Nivel de satisfacción de los pacientes egresados de un servicio de Clínica Médica del Paraguay

Introduction: the level of satisfaction in health services is a complex concept that is related to many factors, such as the patient's previous experiences, his lifestyle, expectations regarding treatment and the values of the subject and of society per se. Objectives: to determine the level of satisfaction that patients present upon discharge from the Medical Clinic service of the National Hospital (Itauguá, Paraguay) in 2020. Methods: we perform an observational, descriptive, correlational study. Sample: patients discharged from the Medical Clinic service of the National Hospital in 2020. We included those who could communicate in writing. Those who did not give their informed consent were excluded. Satisfaction was determined with the SERVQUAL questionnaire. Demographic and clinical variables were also measured, as well as functionality with the Barthel scale. The study was approved by the Ethics Committee of the National University of Itapúa (Paraguay). Results: 312 patients entered the study, with a mean age of 47 ± 18 years, being 54% male. The average length of stay was 21 ± 22 days. We found 58% of satisfaction. The Barthel scale showed 49% of some type of dependency. No statistically significant risk factors associated with dissatisfaction were found. Conclusion: the level of satisfaction was high. It is recommended to continue applying quality assessment tools in health care in a systematic and continuous way.Introducción: el nivel de satisfacción en servicios de salud es un concepto complejo que está en relación con muchos factores, como las experiencias previas del paciente, el estilo de vida del mismo, las expectativas respecto al tratamiento y los valores del sujeto y de la sociedad en sí. Objetivos: determinar el nivel de satisfacción que presentan al alta los pacientes del servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) en 2020. Métodos: estudio observacional, descriptivo, correlacional. Muestra: pacientes egresados del servicio de Clínica Médica del Hospital Nacional en 2020. Se incluyeron a aquellos que podían comunicarse por escrito. Se excluyeron a los que no daban su consentimiento informado. La satisfacción se determinó con el cuestionario SERVQUAL. Se midieron también variables demográficas y clínicas, así como la funcionalidad con la escala de Barthel. El estudio fue aprobado del Comité de Ética de la Universidad Nacional de Itapúa (Paraguay). Resultados: ingresaron al estudio 312 pacientes, con edad media 47 ± 18 años, siendo 54% del sexo masculino. El tiempo promedio de internación fue 21 ± 22 días. Se halló 58% de satisfacción. La escala de Barthel arrojó 49% de algún tipo de dependencia. No se encontraron factores de riesgo estadísticamente significativos asociados a la insatisfacción. Conclusión: el nivel de satisfacción fue elevado. Se recomienda continuar aplicando herramientas de evaluación de calidad en la atención de la salud de forma sistemática y continuada

Clinical utility of computed tomography Hounsfield characterization for percutaneous nephrolithotomy: A cross-sectional study

Background Computed Tomography (CT) is considered the gold-standard for the pre-operative evaluation of urolithiasis. However, no Hounsfield (HU) variable capable of differentiating stone types has been clearly identified. The aim of this study is to assess the predictive value of HU parameters on CT for determining stone composition and outcomes in percutaneous nephrolithotomy (PCNL). Methods Seventy seven consecutive cases of PCNL between 2011 and 2016 were divided into 4 groups: 40 (52%) calcium, 26 (34%) uric acid, 5 (6%) struvite and 6 (8%) cystine stones. All images were reviewed by a single urologist using abdomen/bone windows to evaluate: stone volume, core (HUC), periphery HU and their absolute difference. HU density (HUD) was defined as the ratio between mean HU and the stone\u2019s largest diameter. ROC curves assessed the predictive power of HU for determining stone composition/stone-free rate (SFR). Results No differences were found based on the viewing window (abdomen vs bone). Struvite stones had values halfway between hyperdense (calcium) and low-density (cystine/uric acid) calculi for all parameters except HUD, which was the lowest. All HU variables for medium-high density stones were greater than low-density stones (p\u2009<\u20090.001). HUC differentiated the two groups (cut-off 825 HU; specificity 90.6%, sensitivity 88.9%). HUD distinguished calcium from struvite (mean\u2009\ub1\u2009SD 51\u2009\ub1\u200916 and 28\u2009\ub1\u200912 respectively; p\u2009=\u20090.02) with high sensitivity (82.5%) and specificity (80%) at a cut-off of 35 HU/mm. Multivariate analysis revealed HUD\u2009 65\u200938.5 HU/mm to be an independent predictor of SFR (OR\u2009=\u20093.1, p\u2009=\u20090.03). No relationship was found between HU values and complication rate. Conclusions HU parameters help predict stone composition to select patients for oral chemolysis. HUD is an independent predictor of residual fragments after PCNL and may be fundamental to categorize it, driving the imaging choice at follow-up

Computer simulation of diffusion processes in tilt spatio-periodic potentials

Нещодавно було показано, що в істотно нерівноважних системах коефіцієнт дифузії може вести себе немонотонно з температурою. Одним із прикладів таких систем з аномальною температурної залежністю є рух броунівських часток в просторово-періодичних структурах. Метою статті було дослідження зміни температурної залежності дифузії в недодемпфованих системах з низьким коефіцієнтом тертя. В роботі методами комп'ютерного моделювання вивчено зміна коефіцієнта дифузії частинок в широкому діапазоні температур в нахилених просторово-періодичних потенціалах для різних значень коефіцієнта тертя. Показано, що дифузія досягає максимуму при певній величині зовнішньої сили. Її значення залежить від величини коефіцієнта тертя. Показано, що на відміну від звичайної залежності Аррениуса, в разі нахиленого періодичного потенціалу, максимальний коефіцієнт дифузії зростає, а не зменшується з пониженням температури експоненціальним чином. Встановлено, що така залежність характерна для всіх недодемпфованих систем. Показано, що для просторово-періодичних структур існує обмежена ділянка сил, в якому спостерігається зростання коефіцієнта дифузії зі зменшенням температури. Це область так званої температурно-аномальної дифузії (ТАД). Визначено ширина і положення області ТАД в залежності від коефіцієнта тертя γ і параметрів системи. Показано, що зі зменшенням γ, ширина області ТАД зменшується пропорційно γ. При цьому коефіцієнт дифузії в області ТАД, навпаки зростає ~γ. Отримані дані про температурно-аномальної дифузії мають важливе значення для різних областей фізики і техніки та відкривають перспективи створення новітніх технологій управління процесами дифузії.It was recently shown that in essentially nonequilibrium systems, the diffusion coefficient can behave nonmonotonically with temperature. One example of such systems with anomalous temperature dependence is the motion of Brownian particles in spatially periodic structures. The aim of the article was to study the change in the temperature dependence of diffusion in underdamped systems with a low coefficient of friction. In this paper, computer simulation methods are used to study the change in the diffusion coefficient of particles in a wide range of temperatures in oblique spatially periodic potentials for different values of the friction coefficient. It is shown that diffusion reaches a maximum at a certain external force. Its value depends on the coefficient of friction. It is shown that, in contrast to the usual Arrhenius dependence, in the case of an inclined periodic potential, the maximum diffusion coefficient increases while temperature is decreasing exponentially. It is established that such a dependence is common to all underdamped systems. It is shown that for spatially periodic structures there is a limited portion of forces in which an increase in the diffusion coefficient while decreasing temperature is observed. This is the area of the so-called temperature-anomalous diffusion (TAD). The width and position of the TAD region are determined depending on the friction coefficient γ and the system parameters. It has been shown that a decrease in γ, width TAD region decreases proportionally γ. In this case, the diffusion coefficient in the TAD region, on the contrary, increases ~γ. The data obtained on the temperature and the anomalous diffusion are important for various fields of physics and engineering, and opens new prospects for a diffusion process control technology

Considerations for reducing food system energy demand while scaling up urban agriculture

There is an increasing global interest in scaling up urban agriculture (UA) in its various forms, from private gardens to sophisticated commercial operations. Much of this interest is in the spirit of environmental protection, with reduced waste and transportation energy highlighted as some of the proposed benefits of UA; however, explicit consideration of energy and resource requirements needs to be made in order to realize these anticipated environmental benefits. A literature review is undertaken here to provide new insight into the energy implications of scaling up UA in cities in high-income countries, considering UA classification, direct/indirect energy pressures, and interactions with other components of the food–energy–water nexus. This is followed by an exploration of ways in which these cities can plan for the exploitation of waste flows for resource-efficient UA. Given that it is estimated that the food system contributes nearly 15% of total US energy demand, optimization of resource use in food production, distribution, consumption, and waste systems may have a significant energy impact. There are limited data available that quantify resource demand implications directly associated with UA systems, highlighting that the literature is not yet sufficiently robust to make universal claims on benefits. This letter explores energy demand from conventional resource inputs, various production systems, water/energy trade-offs, alternative irrigation, packaging materials, and transportation/supply chains to shed light on UA-focused research needs. By analyzing data and cases from the existing literature, we propose that gains in energy efficiency could be realized through the co-location of UA operations with waste streams (e.g. heat, CO2, greywater, wastewater, compost), potentially increasing yields and offsetting life cycle energy demands relative to conventional approaches. This begs a number of energy-focused UA research questions that explore the opportunities for integrating the variety of UA structures and technologies, so that they are better able to exploit these urban waste flows and achieve whole-system reductions in energy demand. Any planning approach to implement these must, as always, assess how context will influence the viability and value added from the promotion of UA

Frecuencia de prolongación del intervalo QTc en adultos infectados con VIH de Paraguay en 2020

Introduction: the prolonged QTc interval predisposes to serious arrhythmias. Various medications, including antiretrovirals, can prolong it. The objectives were to determine the demographic, clinical characteristics and the frequency of the prolonged QTc interval in patients with HIV. Methods: we conducted a prospective, observational study with a control group. Men and women, over 18 years of age, with HIV infection, who attended the National Hospital (Itauguá, Paraguay) during 2020, were included. Medical students acted as a control group. All subjects who did not give their consent and those with arrhythmias were excluded. Demographic, clinical, laboratory variables and 12-channel electrocardiogram at rest were measured. The study was approved by the Ethics Committee of the Universidad Privada del Este (Paraguay). Results: 39 HIV patients and 39 healthy controls entered the study. The mean age of the cases was 37 ± 11 years, being 59% male. The most frequent comorbidity in the cases was obesity (7.6%). The mean values ​​of urea, creatinine, K, Ca and Mg in the cases were in the normal range. Prolonged QTc was detected in 18% of the cases and in 0% of the controls. The subjects with the electrocardiographic alteration were all on antiretroviral and multiple antibiotic treatment known to be associated with prolonged Qtc. Conclusion: the frequency of prolonged QTc in HIV patients was 18% and in healthy controls it was 0%. Regular monitoring of the electrocardiogram is recommended in HIV patients receiving drugs that prolong the QT interval.Introducción: el intervalo QTc prolongado predispone a arritmias graves. Diversos medicamentos, entre ellos los antirretrovirales, pueden prolongarlo. Los objetivos fueron determinar las características demográficas, clínicas y la frecuencia del intervalo QTc prolongado en pacientes con VIH. Métodos: estudio observacional, prospectivo, con grupo control. Se incluyeron varones y mujeres, mayores de 18 años, portadores de infección por VIH, que acudieron al Hospital Nacional (Itauguá, Paraguay) durante 2020. Actuaron como grupo control los estudiantes de Medicina. Se excluyeron todos los sujetos que no dieron su consentimiento y los portadores de arritmias. Se midieron variables demográficas, clínicas, laboratoriales y electrocardiograma de 12 canales en reposo. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este (Paraguay). Resultados: ingresaron al estudio 39 pacientes con VIH y 39 controles sanos. La edad media de los casos fue 37 ± 11 años, siendo 59% del sexo masculino. La comorbilidad más frecuente en los casos fue la obesidad (7,6%). Los valores medios de urea, creatinina, K, Ca y Mg en los casos se hallaban en rango normal. Se detectó 18% de QTc prolongado en casos y 0% en los controles. Estos sujetos con alteración electrocardiográfica se hallaban todos en tratamiento antirretroviral y antibiótico múltiple de conocida asociación con QTc prolongado. Conclusión: la frecuencia de QTc prolongado en pacientes con VIH fue del 18% y en controles sanos fue del 0%. Se recomienda el control periódico del electrocardiograma en pacientes con VIH en tratamiento con fármacos que prolongan el intervalo QT

Gestão por competências em organizações de governo

Ao longo dos últimos anos vem se ampliando os espaços e o interesse, no meio acadêmico e empresarial, pelas discussões sobre uso da abordagem da competência como marco importante para as atividades de gestão de recursos humanos. A difusão dessa abordagem entre as organizações públicas brasileiras é, entretanto, bem mais recente, e conta, ainda hoje, com um número insuficiente de estudos e publicações. É esta a razão da importância e pertinência da publicação do livro " Gestão por competências em organizações de governo"Número de páginas: 100 p.Gestão de PessoasISBN 85-256-0046-