53 research outputs found
La opinión militar española ante el sistema político : (1874-1898)
Tesis Universidad Complutense de Madrid, 1983.Fac. de Ciencias Políticas y SociologíaTRUEProQuestpu
La opinión militar española ante el sistema político : (1874-1898)
Tesis Universidad Complutense de Madrid, 1983.Fac. de Ciencias Políticas y SociologíaTRUEProQuestpu
Prestige y 11-M : la vertebración política de la gestión de catástrofes
Between 2002 and 2004 Spain was jolted by two
big crisis scenarios with a very different nature but two common
characteristics. On one hand, they required an immediate response
of some magnitude and complex management. On the other, they both caused a very deep impact on Spanish society and politics.
Such two characteristics made them especially interesting in order to
analyzed multiple aspects related to decisionmaking
and “first
response” management as a reaction against catastrophes. We can
also withdraw several lessons about which factors and criteria are
employed by critical actors to evaluate crisis management and “first
response” as successful.
This article focuses on the lessons learned by analyzing two
singular events occurred in Spain and partly associated to very
Spanish civic culture keys and political dynamics. At the same time,
both of them have similar features and iconic meaning to other more
recent crisis occurred in other places around the world.
The first case studied is the crisis provoked by the accident of
the oil ship “Prestige”, drawn in November 2002, 130 miles away
from the Spanish coast in Galicia. It poured around 64.000 tones of
oil in the Atlantic Ocean. It provoked a huge ecological disaster
mainly in Galicia though to a great extent it reached 2.500Kms of
coastal line, from the North of Portugal to the South of France.
The second one is the terrorist attack of March 11th, 2004 in
Madrid. A cell of Islamist terrorists linked to Al Qaeda made explode
simultaneously ten bombs in train stations and suburban trains in
four different locations. More than 1.600 people were injured and
191 were killed.
The analysis of crisis management success criteria and
factors is framed in two competitive research projects 1 . Three
different qualitative research techniques are employed: (a) interviews
to critical actors involved in crisis management; (b) semistructured
questionnaires addressed to key informants; and (c) four workshops,
composed by experts, managers and decisionmakers
involved in
Prestige Oil Spill and M11
crisis. The method used is an original
and renewed version of the Nominal Group Technique (NGT). The
application of these techniques was complemented with the
information obtained out of other sources such as official reports,
press releases, articles and specialized monographs and some results
of the inquiries carried out by the Spanish Center of Sociological
Research (CIS
Minimally invasive sacroiliac joint arthrodesis : experience in a prospective series with 24 patients
Background: Sacroiliac (SI) joint pain conservative treatments show poor outcomes. Hypothesis: surgical treatment will show better results. Patients and methods: Prospective series: 24 patients undergoing SI fusion after failure of medical treatment and showing temporary relief with SI infiltration. Period: Nov 2009-July 2013. Gender: 9/15. 11 cases bilaterally (all ). Age: 32-71 years (mean 47.4 years). Height: 161-178 cm (mean 168.2 cm). Weight: 56-84 kg (mean 68.4 kg). Etiology: 12 degenerative/spontaneous, 7 fall on buttocks, 3 coincident with lumbar disc and 2 with lumbar posterolateral fusion. Exclusion criteria: ankylosing spondylitis, osteitis condensans ilii, sacro-iliac joint arthropaty. Demographics, analgesics and NSAID's consumption, incidence and severity of complications, clinical outcome using a visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) and time to returning to work were collected postoperatively at 1, 3 and 6 months, and then at six months interval until last follow-up. Results: Follow-up: 1-4.5 years (mean 23.3 months). No intra-operative or post-operative major complications. No blood transfusions. Patients stayed over-night, and discharged next morning. No crutches used. Time to returning to work: 47.4 days (range 30-67 days). Post-op: marked reduction in VAS and analgesic consumption (preop 8.7, post-op 1 month 3.2, 3 months 2.8, 6 months post-op 2.1, 12 months 1.7, 18 months 1.7, 2 years 1.9, 2½ years 1.8, 3 years 2.0, at 3½ years 2.1, 4 years 2.1 and 4½ 2.1). Mean ODI scores improved from 54.1 preoperatively to 23.9, 21.2, 20.4 and 14.3 at 1, 3, 6 and 12 months postoperatively, and 15.1, 15.5 15.8, 16.0, 16.1, 16.3 and 16.3 at 1½, 2, 2½, 3, 3½, 4 and 4½ years (p<.001). 1 year post-op 22/24 patients would undergo the procedure again. Conclusion: Percutaneous SI joint arthrodesis is effective and safe to treat chronic SI joint pain
High frequency of lumbar fusion in patients denied surgical treatment of the sacroiliac joint
Purpose: Effective treatment of medical conditions relies on proper diagnosis. Clinical trials show the safety and effectiveness of sacroiliac joint (SIJ) fusion in patients with chronic SI joint dysfunction. To what extent is the condition under recognised? Objective: To determine whether under recognition of SIJ pain affects healthcare trajectories in Spanish patients with low back pain. Methods: Retrospective study of characteristics and consequences of 189 patients with persistent SIJ pain seen in an outpatient neurosurgery clinic. Results: Patients with SIJ pain who were denied surgical treatment had a longer pain duration, higher likelihood of prior lumbar fusion, and a high rate (63%) of lumbar fusion within 2 years prior to SIJ pain diagnosis, which, in most cases, provided little benefit. Conclusions: Lack of knowledge of the role of the SIJ in chronic low back pain probably results in diagnostic confusion and may lead to misdirected treatment
Agreement in metastatic spinal cord compression
Background: Metastatic epidural spinal cord compression (ESCC) is a devastating medical emergency. The purpose of this study was to determine the reliability of the 6-point ESCC scoring system and the identification of the spinal level presenting ESCC. Methods: Clinical data and imaging from 90 patients with biopsy-proven spinal metastases were provided to 83 specialists from 44 hospitals. The spinal levels presenting metastases and the ESCC scores for each case were calculated twice by each clinician, with a minimum of 6 weeks' interval. Clinicians were blinded to assessments made by other specialists and their own previous assessment. Fleiss kappa (κ) statistic was used to assess intraobserver and interobserver agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery, and radiation oncology), years of experience, and type of hospital. Results: Intraobserver and interobserver agreement on the location of ESCC was substantial (κ>0.61). Intraobserver agreement on the ESCC score was 'excellent' (κ=0.82), whereas interobserver agreement was substantial (κ=0.64). Overall agreement with the tumor board classification was substantial (κ=0.71). Results were similar across specialties, years of experience and hospital category. Conclusions: The ESCC score can help improve communication among clinicians involved in oncology care
Patient-to-patient transmission of hepatitis C virus (HCV) during colonoscopy diagnosis
<p>Abstract</p> <p>Background</p> <p>No recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified. Invasive diagnostic procedures, such as endoscopy, have been considered as a potential HCV transmission route; although the actual extent of transmission in endoscopy procedures remains controversial. Most reported HCV outbreaks related to nosocomial acquisition have been attributed to unsafe injection practices and use of multi-dose vials. Only a few cases of likely patient-to-patient HCV transmission via a contaminated colonoscope have been reported to date. Nosocomial HCV infection may have important medical and legal implications and, therefore, possible transmission routes should be investigated. In this study, a case of nosocomial transmission of HCV from a common source to two patients who underwent colonoscopy in an endoscopy unit is reported.</p> <p>Results</p> <p>A retrospective epidemiological search after detection of index cases revealed several potentially infective procedures: sample blood collection, use of a peripheral catheter, anesthesia and colonoscopy procedures. The epidemiological investigation showed breaches in colonoscope reprocessing and deficiencies in the recording of valuable tracing data. Direct sequences from the NS5B region were obtained to determine the extent of the outbreak and cloned sequences from the E1-E2 region were used to establish the relationships among intrapatient viral populations. Phylogenetic analyses of individual sequences from viral populations infecting the three patients involved in the outbreak confirmed the patient pointed out by the epidemiological search as the source of the outbreak. Furthermore, the sequential order in which the patients underwent colonoscopy correlates with viral genetic variability estimates.</p> <p>Conclusions</p> <p>Patient-to-patient transmission of HCV could be demonstrated although the precise route of transmission remained unclear. Viral genetic variability is proposed as a useful tool for tracing HCV transmission, especially in recent transmissions.</p
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