Plan gallego de hospitalización a domicilio. Estrategia HADO 2019-2023

Documento estratéxico que pretende potenciar e consolidar a hospitalización a domicilio como un modelo asistencial do Servizo Galego de Saúde e garantir o seu desenvolvemento nos próximos seis anos, establecendo criterios homoxéneos de atención coa finalidade de normalizar os modelos asistenciais, carteira de servizos e fluxos de traballo para asegurar una asistencia sanitaria de calidadeDocumento estratégico que pretende potenciar y consolidar la hospitalización a domicilio como un modelo asistencial del Servicio Gallego de Salud y garantizar su desarrollo en los próximos seis años, estableciendo criterios homogéneos de atención con la finalidad de normalizar los modelos asistenciales, cartera de servicios y flujos de trabajo para asegurar una asistencia sanitaria de calida

Intervencion para reducir la variabilidad de las indicaciones quirurgicas y la lista de espera de pacientes con prioridad 1. Una experiencia en Galicia

ResumenLos objetivos de este trabajo fueron homogeneizar las indicaciones quirúrgicas de prioridad 1 en los hospitales gallegos y proponer una metodología orientada a conseguir que las esperas de los pacientes en prioridad 1 no superen los 30 días. Se recopilaron y revisaron todas las indicaciones quirúrgicas de prioridad 1 de los diferentes servicios quirúrgicos de Galicia y se enviaron a las sociedades científicas para validar. Para reducir la espera a menos de 30 días se implantó un procedimiento de monitorización periódica de pacientes, con asignación de tareas a todos los implicados. Para medir el cambio se compararon los tiempos medios de espera previos con los de después de la implantación, y se habían reducido en un 55,7% respecto a la situación previa a la intervención. Todas las especialidades quirúrgicas redujeron sus tiempos medios de espera, excepto una. El procedimiento instaurado ha permitido disminuir el número de pacientes en espera y reducir ésta a menos de 30 días en casi todas las especialidades quirúrgicas.AbstractThe aims of this study were to homogenize priority 1 surgical indications in Galician hospitals and propose a methodology designed to ensure that that the waiting times of priority 1 patients do not exceed 30 days. The priority 1 surgical indications of the distinct surgical services in Galicia were obtained and reviewed and were then sent for validation to the scientific societies. To reduce waiting times to less than 30 days, a procedure of periodic patient monitoring was established, with allocation of tasks to all the parties involved. Comparison of the mean waiting times before and after the implantation of periodic monitoring showed that this procedure reduced the mean waiting time by 55.7%. The mean waiting time was reduced in all the surgical specialities except one. In almost all of the surgical specialities, the procedure established reduced the number of patients on the waiting lists and the mean waiting time to less than 30 days

Intervención para reducir la variabilidad de las indicaciones quirúrgicas y la lista de espera de pacientes con prioridad 1: Una experiencia en Galicia Intervention to reduce variability in surgical indications and the waiting list of priority 1 patients: An experience in Galicia (Spain)

Los objetivos de este trabajo fueron homogeneizar las indicaciones quirúrgicas de prioridad 1 en los hospitales gallegos y proponer una metodología orientada a conseguir que las esperas de los pacientes en prioridad 1 no superen los 30 días. Se recopilaron y revisaron todas las indicaciones quirúrgicas de prioridad 1 de los diferentes servicios quirúrgicos de Galicia y se enviaron a las sociedades científicas para validar. Para reducir la espera a menos de 30 días se implantó un procedimiento de monitorización periódica de pacientes, con asignación de tareas a todos los implicados. Para medir el cambio se compararon los tiempos medios de espera previos con los de después de la implantación, y se habían reducido en un 55,7% respecto a la situación previa a la intervención. Todas las especialidades quirúrgicas redujeron sus tiempos medios de espera, excepto una. El procedimiento instaurado ha permitido disminuir el número de pacientes en espera y reducir ésta a menos de 30 días en casi todas las especialidades quirúrgicas.The aims of this study were to homogenize priority 1 surgical indications in Galician hospitals and propose a methodology designed to ensure that that the waiting times of priority 1 patients do not exceed 30 days. The priority 1 surgical indications of the distinct surgical services in Galicia were obtained and reviewed and were then sent for validation to the scientific societies. To reduce waiting times to less than 30 days, a procedure of periodic patient monitoring was established, with allocation of tasks to all the parties involved. Comparison of the mean waiting times before and after the implantation of periodic monitoring showed that this procedure reduced the mean waiting time by 55.7%. The mean waiting time was reduced in all the surgical specialities except one. In almost all of the surgical specialities, the procedure established reduced the number of patients on the waiting lists and the mean waiting time to less than 30 days

Análisis de la gestión del proceso y de la variabilidad en el manejo de la diabetes mellitus en Galicia

Objectives: a) to establish an approximation to the load of morbidity and management of the process of the diabetes mellitus in Galicia and b) to know the variability in the handle of the diabetes mellitus between areas of primary health care. Material and methods: analysis of the indicators obtained from different sanitary information systems and comparison of the results between the areas of primary care in Galicia. Results: the global prevalence of diabetes mellitus in Galicia by area of primary care oscillates between the 4,7 and 7%, the group of age with higher prevalence is the one of majors of 64 years, with a rank between the 16 and 20,9%. Differences between the areas of primary care regarding the frecuentation of general medicine and pediatric consultations of the diabetic patients have been found, being the difference between the extreme values of 5,16. Variability between the different areas also exists regarding the averages from derivations by diabetic patient, in the registry of the utilization of the retinography and of the appointments for teleophthalmology, as well as in the number of episodes of entry and the hospital average stay of the diabetic patients. However, the prescription of metformin regarding cost by recipe and use of electronic prescribing is quite homogenous between the different sanitary areas. Conclusions: the analysis of the results of this study aims to it could have differences in the load of morbidity and efficiency of the assistential process of the diabetes mellitus in the different areas of primary care in Galicia. In the same way it could be possible to assert that it isn`t answering of equal way to the needs of the diabetic patients in all the areas.Objetivos: a) establecer una aproximación a la carga de morbilidad y a la gestión del proceso de la diabetes mellitus en Galicia y b) conocer la variabilidad en el manejo de la diabetes mellitus entre áreas de atención primaria. Material y método: análisis de los indicadores obtenidos de diferentes sistemas de información sanitaria y comparación de los resultados entre las áreas de atención primaria de Galicia. Resultados: la prevalencia global de diabetes mellitus en Galicia por área de atención primaria oscila entre el 4,7 y el 7%, el grupo de edad de prevalencia más elevada es el de mayores de 64 años, con un rango entre el 16 y el 20,9%. Se han constatado diferencias entre las áreas de atención primaria en lo que respecta a la frecuentación de las consultas de medicina general y pediatría por parte de los pacientes diabéticos, siendo la diferencia entre los valores extremos de 5,16. Existe también variabilidad entre las diferentes áreas en cuanto a las medias de derivaciones por paciente diabético, en el registro de la utilización de la etinografía y de las citas para teleconsultas de Oftalmología, así como en el número de episodios de ingreso y la estancia media hospitalaria de los pacientes diabéticos. Sin embargo, la prescripción de metformina en lo que se refiere a coste por receta y uso de receta electrónica es bastante homogénea entre las distintas áreas sanitarias. Conclusiones: el análisis de los resultados de este estudio apunta a que podría haber diferencias en la carga de morbilidad y eficiencia del proceso asistencial de la diabetes mellitus en las diferentes áreas de atención primaria de Galicia. Del mismo modo se podría afirmar que no se está respondiendo de igual manera a las necesidades de los pacientes diabéticos en todas las áreas

X chromosome inactivation does not necessarily determine the severity of the phenotype in Rett syndrome patients

Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern

IV Premio Nacional Educación para el Desarrollo "Vicente Ferrer" 2012 : buenas prácticas

La Agencia Española de Cooperación Internacional para el Desarrollo (AECID) junto con el Ministerio de Educación convoca anualmente los premios de educación para el desarrollo que están dirigidos a todos los centros docentes españoles sostenidos con fondos públicos que impartan educación infantil, educación primaria, educación secundaria obligatoria, bachillerato y formación profesional. Se recogen las buenas prácticas de los docentes premiados en esta segunda edición. Docentes que en el ejercicio de su función educadora han convertido el proceso educativo en un proceso dinámico e interactivo que permite al alumnado desarrollar un conocimiento crítico de nuestro mundo. Profesores y profesoras que han estimulado la participación del alumnado en la construcción de estructuras sociales más justas y solidarias, y han promovido actuaciones basadas en el principio de la corresponsabilidad de todos los actores implicados.ES

Vascular and connective tissue anomalies associated with X-linked periventricular heterotopia due to mutations in Filamin A

Mutations conferring loss of function at the FLNA (encoding filamin A) locus lead to X-linked periventricular nodular heterotopia (XL-PH), with seizures constituting the most common clinical manifestation of this disorder in female heterozygotes. Vascular dilatation (mainly the aorta), joint hypermobility and variable skin findings are also associated anomalies, with some reports suggesting that this might represents a separate syndrome allelic to XL-PH, termed as Ehlers-Danlos syndrome-periventricular heterotopia variant (EDS-PH). Here, we report a cohort of 11 males and females with both hypomorphic and null mutations in FLNA that manifest a wide spectrum of connective tissue and vascular anomalies. The spectrum of cutaneous defects was broader than previously described and is inconsistent with a specific type of EDS. We also extend the range of vascular anomalies associated with XL-PH to included peripheral arterial dilatation and atresia. Based on these observations, we suggest that there is little molecular or clinical justification for considering EDS-PH as a separate entity from XL-PH, but instead propose that there is a spectrum of vascular and connective tissues anomalies associated with this condition for which all individuals with loss-of-function mutations in FLNA should be evaluated. In addition, since some patients with XL-PH can present primarily with a joint hypermobility syndrome, we propose that screening for cardiovascular manifestations should be offered to those patients when there are associated seizures or an X-linked pattern of inheritance.Eyal Reinstein... Elizabeth M Thompson... et al

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

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research