Diagnosis of the undergraduate dental care clinics of the Santo Tomás University based on the audit program for quality improvement

Durante los últimos años en Colombia se ha empezado a hablar de garantía de la calidad, no queriendo decir que en el pasado no se buscara la excelencia. La puesta en marcha de modelos de garantía de la calidad y mejoramiento continúo, han generado grandes cambios en el sector salud. A partir de la expedición de la Ley 100 de 1993, con sus decretos reglamentarios, se ha generado una gran transformación en le sector salud, lo que ha generado enormes retos a las instituciones en cuanto a su organización, administración y atención al paciente obligándolas a transformarse teniendo en cuenta las expectativas del usuario. Las clínicas odontológicas de la USTA como prestadoras de servicios de salud dentro de sus programas de atención a los pacientes han venido implantando procesos de garantía de la calidad en la prestación de los servicios de salud que ofrece a la comunidad interna y externa. Sin embargo estos procesos se efectúan en forma independiente lo cual impide contar con estándares de calidad que reflejen el grado de eficacia, eficiencia, pertinencia, efectividad, seguimiento y satisfacción de los usuarios de los servicios prestados. Nuestro propósito es evaluar el sistema de calidad de la Universidad, examinando todo el conjunto de la organización, procesos, procedimientos, recursos y responsabilidades para medir la gestión en la organización y conocer si existen puntos críticos en la atención odontológica. Es así como el diagnóstico es la base para en un futuro diseñar un Programa de Auditoría para el Mejoramiento de la Calidad (PAMEC) que permita a la Universidad, como prestador que es cumplir con la normatividad que se ha establecido en el Decreto 2.309 del 15 de Octubre de 2002, por el cual se define el Sistema Obligatorio de Garantía de la Calidad de la Atención en Salud del Sistema General de Seguridad Social en Salud. La UNIVERSIDAD SANTO TOMAS a través del diagnostico de las clínicas odontológicas busca identificar y ajustar los procesos y procedimientos mediante la adecuada identificación, estandarización y control de cada mía de las tareas, actividades y mecanismos que intervienen en el proceso de Auditoría Odontológica; esta estructura debe estar relacionada a unos procedimientos establecidos como el mejoramiento continuo, permitiendo establecer bases que se evalúen periódicamente con el fin de obtener mejores resultados, haciendo más confiable la prestación del servicio.INTRODUCCIÓN 1 OBJETIVOS 4 OBJETIVO GENERAL 4 OBJETIVOS ESPECÍFICOS 4 1. MARCO TEÓRICO 6 1.1 SISTEMA DE SALUD 6 1.2 GARANTÍ A DE CALIDAD 8 1.3 DECRETO 2309 DE OCTUBRE DE 2002 10 1.3.1 Organización del Sistema Obligatorio de Garantía de la Calidad 11 1.3.1.1 Sistema Único de Habilitación 12 1.3.2 Procesos de Auditoria para el Mejoramiento de la Calidad de la Atención en Salud 13 1.3.2.1 Niveles de operación de la auditoría para el mejoramiento de la calidad de ios servicios de salud 14 1.3.2.2 Tipos de acciones 14 1.3.2.3 Énfasis de la auditoría según tipos de entidad 15 1.3.2.4 Procesos de auditoría en las instituciones prestadoras de servicios de salud 15 1.3.2.5 Vigilancia, inspección y control 15 1.3.3 Sistema Único de Acreditación 16 1.3.3.1 Manuales de Estándares del Sistema Único de Acreditación 16 1.3.3.2 Del Sistema de Información para la Calidad 16 1.3.4 Que es un Pamec 17 1.34.1 Filosofía del Pamec 17 1.3.5 La auditoría en el Sistema Obligatorio de Garantía de Calidad 18 1.3.5.1 Autocontrol 20 1.3.5.2 La calidad en los servicios de salud 21 iv 1.3.5.3 Objetivos de la auditoria de salud 21 1.3.5.4 Tipos de acciones de auditoría 22 1.4 RESEÑA HISTÓRICA DE LA UNIVERSIDAD SANTO TOMAS 25 1.4.1 Constitución 25 1.4.2 Misión de la institución 26 1.4.2.1 Misión de la facultad de Odontología 27 1.4.3 Visión de la institución 27 1.4.3.1 Visión de la facultad de Odontología 28 1.4.4 Filosofía y políticas 28 1.4.5 Organigrama de la institución 30 2. METODOLOGÍA 31 2.1 PROPÓSITO 31 2.2 POBLACIÓN 32 2.3 TIPO DE ESTUDIO 32 3. DIAGNÓSTICO INSTITUCIONAL 33 3.1 HALLAZGOS 33 3.1.1 Demanda 33 3.1.2 Oferta 33 3.1.2.1 Recurso humano 33 3.1.2.2 Recursos físicos 35 3.1.2.3 Recursos económicos ' 35 3.1.2.4 Procesos 35 3.1.2.5 Resultados 35 4. HALLAZGOS DEL AUTOCONTROL DE LA UNIVERSIDAD SANTO TOMAS 50 4.1 FASE AMBIENTE DE CONTROL 50 4.1.1 Principios y valores institucionales 50 4.1.2 Compromiso y respaldo de la alta dirección 50 4.1.3 Cultura del autocontrol 50 4.1.4 Pilares del autocontrol 50 4.2 FASE DE DOCUMENTACIÓN 52 4.2.1 Normas y disposiciones internas 52 4.2.2 Fase retroal ¡mentación 53 4.3 AUDITORIA INTERNA 53 4.3.1 Necesidades y expectativas del cliente 53 4.3.2 Proceso de atención odontológica 54 4.3.3 Proceso de atención al usuario 60 5. CONCLUSIONES 64 6. RECOMENDACIONES 65 BIBLIOGRAFÍA 69 ANEXOS 71Especializaciónn recent years, Colombia has begun to talk about quality assurance, not meaning that in the past excellence was not sought. The implementation of models of quality assurance and continuous improvement, They have generated great changes in the health sector. Since the issuance of Law 100 of 1993, with its regulatory decrees, a great transformation has been generated in the health sector, which has generated enormous challenges for institutions in terms of their organization, administration and patient care, forcing them to transform taking into account the expectations of the user. The dental clinics of the USTA as providers of health services within of its patient care programs have been implementing quality assurance processes in the provision of health services offered to the internal and external community. However, these processes are carried out which prevents having quality standards that reflect the degree of efficacy, efficiency, relevance, effectiveness, follow-up and satisfaction of the users of the services provided. Our purpose is to evaluate the quality system of the University, examining the entire organization, processes, procedures, resources and responsibilities to measure management in the organization and to know if there are critical points in dental care. This is how the diagnosis is the basis for in the future designing an Audit Program for Quality Improvement (PAMEC) that allows the University, as a provider to comply with the regulations that have been established in Decree 2,309 of October 15, 2002, which defines the Mandatory System of Quality Assurance of Health Care of the General System of Social Security in Health. SANTO TOMAS UNIVERSITY through the diagnosis of dental clinics seeks to identify and adjust processes and procedures through proper identification, standardization and control of each of the tasks, activities and mechanisms involved in the Dental Audit process; This structure must be related to established procedures such as continuous improvement, allowing the establishment of bases that are periodically evaluated in order to obtain better results, making the provision of the service more reliable

Eficacia de las Tecnologías de la Información y Comunicación (TIC) para facilitar a los pacientes la comprensión del protocolo en el tratamiento de ortodoncia.

Resumen Objetivo: determinar  la eficacia de un medio educativo multimedia como herramienta de las tecnologías de la información y comunicación para mejorar la comprensión  del protocolo a seguir para el tratamiento de ortodoncia de los pacientes. Materiales y métodos: Se condujo un estudio tipo experimental, ensayo comunitario. Se evaluó una muestra de 126 pacientes de ortodoncia que asisten a las clínicas odontológicas de la Universidad Santo Tomás, a quienes se les asigno la intervención aleatoriamente.  El grupo intervenido conformado por 63 pacientes, se les explico el protocolo a seguir durante el tratamiento de ortodoncia mediante el MEM. El grupo control, de 63 pacientes se les explico dicho protocolo mediante el método convencional, es decir de forma verbal en consulta de forma estandarizada. Resultados: El 98% de las personas consideran que el lenguaje utilizado para la explicación fue sencillo y fácil de entender, el 100% de los pacientes manifestaron entender el protocolo del tratamiento con la ayuda del MEM. La prueba estadística arrojó diferencia estadísticamente significativa, con una comprensión totalmente del protocolo a seguir en la Ortodoncia por encima del 90% lo que se interpreta como una ventaja al utilizar el MEM cuando se quiera explicar el protocolo a seguir durante y después del tratamiento de ortodoncia. Conclusión: El presente estudio demostró que los dos grupos tuvieron un entendimiento en alto grado del protocolo a seguir durante el tratamiento de ortodoncia. Sin embargo dicho entendimiento fue mayor en el grupo al que se aplicó el MEM, lo cual nos mostró la eficacia del  MEM cuando se quiera explicar el protocolo a seguir durante y después del tratamiento de ortodoncia

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat