Índices de sustitución en cirugía mayor ambulatoria: medir, contar y comparar

ResumenObjetivoComparar los índices de sustitución de la actividad realizada por cirugía mayor ambulatoria en el Hospital Vall d’Hebron con aquellos índices obtenidos por el conjunto de hospitales públicos de Catalunya, los cuales constituyen la Xarxa Hospitalaria d’Utilització Pública (XHUP).MétodosSe calculan los índices de sustitución del 65% de los Grupos Relacionados en el Diagnóstico (GRD) susceptibles de cirugía sin ingreso del Hospital Vall d’Hebron y los de la XHUP para después poder calcular y comparar las medias de los dos grupos. Para ello se utilizan las bases de datos del CMBDH de los años 1998 y 1999.ResultadosLas medias de los índices de sustitución son de un 48,88% para el Hospital Vall d’Hebron y de un 35,14% para los hospitales de la XHUP. Esta diferencia es estadísticamente significativa (p < 0,0001) calculada con un nivel de significación de un 5%. También se observa que los DRG con índices de sustitución más elevados son coincidentes en los dos grupos y son los siguientes: 039, 229, 364, 262, 062, 362 y 342.ConclusionesConsiderando las actuales técnicas de benchmarking en el ámbito sanitario, este trabajo demuestra que los índices de sustitución son una herramienta válida a utilizar para comparar hospitales, especialmente en el caso que se pudiera trabajar con bases de datos robustas.SummaryObjectiveCompare the substitution indexes of the ambulatory surgery activity done in the Vall d’Hebron Hospital with those indexes obtained from the all public hospitals of Catalonia which constitute the Public Hospital Net.MethodsThere have been calculated the substitution indexes of the 65% of DRGs which are treated with ambulatory surgery at the Vall d’Hebron Hospital and in the global of public hospital net in Catalonia. For this pourpose, it has been used the MBDS of the years 1998 and 1999. The means of the substitution indexes have been compared with a Z test.ResultsThe means of the substitution indexes are of a 48.88% for the Vall d’Hebron Hospital and of a 35.14% for the whole public hospitals. The difference is statically significant (p < 0.0001). Moreover, the highest substitution indexes are the same for both groups and are the follow: 039, 229,364, 262, 062, 362 y 342.ConclusionsTaking into account the present techniques of benchmarking in the health care field, this work shows that the substitution indexes are a valid tool that can be used to compare hospitals, specially in the case that it could be possible to work with robust data bases

Protección de menores en situación de riesgo y desamparo: acogimiento y adopción. Una mirada desde el trabajo social

El Sistema de Protección a la Infancia trata de prevenir y responder ante casos de cualquier tipo de maltrato infantil, con el fin de evitar que los menores terminen en situación de desprotección. El presente trabajo pretende trasladar el conocimiento sobre las situaciones de desprotección en la infancia, los diferentes recursos y protocolos ante las situaciones de riesgo y desamparo infantil, haciendo hincapié en los recursos de acogimiento y adopción. Todo ello recogido en el marco de la legislación vigente y el conjunto de políticas sociales en dicho área a nivel autonómico, estatal, europeo e internacional. Asimismo, se pretende explorar el sistema de Servicios Sociales en el ámbito del bienestar social donde el trabajo social tiene un papel fundamental en la protección de menores, tratando de asegurarles un entorno seguro para su desarrollo y protección integral.The Child Protection System tries to prevent and respond to any type of children abuse, in order to halt this minors ending up in a situation characterized by a lack of protection. The aim of this work is to spread awareness about the mentioned situations, resources and protocols to avoid conditions and scenes where children are undergoing negligences or other risks; highlighting foster care and adoption programmes. Moreover, this project will be developed in the framework of the current legislation and social policies at regional, statewide, European and international levels. To end with, this project explores the Social Services system in the field of social welfare, where social work plays a fundamental role in the protection of minors, trying to ensure a safe environment for their development and comprehensive protection.Departamento de Sociología y Trabajo SocialGrado en Trabajo Socia

Educación basada en el pensamiento. Modelo de ciclos

El presente trabajo consiste en un análisis de la educación basada en el pensamiento teniendo en cuenta aspectos como el pensamiento, sus tipos y la importancia de este en el aula. De este modo, se ofrecerá una nueva visión de la educación; cuyo objetivo es capacitar al alumnado para ser un pensador crítico, libre y protagonista de su propio conocimiento. A continuación, se plantea una propuesta educativa basada en el pensamiento, mediante el modelo de ciclos; un enfoque innovador que consiste en transformar las estructuras internas del pensamiento a través de cuatro fases concretas. Por último, se realiza un análisis crítico de la propia historia de vida, sirviendo de autoaprendizaje para la futura práctica docente.The present work consists of an analysis of thought-based education taking into account aspects such as thought, its types and its importance in the classroom. In this way, a new vision of education will be offered; whose objective is to train students to be a critical, free thinker and protagonist of their own knowledge. Then, an educational design based on thought is proposed, by the cycle model; an innovative approach consisting of transforming the internal structures of thought through four concrete phases. Finally, a critical analysis of the own life history is carried out, serving as self-learning for the future teaching practice.Grado en Educación Primari

Randomized trial comparing three fixed combinations of prostaglandins/prostamide with timolol maleate

Jaime Pablo Kelly Rigollet, Joan Anton Ondategui, Angels Pasto, Laura Lop, Institut Catal&amp;agrave; de la Salut, Centre de Atenci&amp;oacute; Prim&amp;agrave;ria MANSO, Eixample esquerra, Barcelona, Spain, The results of this were first presented in the World Glaucoma Congress, Boston (8&amp;ndash;11 July 2009)Introduction: To evaluate the long-term efficacy and safety of 3 commercially available fixed combinations of prostaglandin analogs or a prostamide with timolol maleate in patients with primary open angle glaucoma or ocular hypertension.Methods: In this randomized, prospective, single-blind study, intraocular pressure (IOP) was measured after a 1-month washout period and pachymetry was performed before randomizing patients to latanoprost 50 &amp;micro;g/timolol 5 mg/1 mL (L/T), bimatoprost 300 &amp;micro;g/timolol 5 mg/1 mL (B/T), or travoprost 40 &amp;micro;g/timolol 5 mg/1 mL (T/T). IOP was measured monthly for 6 months and then at 12 months by an investigator blinded to the study drug. Adverse reactions were recorded.Results: 128 cases were included in the study. The 3 treatment groups had similar baseline characteristics and comparable IOP. All 3 combinations decreased IOP by at least 6 mmHg and IOP remained below 21 mmHg throughout the study. At 12 months L/T achieved greater reduction in IOP than the other 2 fixed combinations, but the difference between L/T and B/T was not statistically significant. At 6 months, more B/T-treated patients reported red eye (P &amp;lt; 0.05 vs L/T and T/T). At 12 months, fewer adverse reactions were reported, with no cases of red eye reported for L/T (P = 0.03 vs B/T).Conclusions: All 3 combinations are effective at lowering IOP but at 12 months L/T and B/T were found to be more effective than T/T. Treatments were well tolerated after 12 months but L/T showed less hyperemia than B/T throughout the study (P &amp;lt; 0.05).Keywords: bimatoprost/timolol, fixed combinations, intraocular pressure, latanoprost/timolol, ocular hypertension, primary open angle glaucoma, travoprost/timolol

Double-pass technique and compensation-comparison method in eyes with cataract

PURPOSE To clinically assess the objective scatter index (OSI) obtained from double-pass images and the log(s) parameter measured with the direct compensation-comparison psychophysical technique in eyes with cataract. SETTING Ophthalmology Service, Terrassa Hospital, Barcelona, Spain. DESIGN Prospective observational case series. METHODS The analysis comprised eyes diagnosed with nuclear, cortical, or posterior subcapsular cataracts and healthy eyes (control group). Patient examinations included assessment of the manifest subjective refraction, corrected distance visual acuity, contrast sensitivity, and cataract grade using the Lens Opacities Classification System III (LOCS III) score. The protocol also included the straylight (log[s]) measured by the C-Quant device, measurement of the objective optical quality (Strehl ratio and modulation transfer function cutoff frequency), and the OSI (HD Analyzer). RESULTS Significant correlations with LOCS III classification were found in terms of log(s) and OSI, although they were slightly stronger with OSI for all cataract types, which could be attributable to higher-order aberrations. The OSI and log(s) shared approximately 44% of the scattering estimation and to coincide on the visual function decline with scattering for the 3 cataract types evaluated. Limits to discriminate between healthy and cataractous eyes and sensitivity and specificity values were 1.15 (sensitivity 91%, specificity 100%) for log(s) and 1.18 (sensitivity 89%, specificity 100%) for OSI (P < .05). CONCLUSIONS Both instruments provide complementary information to diagnose cataracts and follow patients. Although backscattered light from deeper retinal layers can have an effect on OSI, the double-pass image provides information to grade different types of cataract when assessing cataractous eyes for treatment.Preprin

Variations of OCT measurements corrected for the magnification effect according to axial length and refractive error in children

The aim of this paper was to examine the distribution of macular, retinal nerve fiber layer (RNFL) thickness and optic disc parameters of myopic and hyperopic eyes in comparison with emmetropic control eyes and to investigate their variation according to axial length (AL) and spherical equivalent (SE) in healthy children. Methods: This study included 293 pairs of eyes of 293 children (145 boys and 148 girls), ranging in age from 6 to 17 years. Subjects were divided according to SE in control (emmetropia, 99 children), myopia (100 children) and hyperopia (94 children) groups and according to axial AL in 68 short ((Formula presented.)22.00(Formula presented.)mm, 68), medium (from (Formula presented.)22.00(Formula presented.)mm to 25.00(Formula presented.)mm, 189) and long eyes ((Formula presented.)25.00(Formula presented.)mm, 36). Macular parameters, RNFL thickness and optic disc morphology were assessed by the CirrusTM HD-OCT. AL was measured using the IOL-Master system. Littmann’s formula was used for calculating the corrected AL-related ocular magnification. Results: Mean age ((Formula presented.)(Formula presented.)SD) was 10.84(Formula presented.)(Formula presented.)(Formula presented.)3.05 years; mean ((Formula presented.)(Formula presented.)SD) SE was (Formula presented.)0.14(Formula presented.)(Formula presented.)(Formula presented.)0.51 D (range from (Formula presented.)8.75 to (Formula presented.)8.25 D) and mean AL ((Formula presented.)(Formula presented.)SD) was 23.12(Formula presented.)(Formula presented.)(Formula presented.)1.49. Average RNFL thickness, average macular thickness and macular volume decreased as AL and myopia increased. No correlations between AL/SE and optic disc parameters were found after correcting for magnification effect. Conclusions: AL and refractive error affect measurements of macular and RNFL thickness in healthy children. To make a correct interpretation of OCT measurements, ocular magnification effect should be taken into account by clinicians or OCT manufacturers.Postprint (published version

Aplicació d’eines TIC a la millora de les competències clíniques en l’àmbit de l’òptica i l’optometria: “OPTOstream”

Actualment, l’estudiantat de la Facultat d’Òptica i Optometria de les assignatures clíniques (Grau i Màster) participen de forma activa en l’atenció de pacient reals, sota la supervisió del professorat. Els casos atesos durant les sessions pràctiques es plantegen i discuteixen en les sessions de seminari amb els docents i la resta del grup. Malgrat el valor docent d’aquesta metodologia, l’estudiant no tenia la possibilitat de comprovar la seva actuació durant l’atenció d’un cas real, a partir de les observacions del docent. Aquesta situació dificulta un aprofitament òptim de l’experiència d’aprenentatge per part de l’estudiant. La incorporació de solucions tècniques contrastades en l’àmbit de la formació, com és el cas de l’enregistrament i visionat posterior o en temps real de casos, permeten a l’estudiant participar més activament en el seu procés d’aprenentatge i contribueixen a fer més efectiva l’adquisició de determinats coneixements i competències bàsiques per al desenvolupament de la seva carrera professional i investigadora. El projecte “OPTOstream” ha permès desenvolupar una metodologia pròpia basada en l’elaboració i anàlisi posterior de casos enregistrats en vídeo o bé la projecció en temps real de les actuacions clíniques al nou auditori de la Facultat.Peer Reviewe

System based on the contrast of Purkinje images to measure corneal and lens scattering

Current methods to measure intraocular scattering provide information on the total scattered light, which consists of the combined contributions originating from different ocular structures. In this work, we propose a technique for the objective and independent assessment of scattering caused by the cornea and the lens based on the analysis of the contrast of the third and fourth Purkinje images. The technique is preliminarily validated first by using artificial eyes with different levels of corneal and lens scattering; second, it is validated in eyes wearing customized contact lenses to simulate corneal scattering and eyes with nuclear cataracts. Finally, it is tested on a larger population of eyes with cataracts and corneal disorders to prove its clinical usefulness.Postprint (published version