RESUMO
Los objetivos de gestión, en ocasiones, plantean importantes conflictos de valor, hasta el momento poco estudiados. En el presente artículo se analiza qué cuestiones éticas plantean los objetivos operativos de gestión a los médicos que trabajan en hospitales españoles. Estas cuestiones son las siguientes: 1) en el sistema actual se prima la cantidad sobre la calidad, lo que supone una perspectiva de gestión predominantemente economicista; 2) se trata de un sistema jerarquizado, en el que apenas hay participación y en el que los clínicos carecen de capacidad decisoria y 3) los objetivos se centran en actividades desfasadas respecto a la realidad del sistema sanitario actual, por lo que deben ser actualizados considerando, por ejemplo, la cronicidad o la continuidad asistencial. Al analizar estas cuestiones, se realiza una propuesta de elaboración de los objetivos de gestión basada en 3 aspectos: priorizar la calidad asistencial (lo que finalmente repercute en una gestión eficiente), elaborar los objetivos de forma participativa y mixta (con objetivos colectivos e individuales) y diseñar nuevos objetivos acordes con la realidad del actual sistema sanitario. No es complicado poner en práctica esta propuesta, ya que la meta final de los clínicos y de la gerencia es la de proporcionar una asistencia sanitaria óptima
Management objectives at times create significant value conflicts that have so far been seldom studied. This article analyses the ethical issues created by the operational objectives of management for physicians who work in Spanish hospitals. These issues are as follows: 1) the current system places quantity above quality, which represents a predominantly economist management perspective; 2) the system is hierarchical, lacks participation and deprives clinicians of decision-making authority; 3) the objectives are focused on outdated activities in terms of the current reality of the healthcare system and should therefore be updated considering, for example, chronicity and the continuity of care. After analysing these issues, we created a proposal for developing management objectives based on prioritising quality care (which ultimately results in efficient management), developing objectives in a participatory and mixed manner (with group and individual objectives) and designing new objectives in keeping with the current reality of the healthcare system. Putting this proposal into practice is not complicated because the final goal of clinicians and management is to provide optimal health care
Assuntos
Humanos , Ética Institucional , Administração Hospitalar/ética , Objetivos Organizacionais , Dissidências e Disputas , Organizações de Assistência Responsáveis/organização & administraçãoRESUMO
Management objectives at times create significant value conflicts that have so far been seldom studied. This article analyses the ethical issues created by the operational objectives of management for physicians who work in Spanish hospitals. These issues are as follows: 1) the current system places quantity above quality, which represents a predominantly economist management perspective; 2) the system is hierarchical, lacks participation and deprives clinicians of decision-making authority; 3) the objectives are focused on outdated activities in terms of the current reality of the healthcare system and should therefore be updated considering, for example, chronicity and the continuity of care. After analysing these issues, we created a proposal for developing management objectives based on prioritising quality care (which ultimately results in efficient management), developing objectives in a participatory and mixed manner (with group and individual objectives) and designing new objectives in keeping with the current reality of the healthcare system. Putting this proposal into practice is not complicated because the final goal of clinicians and management is to provide optimal health care.
RESUMO
No disponible
Assuntos
Humanos , Hiperuricemia/diagnóstico , Gota/diagnóstico , Febuxostat/uso terapêutico , Doenças Assintomáticas , Anti-Hipertensivos/uso terapêuticoAssuntos
Humanos , Xeroderma Pigmentoso/induzido quimicamente , Xeroderma Pigmentoso/complicações , Xeroderma Pigmentoso/diagnóstico , Esteroides/efeitos adversos , Esteroides/uso terapêutico , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Xeroderma Pigmentoso/terapia , Esplenomegalia/complicações , Esplenomegalia/diagnósticoRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Tecido Linfoide/patologia , Linfoma de Células B/tratamento farmacológico , Anticorpos Monoclonais Murinos , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/tendências , Tomografia por Emissão de PósitronsAssuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Bronquite Crônica/tratamento farmacológico , Infecções Bacterianas/microbiologia , Bronquite Crônica/microbiologia , Fluoroquinolonas/uso terapêutico , Humanos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacosRESUMO
No disponible
Assuntos
Humanos , Pneumonia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antibacterianos/administração & dosagemRESUMO
This study evaluated the validity of bone marrow (BM) and blood specimens for the diagnosis of disseminated mycobacterial infections (DMIs). From 1990 to February 1997, all specimens were processed with the lysis-centrifugation procedure; thereafter (until December 2001), they were processed with the BACTEC Myco/F Lytic system. Twenty-three paired BM-blood specimens with mycobacteria in at least one specimen were studied from 23 patients. The strains isolated were 14 Mycobacterium avium complex (MAC) and nine M. tuberculosis complex (MTBC). Blood specimens had a statistically significant greater sensitivity for the isolation of MAC than BM (100% vs. 57.1%, respectively), whereas sensitivity for the isolation of MTBC was equal for the two specimen types (66.7%). Although not statistically significant, the times required to detect mycobacteria from blood specimens were lower than those from BM in the MycoF/Lytic system. Overall, blood cultures represented a more sensitive and less invasive alternative to BM cultures for the diagnosis of disseminated mycobacteriosis caused by MAC, especially when the MycoF/Lytic system was used, but provided no advantage for the diagnosis of DMI caused by MTBC.