21 research outputs found
Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial
Background: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. Methods: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. Results: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. Conclusions: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation
Metodología Lean Healthcare. ¿ Es posible su sostenibilidad en un sistema público de salud?
[EN] Objectives: To evaluate if the application of the Lean healthcare
methodology is sustainability in a tertiary department
of a Spanish Health Service public hospita~ which is looking
for improving efficiency.
Methods: The implementation of the Lean Healthcare
methodology in a urology department was conducted carrying
out the five consecutive steps described in this
methodology, and it was applied in three non-sequential
phases: team training, process management and continuous
improvement
Results: The implementation of this methodology translated
into high practitioner satisfaction, increased the care
production and improved quality indicators, mainly risk-adjusted
length ofstay, risk-adjusted complication index, risk
adjusted mortality rate. The readmissions rate was the only
indicator above the standard dueto the adjusted length of
stay. The application ofthis methodology resulted essential
to improve the efficiency ofthe service and hospital.
Conclusions: The implementation of the Lean Healthcare
methodology is possible in the Spanish Public Health Care,
however its sustainability depends on a parallel increase of
resources to the care production and an intrinsic and extrinsic
recognition ofthe Unit, Service or Center that has incorporated
it[ES] Objetivos: Evaluar si la metodología Lean Healthcare es sostenible
en un servicio de un hospital público terciario de la red sanitaria
española que buscaba mejorar su eficiencia.
Métodos: La implantación de la metodología Lean Healthcare se
inició en el año 2012, siguiendo losS pasos secuenciales de dicha
metodología y mediante 3 fases no necesariamente secuenciales;
formación de equipo, gestión por procesos y mejora continua.
Resultados: la aplicación de la metodología mostró una importante
satisfacción de los profesionales, un incremento de la producción
asistencial (GRDs producidos), una mejora de los principales
indicadores, especialmente el de estancia media, índice
de complicaciones ajustadas por riesgo, índice de mortalidad
ajustada por riesgo e índice de estancia media ajustada por riesgo.
Sólo el índice de readmisiones sufrió u na desviación frente al
estándar debido fundamentalmente a las estancias tan ajustadas
que se manejan. La aplicación de Lean healthcare resultó
esencial para mejorar la eficiencia del servicio y del hospital
Conclusiones: La aplicación de la metodología Lean Health es
posible en un sistema sanitario público como elespaño~ sin embargo
su sostenibilidad depende de una asignación de recursos
paralela al aumento de p rod ucció n y de un reconocí miento tanto
intrínseco como extrínseco de la Unidad, Servicio o Centro que la
ha incorporado.Budía Alba, A.; Boronat-Tormo, F.; Vivas-Consuelo, D.; Barrachina Martínez, I. (2017). Metodología Lean Healthcare. ¿ Es posible su sostenibilidad en un sistema público de salud?. Revista Espanola de Economia de la Salud (Online). 12(4):722-728. http://hdl.handle.net/10251/103143S72272812