales Públicos/estadística & datos numéricos , Espirometría/estadística & datos numéricos , Análisis de los Gases de la Sangre/estadística & datos numéricos , Pruebas de Provocación Bronquial/estadística & datos numéricos , Estudios Transversales , Educación Médica Continua/estadística & datos numéricos , Departamentos de Hospitales , Hospitales Públicos/organización & administración , Humanos , Medicina Interna , Laboratorios de Hospital/provisión & distribución , Mediciones del Volumen Pulmonar , Resistencia Física , Médicos , Médicos de Atención Primaria/educación , Neumología/educación , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/fisiopatología , España , Caminata
4.
Circ Cardiovasc Qual Outcomes ; 5(1): 14-20, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22147882

RESUMEN

BACKGROUND: In 2001, 1176 US hospitals were capable of performing primary percutaneous coronary intervention (PCI), and 79% of the population lived within 60-minute ground transport of these hospitals. We compared these estimates with data from 2006 to explore how hospital PCI capability and population access have changed over time. METHODS AND RESULTS: We estimated the proportion of the population 18 years of age or older, living in 2006 within a 60-minute drive of a PCI-capable hospital, and we compared our estimate with a previously published report on 2001 data. Over the 5-year period, the number of PCI-capable hospitals grew from 1176 to 1695 hospitals, a relative increase of 44%; access to the procedure grew from 79.0% to 79.9% of the population, a relative increase of 1%. CONCLUSIONS: Our data indicate a large increase in the number of hospitals capable of performing PCI from 2001 to 2006, but this increase was not associated with an appreciable change in the proportion of the population with access to the procedure. In the future, more attention is needed on changes in PCI capacity over time and on the effects of these changes on outcomes of interest such as service utilization, expenditures, patient outcomes, and population health.


Asunto(s)
Angioplastia Coronaria con Balón , Competencia Clínica , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/terapia , Accesibilidad a los Servicios de Salud , Laboratorios de Hospital/provisión & distribución , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Grupos de Población , Factores de Tiempo , Estados Unidos
5.
J Infect Dis ; 204 Suppl 4: S1102-9, 2011 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-21996692

RESUMEN

Clinical and logistic systems to support the timely diagnosis of tuberculosis are currently not preventing large numbers of tuberculosis deaths in South Africa. Context-appropriate systems for the diagnosis of tuberculosis are entirely dependent on effective and responsive management of human resources and an uninterrupted supply of clinical materials. Attention to these components of the tuberculosis program is urgently needed before new diagnostic technologies can be expected to impact on tuberculosis mortality in resource constrained settings.


Asunto(s)
Tuberculosis/diagnóstico , Adulto , Niño , Técnicas de Laboratorio Clínico , Prestación de Atención de Salud , Países en Desarrollo , Humanos , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/provisión & distribución , Personal de Laboratorio Clínico/organización & administración , Personal de Laboratorio Clínico/provisión & distribución , Sudáfrica , Esputo/microbiología
8.
Niger Postgrad Med J ; 17(1): 60-3, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20348985

RESUMEN

OBJECTIVES: To highlight the problems encountered in the set up, organisation and operations of a microsurgery laboratory in a low resource tertiary care hospital in Lagos, Nigeria. METHODS: The basic infrastructural deficiencies of this setting were encountered. Significant administrative, logistic and technical obstacles needed to be overcome. The need for improvisation and flexibility in the organisation and operations of such a laboratory is highlighted. The use of locally available, cheaper variety of instruments and consumables in the microsurgery laboratories of developing countries with limited resources was demonstrated by our experience . CONCLUSION: We conclude that even in the setting of low resource tertiary centres found in many developing countries, challenges could be overcome and standard acceptable patency rates obtained in the microsurgery laboratory .


Asunto(s)
Técnicas de Laboratorio Clínico/normas , Recursos en Salud/organización & administración , Laboratorios de Hospital/organización & administración , Microcirugia , Humanos , Laboratorios de Hospital/normas , Laboratorios de Hospital/provisión & distribución , Nigeria
9.
Enferm Infecc Microbiol Clin ; 26 Suppl 15: 23-32, 2008 Dec.
Artículo en Español | MEDLINE | ID: mdl-19195465

RESUMEN

Despite the specialist activity of Infectious Diseases not being officially recognised, the majority of the hospitals in the autonomous communities of Spain are equipped with structures, with significant heterogeneity among them, to be able to offer high quality care in these diseases. The main characteristics of and Infectious Diseases Department is its important healthcare activity, more than in other officially recognised medical specialities, and also its important interrelationship with other services in the hospital which is clearly horizontal healthcare. Furthermore, the aforementioned infectious disease care units have developed important activities in the arena of community and public health and, in collaboration with health authorities, contribute to the rational use of antimicrobials and the relationship with Primary Care. The future of specialists in infectious diseases, when they are officially recognised, will be the creation of clinical management units in every health institution with the objective of coordinating all the specialised health care, both in the hospital environment and in its health area of influence.


Asunto(s)
Enfermedades Transmisibles/terapia , Unidades Hospitalarias/organización & administración , Infectología/organización & administración , Antiinfecciosos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/epidemiología , Servicios de Salud Comunitaria/organización & administración , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/prevención & control , Infecciones Comunitarias Adquiridas/terapia , Manejo de la Enfermedad , Farmacorresistencia Microbiana , Predicción , Accesibilidad a los Servicios de Salud , Servicios Hospitalarios Compartidos/organización & administración , Servicios Hospitalarios Compartidos/estadística & datos numéricos , Unidades Hospitalarias/provisión & distribución , Humanos , Control de Infecciones/organización & administración , Infectología/educación , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/provisión & distribución , Microbiología/organización & administración , Vigilancia de la Población , Atención Primaria de Salud/organización & administración , Administración en Salud Pública , España/epidemiología
11.
Mol Genet Metab ; 88(1): 3-6, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16311054

RESUMEN

Provision of health care to patients during and after events like those which occurred in association with hurricanes Katrina and Rita poses particular difficulties for rare disease patients, including those with genetic/metabolic diseases. In this summary, we recount the obstacles encountered in attempting to maintain and restore essential medical care to these patients, and offer proposals which may mitigate future such events.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Desastres , Enfermedades Genéticas Congénitas , Enfermedades Metabólicas , Enfermedades Genéticas Congénitas/terapia , Humanos , Laboratorios de Hospital/provisión & distribución , Louisiana , Enfermedades Metabólicas/terapia , Educación del Paciente como Asunto/organización & administración , Telecomunicaciones/organización & administración
12.
AIDS ; 18 Suppl 3: S33-8, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15322482

RESUMEN

Here we review a number of issues of relevance to the scale-up of antiretroviral therapy in Thailand. Thailand has an estimated number of people living with HIV/AIDS of approximately 600,000. Currently less than 10% of those are receiving highly active antiretroviral therapy. Government commitment to increase the numbers of individuals being treated has increased because of advocacy from various sectors of society, most importantly from organizations of individuals living with HIV/AIDS, decreasing antiretroviral drug prices, the availability of external funds, and the example of successful treatment initiatives by non-governmental organizations, academia and the private sector. It has also been prompted by the hosting of the 2004 International AIDS Conference in Bangkok.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Antirretrovirales/economía , Antirretrovirales/provisión & distribución , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa/economía , Investigación Biomédica/organización & administración , Presupuestos , Costos de los Medicamentos , Infecciones por VIH/economía , Gastos en Salud , Accesibilidad a los Servicios de Salud , Humanos , Cooperación Internacional , Laboratorios de Hospital/provisión & distribución , Cooperación del Paciente , Tailandia
14.
J Med Assoc Thai ; 85 Suppl 1: S253-61, 2002 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12188421

RESUMEN

Laboratory instruments are one of the main items in laboratory investment. To establish data for the situation of laboratory service and instruments in Thailand, questionnaires were randomly sent to one hundred and twenty laboratories. Sixty-three filled questionnaires from eleven university and affiliated hospitals, thirty-four government hospitals, and eighteen private hospital laboratories were sent back to the authors to be analyzed. Only the number of samples and instruments used during office hours were analyzed in this study by descriptive method. From the data it was found that the average number of personnel and tests of the university and affiliated hospital laboratories was the highest. To analyze the efficiency of the instruments used in the laboratories, the authors compared the average service number of samples or tests to the average number of samples or tests that was calculated from the instruments. The ratio of the average number of samples or tests that were calculated from the instruments and the average service number of samples or tests for chemistry and CBC were 2.13, 3.41, 5.24 and 2.33, 2.76, 3.71 in university and affiliated hospital laboratories, government hospital laboratories, and the private hospital laboratories, respectively. From the data, it was concluded that the instrument situation in laboratories of the university and affiliated hospitals was more appropriate than government hospital and private hospital laboratories. To improve the efficiency of using laboratory instruments, more concern must be given to the management of laboratory instruments and cooperation between hospitals could increase the efficiency of the instrument investment.


Asunto(s)
Laboratorios de Hospital/provisión & distribución , Laboratorios de Hospital/normas , Competencia Profesional , Química Clínica/normas , Química Clínica/tendencias , Encuestas de Atención de la Salud , Humanos , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Tailandia , Gestión de la Calidad Total
15.
Rev. costarric. salud pública ; 7(12): 45-52, jul. 1998.
Artículo en Español | LILACS | ID: lil-238228

RESUMEN

A 1997 document on budgetary Policies and Standards issued by Costa Rica's government-operated Soocialized Health Care System (CCSS) requires the State Health Clinics to comply with the stipulations included in the Enviroment Organic Law. Because the CCSS has focused its interest on achieving appropiate waste management, this study was conducted in order to find out the clinical laboratories perception and kowledge of the problem, types of waste, personnel training, and their employees hygiene and on-the-job safety.


Asunto(s)
Laboratorios de Hospital/provisión & distribución , Laboratorios/normas , Residuos Sólidos/normas , Costa Rica
16.
Circulation ; 96(6): 1770-5, 1997 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-9323060

RESUMEN

BACKGROUND: Previous studies have documented the strong association between availability of on-site cardiac catheterization facilities and increased use of coronary angiography in patients with acute myocardial infarction (AMI). Although these studies have shown little influence of the availability of catheterization labs on hospital mortality, no long-term follow-up has been reported. METHODS AND RESULTS: From a cohort of 12,331 AMI patients admitted to 19 Seattle area hospitals, we compared long-term outcome in 7985 patients admitted to hospitals with and 4346 patients admitted to hospitals without on-site catheterization labs. During the index hospitalization, patients admitted to hospitals with on-site catheterization were more likely to undergo coronary angiography (67.1% versus 39.3%, P<.0001), coronary angioplasty (32.5% versus 13.2%, P<.0001), or coronary bypass surgery (12.5% versus 9.5%, P<.0001). At 3-year follow-up, patients admitted to hospitals with on-site catheterization labs were more likely to undergo postdischarge angiography (19.2% versus 15.2%, P=.0001) and coronary angioplasty (11.6% versus 8.2%, P<.0001). This was associated with approximately $2500.00 per patient in higher cumulative costs. Despite this higher rate of procedure use, there was no association between admission to a hospital with on-site catheterization facilities and lower long-term mortality (multivariate hazard ratio, 1.0; 95% CI, 0.93 to 1.1., the hazard being associated with admission to hospitals with on-site catheterization facilities). CONCLUSIONS: In an urban area with unconstrained patient transfer mechanisms and high overall cardiac procedure use rates, AMI patients admitted to hospitals without on-site catheterization facilities were managed with fewer procedures during hospitalization and follow-up. This more conservative treatment approach was not associated with any observed increase in long-term mortality.


Asunto(s)
Cateterismo Cardíaco/estadística & datos numéricos , Servicio de Cardiología en Hospital/organización & administración , Infarto del Miocardio/mortalidad , Resultado del Tratamiento , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco/economía , Servicio de Cardiología en Hospital/economía , Servicio de Cardiología en Hospital/estadística & datos numéricos , Análisis Costo-Beneficio , Femenino , Humanos , Laboratorios de Hospital/provisión & distribución , Masculino , Persona de Mediana Edad , Infarto del Miocardio/economía , Infarto del Miocardio/terapia , Factores de Tiempo , Washingtón/epidemiología
17.
J Health Serv Res Policy ; 2(2): 75-80, 1997 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10180368

RESUMEN

OBJECTIVES: Utilization rates of coronary angiography and cardiac revascularization have been found to vary between areas. This study addresses the relationship between resource supply and procedure rates. METHODS: We compared the association of per capita catheterization laboratories, per capita cardiologists and multi-provider markets (where more than one hospital offers coronary angiography services) with the utilization rates for angiography and cardiac revascularization in northern New England, USA. Administrative data were used to capture invasive cardiac procedures. Small area analyses were used to create coronary angiography service areas. Linear regression methods were used to measure associations between the resource supply and utilization rates. RESULTS: Variation in the use of invasive cardiac procedures was strongly associated with the population-based availability of catheterization facilities and multi-provider markets and unrelated to cardiologist supply or need (as reflected in the hospitalization rates for myocardial infarction). In the multivariate model, an increase of 1 catheterization laboratory per 100,000 population was associated with an increase in the angiography rate of 1.62 per 1000 population; those service areas with multi-provider markets were associated with an additional increase in the angiography rate of 1.27 per 1000 population (R2 = 0.84, P = 0.0006). There was a moderately strong relationship between the catheterization laboratories per capita and the revascularization rates (R2 = 0.43, P = 0.029). Angiography rates were highly associated with cardiac revascularization rates: an increase in the angiography rate of 1 per 1000 population was associated with a 0.46 per 1000 increase in the cardiac revascularization rate (R2 = 0.85, P = 0.0001). CONCLUSIONS: Our work suggests that current efforts to address variation in cardiac procedures through activities such as appropriateness criteria, guidelines and utilization review are misdirected and should be redirected towards capacity, in this case the supply of catheterization facilities.


Asunto(s)
Cateterismo Cardíaco/estadística & datos numéricos , Cardiología , Angiografía Coronaria/estadística & datos numéricos , Laboratorios de Hospital/provisión & distribución , Pautas de la Práctica en Medicina/estadística & datos numéricos , Asignación de Recursos para la Atención de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Maine/epidemiología , Infarto del Miocardio/cirugía , New Hampshire , Análisis de Área Pequeña , Revisión de Utilización de Recursos , Recursos Humanos
20.
G Ital Cardiol ; 24(5): 477-82, 1994 May.
Artículo en Italiano | MEDLINE | ID: mdl-8076725

RESUMEN

BACKGROUND: The diffusion of cardiac catheterization laboratories in Italy has been increasing in the last decade, often without a rational planning process evaluating costs, safety, concentration and case loads. METHODS: Data have been provided by the 1990 annual report of the Italian Group of Hemodynamic Studies and Interventional Cardiology which includes, following the best estimates, about 90% of public and private labs. These data include all cardiac catheterization visits. In analysis, PTCA's have been separately considered. RESULTS: In 1990, 85 laboratories with 101 rooms were active. The distribution of the labs was 58% in the north, 14% in the middle and 28% in the south of the country. The number of labs per million inhabitants was 1.9, 1.1 and 1.2 respectively, with a national average of 1.5. The percentage of labs performing fewer than 300 visits per year was 33% in the country. Within the areas, such percentages were 33%, 17% and 42% respectively. A total of 48,518 exams were performed (61%, 18% and 21% in the three areas) with a rate per 100,000 of 115, 82 and 51 (national rate 86). 5,145 PTCA's were carried out in the same year, about 80% of which were in the north area. CONCLUSIONS: Even if data could be underestimated, a great difference in geographical distribution of labs was confirmed. This might be explained by morbidity, population age and mobility of patients across the country. The percentage of labs performing fewer than 300 studies is relevant, in particular in the south and in the Isles. Planning for future requirements should include the amelioration of utilization rates (in a perspective of cost containment and patient safety), a thorough evaluation of demographic and morbidity trends, and an estimate of the proportion of inappropriate procedures.


Asunto(s)
Cateterismo Cardíaco , Hemodinámica , Laboratorios de Hospital/provisión & distribución , Calidad de la Atención de Salud , Angioplastia Coronaria con Balón/normas , Angioplastia Coronaria con Balón/estadística & datos numéricos , Cateterismo Cardíaco/estadística & datos numéricos , Humanos , Italia , Laboratorios de Hospital/normas , Laboratorios de Hospital/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Recursos Humanos , Carga de Trabajo/estadística & datos numéricos
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