Calidad del llenado del certificado de defunción y muerte fetal en un hospital de segundo nivel en México

l os certificados de defunción y muerte fetal son de valor legal, epidemiológico y es tadístico, el objetivo del presente estudio es proponer un modelo objetivo y evaluar la calidad del llenado en un hospital de segundo nivel en México. Metodologí a: Se realizó un estudio observacional, descriptivo, retrospectivo, tomando como variables los requisitos establecidos en la Guía Para el Llenado del Certificado de Defunción y del Certificado de Muerte Fetal. La evaluación de los certificados se realizó mediante la aplicación del modelo propuesto. Resultados: Se evaluaron 26 certificados de defunci ón y 73 certificados de muerte fetal. De los certificados de defunción evaluados, el 26.9% presentaban una calidad buena y el 7.6% presentaba una calidad pésima, encontra ndo como principales errores la existencia de causas de muerte ubicadas sin una secuen cia lógica, rubros sin llenar, uso de abreviaturas y deficiente legibilidad de la letra. De los certificados de muerte fetal el 21% de los presentaba una calidad buena, y en el 3 9.8% de los casos la calidad era pésima, detectando problemática en la utiliza ción de causas de muerte no clasificables en la Clasificación Internacional de Enfermedades en su 10ª revisión (CIE 10), uso de abreviaturas, rubros sin llenar y la deficiente legibilida d de la letra. Conclusión: La utilización de un sistema objetivo de e valuación de la calidad del llenado del certificado de defunción y muerte fetal, es una herramienta de utilidad para la identificación de las oportunidades de mejora, y centrar la capacitación de fo rma adecuada en las Instituciones.t he death certificates and fetal death are of legal, epidemiological and statistical value, the objective of the present work was to propose an objective model and to evalua te the quality of filling in a second level hospital in México. Methods, we realized and observational, descriptive, retrospective trials, bearing in mind the variables: The requirements that establishes the gu idelines of Filling Death Certificates and Fet al Death Certificates. The evaluation of the certificates was review by the proposed model. Results: Were evaluated 26 death certificates and 73 fetal death certificates, It was found that 26.9% had a good quality and 7.6% had a terrible quality. The most common errors were the cause of death without a logical sequence, items without filling, use of abbreviations, deficient legibility of the letter. In the fetal death certificates, 21% had a good quality, 39.8% had a terri ble quality, detecting the principa ls errors in causes of death not classifiable on the 10th review of international disease classification (CIE 10), use of abbreviations, items without filling and deficient legibility of the letter. Conclusions: The use of an objective eval uation in the qu ality on filling death certificates and fetal death system is a useful tool to identify the improvement opportunities and to focus on institutions trainin

La medicina legal y forense en México

Introducción: Los Servicios Periciales desempeñan un papel fundamental en la investigación científica de probables hechos delictivos, y la formación del perito es de gran importancia en el Proceso, por ello se planteó como problema ¿cómo se encuentra organizada la medicina legal en México? y ¿cuál es el nivel de especialización en el área?, con el objetivo de determinar su organización y su grado de especialización para el Sistema Penal Acusatorio. Material y método: Estudio observacional descriptivo; la información fue solicitada a través del portal de Transparencia para cada Entidad, y fue analizada mediante estadística descriptiva. Resultados: El 87.8% de la Entidades a nivel Nacional proporcionaron información, identificando que el 53.5% de los médicos tenían solo el grado de licenciatura en medicina, y el 34.2% contaban con Especialidad en Medicina Legal o Forense, siendo la Procuraduría General de la República, la dependencias con mayor porcentaje de Médicos especialistas. Conclusiones: Existe deficiencia de médicos con especialidad en Medicina Legal o forense, lo que muestra la necesidad imperativa de capacitación, así como de llevar a cabo el proceso de certificación por el Consejo.Introduction: Forensic Services perform a fundamental role in scientific investigation of probable criminal acts, and the formation of the expert is of utmost importance in the process, that is why it was presented as a problem, how is legal medicine organized in Mexico? and what is the level of specialization in the area?, with the objective of determining its organization and degree of specialization for the accusatorial System of Criminal Justice. Material and method: Descriptive observational study; the information was required through the website Transparency for each Entity. And it was analyzed with descriptive statistics. Results: The 87.8% of the Entities at a national level provided information, identifying that the 53.5% of the doctors only possessed an undergraduate degree in Medicine, and the 34.2% held a specialty degree in Forensic or Legal Medicine, being the Procuraduría General de República, the department with the highest number of specialized medical practitioners. Conclusions: There is a lack of medical practitioners who hold a specialty degree in Legal or Forensic Medicine, which shows the imperative necessity for training, as well as the certification process being carried out by the Counci

Quejas relacionadas con la atención médica recibidas en una institución de salud en México

En México, la práctica médica se encuentra regulada por la Constitución Política de los Estados Unidos Mexicanos y corresponde a La Ley General de salud definir las bases para el acceso y los derechos de los usuarios. Diversos estudios informan que la responsabilidad médica ha tomado una dimensión de gravedad, ya que países de la comunidad Europea han reportado tasa de incremento de demandas que van desde el 50% hasta el 500% en los últimos 10 años. Metodología: Estudio observacional, descriptivo, retrospectivo, en el cual se analizaron las quejas atendidas en una Institución de Seguridad Social en Salud de San Luis Potosí, México, en el periodo comprendido entre el 01 de enero y el 31 de diciembre del 2014. Como variables se utilizaron el número de quejas, especialidades médicas involucradas, causas que generaron las quejas a nivel Institucional, peticiones plasmadas por el usuario en la queja y la conclusión de la misma. Resultado: Se analizaron 140 quejas interpuestas, la especialidad con mayor número fue Urgencias, el principal motivo deriva de la necesidad de utilizar servicios de atención médica privada ante deficiencias de atención, las principales peticiones son económicas, y en el 35% de los casos se demuestra el dicho del quejoso.In México, medical practice is regulated by the Political Constitution of the Mexican United States, and The General Health Law defines the bases for the access and users rights. Other studies inform that medical liability has taken serious dimensions, since in European community have reported an increase in demands from 50% to 500% on the past 10 years. Methods: Retrospective, descriptive, observational study, in which were analyzed the complaints related to health care in a Mexican health institution in San Luis Potosí, México, on the period from January 1st to December 31st 2014. As variables were use the number of complaints, medical specialists involve, causes that generated the complaints at Institutional level, users requests on the complaint and the conclusion. Results: Were analyzed 140 filed complaints; emergency specialty had the most number of complaints; the principal cause was the need of using private services because of attention deficits, the main requests are economics and in 35% of cases is demonstrated the complainer said

Reporte de caso: decapitación y desmembramiento del cuerpo; Lesiones postmortem con sierra de cinta.

El desmembramiento y la decapitación son procedimientos que frecuentemente se observan en la práctica médico forense, en la etiología descrita se incluyen de tipo suicida, accidental y criminal, esta última se produce generalmente de forma inmediata posterior a la muerte; dentro los principales motivos por los cuales se realiza la mutilación de un cadáver postmortem incluyen el transporte del cuerpo a un lugar distinto de la escena primaria, impedir la identificación del fallecido, envío de mensajes, limpiar la escena, retrasas la investigación e incluso facilitar el transporte del cuerpo. Este proceso es realizado en dos tiempos, en el primero se seccionan piel, tejidos blandos, músculos y tendones y posteriormente en un segundo tiempo realizar el corte sobre el hueso o las articulaciones. Diversas líneas de investigación se han enfocado en la identificación de las características morfológicas a nivel de los bordes de corte, es por ello que en el presente reporte de caso se busca mostrar las características macroscópicas de una amputación postmortem realizada mediante la utilización de una sierra de cintaDismemberment and decapitation are procedures that are frequently seen in forensic medical practice, the described etiology include suicide, accidental and criminal. the criminal etiology usually occurs immediately after death; the main reasons for the mutilation of a corpse include transportation of the body to a different place than the primary scene, impede the identification of the deceased, send messages, clean the crime scene, obstruct the investigation and facilitate the body transportation. This process is performed in two stages, in the first time the skin, soft tissues, muscles and tendons are dissected and then in the second time the bones or articulations are cut. Several lines of research have focused on the identification of morphological characteristics, it is why in the present case report we want to show the macroscopic characteristics of an amputation postmortem with a bland saw

Photoionization Of Gallium At 3D-4P And 4S-5P 4S-6P Resonances

The simplest atoms having nonspherical symmetry are those with a single p electron in a valence shell. Of these, the group IIIB elements are excellent examples. As such, they form test cases for photoionization from open-shell systems. Through photoelectron-spectroscopy techniques, we have examined both partial cross sections and angular-distribution parameters for autoionization corresponding to promotion of a 3d electron to the 4p shell of gallium. The resulting dp/sup 2/ configuration gives rise to a complicated multiplet structure across which the angular-distribution parameter varies considerably. We have also looked at the simpler structure resulting from promotion of one s electron to an np level, n = 5,6. For these cases, the multiplet structure is simpler, but the influence of the resonance on the cross section and the angular distribution is pronounced. For the 4s4p(/sup 3/P)5p resonance we find a value of ..beta.. = -1 at the cross-section minimum. No calculations have been performed for this system, so we attempt a qualitative interpretation of our results based on an angular-momentum-transfer analysis

GPS測位誤差と地震発生との関連解析

修士論

Arcanobacterium hemolyticum: identification and susceptibility to nine antimicrobial agents

AbstractObjective To evaluate the in vitro spectrum and activity of linezolid, a recent oxazolidinone, according to well-controlled surveillance data from 42 medical centers in 13 countries throughout Europe.Methods Participants tested the susceptibility of 125 clinical strains of enterococcal and staphylococcal species against 13 drugs using reference broth microdilution trays or the standardized disk diffusion method of the National Committee for Clinical Laboratory Standards (NCCLS). Streptococcal species (n = 25 at each center) were tested against six drugs using E test (AB BIODISK, Solna, Sweden). Quality assurance testing was conducted using NCCLS-recommended strains and verification of resistance to linezolid and other selected agents was performed by retesting strains at the regional (Europe) and international (USA) monitor sites.Results A total of 5598 strains from throughout Europe (91% compliance) were tested. Vancomycin resistance was reported in only 0.6 and 3.0% of Enterococcus faecalis and E. faecium, respectively. Penicillin resistance occurred in 25.1% of Streptococcus pneumoniae; 4.9% at the high-level (≥2 mg/L). The MIC90 for linezolid was 1 mg/L for streptococci and 2 mg/L for enterococci and staphylococci. Using the US FDA- and EUCAST-recommended susceptible breakpoints for linezolid, there were no confirmed reports of linezolid resistance [minimum inhibitory concentration (MIC), ≥8mg/L]. The distribution of linezolid MIC values was unimodal and varied between 0.25 and 1 mg/L for streptococci (≥90% of isolates), and between 1 and 2 mg/L for staphylococci (≥90%) and enterococci (≥95%). There were no differences in linezolid susceptibility in the vancomycin-, oxacillin-, or penicillin-resistant subsets of strains when compared to susceptible organism populations.Conclusions Compared to the North American component of this study, there was substantially less vancomycin resistance among E. faecium isolates (Europe 3.0% vs. North America 63.4%). While the occurrence of penicillin-resistant S. pneumoniae in Europe and North America was similar (25.1% vs. 29.7%), the recovery of high-level penicillin-resistant strains was nearly three-fold higher in North America (4.9% vs. 13.2%). Only linezolid was universally active against all the tested Gram-positive isolates at ≤4mg/L

The Wear Responses of the Welded Joints of ASTM A335 Gr. P11 Steels Affected by Accelerated Flow Corrosion

[Abstract] This study shows the efects of wear on welded joints of ASTM A355 Gr. P11 “Seamless Ferritic Alloy-Steel Pipe for High Temperature Service” steels subjected to the welding procedures established by codes B31.1 and ASME III. The standard welding procedure establishes the following steps: a preheating process, welding and post-weld heat treatment. This generates a wear behavior that depends on the thermal cycles to which the diferent areas of the joint are subjected. The objective of this article was the study of the behavior against the flow-accelerated corrosion of the welded joints of a low alloy steel. There is the possibility of establishing welding procedures other than those established, while maintaining the safety ranges, depending on the field of application for the steel

Fatigue Study of the Pre-Corroded 6082-T6 Aluminum Alloy in Saline Atmosphere

[Abstract] This work studies the influence of the saline atmospheric corrosion on the fatigue strength of 6061-T6 aluminum alloy. For this purpose, this alloy was subjected to tests in a salt spray corrosion chamber at different exposure times (1, 2, and 3 months) according to ASTM B117 standard. The morphological study of the pits was carried out by confocal microscopy. Subsequently, fatigue tests were performed at variable stresses whose maximum stress (Smax) was between 30% and 95% of the yield strength (S0) in order to keep them within the zone of elastic behavior of the material. Data were analyzed using the Basquin equation and the maximum likelihood function method. The results show a similar decrease in the conventional fatigue limit (2 × 106 cycles) after one month (98 MPa) and two months (91 MPa) of corrosion. After three months of corrosion, the material showed a very important reduction in the fatigue limit (68 MPa) with respect to the uncorroded material (131 MPa). The data of Se/S0 (fatigue limit/yield strength) versus the ratio Pm/Dm (pit average depth/pit diameter at zero depth) can be fitted to a logarithmic curve