LA GESTIÓN POR COMPETENCIAS: UN MODELO PARA LA GESTIÓN DE RECURSOS HUMANOS EN LAS ORGANIZACIONES SANITARIAS.

The management for competences constitutes a model of participation and an adaptable stimulus to the career of the health professional. It is an integral model of management of the human resources that contributes, detecting, acquiring, promoting and developing the competences that give an extra value to the organization and for this reason this model is unique in this field of management. It proposes a management style in which the human factor is a priority and every person must contribute with their best skills to the organization. The aims we have proposed are to extend a new model of direction in the health organization, make the readers aware of the importance and impact of the management for competences and contribute with a global and integral vision knowing the specific tools of the management of human resources for competences. The model we are presenting in this paper is considered as one of the most appropriate for the current period. It is a way to fight the daily challenges in such a way that it makes it possible to train the intellectual capital of institutions and organizations. In general most of the companies and especially health organizations do not invest enough in the development of their teams, for reasons like the lack of systematized strategies for the evaluation of performance, or the unawareness of the importance of training the intellectual capital as a key factor.La gestión por competencias constituye un modelo de participación y estímulo adaptable a la carrera profesional del profesional sanitario. Es un modelo integral de gestión de los recursos humanos que contribuye a tal fin, detectando, adquiriendo, potenciando y desarrollando las competencias que dan valor añadido a la organización y que le diferencia en su sector. Propone un estilo de dirección donde prima el factor humano, en el que cada persona debe aportar sus mejores cualidades a la organización. Extender un nuevo modelo de dirección en la organización sanitaria, sensibilizar a los lectores sobre la importancia y la repercusión de la gestión por competencias y aportar una visión global e integral conociendo las herramientas específicas de la gestión de recursos humanos por competencias, son los objetivos que nos hemos planteado. El modelo que presentamos, se viene posicionando como uno de los más adecuados para los nuevos tiempos. Se trata de una manera de lidiar con lo cotidiano, de tal manera que posibilita la formación del capital intelectual de una institución u organización. La mayoría de las empresas en general y de las organizaciones sanitarias en particular, invierten de forma muy tímida en el desarrollo de sus equipos, por motivos que varían desde la inexistencia de estrategias sistematizadas de evaluación de desempeño, hasta el desconocimiento de la importancia de la formación de un capital intelectual como factor diferencial

Antimicrobial use and microbiological testing in district general hospital ICUs of the Veneto region of north-east Italy

International - predominantly American - studies undertaken in the ICUs of teaching centres show that inadequate antibiotic therapy increases mortality and length of stay. We sought to ascertain whether this also pertains to smaller ICUs in the Veneto region of north-east Italy. To the best of our knowledge, this is the first such survey in the Veneto area or in Italy as a whole. A retrospective, observational study was performed across five general-hospital ICUs to examine appropriateness of microbiological sampling, empirical antibiotic adequacy, and outcomes. Among 911 patients (mean age, 65.8 years ± 16.2 SD; median ICU stay, 17.0 days [IQR, 8.0–29.0]), 757 (83.1 %) were given empirical antibiotics. Treatment adequacy could be fully assessed in only 212 patients (28.0 %), who received empirical treatment and who had a relevant clinical sample collected at the initiation of this antibiotic (T0). Many other patients only had delayed microbiological investigation of their infections between day 1 and day 10 of therapy. Mortality was significantly higher among the 34.9 % of patients receiving inadequate treatment (48.6 % vs 18.80 %; p < 0.001). Only 32.5 % of combination regimens comprised a broad-spectrum Gram-negative β-lactam plus an anti-MRSA agent, and many combinations were irrational. Inadequate treatment was frequent and was strongly associated with mortality; moreover, there was delayed microbiological investigation of many infections, precluding appropriate treatment modification and de-escalation. Improvements in these aspects and in antibiotic stewardship are being sought

Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Management by area: a model for the management of human resources in health organizations

La gestión por competencias constituye un modelo de participación y estímulo adaptable a la carrera profesional del profesional sanitario. Es un modelo integral de gestión de los recursos humanos que contribuye a tal fin, detectando, adquiriendo, potenciando y desarrollando las competencias que dan valor añadido a la organización y que le diferencia en su sector. Propone un estilo de dirección donde prima el factor humano, en el que cada persona debe aportar sus mejores cualidades a la organización. Extender un nuevo modelo de dirección en la organización sanitaria, sensibilizar a los lectores sobre la importancia y la repercusión de la gestión por competencias y aportar una visión global e integral conociendo las herramientas específicas de la gestión de recursos humanos por competencias, son los objetivos que nos hemos planteado. El modelo que presentamos, se viene posicionando como uno de los más adecuados para los nuevos tiempos. Se trata de una manera de lidiar con lo cotidiano, de tal manera que posibilita la formación del capital intelectual de una institución u organización. La mayoría de las empresas en general y de las organizaciones sanitarias en particular, invierten de forma muy tímida en el desarrollo de sus equipos, por motivos que Enfermería Global Nº 5 Noviembre 2004 Página 2 varían desde la inexistencia de estrategias sistematizadas de evaluación de desempeño, hasta el desconocimiento de la importancia de la formación de un capital intelectual como factor diferencial.ABSTRACT: The management for competences constitutes a model of participation and an adaptable stimulus to the career of the health professional. It is an integral model of management of the human resources that contributes, detecting, acquiring, promoting and developing the competences that give an extra value to the organization and for this reason this model is unique in this field of management. It proposes a management style in which the human factor is a priority and every person must contribute with their best skills to the organization. The aims we have proposed are to extend a new model of direction in the health organization, make the readers aware of the importance and impact of the management for competences and contribute with a global and integral vision knowing the specific tools of the management of human resources for competences. The model we are presenting in this paper is considered as one of the most appropriate for the current period. It is a way to fight the daily challenges in such a way that it makes it possible to train the intellectual capital of institutions and organizations. In general most of the companies and especially health organizations do not invest enough in the development of their teams, for reasons like the lack of systematized strategies for the evaluation of performance, or the unawareness of the importance of training the intellectual capital as a key factor