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1.
Cuad. bioét ; 31(102): 183-202, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194277

RESUMO

El artículo aborda el análisis de los criterios de asignación de recursos sanitarios escasos durante la pandemia producida por el virus covid 19 en España. Se analiza críticamente la ausencia de una perspectiva jurídico-constitucional en la elaboración de tales criterios y se sugiere la incorporación del criterio de equidad como garantía del efectivo disfrute del derecho constitucional a la protección de la salud por parte de las personas vulnerables


The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the covid 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Vulnerabilidade a Desastres , Protocolos Clínicos/classificação , 17627/legislação & jurisprudência , Pandemias/ética , Prevenção de Doenças , Capacidade de Resposta ante Emergências/legislação & jurisprudência , Alocação de Recursos/legislação & jurisprudência , Prioridades em Saúde/ética
2.
J Clin Epidemiol ; 98: 62-69, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29454030

RESUMO

OBJECTIVES: To evaluate how the rank probabilities obtained from network meta-analysis (NMA) change with the use of increasingly stringent criteria for the relative effect comparing two treatments which ranks one treatment better than the other. STUDY DESIGN AND SETTING: Systematic survey and reanalysis of published data. We included all systematic reviews (SRs) with NMA from the field of cardiovascular medicine that had trial-level data available, published in Medline up to February 2015. We reran all the NMAs and determined the probabilities of each treatment being the best. For the best treatment, we examined the effect on these probabilities of varying, what we call the decision threshold, the relative effect required to declare two treatments different. RESULTS: We included 14 SRs, having a median of 20 randomized trials and 9 treatments. The best treatments had probabilities of being best that ranged from 38% to 85.3%. The effect of changing the decision thresholds on the probability of a treatment being best varied substantially across reviews, with relatively little decrease (∼20 percentage points) in some settings but a decline to near 0% in others. CONCLUSION: Rank probabilities can be fragile to increases in the decision threshold used to claim that one treatment is more effective than another. Including these thresholds into the calculation of rankings may aid their interpretation and use in clinical practice.


Assuntos
Protocolos Clínicos/classificação , Interpretação Estatística de Dados , Tomada de Decisões , Metanálise em Rede , Cardiologia , Protocolos Clínicos/normas , MEDLINE , Probabilidade , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
J Eval Clin Pract ; 24(1): 293-300, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28370977

RESUMO

RATIONALE: Experienced primary care physicians handle most illnesses to everyone's satisfaction despite limited resources of time and means. However, cases can be multifaceted in that harmless-presenting symptoms may also be warning signals or an indicator of a health disorder that too infrequently presents in family practice to be diagnosed correctly. On the basis of these observations, RN Braun developed 82 diagnostic protocols for a structured recording of various complaints. METHOD: All consultations during the years 2001 to 2014, in which 1 author (WF) had used diagnostic protocols in her single-handed practice, were analyzed retrospectively regarding reasons for encounter, diagnostic classification, and long-term outcome. RESULTS: During the period, a diagnostic protocol was used 1686 times. It was applied at a rate of approximately 5% of 2500 new complaints annually, most often (1366 times) for febrile conditions. In 320 consultations for other complaints, 43 different diagnostic protocols were applied. Among them, the "tabula diagnostica" for various undifferentiated symptoms was used most frequently (n = 54), followed by diagnostic protocols for headache (n = 45), dizziness (n = 36), precordial pain (n = 20), nonspecific abdominal pain (n = 15), low back pain (n = 14), hypertension (n = 12), diarrhea > 1 week (n = 12), epigastralgia (n = 11), depression (n = 10), polyarthralgia (n = 8), cough, and lower abdominal pain (each n = 7). A final diagnosis was established in less than 20% of cases. CONCLUSIONS: This observational study from routine practice gives an insight how diagnostic protocols helped to manage complex patient presentations. A broader use of diagnostic protocols could investigate the potential of this consultation tool to handle the complexity of primary health care. The use of a standardized diagnostic approach could stimulate research, in particular on managing common complaints/undifferentiated illness and their inherent diagnostic uncertainty.


Assuntos
Protocolos Clínicos , Administração dos Cuidados ao Paciente , Atenção Primária à Saúde/métodos , Assistência Ambulatorial/métodos , Protocolos Clínicos/classificação , Protocolos Clínicos/normas , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Anamnese/métodos , Registros Médicos , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Melhoria de Qualidade , Encaminhamento e Consulta , Avaliação de Sintomas/métodos , Análise de Sistemas
4.
Angiología ; 69(1): 18-25, ene.-feb. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-159242

RESUMO

INTRODUCCIÓN: La reparación endovascular de los aneurismas de la aorta abdominal (EVAR) con éxito precisa la previa realización de una medición anatómica precisa basada en el estudio angio-TC aórtica. En situaciones de urgencia el tiempo para medición y planificación del caso es limitado y la disponibilidad del estudio en formato DICOM no siempre es posible. OBJETIVO: Presentar un protocolo de planificación desarrollado en nuestro centro que permite reducir el tiempo necesario para realizar las medidas en terapia EVAR de aneurismas de aorta abdominal (AAA) rotos en situaciones de urgencia y describir los resultados de nuestro centro antes y después de la aplicación de este protocolo. MÉTODO: Presentamos un análisis descriptivo de morbimortalidad a 30 días y a un año basado en un registro prospectivo de todos los casos de rotura de AAA admitidos de modo consecutivo (n = 32) en el servicio de urgencias de un hospital nacional de referencia durante el periodo enero del 2013 a mayo del 2015 (28 meses). El protocolo SANTIAGO es un acrónimo que describe (en lengua inglesa) 8 pasos que deben ser siempre tenidos en cuenta para una planificación EVAR: S (Size the aneurysms), A (Access), N (Neck), T (bifurcaTion), I (Iliacs), A (Angulations), G (LenGth-LonGitud) y O (OK for material). En nuestro centro, la terapia EVAR en rotura aórtica se realiza bajo anestesia local y de modo percutáneo si la situación clínica del paciente lo permite. RESULTADOS: Tras la aplicación del protocolo SANTIAGO en nuestro centro, desde junio del 2014, se consiguió reducir la mortalidad en el tratamiento urgente de aneurismas aórticos infrarrenales rotos. Fueron desestimados para ningún tipo de intervención por su elevada morbimortalidad 3 pacientes de los 32 (9,3%) admitidos en urgencias. La mortalidad total a 30 días en pacientes tratados disminuyó del 46,6% (7/15) preprotocolo frente al 35,7%(5/14) posprotocolo y en pacientes intervenidos mediante técnica endovascular pasó del 25% (1/4) preprotocolo frente a un 0%(0/6) de mortalidad posprotocolo. El 66,6% (4/6) de los pacientes tratados mediante EVAR tras el implante del protocolo fueron intervenidos de modo percutáneo y bajo anestesia local. La mortalidad al año, registrada en mayo del 2016, fue en el grupo EVAR del 10% (1/10), tasa de reintervención al año del 7,1% (1/9) por endofuga tipo ib, resuelta con éxito. En el grupo de cirugía abierta la morbimortalidad a 12 meses fue del 63,15% (12/19) de los pacientes intervenidos, con registro de un fallecimiento por IAM 7 meses postintervención y sin datos de reintervenciones mayores al año. CONCLUSIONES: Basados en la mejora de resultados observada en nuestro centro, consideramos que la existencia de un protocolo de planificación EVAR permite una planificación esquemática y reproducible que optimiza el tiempo necesario para afrontar una situación de urgencia crítica y propicia el éxito de la reparación. Asimismo, existe la tendencia progresiva en nuestro centro a considerar el tratamiento EVAR como primera opción terapéutica para pacientes con AAA-r. La posibilidad de realizar esta técnica con anestesia local y abordaje percutáneo podría ser considerada como un factor independiente que condiciona la menor morbimortalidad global del procedimiento


INTRODUCTION: Successful endovascular treatment of ruptured abdominal aortic aneurysms (R-EVAR) requires a detailed planning of the procedure, as planning is the key step. Nevertheless, in cases of emergency the limited time for planning and the non-availability of good quality scan images (DICOM format) are common issues that determine the final result. OBJECTIVE: The aim of this paper is to present the results of r-AAA survival before and after a fast protocol was implemented in our centre for measuring and sizing r-EVAR in emergency situations. METHOD: Morbidity and mortality at 30 days and 1 year was prospectively recorded in all consecutive cases of r-AAA admitted to the emergency department of our hospital (n = 32) from January 2013 to May 2015 (28 months). The «SANTIAGO planning & sizing protocol» was implemented in June 2014. It is a fast method to remember key steps in planning EVAR. With the word SANTIAGO being a mnemonic device in which 8 basic and mandatory steps in planning can be summarised: S: Size, A: Access N: Neck, T: Bifurcation I: Iliacs, A: Angulations, G: Length, O: Ok for material. R-EVAR is performed in this centre under local anaesthesia and using a percutaneous approach, if the patient tolerates it, since June 2014. RESULTS: After implementation of the SANTIAGO protocol in June 2014, the 30 day mortality was reduced from 46.6% (7/15) to 35.7% (5/14) in all patients treated in our centre for a ruptured AAA. The mortality recorded in the endovascular group was 25% (1/4) pre-protocol and 0% (0/6) after in the period analysed. A percutaneous approach and local anaesthesia was used in 66% (4/6) patients in the EVAR Group after the protocol was implemented. The 1 year mortality was 10% for all patients treated in the R-EVAR group, with a secondary intervention rate of 7.1% (1/9) due to a type Ib endoleak. In the open repair group, the 1 year morbidity/mortality was 63.15% (12/19), with a patient death at 7 months due to a myocardial infarction. CONCLUSIONS: Our first results suggest that a fast protocol for planning and sizing in emergency situations seems to be associated with a lower 30 day mortality. A higher trend for considering the patient candidate for r-EVAR has been observed in our centre. Local anaesthesia and percutaneous approach have a probable influence on the lower morbidity and mortality of the endovascular cases


Assuntos
Humanos , Masculino , Feminino , Protocolos Clínicos/classificação , Procedimentos Endovasculares/métodos , Serviços Médicos de Emergência/métodos , Aneurisma da Aorta Abdominal/patologia , Aneurisma Roto/diagnóstico , Epidemiologia Descritiva , Stents/classificação , Protocolos Clínicos/normas , Procedimentos Endovasculares/normas , Serviços Médicos de Emergência , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma Roto/complicações , Estudos Prospectivos , Stents/normas
5.
Health Informatics J ; 23(1): 56-68, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-26868770

RESUMO

Data mining methods in biomedical research might benefit by combining genetic algorithms with domain-specific knowledge. The objective of this research is to show how the evolution of treatment rules for autism might be guided. The semantic distance between two concepts in the taxonomy is measured by the number of relationships separating the concepts in the taxonomy. The hypothesis is that replacing a concept in a treatment rule will change the accuracy of the rule in direct proportion to the semantic distance between the concepts. The method uses a patient database and autism taxonomies. Treatment rules are developed with an algorithm that exploits the taxonomies. The results support the hypothesis. This research should both advance the understanding of autism data mining in particular and of knowledge-guided evolutionary search in biomedicine in general.


Assuntos
Algoritmos , Transtorno Autístico/terapia , Protocolos Clínicos/classificação , Resultado do Tratamento , Classificação/métodos , Mineração de Dados/métodos , Humanos , Conhecimento , Semântica
7.
Rev. patol. respir ; 19(4): 124-128, oct.-dic. 2016. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-159484

RESUMO

La atención médica a los pacientes ingresados en el hospital gira alrededor del «pase de planta». La forma de realizarlo no está estandarizada, siendo habitual hacer salir a los familiares de la habitación mientras atendemos al paciente. No disponemos de estudios que hayan valorado el impacto de realizar el pase de planta dejando a los familiares dentro de la habitación. Es por ello que nos planteamos realizar el presente estudio prospectivo, controlado, sobre humanización de la visita médica en pacientes ingresados en la planta de neumología, fundamentado en la incorporación de los familiares de los pacientes ingresados al pase de visita médica. En el periodo comprendido entre enero 2014 y diciembre 2015 fueron incluidos en el estudio 895 pacientes. Los resultados muestran que el 98% de los pacientes quieren que estén presentes su familiares (cónyuge, hijos,..) y el 100% de los familiares directos quieren estar presentes en el momento del pase de visita médica. El 95% de los pacientes quiere compartir la información médica con sus familiares en un único escenario. El grado de satisfacción de los pacientes y familiares fue muy elevado en la escala analógica-visual. La valoración del cuestionario de satisfacción mostró una elevada puntuación en todos los apartados: «comunicación médico-paciente», «relación médico-paciente» y «accesibilidad y disponibilidad». El grado de satisfacción de los profesionales fue muy elevado con este modelo de pase de visita. Además, se ha estimado un ahorro de tiempo sustancial al no tener que repetir la información a diferentes personas en distinto espacio y tiempo. Se han evitado problemas de comunicación e incertidumbres al proporcionar una información común al paciente acompañado de su familia. Han disminuido drásticamente las situaciones de conflicto entre pacientes y profesionales. Se ha reducido la variabilidad en la interpretación de la información transmitida. Por último y no menos importante, se ha generado un clima de confianza con el equipo médico que facilita la toma de decisiones por ambas partes


Medical care for patients admitted to the hospital revolves around the «daily medical visit». The way of doing this is not standardized, being common to flush out the family of the room while we take care of the patient. No studies that have assessed the impact of the daily medical visit leaving the family inside the room. That is why we plan to make this prospective controlled study on humanization of daily medical visits in patients admitted to the pulmonology plant, based on the incorporation of the relatives of patients. In the period between January 2014 and December 2015 they were included in the study 895 patients. The results have shown that 98% of patients want their family members (spouse, children, ..) are present and 100% of the relatives want to be present at the time of daily medical visit. 95% of patients want to share medical information with your family in a unique setting. The degree of satisfaction of patients and relatives was very high in the visual analog scale. The assessment of satisfaction survey showed a high score in all sections: «doctor-patient communication», «doctor-patient relationship» and «accessibility and availability». The degree of professional satisfaction was very high with this model of daily medical visit. In addition, it is estimated a substantial saving time by not having to repeat information to different people in different space and time. They have been avoided communication problems and uncertainties by providing a common patient information accompanied his family. They have drastically reduced the conflict between patients and professionals. It has been reduced variability in the interpretation of the information transmitted. Last but not least, it has generated a climate of trust with the medical team that facilitates decision-making by both parties


Assuntos
Humanos , Masculino , Feminino , Pneumologia/educação , Humanização da Assistência , Hospitalização , Cuidadores/classificação , Relações Médico-Paciente , Protocolos Clínicos/classificação , Pneumologia/normas , Estudos Prospectivos , Cuidadores/normas , Satisfação do Paciente , Relações Médico-Paciente/ética , Protocolos Clínicos/normas
10.
Stud Health Technol Inform ; 225: 592-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27332270

RESUMO

Healthcare delivery is largely based on medical best practices as in clinical protocols. Research so far has addressed the computerized execution of clinical protocols by developing a number of related representation languages, execution engines and integrated platforms to support real time execution. However, much less effort has been put into organizing clinical protocols for use and reuse. In this paper we propose a heterogeneous semantic social network to describe and organize clinical protocols based on their provenance, evolution and modifications. The proposed approach allows semantic tagging and enrichment of clinical protocols so that they can be used and re-used across platforms and also be linked directly to other relevant scientific information, e.g. published works in PubMed or personal health records, and other clinical information systems.


Assuntos
Protocolos Clínicos/classificação , Protocolos Clínicos/normas , Registro Médico Coordenado/normas , Semântica , Mídias Sociais/normas , Vocabulário Controlado , Grécia , Disseminação de Informação , Apoio Social , Terminologia como Assunto
11.
Rev. andal. med. deporte ; 9(2): 75-79, jun. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-152591

RESUMO

Objective. The effects of exercise protocols on postural control changes have been supported, but the influence of a common and specific type neuromuscular exercise such as plyometric on postural control is not clear. Therefore, the aim of this study was to examine the effects of plyometric type neuromuscular exercise on balance or postural control performance of young male volleyball players. Method. Ten professional young male volleyball players participated in this study and performed plyomeric exercises including 4 × 10 squat jump, broad jump, tuck jump with knee to chest, and depth jump from 45-cm box high 60 and 90 s rest between sets and exercises, respectively. Before and immediately after completing the plyometric exercise, postural control was assessed by the Star Excursion Balance Test (SEBT) at 8 directions (anterior, A; anteromedial, AM; anterolateral, AL; medial, M; lateral, L; posterior, P; posteromedial, PM; and posterolateral, PL). Results. The results indicated that plyometric exercise induced deficits in reach directions and greater changes occurred in the M, P and AL directions. Conclusions. It can be recommend that strength and conditioning professionals in the field of volleyball do not perform other type of landing exercise in plyometric training sessions because of postural control impaired and consequently the probability of lower extremity injuries will increase (AU)


Objetivo. O efeito de protocolos de exercícios sobre as mudanças no controle postural ébem conhecido, mas a influência de um tipo de treinamento neuromuscular comum e específico como o pliométrico no controle postural não está claro. O objetivo deste estudo foi examinar os efeitos dos exercícios neuromusculares do tipo pliométrico no equilíbrio e controle postural de jovens jogadores de voleibol masculino. Métodos. Dez jovens, jogadores profissionais de voleibol, participaram desse estudo e realizaram exercícios pliométricos que incluíram: 4 × 10 saltos partindo da posição de agachamento, saltos longitudinais, saltos com joelho encostando no peito e salto com rebote sob uma caixa de 40 cm de altura, com descanso entre 60-90 segundos entre as séries e exercícios, respectivamente. Antes e imediatamente após completarem o exercício de pliometria, o controle postural foi medido com as 8 direções do Star Excursion Test (SEBT) (anterior: A; antero-medial; AM; antero-lateral: AL; medial: M; lateral: L; posterior: P; póstero-medial: PM e postero-lateral: PL). Resultados. Os resultados indicam que os exercícios pliométricos induziram déficits no alcance das direções do SEBT e as maiores mudanças ocorrem nas direções M, P e AL. Conclusão. Pode ser recomendado que os profissionais que trabalham com força e condicionamento físico voltado ao voleibol não realizem outro tipo de exercício com carga nas sessões de pliometria, por causa da debilidade no controle postural que o treinamento pliométrico ocasiona e consequentemente na probabilidade de aumentar o risco de lesões nos membros inferiores (AU)


Objetivo. El efecto de protocolos de ejercicios, en cambios del control postural, son bien conocidos, pero la influencia de un sencillo y específico tipo de ejercicio neuromuscular, como los ejercicios pliométricos, en el control postural, no está clara. Por tanto, el objetivo de este estudio fue examinar los efectos de los ejercicios neuromusculares, de tipo pliométrico, en el equilibrio o en el control postural, de varones jóvenes jugadores de voleibol. Método. Diez varones jóvenes jugadores profesionales de voleibol participaron en este estudio y realizaron ejercicios pliométricos incluyendo 4 × 10 saltos con sentadilla, saltos de longitud, saltos con rodillas al pecho y saltos con rebote desde un cajón de 45 cm de altura, con 60 y 90 s de reposo entre series y ejercicios, respectivamente. Antes e inmediatamente después de completar los ejercicios pliométricos se midió el control postural mediante el Star Excursion Balance Test (SEBT) en 8 direcciones (anterior: A; anteromedial: AM; anterolateral: AL; medial: M; lateral: L; posterior: P; posteromedial: PM y posterolateral: PL). Resultados. Los resultados indican que los ejercicios pliométricos indujeron déficits en las direcciones analizadas y que los mayores cambios se produjeron en las direcciones M, P y AL. Conclusión. Se puede recomendar, a los profesionales del voleibol, en el campo del entrenamiento de la fuerza, que no realicen otros tipos de ejercicios de suelo en las sesiones de entrenamiento pliométrico, porque la disminución del control postural podría incrementar secundariamente la probabilidad de lesión del miembro inferior (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Monitoração Neuromuscular/métodos , Monitoração Neuromuscular , Postura/fisiologia , Voleibol/fisiologia , Exercícios de Alongamento Muscular/instrumentação , Exercícios de Alongamento Muscular/métodos , Exercícios de Alongamento Muscular/tendências , Técnicas de Exercício e de Movimento/métodos , Exercícios de Alongamento Muscular/organização & administração , Exercícios de Alongamento Muscular/normas , Protocolos Clínicos/classificação
12.
J Cyst Fibros ; 15(3): 313-7, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26826912

RESUMO

BACKGROUND: The aim of newborn screening (NBS) for CF is to detect children with 'classic' CF where early treatment is possible and improves prognosis. Children with inconclusive CF diagnosis (CFSPID) should not be detected, as there is no evidence for improvement through early treatment. No algorithm in current NBS guidelines explains what to do when sweat test (ST) fails. This study compares the performance of three different algorithms for further diagnostic evaluations when first ST is unsuccessful, regarding the numbers of children detected with CF and CFSPID, and the time until a definite diagnosis. METHODS: In Switzerland, CF-NBS was introduced in January 2011 using an IRT-DNA-IRT algorithm followed by a ST. In children, in whom ST was not possible (no or insufficient sweat), 3 different protocols were applied between 2011 and 2014: in 2011, ST was repeated until it was successful (protocol A), in 2012 we proceeded directly to diagnostic DNA testing (protocol B), and 2013-2014, fecal elastase (FE) was measured in the stool, in order to determine a pancreas insufficiency needing immediate treatment (protocol C). RESULTS: The ratio CF:CFSPID was 7:1 (27/4) with protocol A, 2:1 (22/10) with protocol B, and 14:1 (54/4) with protocol C. The mean time to definite diagnosis was significantly shorter with protocol C (33days) compared to protocol A or B (42 and 40days; p=0.014 compared to A, and p=0.036 compared to B). CONCLUSIONS: The algorithm for the diagnostic part of the newborn screening used in the CF centers is important and affects the performance of a CF-NBS program with regard to the ratio CF:CFSPID and the time until definite diagnosis. Our results suggest to include FE after initial sweat test failure in the CF-NBS guidelines to keep the proportion of CFSPID low and the time until definite diagnosis short.


Assuntos
Protocolos Clínicos , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística , Elastase Pancreática/análise , Algoritmos , Protocolos Clínicos/classificação , Protocolos Clínicos/normas , Fibrose Cística/diagnóstico , Fibrose Cística/genética , Fibrose Cística/metabolismo , Fibrose Cística/terapia , Diagnóstico Precoce , Intervenção Médica Precoce/métodos , Testes Genéticos/métodos , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Triagem Neonatal/normas , Prognóstico , Melhoria de Qualidade , Suor/metabolismo , Suíça/epidemiologia , Fatores de Tempo , Tripsinogênio/análise
13.
Rev. clín. esp. (Ed. impr.) ; 216(1): 8-14, ene.-feb. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-149726

RESUMO

Objetivos. La insuficiencia cardíaca (IC) es una enfermedad con una elevada morbimortalidad. Evaluamos la utilidad del programa de Unidades de Manejo Integral para Pacientes con IC (UMIPIC). Pacientes y método. Se analizaron los datos de los pacientes incluidos en el programa UMIPIC, recogidos en el registro de IC (RICA) de la Sociedad Española de Medicina Interna. Se compararon las visitas a Urgencias y las hospitalizaciones por cualquier causa y por IC durante el año anterior a la inclusión en el programa, con las que tuvieron durante el año de seguimiento posterior, usando el test de la chi-cuadrado. Resultados. Se incluyeron 258 pacientes (edad media 80 años, 51,9% mujeres). Durante el año previo hubo 693 hospitalizaciones por cualquier causa y 174 durante el seguimiento (reducción del 75%, p<0,001); 613 hospitalizaciones por IC el año antes y 92 durante el seguimiento (reducción del 85%, p<0,001); 655 vs 302 en cuanto a las visitas a Urgencias por cualquier causa (reducción del 53,9%, p<0,001); 440 vs 120 para las visitas a Urgencias por IC (reducción del 72%, p<0,001). No hubo diferencias significativas en el número de hospitalizaciones o visitas a Urgencias por otras causas diferentes a la IC. Conclusiones. El programa UMIPIC basado en la atención integral a pacientes ancianos con IC y comorbilidad reduce el porcentaje de reingresos hospitalarios y visitas a Urgencias durante el primer año de seguimiento (AU)


Objectives. Heart failure (HF) is a disease with high morbidity and mortality. We evaluated the usefulness of the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral para Pacientes con IC [UMIPIC]) programme. Patients and method. We analysed the patient data from the UMIPIC programme, which was recorded in the HF registry (RICA) of the Spanish Society of Internal Medicine. We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the programme against those that occurred during the subsequent follow-up year, using the chi-squared test. Results. A total of 258 patients (mean age, 80years; 51.9% women) were included in the study. During the previous year, there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up (75% reduction, P<.001). There were 613 hospitalisations for HF during the previous year and 92 during the follow-up (85% reduction, P<.001); 655 vs. 302 in terms of emergency department visits for any cause (53.9% reduction, P<.001); and 440 vs. 120 for emergency department visits for HF (72% reduction, P<.001). There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF. Conclusions. The UMIPIC programme based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/metabolismo , Assistência Ambulatorial/métodos , Hospitalização/estatística & dados numéricos , Espanha , Protocolos Clínicos/classificação , Terapêutica/métodos , Terapêutica/normas , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Assistência Ambulatorial/normas , Hospitalização/tendências , Protocolos Clínicos/normas , Terapêutica/classificação , Terapêutica
14.
Rev. clín. esp. (Ed. impr.) ; 216(1): 27-33, ene.-feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-149731

RESUMO

Los servicios quirúrgicos tienen dificultades crecientes en la atención a sus pacientes ingresados debido a la mayor edad y comorbilidad, a una formación médica en creciente especialización y a la fuerte presión político-sanitaria que impone una organización asistencial donde prima el acto quirúrgico frente a las demás actividades. La presión que ejercen estos servicios sobre el área médica y la respuesta deficiente ofrecida por el sistema de interconsulta han provocado el desarrollo de un modelo diferente de organización asistencial: la asistencia compartida, la cual incluye la medicina perioperatoria. En ella 2 especialistas diferentes comparten la responsabilidad y autoridad en la atención de un paciente quirúrgico ingresado. Medicina Interna es la especialidad más adecuada para la asistencia compartida. El internista que la ejerza ha de tener unas características determinadas y debe superar una serie de temores del cirujano y del anestesista (AU)


Surgical departments have increasing difficulties in caring for their hospitalised patients due to the patients’ advanced age and comorbidity, the growing specialisation in medical training and the strong political-healthcare pressure that a healthcare organisation places on them, where surgical acts take precedence over other activities. The pressure exerted by these departments on the medical area and the deficient response by the interconsultation system have led to the development of a different healthcare organisation model: Shared care, which includes perioperative medicine. In this model, 2 different specialists share the responsibility and authority in caring for hospitalised surgical patients. Internal Medicine is the most appropriate specialty for shared care. Internists who exercise this responsibility should have certain characteristics and must overcome a number of concerns from the surgeon and anaesthesiologist (AU)


Assuntos
Humanos , Masculino , Feminino , Cirurgiões/educação , Cirurgiões/normas , Enfermeiras Anestesistas/educação , Medicina Interna/educação , Enfermagem Perioperatória , Protocolos Clínicos/classificação , Cirurgiões/psicologia , Cirurgiões , Enfermeiras Anestesistas/normas , Medicina Interna/métodos , Enfermagem Perioperatória/métodos , Protocolos Clínicos/normas
15.
Crit Care ; 20: 23, 2016 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-26796793

RESUMO

Critical care physicians have debated an appropriate term for the clinical phase preceding acute kidney injury (AKI). The recent development of cell cycle arrest biomarkers that signal the potential development of AKI is part of an evolution in the molecular diagnosis and understanding of AKI. It is proposed that the pre-injury phase that leads to AKI can be described as "acute kidney stress". This term has the potential to expand horizons in regard to the early detection of situations that will lead to AKI and the early implementation of corrective measures.


Assuntos
Lesão Renal Aguda/classificação , Lesão Renal Aguda/diagnóstico , Biomarcadores/sangue , Rim/metabolismo , Protocolos Clínicos/classificação , Humanos
16.
Clin. transl. oncol. (Print) ; 18(1): 82-87, ene. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-148055

RESUMO

Background. The recent immunotherapy treatment on triple-negative breast cancer (TNBC) leads to the breakthrough assignation. In this study, we have tried the new combinations of specific chemo with DC-CIKs immunotherapy to treat those patients. Patients and methods. Twenty-three metastatic anthracyclines and taxanes pretreated TNBC younger (mean 41.5 years) patients were initially mobilized with cyclophosphamide (3 g/m2) for the preparation of CD34+ peripheral blood mononuclear cells as the resources for generating DC/CIKs and marrow function supports. All cases were subsequently experienced 2 cycles of chemotherapy with cyclophosphamide 3 g/m2, thiotepa 150 mg/m2, and carboplatin AUC = 6, Q4w. The patients then received 3 infusions of DC-CIKs at the chemo intervals and followed by maintenance therapy with oral cyclophosphamide 50 mg daily. The endpoints were progression-free survival and overall survival. Results. The partial response rate was 13.0 %, stable and progressive disease rates were 56.5 and 30.4 %, respectively. The median PFS was 13.5 months (95 % confidence interval (CI) 10.1-16.9 months) and OS was 15.2 months (95 % CI 12.5-18.1 months). The most common serious adverse events were neutropenia (100.0 %) and anemia (69.7 %) but without treatment-related mortality. Conclusion. These data suggested that such combination therapy model be effective and safe for younger metastatic TNBC exposure to previous anthracyclines and taxanes based adjuvant chemotherapy (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Preparações Farmacêuticas/administração & dosagem , Neutropenia Febril Induzida por Quimioterapia/complicações , Neutropenia Febril Induzida por Quimioterapia/metabolismo , Medula Óssea/anormalidades , Protocolos Clínicos/classificação , Anemia/sangue , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Preparações Farmacêuticas/metabolismo , Intervalo Livre de Doença , Neutropenia Febril Induzida por Quimioterapia/enfermagem , Neutropenia Febril Induzida por Quimioterapia/prevenção & controle , Medula Óssea/metabolismo , Protocolos Clínicos/normas , Anemia/metabolismo
17.
J Cyst Fibros ; 15(1): 78-84, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26233897

RESUMO

BACKGROUND: Contamination is a key element in cystic fibrosis. For this reason, nebulizer hygiene is an important, but complex and time-consuming task for cystic fibrosis patients. The aim of this study was to compare different steam disinfection and drying protocols. METHODS: One hundred nebulizer parts were inoculated with cystic fibrosis-related bacteria in high concentrations (Burkholderia multivorans 3.9 × 10(10)/ml, Staphylococcus aureus 8.9 × 10(8/)ml and Pseudomonas aeruginosa 2.1 × 10(9)/ml). Tubes with Mycobacterium abscessus complex were additionally tested. Six steam disinfectors were compared. Different methods of drying were examined. RESULTS: All tested bacteria were efficiently killed by the different steam disinfectors tested. The risk of contamination depended on the method of drying. CONCLUSIONS: Steam disinfection is a safe disinfection method. It is better to leave the nebulizers wet after steam disinfection than to manipulate them by active drying, which seems to be a source of recontamination.


Assuntos
Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Protocolos Clínicos , Fibrose Cística/tratamento farmacológico , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Expectorantes/administração & dosagem , Nebulizadores e Vaporizadores/microbiologia , Aerossóis , Protocolos Clínicos/classificação , Protocolos Clínicos/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Vapor
18.
Rev. esp. pediatr. (Ed. impr.) ; 71(6): 363-368, nov.-dic. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-148702

RESUMO

El presente documento expone un resumen de la actual sistemática de trabajo de las Unidades dc Neuropediatría y Metabolismo del Hospital Universitario Miguel Servet de Zaragoza. Se dispone de herramientas de trabajo de enorme utilidad: bases de datos de neuropediatría y metabolismo, protocolos, hojas de información y consentimientos informados. A partir de dichas herramientas, se expone la actividad de las Unidades asistenciales, docentes y de investigación, incluida la actividad generada por el cribado neonatal ampliado (AU)


This document represents a summary of how the Neutopediatric and Metabolic Units work at the University Hospital Miguel Servet in Zaragoza. The extremely useful tools available today are Neuropediatric and Metabolic Data Bases, clinical protocols, parents’ and professionals’ information sheets and informed consent forms. Health-care, educational and research activity, including amplified neonatal screening, are drawn from these tools (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Pediatria/educação , Pediatria/métodos , Metabolismo/genética , Cuidado do Lactente/organização & administração , Ensino/classificação , Ensino/organização & administração , Protocolos Clínicos/classificação , Consentimento dos Pais/ética , Atenção Primária à Saúde , Pediatria/classificação , Pediatria , Metabolismo/fisiologia , Cuidado do Lactente/história , Ensino/história , Ensino , Bases de Dados Estatísticos , Protocolos Clínicos/normas , Consentimento dos Pais/história , Atenção Primária à Saúde/métodos
19.
Rev. esp. pediatr. (Ed. impr.) ; 71(6): 374-379, nov.-dic. 2015. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-148704

RESUMO

La Unidad de Urgencias de Pediatría del Hospital Universitario Miguel Servet de Zaragoza, centro de referencia de la Comunidad Autónoma de Aragón, tiene un compromiso con las líneas estratégicas del centro, destacando la actividad asistencial, docencia e investigacion clínica en las que están involucrados todos los profesionales de la Unidad. Su finalidad está centrada en el paciente y sus familias, en la resolución urgente de todas las situaciones clínicas que requieran atención inmediata por problemas médicos, quirúrgicos o traumatológicos, en el menor tiempo posible, con la mayor efectividad y con una óptima calidad científico- técnica, durante las 24 horas del día, todos los días del año. Exponemos los principales datos asistenciales, docentes y de investigación (AU)


The Children’s Emergency Department at the Miguel Servet University Hospital in Zaragoza, as a reference centre in Aragon, has a commitment to the hospital strategies emphasising health care, teaching and research activities, in which all professionals Working in the department are involved. Its purpose is, focused on the patient and their family, the urgent solution to all clinical situations requiring immediate attention due to medical, surgical or trauma problems with the greatest effectiveness and optimum scientific and technical quality 24 hours a day, every day of the year (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Serviços Médicos de Emergência , Serviços Médicos de Emergência/organização & administração , Hospitais Pediátricos/história , Hospitais Pediátricos/organização & administração , Clínicas de Dor/organização & administração , Protocolos Clínicos/classificação , Pesquisa Biomédica/educação , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Hospitais Pediátricos , Hospitais Pediátricos/normas , Clínicas de Dor/história , Protocolos Clínicos/normas , Pesquisa Biomédica/normas
20.
Pharm. pract. (Granada, Internet) ; 13(4): 0-0, oct.-dic. 2015. tab, graf
Artigo em Inglês | IBECS | ID: ibc-147601

RESUMO

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols. Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation. Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidencebased practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05). Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily by community pharmacists, especially as regards nonprescription medication counseling (AU)


Antecedentes: Para proporcionar asesoramiento adecuado al paciente en la dispensación de medicamentos over-the-counter (OTC), los farmacéuticos comunitarios necesitan acceso a información actual y fiable sobre medicamentos. Los farmacéuticos brasileños han asumido nuevas funciones, tales como la prescripción de la medicación, en un modelo independiente basado en protocolos. Objetivo: Examinar la práctica de los farmacéuticos comunitarios en un estado de Brasil, centrándose en las recomendaciones de OTC. Métodos: Se realizó un estudio transversal de farmacéuticos comunitarios en un estado de Brasil entre octubre 2013 y enero 2014, con recogida de datos mediante un cuestionario auto-administrado, pre-pilotado y anónimo en una plataforma Survey Monkey®. Después de la aprobación ética, se envió el instrumento online a 8.885 farmacéuticos registrados en el estado de Paraná (Brasil), centrándose en los profesionales que trabajan en farmacia comunitaria. El cuestionario evaluaba el establecimiento de la farmacia comunitaria, la busca de información, el conocimiento de las prácticas basadas en la evidencia, los factores importantes a considerar cuando se recomienda un medicamento OTC, y la prescripción del farmacéutico. Las respuestas se importaron a SPSS® (versión 22.0) para su análisis. Se usaron pruebas no paramétricas para evaluar la asociación entre respuestas y la información demográfica con un nivel de significancia de menos del 5% (p<0,05). Resultados: El 97,4% de los farmacéuticos dispensaba medicamentos y aconsejaba a pacientes durante una mediana de seis horas por día. Los factores más importantes a tener en cuenta cuando se aconsejaba un medicamento sin receta eran la eficacia del producto (97%) y los efectos adversos (62,3%). Pocos farmacéuticos conocían el significado de los términos relacionados con la práctica basada en la evidencia. La mayoría de los respondentes estaban de acuerdo con que los farmacéuticos tienen la formación necesaria para prescribir medicamentos. Conclusión: El asesoramiento en medicamentos overthe- counter es una práctica diaria entre los farmacéuticos brasileños. Existen necesidades formativas de los farmacéuticos comunitarios en relación a la práctica basada en la evidencia. Así, los farmacéuticos comunitarios podrían usar a diario las fuentes de información con buena evidencia, especialmente relativas al asesoramiento de medicación sin receta (AU)


Assuntos
Humanos , Masculino , Feminino , Prática Clínica Baseada em Evidências/educação , Prática Clínica Baseada em Evidências/ética , Disponibilidade de Medicamentos Via Internet/ética , Disponibilidade de Medicamentos Via Internet , Protocolos Clínicos/normas , Brasil/etnologia , Estudos Transversais/métodos , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/tendências , Disponibilidade de Medicamentos Via Internet/tendências , Disponibilidade de Medicamentos Via Internet , Protocolos Clínicos/classificação , Estudos Transversais
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