La información clínica en Patología Digestiva. Estudio comparativo en tres centros hospitalarios: Variabilidad en la asignación de Grupos Relacionados por el Diagnóstico (GRD) y descripción del Case MIx (CM)

El análisis d la especialidad de Medicina Digestiva en su vertiente asistencial tiene una importante trascendencia para determinar las necesidades que de ella se derivan en el medio sanitario actual. Para la cuantificación del Producto Hospitalario disponemos del Case Mix o Casuística. Medir la producción de los servicios sanitarios es difícil, pues existen tantos productos como pacientes. Disponemos de la clasificación de pacientes. Los Grupos Relacionados por el Diagnóstico (GRD) es el sistema de clasificación de pacientes utilizado para medir el producto hospitalario y poder comparar centros sanitarios. El punto de partida para medir la información del episodio hospitalario está reflejado principalmente el Informe de Alta Hospitalaria (IAH). La información de origen debe ser evaluada, conocer su calidad así como su codificación certificando que los indicadores extraídos a partir de los GRD son fiables. Partimos de la Hipótesis de que los tres servicios analizados son comparables. Los objetivos son; conocer el producto hospitalario y el funcionamiento de los tres centros y analizar la casuística, comparando los tres servicios de Patología Digestiva de los tres centros. Se realiza un análisis de la calidad de los informes de alta hospitalaria, así como una validación del tratamiento documental. Se concluye en que los tres centros hospitalarios funcionan de forma similar, aunque cada uno con sus peculiaridades, ya que de forma predeterminada en algunas patologías se destina el manejo a un servicio diferente. Los tres servicios de Medicina Digestiva funcionan de forma similar aunque con matices. Los IAH presentan una buena calidad. En cuanto a la indización y codificación nuestra serie presenta porcentajes de error aceptables. El manejo hospitalario por parte de los especialista de Medicina Digestiva queda demostrado que evita ingresos y acorta estancias, con una mayor eficiencia en el consumo de recursos.The analysis d the speciality of Digestive Medicine in his welfare slope has an important transcendency to determine the needs that from her stem in the sanitary current way. For the quantification of the Hospitable Product we have of Case Mix or Casuistry. To measure the production of the sanitary services is difficult, since so many products exist as patients. We have the patients' classification. The Groups Related by the Diagnosis (DRG) it is the system of patients' classification used to measure the hospitable product and to be able to compare sanitary centers. The point of item to measure the information of the hospitable episode is reflected principally Hospitalaria's Report (HR).The information of origin must be evaluated, know his quality as well as his codification certifying that the indicators extracted from the GRD are trustworthy. We depart from the Hypothesis of that three analyzed services are comparable. The aims are; to know the hospitable product and the functioning of three centers and to analyze the casuistry, comparing three services of Digestive Pathology of three centers. There is realized an analysis of the quality of the reports of hospitable discharge, as well as a validation of the documentary treatment. He concludes in that three hospitable centers work of similar form, though each one with his peculiarities, since of form predetermined in some pathologies the managing is destined to a different service. Three services of Digestive Medicine work of similar form though with shades. The IAH present a good quality. As for the indexation and codification our series presents acceptable percentages of mistake. The hospitable managing on the part of the especialista of Digestive Medicine remains demonstrated that avoids income and shortens stays, with a major efficiency in the consumption of resources

La importància de la vinculació educativa com a prevenció de la deliqüència juvenil

L’accés al sistema educatiu i la trajectòria en aquest sistema són dos dels elements principals que configuren els factors de risc o de protecció en una societat precària i dualitzada com l’actual. La bibliografia científica considera fonamental analitzar la relació entre la trajectòria educativa i la vinculació amb la delinqüència juvenil. En aquesta investigació s’aprofundeix en la relació que hi ha entre el procés educatiu i la trajectòria delinqüencial dels adolescents en conflicte amb la llei. La nostra perspectiva parteix de les hipòtesis següents: a) el fracàs educatiu està relacionat amb la situació de vulnerabilitat i exclusió prèvia de les unitats familiars, com s’ha posat de manifest en nombroses investigacions; b) a més fracàs escolar i desvinculació de les instàncies educatives, més probabilitat de desenvolupar una trajectòria delinqüencial, i c) per prevenir la delinqüència juvenil cal actuar a dintre de l’escenari educatiu. La recerca es desenvolupa mitjançant tècniques quantitatives i qualitatives, cercant la complementarietat entre ambdues. S’aporta com a originalitat la construcció de tres tipologies de trajectòries delinqüencials, que es vinculen a les categories de la situació educativa dels adolescents. El resultat principal és que la trajectòria educativa s’associa a la trajectòria delinqüencial dels adolescents, la qual cosa implica que l’escenari educatiu ha de ser un espai de prevenció i intervenció de la delinqüència juvenil.El acceso al sistema educativo y la trayectoria en el mismo es uno de los elementos principales que configuran los factores de riesgo o de protección en una sociedad precaria y dualizada como la actual. La bibliografía científica considera fundamental analizar la relación entre la trayectoria educativa y la vinculación con la delincuencia juvenil. En esta investigación se profundiza en la relación existente entre el proceso educativo y la trayectoria delincencia de los adolescentes en conflicto con la ley. Nuestra perspectiva parte de las hipótesis siguientes: a) el fracaso educativo está relacionado con la situación de vulnerabilidad y exclusión previa de las unidades familiares, como se ha puesto de manifiesto en numerosas investigaciones; b) a mayor fracaso escolar y desvinculación de las instancias educativas, mayor probabilidad de desarrollar una trayectoria delincuencial, y c) para prevenir la delincuencia juvenil es necesario actuar dentro del escenario educativo. La investigación se desarrolla mediante técnicas cuantitativas y cualitativas, buscando la complementariedad entre ambas. Se aporta como originalidad la construcción de tres tipologías de trayectorias delincuenciales, que se vinculan a las categorías de la situación educativa de los adolescentes. El principal resultado es que la trayectoria educativa se encuentra asociada a la trayectoria delincuencial de los adolescentes, lo cual implica que el escenario educativo tiene que ser un espacio de prevención e intervención de la delincuencia juvenil.Access to educational systems is one of the main elements contributing to risk or protective factors in a precarious and dual society such as the one we live in. According to the scientific literature, the analysis of educational paths and their connection with juvenile delinquency is fundamental. This study explores the existing relationship between educational processes and the criminal paths of adolescents with legal problems. Our approach is based on the following hypotheses: a) educational failure is related to a situation of vulnerability and prior exclusion from family units, as has been demonstrated in numerous studies, b) the greater the failure in school and the distance from educational authorities, the greater the probability of future criminal behaviour, and c) preventing juvenile delinquency requires that action be taken in educational settings. This research has been developed using quantitative and qualitative techniques that complement each other. Its original contribution is the creation of three types of criminal paths, which are associated with categories of the adolescents’ educational situations. The main result is that the educational paths are associated with the criminal paths of adolescents, which means that educational settings must include the prevention of and intervention in juvenile delinquency

La incidència de l'oferta de serveis educatius públics i privats en la vulnerabilitat i l'exclusió social: el cas de la ciutat de València.

El paper de l'educació en la prevenció de la vulnerabilitat i l'exclusió social és un tema recurrent que han tractat nombrosos autors. En canvi, la relació entre l'exclusió educativa i el territori no ha sigut un tema tan investigat. A més de la qualitat educativa, no és menys important l'existència d'una oferta escolar per a tots els nivells, fàcilment accessible per al jove que desitge millorar les seues possibilitats d'ascens social i les seues perspectives laborals

La importància de la vinculació educativa com a prevenció de la delinqüència juvenil

L’accés al sistema educatiu i la trajectòria al mateix, és un dels elements principals que configuren els factors de risc o de protecció en una societat precària i dualitzada com l’actual. La literatura científica considera fonamental analitzar la relació entre la trajectòria educativa i la vinculació amb la delinqüència juvenil. En aquesta investigació aprofundint en la relació existent entre el procés educatiu i la trajectòria delinqüèncial dels adolescents en conflicte amb la llei. La nostra perspectiva parteix de les hipòtesi següents: a) el fracàs educatiu està relacionat amb la situació de vulnerabilitat i exclusió prèvia de les unitats familiars, com s’ha posat de manifest en nombroses investigacions, b) a major fracàs escolar i desvinculació de les instàncies educatives, major probabilitat de desenvolupar una trajectòria delinqüèncial, i c) per a previndre la delinqüència juvenil cal actuar a dintre de l’escenari educatiu. Es desenvolupa mitjançant tècniques quantitatives i qualitatives, cercant la complementarietat entre ambdues. S’aporta com a originalitat la construcció de tres tipologies de trajectòries delinqüèncials i es vinculen a les categories de la situació educativa dels adolescents. El principal resultat és que la trajectòria educativa es troba associada a la trajectòria delinqüèncial dels adolescents, la qual cosa implica que l’escenari educatiu ha de ser un espai de prevenció i intervenció de la delinqüència juvenil.El acceso al sistema educativo y la trayectoria en el mismo es uno de los elementos principales que configuran los factores de riesgo o de protección en una sociedad precaria y dualizada como la actual. La bibliografía científica considera fundamental analizar la relación entre la trayectoria educativa y la vinculación con la delincuencia juvenil. En esta investigación se profundiza en la relación existente entre el proceso educativo y la trayectoria delictiva de los adolescentes en conflicto con la ley. Nuestra perspectiva parte de las hipótesis siguientes: a) el fracaso educativo está relacionado con la situación de vulnerabilidad y exclusión previa de las unidades familiares, como se ha puesto de manifiesto en numerosas investigaciones; b) a mayor fracaso escolar y desvinculación de las instancias educativas, mayor probabilidad de desarrollar una trayectoria delictiva, y c) para prevenir la delincuencia juvenil es necesario actuar dentro del escenario educativo. La investigación se desarrolla mediante técnicas cuantitativas y cualitativas, buscando la complementariedad entre ambas. Se aporta como originalidad la construcción de tres tipologías de trayectorias delincuenciales, que se vinculan a las categorías de la situación educativa de los adolescentes. El principal resultado es que la trayectoria educativa se encuentra asociada a la trayectoria delincuencial de los adolescentes, lo cual implica que el escenario educativo tiene que ser un espacio de prevención e intervención de la delincuencia juvenil.Access to educational systems is one of the main elements contributing to risk or protective factors in a precarious and dual society such as the one we live in. According to the scientific literature, the analysis of educational paths and their connection with juvenile delinquency is fundamental. This study explores the existing relationship between educational processes and the criminal paths of adolescents with legal problems. Our approach is based on the following hypotheses: a) educational failure is related to a situation of vulnerability and prior exclusion from family units, as has been demonstrated in numerous studies, b) the greater the failure in school and the distance from educational authorities, the greater the probability of future criminal behaviour, and c) preventing juvenile delinquency requires that action be taken in educational settings. This research has been developed using quantitative and qualitative techniques that complement each other. Its original contribution is the creation of three types of criminal paths, which are associated with categories of the adolescents’ educational situations. The main result is that the educational paths are associated with the criminal paths of adolescents, which means that educational settings must include the prevention of and intervention in juvenile delinquency

Transitioning From Preclinical Evidence to Advanced Therapy Medicinal Product: A Spanish Experience

A systematic and ordered product development program, in compliance with current quality and regulatory standards, increases the likelihood of yielding a successful advanced therapy medicinal product (ATMP) for clinical use as safe and effective therapy. As this is a novel field, little accurate information is available regarding the steps to be followed, and the information to be produced to support the development and use of an ATMP. Notably, successful clinical translation can be somewhat cumbersome for academic researchers. In this article, we have provided a summary of the available information, supported by our experience in Spain throughout the development of an ATMP for myocardial infarction, from the pre-clinical stage to phase I clinical trial approval

Noninvasive assessment of an engineered bioactive graft in myocardial infarction: impact on cardiac function and scar healing

Cardiac tissue engineering, which combines cells and biomaterials, is promising for limiting the sequelae of myocardial infarction (MI). We assessed myocardial function and scar evolution after implanting an engineered bioactive impedance graft (EBIG) in a swine MI model. The EBIG comprises a scaffold of decellularized human pericardium, green fluorescent protein-labeled porcine adipose tissue-derived progenitor cells (pATPCs), and a customized-design electrical impedance spectroscopy (EIS) monitoring system. Cardiac function was evaluated noninvasively by using magnetic resonance imaging (MRI). Scar healing was evaluated by using the EIS system within the implanted graft. Additionally, infarct size, fibrosis, and inflammation were explored by histopathology. Upon sacrifice 1 month after the intervention, MRI detected a significant improvement in left ventricular ejection fraction (7.5%64.9% vs. 1.4%63.7%; p = .038) and stroke volume (11.565.9 ml vs. 364.5 ml; p = .019) in EBIG-treated animals. Noninvasive EIS data analysis showed differences in both impedance magnitude ratio (20.02 6 0.04 per day vs. 20.48 6 0.07 per day; p = .002) and phase angle slope (20.18°60.24° per day vs.23.52°60.84° per day; p = .004) in EBIG compared with control animals. Moreover, in EBIG-treated animals, the infarct size was 48% smaller (3.4%60.6% vs. 6.5%61%; p = .015), less inflammation was found by means of CD25+ lymphocytes (0.65 6 0.12 vs. 1.26 6 0.2; p = .006), and a lower collagen I/III ratio was detected (0.4960.06 vs. 1.6660.5; p = .019). An EBIG composed of acellular pericardium refilled with pATPCs significantly reduced infarct size and improved cardiac function in a preclinical model of MI. Noninvasive EIS monitoring was useful for tracking differential scar healing in EBIG-treated animals, which was confirmed by less inflammation and altered collagen deposit.Peer ReviewedPostprint (published version

Mechanisms of action of sacubitril/valsartan on cardiac remodeling : a systems biology approach

Sacubitril/Valsartan, proved superiority over other conventional heart failure management treatments, but its mechanisms of action remains obscure. In this study, we sought to explore the mechanistic details for Sacubitril/Valsartan in heart failure and post-myocardial infarction remodeling, using an in silico, systems biology approach. Myocardial transcriptome obtained in response to myocardial infarction in swine was analyzed to address post-infarction ventricular remodeling. Swine transcriptome hits were mapped to their human equivalents using Reciprocal Best (blast) Hits, Gene Name Correspondence, and InParanoid database. Heart failure remodeling was studied using public data available in gene expression omnibus (accession GSE57345, subseries GSE57338), processed using the GEO2R tool. Using the Therapeutic Performance Mapping System technology, dedicated mathematical models trained to fit a set of molecular criteria, defining both pathologies and including all the information available on Sacubitril/Valsartan, were generated. All relationships incorporated into the biological network were drawn from public resources (including KEGG, REACTOME, INTACT, BIOGRID, and MINT). An artificial neural network analysis revealed that Sacubitril/Valsartan acts synergistically against cardiomyocyte cell death and left ventricular extracellular matrix remodeling via eight principal synergistic nodes. When studying each pathway independently, Valsartan was found to improve cardiac remodeling by inhibiting members of the guanine nucleotide-binding protein family, while Sacubitril attenuated cardiomyocyte cell death, hypertrophy, and impaired myocyte contractility by inhibiting PTEN. The complex molecular mechanisms of action of Sacubitril/Valsartan upon post-myocardial infarction and heart failure cardiac remodeling were delineated using a systems biology approach. Further, this dataset provides pathophysiological rationale for the use of Sacubitril/Valsartan to prevent post-infarct remodeling. The new wonder drug in heart failure management, Sacubitril/Valsartan, rejuvenates the heart by preventing its dilation. Using data from myocardial infarction and heart failure samples, we generated a mathematical model to better understand how Sacubitril/Valsartan modulates pathological heart resize and the combined effect of the drug. Our analysis revealed that Sacubitril/Valsartan mainly acts by blocking both, cell death and the pathological makeover of the outer-membrane of the cardiac cells. These two major processes occur after a heart attack. Most importantly, we discovered a core of 8 proteins that emerge as key players in this process. A better understanding of the mechanism of novel cardiovascular drugs at the most basic level may help decipher future therapies and indications

Deep Learning Analyses to Delineate the Molecular Remodeling Process after Myocardial Infarction

Specific proteins and processes have been identified in post-myocardial infarction (MI) pathological remodeling, but a comprehensive understanding of the complete molecular evolution is lacking. We generated microarray data from swine heart biopsies at baseline and 6, 30, and 45 days after infarction to feed machine-learning algorithms. We cross-validated the results using available clinical and experimental information. MI progression was accompanied by the regulation of adipogenesis, fatty acid metabolism, and epithelial-mesenchymal transition. The infarct core region was enriched in processes related to muscle contraction and membrane depolarization. Angiogenesis was among the first morphogenic responses detected as being sustained over time, but other processes suggesting post-ischemic recapitulation of embryogenic processes were also observed. Finally, protein-triggering analysis established the key genes mediating each process at each time point, as well as the complete adverse remodeling response. We modeled the behaviors of these genes, generating a description of the integrative mechanism of action for MI progression. This mechanistic analysis overlapped at different time points; the common pathways between the source proteins and cardiac remodeling involved IGF1R, RAF1, KPCA, JUN, and PTN11 as modulators. Thus, our data delineate a structured and comprehensive picture of the molecular remodeling process, identify new potential biomarkers or therapeutic targets, and establish therapeutic windows during disease progression