Recurso humano de enfermería según grado de dependencia de los pacientes

Quality of care in hospitals mainly depends on an effective use of resources, especially the staff. In the case of nursing, it is important to establish the nurse-patient ratio in order to optimise the quality of care. Thus, nursing staff must be aware of the conditions of the patients in their care, in order to determine both how many members of staff are required and the preparation needed. A quantitative, descriptive and cross-sectional study was carried out. The sample consisted of 98 patients, selected through non-probabilistic sampling for convenience. The information was collected over a period of two months using 'Test Delta' which determined the degree of dependence. The statistical package SPSS V20.00 was used for the analysis. The study identified four levels of dependence: no assistance required (22.4%), minor assistance required (28.6%), moderate assistance required (22.4%) and substantial assistance required (26.5%). Once categorised, the nursing staff demand was calculated. It was estimated that thirteen nursing professionals are required to satisfy the demand for care. The data reported shows that the majority of staff should be assigned to patients in the 'substantial assistance required' category. These results lead to the conclusion that it is important to develop methodologies to efficiently determine and assign nursing staff, taking into account the level of dependency as this is closely linked with the best outcome in patients. La calidad de la atención dentro de las organizaciones hospitalarias depende principalmente de la buena utilización de los recursos, especialmente el recurso humano; para enfermería resulta importante determinar la razón enfermera – paciente, con el fin de optimizar la calidad del cuidado, por ello, el profesional debe conocer las condiciones de los pacientes a su cargo, de tal manera que pueda definir cuanto personal requiere y su preparación. Se utilizó un estudio cuantitativo, descriptivo y transversal. La muestra fue de 98 pacientes, seleccionados a través del muestreo no probabilístico por conveniencia, la información se recolectó durante dos meses, mediante el instrumento “Test Delta” que determinó el grado de dependencia. Para el análisis se utilizó el paquete estadístico SPSS V20.00. Se identificaron cuatro categorías de dependencia: 22,4% válidos, 28,6% asistido leve, 22,4% asistido moderado y 26,5% asistido severo. Una vez categorizados, se calculó el recurso humano de enfermería, se estimó una dotación de trece profesionales para satisfacer las demandas de cuidado, los datos reportados muestran que la mayor parte del personal debe ser asignado a los pacientes en la categoría asistidos severos. Esto permite concluir que es importante desarrollar metodologías para determinar y asignar de forma eficiente, el recurso humano de enfermería, teniendo en cuenta el grado de dependencia, dado que está relacionado con mejores resultados en los pacientes

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

A review of the knowledge base for the development of natural ingredients value chains for a sustainable biobased economy in Colombia

Abstract Natural ingredients (NIs) from plant biodiversity represent a value creation strategy in the transition to a sustainable biobased economy, especially in biodiversity rich countries. A necessary action to achieve this purpose is to orientate research and strengthen the knowledge base of NIs following a value chain (VC) approach. Although the promotion of NIVCs has gained increasing attention in the bioeconomy, a description of the scientific progress, research advances and gaps towards their development is necessary. This review aimed to scrutinize the existing literature on NIVCs to determine its state of progress. Firstly, we explored the global diffusion of research on natural plant ingredients. Secondly, we examined the research landscape in Colombia, focusing on the cooperation between countries, economic sectors impacted, and plant species reported. Lastly, we selected the most reported plant species as a promising NI source in Colombia to assess the literature that constitute the knowledge base of this plant in relation to the VC building blocks: biomass production, biomass processing, product development, and transversal aspects such as sustainability and governance. We show that research on NIs has risen worldwide, with notable scientific output from China, India, and the United States. In Colombia, the interest in NIs from plant biodiversity has also gained importance in the research agenda. Its progress is based on extensive collaboration between institutions, mainly from Spain, the United States, and Brazil. Its research prospects include diverse applications in the pharmaceutical and food sectors. We identify Lippia origanoides as the most reported native plant in scientific literature in Colombia. Using this plant as case study, we provide an overview of the knowledge base of L. origanoides in relation to the VC. Our results indicate that most publications focus on product development, suggesting a lack of comprehensive coverage of the VC and potentially neglected aspects. Based on this, we describe the current and desired scenario of L. origanoides VCs, as well as needs and opportunities for their sustainable implementation in Colombia. This contributes to build research and development roadmaps of sustainable NIVCs from plant diversity supported by multi-stakeholder collaboration

Efecto de la temperatura y el pH en la producción de biomasa de Azospirillum brasilense C16 aislada de pasto guinea

El objetivo del estudio fue evaluar el efecto de la temperatura y el pH en la viabilidad celular de la cepa Azospirillum brasilense C16. Se estudiaron cinco temperaturas (entre 28 y 36°C) y cinco pH (de 4,5 a 8,5). El efecto de la temperatura se evaluó mediante la medición del crecimiento radial (mm) de la cepa, sobre un papel de filtro en medio batata. En el caso del pH se utilizó un fermentador de tanque agitado -con una configuración tipo Rushton- para cuantificar la velocidad de crecimiento, la producción de biomasa y el tiempo de duplicación de la cepa; las condiciones de fermentación fueron: 400 rpm, 1 Lpm y 30°C, durante 24 horas. El pH y la temperatura influyeron significativamente (p < 0,05) en la producción de A. brasilense C16. La temperatura de 30°C fue la más favorable para que se multiplicara la cepa, con 23,21 mm de crecimiento radial; mientras que la mayor o igual a 34°C inhibió su crecimiento. Los mejores resultados se obtuvieron con un pH de 6,8, con diferencias significativas (p < 0,05) respecto al resto. Con esta condición se obtuvieron los valores más altos de velocidad de crecimiento (1,79 h-1) y producción de biomasa (8,65 log10 UFC mL-1), y el valor más bajo del tiempo de duplicación (1,09 h-1). Estos resultados poseen aplicabilidad biotecnológica, y son de gran importancia en el momento de definir y controlar las condiciones de producción masiva de biomasa de A. brasilense C16 para futuras formulaciones como biofertilizante en diversos cultivos de interés en Colombia

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit