Indicadores bibliométricos: origen, aplicación, contradicción y nuevas propuestas

ResumenLa profileración y globalización de la literatura científica ha puesto en evidencia la ya reconocida necesidad de crear un sistema de evaluación, clasificación y comparación de la calidad para este tipo de producción. En respuesta ha esta necesidad ha surgido metodologías  que incluyen escalas e indicadores para la cuantificación, evaluación y calificación del efecto que una publicación tiene sobre el entorno cientifico.[Rueda Clausen CF, Villa Roel C, Rueda Clausen CE. Indicadores bibliométricos: origen, aplicación, contradicción y nuevas propuestas. MedUNAB 2005; 8(1):29-36].Palabras clave: Indicadores bibliométricos, Factor de impacto, Evaluación, Calidad, Publicaciones científicas, Valides.&nbsp

Aportaciones al estudio y desarrollo de la documentación sanitaria: propuesta de un modelo para el sistema de documentación sanitaria en Colombia

Un sistema sanitario es funcional y eficiente si todas las partes y sus integrantes tienen un fluido intercambio de información, ésta, a su vez, debe poseer unas características irrenunciables para cumplir la función integradora del Sistema. Los postulados de la documentación aplicados a salud, así como los principios de la calidad, ofrecen un escenario muy propicio para desarrollar soluciones a problemas relacionados con la información sanitaria. El sistema de salud colombiano está inmerso en un proceso de reformas y cambios a los que no son ajenos los canales de comunicación, el manejo de la información y su utilización para la gestión. La presente tesis hace una propuesta que puede implementarse de una forma sencilla, sin requerimiento de grandes inversiones y de forma escalonada. Los objetivos fundamentales del modelo propuesto están centrados en ofrecer una mejor calidad de la atención y aumentar la satisfacción de los usuarios

La historia clínica informatizada. Evaluación de los casos colombiano y español

ResumenLa Historia Clínica (HC) es un documento con unas características muy especiales que requieren un manejo diferente desde el punto de vista documental. Tiene una serie de usos y usuarios que utilizan con diferentes fines. Para mantener su utilidad y cumplir con las normas propias de cada país se hace imprescindible el cambio de la forma tradicional en que se construye (mediante la adición de folios manuscritos) a la utilización de las tecnologías informáticas y de comunicación (TIC) que se disponen. Se presentan las principales ventajas y desventajas de la Historia Clínica Informatizada(HCI), frente a la tradicional en papel, relacionando los diferentes usos y usuarios, así como los condicionantes que cada uno de ellos requiere para el eficiente manejo de la información. Se analizan fundamentalmente los casos de Colombia y España, contrastando los aspectos normativos y los logros alcanzados con el propósito de tener un comparativo que permita orientar los futuros desarrollos, buscando integraciones básicas de los modelos.[Rueda-Clausen CE. La historia clínica informatizada. Evaluación de los casos colombiano y español. MedUNAB 2006; 9:63-71].Palabras clave: Historia Clínica, Historia Clínica Informatizada, Expediente Sanitario, Desarrollo informático, Colombia, España

Aportaciones al estudio y desarrollo de la documentación sanitaria: propuesta de un modelo para el sistema de documentación sanitaria en Colombia

Un sistema sanitario es funcional y eficiente si todas las partes y sus integrantes tienen un fluido intercambio de información, ésta, a su vez, debe poseer unas características irrenunciables para cumplir la función integradora del Sistema. Los postulados de la documentación aplicados a salud, así como los principios de la calidad, ofrecen un escenario muy propicio para desarrollar soluciones a problemas relacionados con la información sanitaria. El sistema de salud colombiano está inmerso en un proceso de reformas y cambios a los que no son ajenos los canales de comunicación, el manejo de la información y su utilización para la gestión. La presente tesis hace una propuesta que puede implementarse de una forma sencilla, sin requerimiento de grandes inversiones y de forma escalonada. Los objetivos fundamentales del modelo propuesto están centrados en ofrecer una mejor calidad de la atención y aumentar la satisfacción de los usuarios

Inflammation but Not Endothelial Dysfunction Is Associated with the Severity of Coronary Artery Disease in Dyslipidemic Subjects

Introduction. Endothelial dysfunction and inflammation play a key role in the development of atherosclerosis. The present study evaluated endothelial function, inflammatory parameters, and carotid intima-media thickness (IMT) in dyslipidemic patients with or without coronary artery disease (CAD). Methods. Metabolic profile and inflammatory parameters were determined in dyslipidemic patients with (+CAD, n = 33) and without (−CAD, n = 69) symptomatic CAD. Endothelial function was evaluated by flow mediated dilatation (FMD) and plasma concentration of nitrites and nitrates. Carotid IMT was measured by ultrasound. Results. No significant differences were observed in anthropometric hemodynamic or metabolic parameters between the groups. After adjusting by age and medication usage, some inflammatory markers were significantly higher in +CAD; however no significant differences in FMD or plasma levels of nitrites were observed. Conclusions. In subjects with dyslipidemia, the presence of CAD is associated with an elevation of certain inflammatory markers and carotid IMT but not with further endothelial dysfunction

A randomized, double blind, cross-over, placebo-controlled clinical trial to assess the effects of Candesartan on the insulin sensitivity on non diabetic, non hypertense subjects with dysglyce mia and abdominal obesity. "ARAMIA"

BACKGROUND: The raising prevalence of type-2 diabetes mellitus and obesity has been recognized as a major problem for public health, affecting both developed and developing countries. Impaired fasting plasma glucose has been previously associated with endothelial dysfunction, higher levels of inflammatory markers and increased risk of developing insulin resistance and cardiovascular events. Besides life-style changes, the blockade of the renin-angiotensin system has been proposed as a useful alternative intervention to improve insulin resistance and decrease the number of new type-2 diabetes cases. The aim of this clinical trial is to study the effect of the treatment with Candesartan, an angiotensin II receptor antagonist, on the insulin resistance, the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in a group of non diabetic, non hypertensive, dysglycemic and obese subjects. METHODS AND DESIGN: A randomized, double blind, cross-over, placebo-controlled, clinical trial was designed to assess the effects of Candesartan (up to 32 mg/day during 6 months) on the Homeostasis Model Assessment (HOMA) index, lipid profile, protrombotic state, oxidative stress and plasma levels of inflammatory markers. The participants will be recruited in the "Fundación Cardiovascular de Colombia". Subjects who fullfil selection criteria will receive permanent educational, nutritional and exercise support during their participation in the study. After a 15 days-run-in period with placebo and life-style recommendations, the patients who have a treatment compliance equal or greater than 80% will be randomlly assigned to one of the treatment groups. Group A will receive Candesartan during 6 months and placebo during 6 months. Group B will receive placebo during the first 6 months, and then, Candesartan during the last 6 months. Control visits will be programed monthly and all parameters of interest will be evaluated every 6 months. HYPOTHESIS: Treatment with Candesartan, could improve the HOMA index, the response to the oral glucose tolerance test and reduce the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in non diabetic, non hypertense subjects with dysglycemia and abdominal obesity, recruited from a population at high risk of developing insulin resistance. These effects are independent of the changes in arterial blood pressure. Trial registration: NCT0031920

Maternal hypoxia decreases capillary supply and increases metabolic inefficiency leading to divergence in myocardial oxygen supply and demand

Maternal hypoxia is associated with a decrease in left ventricular capillary density while cardiac performance is preserved, implying a mismatch between metabolism and diffusive exchange. We hypothesised this requires a switch in substrate metabolism to maximise efficiency of ATP production from limited oxygen availability. Rat pups from pregnant females exposed to hypoxia (FIO2=0.12) at days 10-20 of pregnancy were grown to adulthood and working hearts perfused ex vivo. 14 C-labelled glucose and 3 H-palmitate were provided as substrates and metabolism quantified from recovery of 14CO2 and 3 H2O, respectively. Hearts of male offspring subjected to Maternal Hypoxia showed a 20% decrease in cardiac output (P<0.05), despite recording a 2-fold increase in glucose oxidation (P<0.01) and 2.5-fold increase (P<0.01) in palmitate oxidation. Addition of insulin to Maternal Hypoxic hearts, further increased glucose oxidation (P<0.01) and suppressed palmitate oxidation (P<0.05), suggesting preservation in insulin signalling in the heart. In vitro enzyme activity measurements showed that Maternal Hypoxia increased both total and the active component of cardiac pyruvate dehydrogenase (both P<0.01), although pyruvate dehydrogenase sensitivity to insulin was lost (NS), while citrate synthase activity declined by 30% (P<0.001) and acetyl-CoA carboxylase activity was unchanged by Maternal Hypoxia, indicating realignment of the metabolic machinery to optimise oxygen utilisation. Capillary density was quantified and oxygen diffusion characteristics examined, with calculated capillary domain area increased by 30% (P<0.001). Calculated metabolic efficiency decreased 4-fold (P<0.01) for Maternal Hypoxia hearts. Paradoxically, the decline in citrate synthase activity and increased metabolism suggest that the scope of individual mitochondria had declined, rendering the myocardium potentially more sensitive to metabolic stress. However, decreasing citrate synthase may be essential to preserve local PO2, minimising regions of hypoxia and hence maximising the area of myocardium able to preserve cardiac output following maternal hypoxia

The Unseen Population of F to K-type Companions to Hot Subdwarf Stars

We present a method to select hot subdwarf stars with A to M-type companions using photometric selection criteria. We cover a wide range in wavelength by combining GALEX ultraviolet data, optical photometry from the SDSS and the Carlsberg Meridian telescope, near-infrared data from 2MASS and UKIDSS. We construct two complimentary samples, one by matching GALEX, CMC and 2MASS, as well as a smaller, but deeper, sample using GALEX, SDSS and UKIDSS. In both cases, a large number of composite subdwarf plus main-sequence star candidates were found. We fit their spectral energy distributions with a composite model in order to estimate the subdwarf and companion star effective temperatures along with the distance to each system. The distribution of subdwarf effective temperature was found to primarily lie in the 20,000 - 30,000 K regime, but we also find cooler subdwarf candidates, making up ~5-10 per cent. The most prevalent companion spectral types were seen to be main-sequence stars between F0 and K0, while subdwarfs with M-type companions appear much rarer. This is clear observational confirmation that a very efficient first stable Roche-lobe overflow channel appears to produce a large number of subdwarfs with F to K-type companions. Our samples thus support the importance of binary evolution for subdwarf formation.Comment: 30 pages, 10 figures, 11 tables. Accepted for publication in MNRA

Adiposity indices in the prediction of insulin resistance in prepubertal Colombian children

248-255OBJECTIVE: To compare BMI with abdominal skinfold thickness (ASF), waist circumference and waist-to-height ratio in the prediction of insulin resistance (IR) in prepubertal Colombian children. DESIGN: We calculated age- and sex-specific Z-scores for BMI, ASF, waist circumference, waist-to-height ratio and three other skinfold-thickness sites. Logistic regression with stepwise selection (P = 0·80 for entry and P = 0·05 for retention) was performed to identify predictors of IR and extreme IR, which were determined by age- and sex-specific Z-scores to identify the ≥ 90th and ≥ 95th percentile of homeostasis model assessment (HOMAIR), respectively. We used receiver operating characteristic curves to compare the area under the curve between models. SETTING: Bucaramanga, Colombia. SUBJECTS: Children (n 1261) aged 6-10 years in Tanner stage 1 from a population-based study. RESULTS: A total of 127 children (seventy girls and fifty-seven boys) were classified with IR, including sixty-three children (thirty-three girls and thirty boys) classified with extreme IR. Only ASF and BMI Z-scores were retained as predictors of IR by stepwise selection. Adding ASF Z-score to BMI Z-score improved the area under the curve from 0·794 (95 % CI 0·752, 0·837) to 0·811 (95 % CI 0·770, 0·851; P for contrast = 0·01). In predicting extreme IR, the addition of ASF Z-score to BMI Z-score improved the area under the curve from 0·837 (95 % CI 0·790, 0·884) to 0·864 (95 % CI 0·823, 0·905; P for contrast = 0·01). CONCLUSIONS: ASF Z-score predicted IR independent of BMI Z-score in our population of prepubertal children. ASF and BMI Z-scores together improved IR risk stratification compared with BMI Z-score alone, opening new perspectives in the prediction of cardiometabolic risk in prepubertal children