Satisfacción de los usuarios frente a la calidad de la atención prestada en el programa de odontología integral del adolescente y ortodoncia, 2001

ABSTRACT: Over the last few years the topic of quality of care in health services in Colombia has raised enormous interest through laws established by the Mandatory System of Warranty in Quality, and particularly within our college by the adoption of the teaching-service model which looks for a comprehensive training of its students. This is about looking at quality not only from the merely technical and scientific point of view, but also integrating other aspects such as personal relationships. A study was done with the purpose of determining the quality of care under this dimension, in which the degree of satisfaction after a service was provided, was measured identifying the critical factors of this service. It was found that the 320 people who used the orthodontic service are a homogeneous population with a degree of satisfaction based upon multifactorial reasons depending on the patient-orthodontist-institution relationship. Also, it was found that the geographical location of the college was important, but, the functional accessibility was difficult due to long waiting periods of time to get an appointment, lack of administrative control, and deficiencies in information given to the public; it is equally important to identify and control the factors that made the treatments longer than necessary. These results will allow us to improve the quality of care, the service to the public, and the formative process of our graduated professionals.RESUMEN: En los últimos años, en los ámbitos nacional e internacional, se ha despertado gran interés por el tema de la calidad en la atención a los pacientes en el sector de la salud. En Colombia, mediante decretos reglamentarios, se estableció el Sistema Obligatorio de Garantía de la Calidad en el Sistema General de Seguridad Social en Salud y, en particular, en la Facultad de Odontología que adoptó el modelo educativo docencia-servicio buscando la formación integral de sus egresados. Se trata de superar el concepto de calidad que se mira solamente desde el punto de vista técnico-científico integrando, entre otras, las relaciones interpersonales. Con el propósito de determinar la calidad del servicio desde las relaciones interpersonales, se realizó un estudio que indagó el grado de satisfacción del usuario frente a la calidad de la atención prestada, identificando los factores críticos del servicio. Se encontró que los 320 usuarios del posgrado de ortodoncia son una población homogénea, con un grado de satisfacción que depende de la relación usuario- ortodoncista-institución; que la Facultad tiene excelente accesibilidad geográfica y cultural, pero deficiente accesibilidad funcional, ya que se presentan, entre otras, dificultades para el ingreso al programa, el largo tiempo de espera, algunas falencias administrativas y deficiencias en la información suministrada; igualmente, que se deben intervenir los factores que alargan los tiempos de duración de los tratamientos. Los resultados de la investigación permitirán mejorar la calidad del servicio, la atención del usuario y el proceso formativo de sus egresados

Comparative study of the clinical effect produced by the first class® and the pendulum in patients trated at the college of dentistry, University of Antioquia. A radiographic and model analysis

ABSTRACT: The purpose of this research was to establish and compare the clinical and radiographic results obtained during the four month use of the pendulum and the First class® in relation with its craneofacial, dental, and soft tissue effects in patients who had indicated as part of their treatment plan, a distalization of their first upper molars. The sample consisted of 27 subjects between 12 and 17 years of age: 11 treated with pendulum, 8 treated with First class®, and 8 controls to discard any changes due to growth. All patients received inicial Panoramic X-rays, inicial and final lateral cephalograms; 1:1 standardized pictures of study casts at the beginning, second and fourth months of treatment. The radiographic results showed there were no significant changes in the skeletal structures. At the dento-alveolar level an average molar distalization of 4.68 ± 4.9 mm was observed with the pendulum and of 2.05 ± 4.06 mm with the First class® both of which were accompanied by distal inclination (12.2º pendulum, 3.2º First class®) and intrusion (0.55 and 0.037 mm respectively) with an assymetric right – left behavior. For each millimeter of molar distalization there was an increment in incisal labialization of 0.9º with the pendulum and 3.0º with the First class® accompanied by a decrease in the nasolabial angle (-5.45º with the pendulum and -6.0º with First class®) and an upper lip protrusion (1.59 and 1.07 mm respectively). The dental casts showed a rotational change in the molar with a heterogenous behavior; with both pendulum and First class®, rotations in opposite directions were observed: distopalatal (+) y distolabial (-). The total average was positive in both, being greater for the First class® (5.87°) than for the pendulum (4.3°), conserving a right-left asymmetric pattern. The effectiveness of the anchorage offered by the palatal acrylic button should be questioned, since there was evidence of anterior displacement of this structure with a negative labialization effect on the anchorage teeth.RESUMEN: El propósito de este estudio fue establecer y comparar los resultados clínicos y radiográficos obtenidos con el del péndulo y del First class® durante cuatro meses de tratamiento, en relación con sus efectos craneofaciales, dentales y de tejidos blandos en pacientes que tuvieran indicado dentro de su plan de tratamiento la distalización de los primeros molares superiores. La muestra estuvo constituida por 27 sujetos entre los 12 y 17 años de edad: 19 experimentales (11 tratados con péndulo y 8 con First class®) y 8 controles, con los cuales se descartaron cambios debidos al crecimiento. Se obtuvieron radiografías panorámicas iniciales y cefálicas laterales iniciales y finales; fotografías estandarizadas 1:1 de modelos de estudio: al inicio, segundo y cuarto mes de tratamiento. Los resultados radiográficos muestran que no se presentan cambios significativos en las estructuras esqueléticas. A nivel dentoalveolar se observa distalización molar promedio con el péndulo de 4,68 ± 4,9 mm y con el First class® de 2,05 ± 4,06 mm acompañadas ambas de inclinación distal (12,2º con péndulo, 3,2º con First class®) e intrusión (0,55 y 0,037 mm respectivamente) con comportamiento asimétrico derecha-izquierda. Por cada milímetro de distalización molar se presentó un incremento en la labialización del incisivo de 0,9º con el péndulo y de 3,0º con el First class® que se acompaña de disminución del ángulo naso-labial (-5,45º con péndulo y -6,0º con First class®) y protrusión del labio superior (1,59 y 1,07 mm respectivamente). En los modelos se observó un cambio rotacional del molar con un comportamiento heterogéneo; tanto con péndulo como con First class®, se observan rotaciones en sentidos opuestos: distopalatinas (+) y distovestibulares (-) El promedio total fue positivo en ambos siendo mayor para el First class® (5,87°) que para el péndulo (4,3°), conservando un patrón asimétrico derecha-izquierda. Debe cuestionarse la efectividad del anclaje ofrecido por el botón de acrílico palatino, ya que se evidencia un desplazamiento anterior de esta estructura con efecto negativo vestibularizador sobre los dientes de anclaj

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)