La opinión de los usuarios como oportunidad de mejora en atención primaria

ObjetivosDeterminar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes.DiseñoEvaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones.EmplazamientoCAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud.Participantes y contextoUsuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord.IntervencionesReorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas.Mediciones principalesVariables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa.ResultadosEntre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente.ConclusionesLa opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población.ObjectivesTo determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions.DesignResults evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed.LocationRambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute.Participants and contextUsers/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service.InterventionsReorganization of the family doctors’ agendas and reduction of bureaucratic tasks in the physicians’ offices.Principal measurementsRespondents sociodemographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment.ResultsAmong reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits.ConclusionsPatient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs

Analysis of the Ush2a Gene in Medaka Fish (Oryzias latipes)

Patients suffering from Usher syndrome (USH) exhibit sensorineural hearing loss, retinitis pigmentosa (RP) and, in some cases, vestibular dysfunction. USH is the most common genetic disorder affecting hearing and vision and is included in a group of hereditary pathologies associated with defects in ciliary function known as ciliopathies. This syndrome is clinically classified into three types: USH1, USH2 and USH3. USH2 accounts for well over one-half of all Usher cases and mutations in the USH2A gene are responsible for the majority of USH2 cases, but also for atypical Usher syndrome and recessive non-syndromic RP. Because medaka fish (Oryzias latypes) is an attractive model organism for genetic-based studies in biomedical research, we investigated the expression and function of the USH2A ortholog in this teleost species. Ol-Ush2a encodes a protein of 5.445 aa codons, containing the same motif arrangement as the human USH2A. Ol-Ush2a is expressed during early stages of medaka fish development and persists into adulthood. Temporal Ol-Ush2a expression analysis using whole mount in situ hybridization (WMISH) on embryos at different embryonic stages showed restricted expression to otoliths and retina, suggesting that Ol-Ush2a might play a conserved role in the development and/or maintenance of retinal photoreceptors and cochlear hair cells. Knockdown of Ol-Ush2a in medaka fish caused embryonic developmental defects (small eyes and heads, otolith malformations and shortened bodies with curved tails) resulting in late embryo lethality. These embryonic defects, observed in our study and in other ciliary disorders, are associated with defective cell movement specifically implicated in left-right (LR) axis determination and planar cell polarity (PCP)

Low folate status enhances pregnancy changes in plasma betaine and dimethylglycine concentrations and the association between betaine and homocysteine

10.3945/ajcn.112.05418