An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector

[EN] Emergency Care Networks (ECNs) were created as a response to the increased demand for emergency services and the ever-increasing waiting times experienced by patients in emergency rooms. In this sense, ECNs are called to provide a rapid diagnosis and early intervention so that poor patient outcomes, patient dissatisfaction, and cost overruns can be avoided. Nevertheless, ECNs, as nodal systems, are often inefficient due to the lack of coordination between emergency departments (EDs) and the presence of non-value added activities within each ED. This situation is even more complex in the public healthcare sector of low-income countries where emergency care is provided under constraint resources and limited innovation. Notwithstanding the tremendous efforts made by healthcare clusters and government agencies to tackle this problem, most of ECNs do not yet provide nimble and efficient care to patients. Additionally, little progress has been evidenced regarding the creation of methodological approaches that assist policymakers in solving this problem. In an attempt to address these shortcomings, this paper presents a three-phase methodology based on Discrete-event simulation, payment collateral models, and lean six sigma to support the design of in-time and economically sustainable ECNs. The proposed approach is validated in a public ECN consisting of 2 hospitals and 8 POCs (Point of Care). The results of this study evidenced that the average waiting time in an ECN can be substantially diminished by optimizing the cooperation flows between EDs.The authors would like to express his gratitude to Giselle Polifroni Avendaño for supporting this research.Ortiz-Barrios, MA.; Alfaro Saiz, JJ. (2020). An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector. 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Methodological approaches to support process improvement in emergency departments: a systematic review

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rate

Auditoría al Servicio de Medicina Nuclear basado en el protocolo de la Agencia Internacional de Energía Atómica al hospital de Alta Complejidad Virgen de la Puerta de la Red Asistencial La Libertad-EsSalud-Trujillo

La siguiente investigación, es un trabajo de una auditoria basado en un protocolo de “Auditorias de gestión de la calidad en prácticas de medicina nuclear (QUANUM)” de la Agencia Internacional de Energía Atómica (IAEA). Tiene como fin conocer la realidad del Servicio de Medicina Nuclear del Hospital de Alta Complejidad “Virgen de la Puerta”-Trujillo, mediante una auditoria exhaustiva. El proceso se inicia con la convocatoria de un grupo de auditores, quienes son trabajadores del servicio y son especialistas en las áreas de; Medicina Nuclear, Física Médica y Tecnología Médica en Medicina Nuclear. Por ser de una auditoría de tipo interna, será el grupo de auditores quienes supervisarán y darán el veredicto final a la auditoría, la cual es ejecutada por los investigadores del presente trabajo con una preparación anticipada en el servicio. Para el proceso de la auditoria y cumplir con el propósito, se adaptó el protocolo al Servicio de Medicina Nuclear. De las 148 preguntas aplicadas del QUANUM al servicio, las cuales están divididas en tres tipos A, B y C. Los de tipo A cumple con un 74%, los del tipo B con 53.3% y los del tipo C con un 50%, y estos resultados nos da un enfoque de la situación del servicio. Finalmente dejamos los resultados a la disposición del servicio para que las autoridades correspondientes se informen de la situación y tomen las medidas correctivas de acuerdo a los resultados de la auditoria

Propuesta de diseño de un ambiente de formación para trabajo seguro en altura basado en la mejora continua en una institución de educación para el trabajo, 2019

Proponer diseño de ambiente de formación para trabajo seguro en altura basado en la mejora continua en una institución de formación para el trabajo, 2019 Metodología: La presente investigación se plantea bajo un enfoque descriptivo transversal con variables cuantitativas con característica de investigación proyectiva ya que se identifican las necesidades y se especifica el hecho a transformar tomando como muestra a conveniencia cuatro centros de entrenamiento de la ciudad de Barranquilla. Resultados: Las condiciones y requisitos normativos existentes para aplicar la formación en altura se analizó en base al diagnóstico realizado a cuatro centros de formación, evidenciando el grado de cumplimento ante la normatividad vigente , dejando recomendaciones relacionadas con el material didáctico y el aspecto metodológico para impartir la formación como un factor diferenciador en la comunidad trabajadora a capacitarse y que consiste en el grado de escolaridad de trabajadores que requieren de esta formación, la normatividad exige que se haga un análisis del perfil de los futuros aprendices antes da la formación haciendo un sondeo que sirve para direccionar la formación en cuanto a las técnicas didáctica a utilizar para trasferir el conocimiento.Propose a design of Work at heights training environment based in continuous quality improvement in an institution for work training, 2019 Methodology: A quantitative, descriptive cross sectional study with characteristics of projective research taking four work at heights training centers in the city of Barranquilla as research samples. Results: Conditions and normative requirements checked in every work at heights training center visited, evidenced high standards of fulfillment of local normativity according to the national work department but also implying a needed to improve the approach to the target students with more didactic material taking in consideration in some cases the low academic level of some of them. Conclusion: the results obtained during the research showed the good management work developed in every work at heights training center visited according to the local the conditions and normative requirements, the current research propose in order to improve the quality of the teaching process a useful tool that can be used during theory teaching as an interactive work at heights training environment that also can be used as a standard for future work at heights training centers in process of certification

The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

This work was supported by the Spanish Association Against Cancer [Asociación Española contra el Cáncer, PROYE20023SANC “High resolution study of social inequalities in cancer (HiReSIC)”], the Cancer Epidemiological Surveillance Subprogram of the CIBER of Epidemiology and Public Health and the Health Institute Carlos III (VICA), and the Health Institute Carlos III (PI18/01593 “Multilevel population-based study of socioeconomic inequalities in the geographical distribution of cancer incidence, mortality and net survival”). DP was supported by a Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain (MCIN/AEI, JC2019- 039691-I, http://doi.org/10.13039/501100011033, Accessed October 4, 2021). The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1183244/full#supplementary-materialIntroduction: Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival. Materials and methods: We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist. Results: Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31–73), k = 18, of the diagnosis interval 35 days (95% CI = 21–38),k = 11, and of the treatment interval 30 days (95% CI = 23–53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates. Conclusion: Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.Asociación Española contra el Cáncer, PROYE20023SANCCancer Epidemiological Surveillance Subprogram of the CIBER of Epidemiology and Public HealthHealth Institute Carlos III (VICA)Health Institute Carlos III: PI18/01593MCIN/AEI, JC2019-039691-

Biosensado con redes de nanoagujeros en oxido de aluminio

Se presenta la explotación analítica de redes de nanoagujeros de óxido de aluminio fabricados sobre sustratos de policarbonato.1 Este novedoso dispositivo se basa en la resonancia de plasmón superficial para monitorizar procesos de bioreconocimiento sin marcaje. El bajo coste de los materiales empleados (policarbonato y aluminio) y la compatibilidad de este dispositivo con las tecnologías de disco compacto encierra un gran potencial para el desarrollo de biosensores

Fiber-Optic Aqueous Dipping Sensor Based on Coaxial-Michelson Modal Interferometers

Fiber-optic modal interferometers with a coaxial-Michelson configuration can be used to monitor aqueous solutions by simple dipping of few centimeters of a fiber tip. The fabrication of these sensors to work around 850 nm enables the use of compact, robust, and low-cost optical spectrum analyzers. The use of this type of portable sensor system to monitor sewage treatment plants is shown

Ejaculation Frequency and Prostate Cancer: CAPLIFE Study

Purpose To evaluate the association between ejaculation frequency (EF) during four stages of life and prostate cancer (PCa) according to tumor aggressiveness, PCa stage, and urinary symptomatology. Materials and Methods A total of 456 incident PCa cases histologically confirmed, and 427 controls aged 40–80 years from the CAPLIFE study were analyzed. This study is a population-based case-control study carried out in the south of Spain. Average EF was measured for: (1) 20s, (2) 30s, (3) 40s, and (4) one year before the interview. EF was categorized into: (1) 0–3, (2) 4, and (3) >4 ejaculations/month. Sociodemographic, lifestyle, and medical information were also collected. To estimate the association between EF and PCa, adjusted ORs (aORs) and 95% CIs were calculated by logistic regression models. Results A year before the interview, PCa cases ejaculated less frequently than the controls. An inverse association was observed between the EF a year before and PCa, aOR=1.64 (95% CI 1.03–2.61) for men with 4 ejaculations/month, and aOR=2.38 (95% CI 1.57–3.60) for men with 0–3 ejaculations/month, compared to men with >4. The association was higher for cases with ISUP 3–5 (aOR=2.76 [95% CI 1.34–5.67] for men with 0–3 ejaculations/month) or with a locally advanced-metastatic tumor (aOR=4.70 [95% CI 1.55–14.29]). Moreover, men with moderate urinary symptoms and 0–3 ejaculations/month had the highest risk, aOR=3.83 (95% CI 1.84–7.95). Conclusions A low EF could be associated with a higher risk of PCa, especially for cases with ISUP 3–5 or with a locally advanced-metastatic tumor.Regional Ministry of Health and Families of Andalusia/Consejería de Salud y Familias, Junta de Andalucía (PI-0514-2016)

Circulating angiotensin-converting enzyme 2 activity in patients with chronic kidney disease without previous history of cardiovascular disease

[Abstract] Background. Patients with cardiovascular (CV) disease have an increased circulating angiotensin-converting enzyme 2 (ACE2) activity, but there is little information about changes in ACE2 in chronic kidney disease (CKD) patients without history of CV disease. We examined circulating ACE2 activity in CKD patients at stages 3–5 (CKD3-5) and in dialysis (CKD5D) without any history of CV disease. Methods. Circulating ACE2 activity was measured in human ethylenediamine-tetraacetic acid (EDTA)-plasma samples from the NEFRONA study (n = 2572): control group (CONT) (n = 568), CKD3-5 (n = 1458) and CKD5D (n = 546). Different clinical and analytical variables such as gender; age; history of diabetes mellitus (DM), dyslipidemia and hypertension; glycaemic, renal, lipid and anaemia profiles; vitamin D analogues treatment and antihypertensive treatments (angiotensin-converting enzyme inhibitor and angiotensin receptor blockade) were analysed. Circulating ACE2 and ACE activities were measured using modified fluorimetric assay for EDTA-plasma samples, where zinc chloride was added to recover enzymatic activity. Results. In CKD3-5 and CKD5D, significant decrease in circulating ACE2 activity was observed when compared with CONT, but no differences were found between CKD3-5 and CKD5 when performing paired case-control studies. By multivariate linear regression analysis, male gender and advanced age were identified as independent predictors of ACE2 activity in all groups. Diabetes was identified as independent predictor of ACE2 activity in CKD3-5. Significant increase in the activity of circulating ACE was found in CKD3-5 and CKD5D when compared with CONT and in CKD5D when compared with CKD3-5. By multiple regression analysis, female gender and younger age were identified as independent predictors of ACE activity in CONT and CKD3-5. Diabetes was also identified as an independent predictor of ACE activity in CKD3-5 patients. Conclusions. Circulating ACE2 and ACE activities can be measured in human EDTA-plasma samples with zinc added to recover enzymatic activity. In a CKD population without previous history of CV disease, ACE2 activity from human EDTA-plasma samples directly correlated with the classical CV risk factors namely older age, diabetes and male gender. Our data suggest that circulating ACE2 is altered in CKD patients at risk for CV event

Vertical resonant microcativites based on pillars analyzed by beam profile ellipsometry and reflectometry

A biosensor design is presented by a combination of ellipsometry, reflectometry and spectrometry based techniques is presented. It consists of a lattice of columns forming resonant microcavities. Calculations for reflectivity profiles are shown, and estimations for detection limit in refractive index units are obtained