Cálculo económico del aporte de los internos y residentes de cirugía general de la Universidad Surcolombiana al Departamento de Cirugía General de la E.S.E. Hospital Universitario de Neiva

Objective: this study estimated the value of surgical assistantships, between May, 2008 and April, 2009; of undergraduate medicine students and different clinical postgraduate studies from Universidad Surcolombiana to University Hospital Hernando Moncaleano Perdomo. The support given by floor review, emergency service, general surgery outpatient and sub-specialties obtained by the surgery. Materials and Methods: it was checked the statistical data reported to the National Health Administration, assistance management, hospitalization, surgery and emergenciy coordination, permanent and contract staff agenda, schedule and duties of interns and residents. Data were crossed, filtered and adjusted in tables of Microsof Office  Excel 2007. By the date of the study, a medical hour is worth 42.500 and an assistantship hour at existing billing and hiring ISS 2001 and SOAT 2008-2009. Results: a minimum total annual contribution of 601.734.830 is quantified coming from surgical assistantships at ISS 2001 rate or $644.566.046 coming from surgical assistantships at SOAT 2008-2009 rate which is divided into$159.778.750 floor review, $62.050.000 thoracic surgery,$62.050.000 gastrointestinal-oncology, $93.075.000 metabolic and nutritional support,$10.625.000 injure clinics and $214.156.080 surgical assistantships ISS 2001 or$256.987.296 surgical assistantships SOAT 2008-2009. Conclusion: the teaching-assistantship agreement represents, regarding General surgery, a strength and an opportunity. Objetivo. En este estudio se cuantificó el valor de las ayudantías quirúrgicas, entre mayo de 2008 y abril de 2009, de estudiantes del pregrado de medicina y de diferentes post-grados clínicos de la Universidad Surcolombiana al Hospital Universitario Hernando Moncaleano Perdomo. Se incluyó el apoyo brindado en: revista de piso, atención de urgencias, consulta externa de Cirugía General y las subespecialidades obtenidas por la intervención. Materiales y métodos. Se revisó la estadística reportada a la Superintendencia Nacional de Salud, Subgerencias, Hospitalización, Coordinación de Cirugía y Urgencias, agendas del personal de planta y contrato, los horarios y funcionamiento de los Internos y Residentes. Se cruzó, filtró y ajustó la información en tablas de Microsoft Office Excel 2007. Para la fecha del estudio, el valor de la hora médica corresponde a $42.500 y el de las ayudantías a la facturación y contratación vigente a tarifas ISS 2001 y SOAT 2008-2009. Resultados. Se cuantifica un aporte mínimo total anual de$ 601.734.830 con ayudantías quirúrgicas a tarifa ISS 2001 o $644.566.046 con ayudantías quirúrgicas a tarifas SOAT 2008-2009, que se discrimina en$ 159.778.750 revista de piso, $62.050.000 cirugía de tórax,$ 62.050.000 gastro-oncología, $93.075.000 soporte metabólico y nutricional,$10.625.000 clínica de heridas y $214.156,080 ayudantías quirúrgicas ISS 2001 o$256.987.296 ayudantías quirúrgicas SOAT 2008-2009. Conclusión. El convenio docencia-asistencia se convierte, en lo referente a Cirugía General, en una fortaleza y una oportunidad

Departamentos de cirugía general de la Universidad Surcolombiana (USCO) y la E.S.E. Hospital Universitario de Neiva (HUN): contextualización 2009-2010

On a regular basis the Surgery Department Coordinator from University Hospital in Neiva is at the same time the Coordinator of undergraduate professorship and the General Surgery post-graduate study. This allows the coordinator to have a broad understanding about the relationship between the two institutions and its environment. The legal framework governing the General System of Social Security on Health and specially on the Quality Guarantee subsystem allows to check the disparity in adaptation processes and performance of hospitals in relation to the current health model. In this respect the university hospital comes out well. The importance of habilitation and accreditation as the “gold standard” is highlighted for University Hospitals what is sufficiently supported in Colombian law and emphasized in Decree 2376 of July 1, 2010. Hospital history and records are reviewed until it finally became a university hospital by means of ordinance of December 24, 1998, its links with Surcolombiana University and the development of teaching-assistantship agreement until the current one, signed on September 22, 2008. University Hospital and Surcolombiana University statistical data and budget execution of 2009 and 2010 are shown. Level III service with an estimated coverage of 1.072.002 inhabitants in 2010. The University Hospital is of paramount importance in the region as a source of research, scientific knowledge and technological formation for the health human talent that is strengthened with the contribution and support of Surcolombiana University.   Tradicionalmente el coordinador del departamento de cirugía del Hospital Universitario de Neiva se desempeña como coordinador de la cátedra de pregrado y del post-grado de cirugía general lo que le permite tener un concepto amplio de la relación de las dos instituciones y de su entorno. El marco jurídico que rige el sistema general de seguridad social en salud y especialmente en el subsistema de garantía de la calidad, permite revisar la disparidad en procesos de adaptación y desempeño de los Hospitales al modelo de salud vigente, el Hospital Universitario de Neiva sale bien librado. Sobresale la importancia de la habilitación y de la acreditación como el “estándar de oro” para los Hospitales Universitarios suficientemente sustentado en la legislación colombiana y enfatizado en el decreto 2376 de 1 de julio de 2010. Se revisa la historia y antecedentes del Hospital hasta su definitiva conversión en Universitario mediante ordenanza del 24 de diciembre de 1998, sus nexos con la Universidad Surcolombiana y la evolución de los convenios docencia-asistencia hasta el vigente firmado el 22 de septiembre de 2008. Presenta la estadística y ejecución presupuestal del 2009 y 2010 del Hospital Universitario de Neiva, III nivel de atención, con una cobertura estimada para el 2010 de 1.072.002 habitantes y de la Universidad Surcolombiana. Se destaca la importancia del Hospital Universitario “Hernando Moncaleano” de Neiva en el contexto regional como generador de formación, investigación, desarrollo científico y tecnológico del talento humano en salud que se afianza con el aporte y respaldo de la Universidad Surcolombiana

Impacto de la implementación de la traqueostomía percutánea en la UCI-A del Hospital Universitario de Neiva

Objective: Open tracheostomy (OT) and percutaneous tracheostomy (PT) are frequent procedures in mechanically ventilated patients in Intensive Care Unit (ICU). Several publications have compared both techniques and their complications, especially in developed countries. This study aims to identify the characteristics of the OT and PT procedures, analyzing their complications in an ICU population of a university hospital in a developing country.  Materials and Methods: in the adult ICU in Neiva University Hospital (NUH), 66 OT and 46 PT were performed in a 21-month and 6-month period, respectively. These two retrospective cohorts were analyzed, including demographic and causal factors, request reasons, accomplishment times. Early complications and mortality were also analyzed. Results: The incidence of PT was 12.5% compared with 9% of OT. Early tracheostomy (first 10 days of orotracheal intubation), was more frequent percutaneously (OT:70%, PT: 96%). Early complications were 2.9 times more common in OT patients compared with PT (p:0.00015). Bleeding was the main complication in both techniques, being 4.7 times greater in OT compared with PT (p: 0.0022). The infection rate of surgical site was 5.6 times greater in OT than in PT (p: 0.0009). There was no association between the coagulation times as a risk factor and postsurgical bleeding. Complications like false route and pneuromathorax were present only in the PT group and were immediately solved by the surgeon in charge of the case. There was no mortality related to the procedure in any case. Conclusions: during the analysis of OT and PT carried out in the Adult ICU of the NUH, complications like bleeding and infection at the operatory site were minimal in the PT group compared with OT. PT was carried out earlier and in less time compared with OT which implies improvement in the opportunity of its performance.Objetivo: La traqueostomía abierta (TA) y la traqueostomía percutánea (TP) son procedimientos frecuentes en los pacientes con ventilación mecánica en la Unidad de Cuidados Intensivos (UCI). Varias publicaciones han comparado ambas técnicas y sus complicaciones especialmente en países desarrollados. El presente estudio busca identificar las características del procedimiento de TA y TP, analizando sus complicaciones en una población de UCI de un Hospital Universitario de un país en vía de desarrollo. Materiales y métodos: En la UCI adultos del Hospital Universitario de Neiva (HUN), se realizaron 66 TA en un periodo de 21 meses y 46 TP en un periodo de 6 meses. Se analizaron estas dos cohortes retrospectivas incluyendo factores demográficos, causales, motivo de solicitud, tiempos de realización, complicaciones tempranas y mortalidad. Resultados: La incidencia de la TP fue de 12.5% comparada con 9% de la TA. La traqueostomía temprana (primeros 10 días de intubación oro-traqueal), fue más frecuente por vía percutánea (TA: 70%, TP: 96%). Se encontraron 2.9 veces más complicaciones tempranas en los pacientes de TA comparados con los de TP (p:0.00015). El sangrado fue la principal complicación en ambas técnicas siendo 4,7 veces mayor en la TA comparada con la TP (p: 0.0022). La infección del sitio operatorio o estoma fue 5.6 veces mayor en la TA que en la TP (p: 0.0009). No se encontró asociación entre los tiempos de coagulación como factor de riesgo y el sangrado post-quirúrgico. Complicaciones como la falsa ruta y el neumotórax se presentaron únicamente en la TP y fueron resueltos inmediatamente por el cirujano que realizo el procedimiento. En ningún caso se reporto mortalidad relacionada con el procedimiento. Conclusiones: En el análisis de las TA y TP realizadas en la UCI adultos del HUN, las complicaciones menores como sangrado e infección del estoma fueron inferiores en la TP comparada con la TA. La TP fue realizada mas tempranamente, comparada con la TA y en menores tiempos lo que implica mejoría en la oportunidad de su realización

Caracterización sociodemográfica y familiar de obesos intervenidos a través de cirugía bariátrica en el Hospital Universitario de Neiva

Objective. To make a clinical and social characterization of obese people who underwent bariatric surgery at University Hospital in Neiva, between September 2011 and September 2012. Materials and Methods. A crosssectional, descriptive study was conducted at Hernando Moncaleano Perdomo University Hospital in Neiva. It was made a telephone survey and medical histories were checked for 25 patients who underwent bariatric surgery at this health center. It was considered the following variables: sex, socioeconomic status, occupation, eating habits, body mass index, characteristics of satisfaction with fitness and lifestyle before and after surgery. In order to determine family characteristics it was carried out APGAR family. Results. Most members of the sample were women whose ages were between 20 and 53. They had a stable partner, belonged to low socioeconomic stratum, had finished high school and lived in Neiva. Weight before surgery was between 93 Kg and 155 Kg, with body mass index between 36 and 59. Before surgery they didn’t feel at all satisfied with their fitness and their life. At present they feel moderately satisfied. In addition, their families are nuclear and a high percentage of them are mild dysfunctional. Conclusion. Patients have bad eating habits before surgery and it was shown family dysfunction. Objetivo. Caracterizar desde el punto de vista clínico y social a las personas obesas sometidas a cirugía bariátrica en el Hospital Universitario de Neiva en el periodo entre septiembre de 2011 y el mismo mes de 2012. Material y métodos. Se realizó un estudio descriptivo de corte trasversal en el Hospital Universitario Hernando Moncaleano Perdomo de Neiva, aplicando una encuesta telefónica y revisión de historias clínicas a 25 pacientes que fueron intervenidos a través de cirugía bariátrica en la Institución. Se estudiaron las variables: sexo, estrato socioeconómico, ocupación, hábitos alimenticios, índice de masa corporal, características de satisfacción con la condición física y vida antes y después de la cirugía, para determinar características a nivel familiar se aplicó el APGAR familiar. Resultados. En la muestra estudiada existió un predominio del sexo femenino, con edades entre 20 y 53 años, con pareja estable de estrato socioeconómico bajo, con un nivel de escolaridad hasta secundaria y viven en Neiva. El peso de las personas antes de la cirugía estaba entre 93 Kg y 155 Kg. con un índice de masa corporal entre 36 y 59. Antes de la cirugía no se sentían para nada satisfechos con su condición física y con su vida, actualmente se sienten moderadamente satisfechos. Además son familias nucleares y existe un elevado número de familias con disfuncionalidad leve. Conclusión. Los pacientes presentan malos hábitos alimenticios antes de la cirugía y se evidencio disfuncionalidad familiar

University Issues. Year 3. Number 3. Journal of the Center for Research in Social Sciences and Arts

Las opiniones contenidas en los artíuclos de esta revista no vinvulan la institución sono que son exclusiva responsabilidad de los autores, dentro de los principios demacráticos de cátedar libre y libertad de expresión, consagrados en el artículo 3° Estatuto Genral de la Corporación Autónoma de Bucaramanga.Presentación. - 5 Investigación científica y tecnológica. - 8 Reflexión derivada de la investigación. -50 Anaquel. -120 Anexos. -122The opinions contained in the articles of this journal do not vindicate the institution but are the sole responsibility of the authors, within the democratic principles of free cattery and freedom of expression, enshrined in Article 3 General Statute of the Autonomous Corporation of Bucaramanga

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Innovación en las enseñanzas universitarias: experiencias presentadas en las III Jornadas de Innovación Educativa de la ULL

En este libro se recoge un conjunto de experiencias de innovación educativa desarrolladas en la ULL en el curso 2011-12. Se abordan distintos ámbitos y ramas del conocimiento, y ocupan temáticas variadas que han sido desarrolladas con rigor, y con un claro potencial para su extrapolación a efectos de la mejora educativa en el ámbito universitario. Esta publicación constituye una primera edición de una serie que irá recogiendo las experiencias de innovación educativa de la ULL. Este es un paso relevante para su impulso en nuestra institución, como lo es el de su vinculación con la investigación educativa, para potenciar su publicación en las revistas científicas en este ámbito cada vez más pujante y relevante para las universidades. Sobre todo representan el deseo y el compromiso del profesorado de la ULL para la mejora del proceso educativo mediante la investigación, la evaluación y la reflexión compartida de nuestras prácticas y planteamientos docentes

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC