Control de calidad del seguimiento del embarazo normal en atención primaria

ObjetivosGeneral: aumentar la calidad de la atención maternoinfantil en nuestra población.Específicomejorar al menos un 10% el registro de las actividades con peor cumplimiento en la primera evaluación del ciclo de calidad.DiseñoCiclo de calidad del programa de seguimiento de embarazo normal en atención primaria (AP).Dimensión de calidad estudiadacientífico-técnica. Evaluación retrospectiva, cruzada, por iniciativa interna y sobre las historias clínicas de las gestantes. Marco temporal: primera evaluación sobre gestaciones de 1994-1995; aplicación de medidas correctoras durante 1996; segunda evaluación sobre gestaciones de 1997-1998.ÁmbitoAtención primaria.SujetosTodas las gestaciones seguidas en nuestro equipo de AP durante los períodos descritos.Mediciones y resultados principalesCriterios evaluados: actividades asistenciales del programa de seguimiento del embarazo normal del Área 10.Primera evaluación (n = 54)incumplimiento global del 11,5%; los criterios con cumplimiento inferior al 80% fueron suplemento con ácido fólico, consejos a la gestante, detección de diabetes gestacional y visita al mes posparto Segunda evaluación (n = 69) incumplimiento global del 6,3%; todas las actividades superaron el 80% excepto la exploración obstétrica en la primera visita, la visita a la semana posparto y la visita al mes posparto.ConclusionesTras la introducción de unas medidas correctoras sencillas, logramos una mejoría global superior al 40% y un aumento en el cumplimiento de la mayor parte de las actividades, excepto en las visitas posparto y la exploración obstétrica en la primera visita. Creemos que es necesario mantener un ciclo continuo de mejora de calidad para conseguir una adecuada asistencia maternoinfantil.ObjectivesGeneral: to increase the quality of mother-baby care in our population. Specific: to improve by at least 10% the record of activities with poorest compliance at the first evaluation on the quality cycle.DesignQuality cycle of the normal pregnancy monitoring programme in primary care (PC). The scientific-technical dimension of quality was the one studied. There was a retrospective, crossed evaluation, on internal initiative, about the clinical records of the pregnant women. Sequence: first evaluation of pregnancies in 1994-95; application of corrective measures in 1996; second evaluation of pregnancies in 1997-98.SettingPrimary care.PatientsAll the pregnancies monitored by our PC team during the periods described.Measurements and main resultsCriteria evaluated: care activities of the programme for monitoring normal pregnancies in Area 10. First evaluation (n = 54): 11.5% overall non-compliance. The criteria with under 80% compliance were: folic acid supplement, counselling, diagnosis of pregnancy diabetes and attendance in the month after delivery. Second evaluation (n = 69): 6.3% overall non-compliance. All activities surpassed 80% compliance except obstetric examination on the first visit, attendance a week after delivery and attendance a month after delivery.ConclusionsAfter introducing certain simple corrective measures, we achieved overall improvement of over 40% and increased compliance in most activities, except for attendance after delivery and obstetric examination on the first visit. We think a continuous cycle of quality improvement needs to be maintained in order to achieve adequate mother-baby care

Cystatin A, a Potential Common Link for Mutant Myocilin Causative Glaucoma

Myocilin (MYOC) is a 504 aa secreted glycoprotein induced by stress factors in the trabecular meshwork tissue of the eye, where it was discovered. Mutations in MYOC are linked to glaucoma. The glaucoma phenotype of each of the different MYOC mutation varies, but all of them cause elevated intraocular pressure (IOP). In cells, forty percent of wild-type MYOC is cleaved by calpain II, a cysteine protease. This proteolytic process is inhibited by MYOC mutants. In this study, we investigated the molecular mechanisms by which MYOC mutants cause glaucoma. We constructed adenoviral vectors with variants Q368X, R342K, D380N, K423E, and overexpressed them in human trabecular meshwork cells. We analyzed expression profiles with Affymetrix U133Plus2 GeneChips using wild-type and null viruses as controls. Analysis of trabecular meshwork relevant mechanisms showed that the unfolded protein response (UPR) was the most affected. Search for individual candidate genes revealed that genes that have been historically connected to trabecular meshwork physiology and pathology were altered by the MYOC mutants. Some of those had known MYOC associations (MMP1, PDIA4, CALR, SFPR1) while others did not (EDN1, MGP, IGF1, TAC1). Some, were top-changed in only one mutant (LOXL1, CYP1B1, FBN1), others followed a mutant group pattern. Some of the genes were new (RAB39B, STC1, CXCL12, CSTA). In particular, one selected gene, the cysteine protease inhibitor cystatin A (CSTA), was commonly induced by all mutants and not by the wild-type. Subsequent functional analysis of the selected gene showed that CSTA was able to reduce wild-type MYOC cleavage in primary trabecular meshwork cells while an inactive mutated CSTA was not. These findings provide a new molecular understanding of the mechanisms of MYOC-causative glaucoma and reveal CSTA, a serum biomarker for cancer, as a potential biomarker and drug for the treatment of MYOC-induced glaucoma

Regional development gaps in Argentina: A multidimensional approach to identify the location of policy priorities

Spatial inequalities within Latin American countries have historically attracted the interest ofacademics, policy-makers, and international agencies. This article aims to provide amultidimensional diagnosis of provincial development gaps in Argentina, in order to identifythe location of policy priorities. Therefore, we built a large database, which covers sevendevelopment dimensions, and applied multivariate analysis techniques to overcome someanalytical limitations of previous studies. Results show the stability of provincial developmentgaps between 2003 and 2013 and some heterogeneity within geographic regions. Instead,cluster analysis offers a better classification of Argentine provinces according to theirdevelopment gaps, which can help the government to prioritize the places wheredevelopment policies are strategic.Fil: Niembro, Andrés Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; ArgentinaFil: Sarmiento, Jesica Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; Argentin

Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study

Objectives To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital.Design and setting Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain.Participants All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020.Results A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0–81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51–71); 74.1% men; median length of stay 9 days (IQR 5–19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6–14).Conclusions This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity