Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013

TITULO DEL TRABAJO: Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013. OBJETIVO: Determinar y analizar la causa raíz de los principales factores de riesgo que afectan la seguridad del paciente que puedan ocasionar eventos adversos en la atención de los pacientes, con el uso de la teoría de restricciones TOC en el Hospital Central de la Policía HOCEN. MATERIALES Y METODO: Se realizó una investigación descriptiva de naturaleza mixta – cuantitativa de tipo correlacional, la población es la totalidad de pacientes atendidos en el hospital de la policía entre enero de 2012 a diciembre de 2013, en el cual se presentaron un total de 189 eventos adversos los cuales sirvieron de objeto a esta investigación, la recolección de datos se realizó por medio de tablas de Excel 2010, posterior a esto se exporto la información al software de IBM SPSS Statistics 19 donde se analiza la información arrojando datos descriptivos y tablas de frecuencia. Finalmente haciendo uso de la Teoría de restricciones TOC se identificó la causa raíz para la ocurrencia de eventos adversos y plantear una intervención estratégica que promueva un sistema efectivo de seguridad del paciente en pro de la búsqueda de la mejora continua. RESULTADOS: Se analizaron 189 eventos adversos, de los cuales 89 fueron reportados en el turno de la noche, seguido por el turno de la mañana con 57, el turno tarde con 27, 28 eventos que no registraron horario, el servicio con mayor ocurrencia es el de medicina interna con 25 eventos, y finalmente la caída de pacientes, lo relacionado con medicamentos, nutriciones y accesos vasculares son los eventos con mayor incidencia. CONCLUSIONES: Se pudo concluir que es necesario que los procesos de seguridad del paciente deben tener un lineamiento directo desde la dirección de la organización permitiendo que las mejoras sean de inmediata aplicación, también es importante generar en el personal una actitud de compromiso frente al proceso de mejora, hay que redefinir las políticas institucionales ya que se concluyó por medio de la teoría de restricciones TOC que el principal factor para la ocurrencia de eventos adversos son las multitareas que el personal tiene que realizar en el proceso de atención.JOB TITLE: Evaluation of the causes of adverse events or incidents affecting patient safety in the central hospital of the police in January 2012 to December 2013. OBJECTIVE: To determine and analyze the root cause of the major risk factors affect patient safety that can cause adverse events in patient care, using the Theory of Constraints TOC at the Central Police Hospital HOCEN. MATERIALS AND METHODS: a descriptive study of mixed nature were made - quantitative correlational, the population is all patients treated at the police hospital from January 2012 to December 2013, in which a total of 189 were filed Adverse events which formed the subject to this research, data collection was performed by means of tables Excel 2010, after this information is exported software IBM SPSS Statistics 19 where information is analyzed throwing tables and descriptive data frequency. Finally using the Theory of Constraints TOC the root cause for the occurrence of adverse events were identified and propose a strategic intervention to promote an effective system of patient safety towards the pursuit of continuous improvement. RESULTS: 189 adverse events, of which 89 were reported on the night shift, followed by the morning shift 57, the late shift with 27, were analyzed 28 events not recording schedule, service with greater occurrence is the internal medicine with 25 events, and finally the fall of patients related to drugs, nourishment and vascular access are the events with the highest incidence. CONCLUSIONS: It is concluded that it is necessary that the processes of patient safety must be a direct guideline from the direction of the organization enabling improvements are immediately applicable, it is also important to build on staff an attitude of commitment to the process improvement, we must redefine the institutional policies as it was concluded by the Theory of Constraints TOC that the main factor for the occurrence of adverse events are multitasking staff has to perform in the care process.Centro de estudios empresariales para la perdurabilida

Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013

TITULO DEL TRABAJO: Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013. OBJETIVO: Determinar y analizar la causa raíz de los principales factores de riesgo que afectan la seguridad del paciente que puedan ocasionar eventos adversos en la atención de los pacientes, con el uso de la teoría de restricciones TOC en el Hospital Central de la Policía HOCEN. MATERIALES Y METODO: Se realizó una investigación descriptiva de naturaleza mixta – cuantitativa de tipo correlacional, la población es la totalidad de pacientes atendidos en el hospital de la policía entre enero de 2012 a diciembre de 2013, en el cual se presentaron un total de 189 eventos adversos los cuales sirvieron de objeto a esta investigación, la recolección de datos se realizó por medio de tablas de Excel 2010, posterior a esto se exporto la información al software de IBM SPSS Statistics 19 donde se analiza la información arrojando datos descriptivos y tablas de frecuencia. Finalmente haciendo uso de la Teoría de restricciones TOC se identificó la causa raíz para la ocurrencia de eventos adversos y plantear una intervención estratégica que promueva un sistema efectivo de seguridad del paciente en pro de la búsqueda de la mejora continua. RESULTADOS: Se analizaron 189 eventos adversos, de los cuales 89 fueron reportados en el turno de la noche, seguido por el turno de la mañana con 57, el turno tarde con 27, 28 eventos que no registraron horario, el servicio con mayor ocurrencia es el de medicina interna con 25 eventos, y finalmente la caída de pacientes, lo relacionado con medicamentos, nutriciones y accesos vasculares son los eventos con mayor incidencia. CONCLUSIONES: Se pudo concluir que es necesario que los procesos de seguridad del paciente deben tener un lineamiento directo desde la dirección de la organización permitiendo que las mejoras sean de inmediata aplicación, también es importante generar en el personal una actitud de compromiso frente al proceso de mejora, hay que redefinir las políticas institucionales ya que se concluyó por medio de la teoría de restricciones TOC que el principal factor para la ocurrencia de eventos adversos son las multitareas que el personal tiene que realizar en el proceso de atención.JOB TITLE: Evaluation of the causes of adverse events or incidents affecting patient safety in the central hospital of the police in January 2012 to December 2013. OBJECTIVE: To determine and analyze the root cause of the major risk factors affect patient safety that can cause adverse events in patient care, using the Theory of Constraints TOC at the Central Police Hospital HOCEN. MATERIALS AND METHODS: a descriptive study of mixed nature were made - quantitative correlational, the population is all patients treated at the police hospital from January 2012 to December 2013, in which a total of 189 were filed Adverse events which formed the subject to this research, data collection was performed by means of tables Excel 2010, after this information is exported software IBM SPSS Statistics 19 where information is analyzed throwing tables and descriptive data frequency. Finally using the Theory of Constraints TOC the root cause for the occurrence of adverse events were identified and propose a strategic intervention to promote an effective system of patient safety towards the pursuit of continuous improvement. RESULTS: 189 adverse events, of which 89 were reported on the night shift, followed by the morning shift 57, the late shift with 27, were analyzed 28 events not recording schedule, service with greater occurrence is the internal medicine with 25 events, and finally the fall of patients related to drugs, nourishment and vascular access are the events with the highest incidence. CONCLUSIONS: It is concluded that it is necessary that the processes of patient safety must be a direct guideline from the direction of the organization enabling improvements are immediately applicable, it is also important to build on staff an attitude of commitment to the process improvement, we must redefine the institutional policies as it was concluded by the Theory of Constraints TOC that the main factor for the occurrence of adverse events are multitasking staff has to perform in the care process.Centro de estudios empresariales para la perdurabilida

Purchase of medications without prescription in Peru: a cross-sectional population-based study [version 1; referees: 2 approved, 1 approved with reservations]

Background: Low availability of medicines in health services, self-medication, inadequate use of medicines, and inadequate dispensing practices in pharmacies are frequent problems in Peru. We aimed to evaluate how frequent the purchase of medications without medical prescription is in Peru, and which factors are associated with this practice. Methods: We conducted a secondary analysis of the 2016 ENSUSALUD national survey data. Purchase of medicines that require a prescription was measured as a dichotomous coded as bought one or more medicines that requires medical prescription or bought medicines that do not require a prescription. Crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using Poisson regressions model with robust variance to assess the association of purchasing of medicines that require prescriptions with sociodemographic factors. Results: There were 3858 participants in the dataset. The prevalence of purchasing medications without prescriptions was 47.2%. History of having previously consumed the same medication (31.6%), and the delay in receiving an appointment at health facilities (26.9%) were the main reasons to buy medications without a prescription. Regarding the recommendation of the medication purchased, the advice of the pharmacy, and remembering a previous old prescription, were the most frequent reasons (38.3%, and 25.9%, respectively). On the multivariable analysis, users that buy medications without prescription were more likely to be of aged 24-45; reside in the Amazon and Highlands regions; and self-consumption of the purchase. Individuals with Seguro Integral de Salud (Comprehensive Health Insurance) were less likely to buy medications without prescription. Conclusions: There is a high prevalence of prescription requiring medication being bought without one from pharmacies in Peru. It is necessary to include the evaluation of consumer patterns to develop strategies with the aim to regulate the consumption of prescription drugs in the Peruvian population

Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks: The GR@ACE project

INTRODUCTION: Large variability among Alzheimer's disease (AD) cases might impact genetic discoveries and complicate dissection of underlying biological pathways. METHODS: Genome Research at Fundacio ACE (GR@ACE) is a genome-wide study of dementia and its clinical endophenotypes, defined based on AD's clinical certainty and vascular burden. We assessed the impact of known AD loci across endophenotypes to generate loci categories. We incorporated gene coexpression data and conducted pathway analysis per category. Finally, to evaluate the effect of heterogeneity in genetic studies, GR@ACE series were meta-analyzed with additional genome-wide association study data sets. RESULTS: We classified known AD loci into three categories, which might reflect the disease clinical heterogeneity. Vascular processes were only detected as a causal mechanism in probable AD. The meta-analysis strategy revealed the ANKRD31-rs4704171 and NDUFAF6-rs10098778 and confirmed SCIMP-rs7225151 and CD33-rs3865444. DISCUSSION: The regulation of vasculature is a prominent causal component of probable AD. GR@ACE meta-analysis revealed novel AD genetic signals, strongly driven by the presence of clinical heterogeneity in the AD series

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

A bibliometric analysis of the global research on biosimilars

Abstract Background Biosimilars could be a promising option to help decrease healthcare costs and expand access to treatment. There is no previous evidence of a global bibliometric analysis on biosimilars. Therefore, we aimed to assess the quantity and quality of worldwide biosimilars research. Methods We performed a bibliometric analysis using documents about biosimilars published until December 2016 in journals indexed in Scopus. We extracted the annual research, languages, countries, journals, authors, institutions, citation frequency, and the metrics of journals. The data were quantitatively and qualitatively analyzed using Microsoft Excel 2013. Additional information about authors' participation was obtained using the R-package Bibliometrix. Publication activity was adjusted for the countries by population size. Also, author co-citation analysis and a term co-occurrence analysis with the terms included in the title and abstract of publications was presented as network visualization maps using VOSviewer. Results A total of 2330 biosimilar-related documents identified in the Scopus database, most of them were articles (1452; 62.32%). The number of documents published had an exponential increased between 2004 and 2016 (p < 0.001). The United States was the country with the highest production with 685 (29.40%) documents followed by Germany and UK with 293 (12.58%) and 248 (10.64%), respectively. Switzerland (11.05), Netherlands (5.85) and UK (3.83) showed the highest per capita ratio. The highest citation/article ratio were for the Netherlands (28.06), Spain (24.23), and France (20.11). Gabi Journal published 73 (3.13%) documents; both Biopharm International and Pharmaceutical Technology and Mabs, 41 (1.76%). Three out of top ten journals were Trade publications. Amgen Incorporated from the USA was the most prolific institution with 51 documents followed by Pfizer Inc. with 48. Terms about specific diseases and drugs were found in recent years, compared with terms such as legislation, structure, protein, dose and generic in the early years. Conclusions Research production and publication of documents on biosimilars are increasing. The majority of publications came from high-income countries. The trends in terminology use are according to state of the art in the topic, and reflects the interest in the utilization of biosimilars in diseases who are expected to obtain benefits of its use

Assessment and management of asymptomatic COVID-19 infection: A systematic review

BACKGROUND COVID-19 can be asymptomatic in a substantial proportion of patients. The assessment and management of these patients constitute a key element to stop dissemination. AIM To describe the assessment and treatment of asymptomatic infection in patients with a confirmed diagnosis of COVID-19. METHODS We searched five databases and search engines for preprints/preproofs, up to August 22, 2020. We included cohort, cross-sectional, and case series studies, reporting the assessment and management of asymptomatic individuals. We extracted data on total discharges with negative PCR, length of hospitalization, treatment, and number of patients who remained asymptomatic. A random-effects model with inverse variance method was used to calculate the pooled prevalence. RESULTS 41 studies (nine cross-sectional studies, five retrospective studies and 27 reports/case series; 647 asymptomatic individuals), were included, of which 47% were male (233/501). The age of patients was between 1month and 73 years. In patients who became symptomatic, length of hospitalization mean was 13.6 days (SD 6.4). Studies used lopinavir/ritonavir, hydroxychloroquine plus ritonavir/lopinavir, hydroxychloroquine with and without azithromycin, ribavirin plus interferon and interferon alfa. The proportion of individuals who remained asymptomatic was 91% (463/588 patients; 95%CI: 78.3%-98.7%); and asymptomatic individuals discharged with negative PCR was 86% (102/124 individuals; 95%CI: 58.4%-100%). CONCLUSIONS There is no standard treatment for asymptomatic COVID-19 individuals. There are no studies of adequate design to make this decision. It has been shown that most asymptomatic individuals who were followed have recovered, but this cannot be attributed to standard treatment

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease