Evaluación del rendimiento de CMSNMS en espacios métricos anidados

La mayoría de los métodos de búsqueda en espacios métricos asumen que la topología de la colección de objetos es razonablemente regular. Sin embargo, se sabe de la existencia de Espacios Métricos Anidados, que son espacios en donde los objetos de la colección pueden agruparse en clusters o subespacios. Aquí diferentes dimensiones explican las diferencias entre los objetos dentro de cada subespacio anidado dentro de un espacio métrico más general. En este trabajo se evalúa el rendimiento del CMSNMS que es una estructura de índice de dos niveles para resolver problemas de búsquedas en espacios de esta topología. En un primer nivel esta técnica utiliza una Lista de Clusters (LC), donde se identifican y ordenan estas agrupaciones utilizando el Sparse Spatial Selection (SSS) y técnicas de LC. En un segundo nivel se genera un índice por cada cluster denso, basado en selección de pivotes, empleando también SSS. Las experimentaciones muestran que el desempeño de CMSNMS es mejor que el de las demás en los espacios métricos anidados.Eje: Workshop Bases de datos y minería de datos (WBDDM)Red de Universidades con Carreras en Informática (RedUNCI

Combining methods for searches in nested metric spaces

Most search methods in metric spaces assume that the topology of the object collection is reasonably regular. However, there exist nested metric spaces, where objects in the collection can be grouped into clusters or subspaces, in such a way that different dimensions or variables explain the differences between objects inside each subspace. This paper proposes a two levels index to solve search problems in spaces with this topology. The idea is to have a first level with a list of clusters, which are identified and sorted using Sparse Spatial Selection (SSS) and Lists of Clusters techniques, and a second level having an index for each dense cluster, based on pivot selection, using SSS. It is also proposed for future work to adjust the second level indexes through dynamic pivots selection to adapt the pivots according to the searches performed in the database.Presentado en el VIII Workshop Bases de Datos y Minería de Datos (WBDDM)Red de Universidades con Carreras en Informática (RedUNCI

Combinando Métodos para Búsquedas en Espacios Métricos Anidados

La mayoría de los métodos de búsqueda en espacios métricos asumen que la topología de la colección de objetos es razonablemente regular. Sin embargo, se sabe de la existencia de los Espacios Métricos Anidados - Nested Metric Spaces, que son algunos espacios métricos en donde los objetos de la colección pueden agruparse en clusters o subespacios. Aquí diferentes dimensiones o variables explican las diferencias entre los objetos dentro de cada subespacio anidado dentro de un espacio métrico más general. En este trabajo se presenta una estructura de índice de dos niveles para procurar resolver problemas de búsquedas en espacios de esta topología, intentando aprovechar las virtudes de un conjunto de técnicas de indexación ya conocidas. La idea es que un primer nivel posea una Lista de Clusters (LC), donde se tienen identificadas y ordenadas estas agrupaciones utilizando el Sparse Spatial Selection (SSS) y técnicas de Listas de Clusters; y en un segundo nivel se tenga un índice por cada cluster denso, basado en selección de pivotes, empleando el SSS. Además, se propone adaptar los índices del segundo nivel a las búsquedas que se están realizando, aplicando la “Selección Dinámica de Pivotes que se Adaptan a las Búsquedas en Espacios Métricos”, con el objetivo de adaptar los pivotes para mejorar las futuras búsquedas usando la información brindada por las búsquedas ya realizadas.Fil: Gercek, Hugo Adrián. Tesista del Departamento de Ciencias de la Computación. Facultad de Ciencias Exactas, Ingeniería y Agrimensura. Universidad Nacional de Rosario; Argentina

Development and validation of potential structure indicators for evaluating antimicrobial stewardship programmes in European hospitals

This study describes the development of structure indicators for hospital antimicrobial stewardship programmes and pilot validation across European hospitals. A multi-disciplinary panel from four European countries developed structure indicators in three steps: identification and listing of indicators, remote ranking of indicators using multi-criteria scoring, selection of indicators in a face-to-face consensus meeting. Additionally, the top-ten indicators were identified as a minimal set of key indicators. A survey was sent to the directors of antimicrobial stewardship programmes in European hospitals. The yes/no answers for the indicators were transformed into numbers in order to calculate the total scores. A list of 58 indicators was selected and categorised into the following topics: antimicrobial stewardship services (12 items), tools (16 items), human resources and mandate (6 items), health care personnel development (4 items), basic diagnostic capabilities (6 items), microbiological rapid tests (2 items), evaluation of microbiological drug resistance data (3 items), antibiotic consumption control (5 items) and drug use monitoring (4 items). The indicator scores, reported by 11 pilot hospitals from five European countries, ranged from 32 to 50 (maximum score = 58) and from 5 to 10 points (maximum score = 10) for, respectively, the complete and the top-ten list. An international panel selected 58 potential structure indicators, among which was a minimal set of ten key structure indicators, that could be useful for assessment of the comprehensiveness and resource-intensity of antimicrobial stewardship programmes. There was significant heterogeneity among participating centres with regard to their score for structural components of effective antimicrobial stewardship

Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics

Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems. The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1 of cases. By intention-to-treat analysis, 37.0 (95 CI 30.543.9) of treatments were inappropriate, ranging from 17.5 to 53.8 across hospitals. The median time needed for case assessment and documentation was 29 min. This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement

Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics

Background: Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems. Methods: The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement. Results: Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1% of cases. By intention-to-treat analysis, 37.0% (95% CI 30.5-43.9) of treatments were inappropriate, ranging from 17.5% to 53.8% across hospitals. The median time needed for case assessment and documentation was 29 min. Conclusions: This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine