Análisis automatizado de la calidad del conjunto mínimo de datos básicos. Implicaciones para los sistemas de ajuste de riesgos

ResumenFundamentosJunto a la edad del paciente, el diagnóstico principal, los diagnósticos secundarios (comorbilidad y complicaciones) y los procedimientos realizados son las variables críticas para el ajuste de riesgos. De ahí la importancia de su correcta incorporación al CMBD. Sin embargo, diversos trabajos, especialmente en Estados Unidos, pero también en España, han puesto en evidencia importantes problemas de calidad en estos datos, dificultades para su mejora y las limitaciones que ello conlleva para evaluar la calidad o la eficiencia de los hospitales. El objetivo de este trabajo es realizar una aproximación a la calidad de la información administrativa y clínica recogida en el CMBD del Servei Valencià de la Salut (SVS) mediante un proceso automatizado de análisis de los datos del propio CMBD, y discutir tanto sus implicaciones para la gestión, como las posibles estrategias de mejora.Material y métodoSe realizó un análisis automatizado de la calidad del CMBD 1994 del SVS (20 hospitales, 241.341 altas), utilizando indicadores de cumplimentación válida de los valores de los campos, relaciones entre campos del mismo episodio, relaciones entre variables en diferentes episodios y volumen y especificidad de la información clínica.ResultadosEl CMBD analizado contiene escasos errores en las variables administrativas, con excepción de la residencia, pero presenta importantes problemas de volumen y especificidad de la información clínica, así como una alta variabilidad en su cumplimentación y calidad en diferentes hospitales.ConclusionesLa calidad de los datos clínicos del CMBD pueden suponer sesgos en su utilización con finalidades de gestión o evaluación de la calidad, así como en los estudios epidemiológicos, de evaluación de tecnologías o utilización de servicios.SummarySettingTogether with the age of the patient, the main diagnosis, secondary diagnosis (comorbility and complications) and the procedures performed are the critical variables for risk-adjusting. Therefore, its correct incorporation to CMBD is of great importance. However, several studies, especially in the United States, but also in Spain, have made evident the existence of important problems of quality in these data, difficulties for its improvement and the limitations which this has to assess the quality or the efficiency of hospitals. The objective of this study is to approach the quality of administrative and clinical collected in the CMBD of the Valencian Health Service (VHS) using an automatized process of analysis of data from the same CMBD, and discuss the implications for its management, as well as possible improvement strategies.Material and methodAn automatized analysis of the quality of CMBD 1994 of the VHS (20 hospitals, 241,341 admissions) was performed, using indicators of valid fulfilling of field values, relationship between fields of the same episode, relationship between variables in different episodes and volume and specificity of clinical information.ResultsThe analysed CMBD contains few errors in management variables, with the exception of residence, but it shows important problems of volume and specificity of clinical information, as well as a high variability in its fulfilling and quality in different hospitals.ConclusionsThe quality of the clinical data of CMBD may be biased in its use with management aims or when assessing quality, as well as in epidemiological studies, evaluation of technology or use of services

Wake dynamics of external flow past a curved circular cylinder with the free stream aligned with the plane of curvature

Accepted versio

Spatial eigensolution analysis of discontinuous Galerkin schemes with practical insights for under-resolved computations and implicit LES

The study focusses on the dispersion and diffusion characteristics of discontinuous spectral element methods - specifically discontinuous Galerkin (DG) - via the spatial eigensolution analysis framework built around a one-dimensional linear problem, namely the linear advection equation. Dispersion and diffusion characteristics are of critical importance when dealing with under-resolved computations, as they affect both the numerical stability of the simulation and the solution accuracy. The spatial eigensolution analysis carried out in this paper complements previous analyses based on the temporal approach, which are more commonly found in the literature. While the latter assumes periodic boundary conditions, the spatial approach assumes inflow/outflow type boundary conditions and is therefore better suited for the investigation of open flows typical of aerodynamic problems, including transitional and fully turbulent flows and aeroacoustics. The influence of spurious/reflected eigenmodes is assessed with regard to the presence of upwind dissipation, naturally present in DG methods. This provides insights into the accuracy and robustness of these schemes for under-resolved computations, including under-resolved direct numerical simulation (uDNS) and implicit large-eddy simulation (iLES). The results estimated from the spatial eigensolution analysis are verified using the one-dimensional linear advection equation and successively by performing two-dimensional compressible Euler simulations that mimic (spatially developing) grid turbulence

Actividades intersectoriales en la prevención de accidentes de tráfico

ResumenSe describen las líneas de trabajo priorizadas y algunos resultados obtenidos en la implantación del programa de prevención y reducción de lesiones por accidentes de tráfico en un área de salud. A partir de 1999 el Centro de Salud Pública priorizó la identificación y búsqueda de aliados en otros sectores (Asociación de policías locales y educación), la construcción de la capacidad de trabajo conjunta y la formación de un grupo intersectorial. Se llevaron a cabo actividades docentes y jornadas. Se formó una red de personas en 17 de un total de 39 ayuntamientos que participan con actividades en el grupo intersectorial. Un total de 10 de estos ayuntamientos participaron con actividades educativas y siete, además, exigieron al cumplimiento de la legislación.El grupo intersectorial potenció la visibilidad de sus actividades a través de los medios de comunicación local. Estas actividades no están dirigidas a reducir las lesiones por tráfico, sino a crear un marco de trabajo para la movilización de los sectores implicados. Se pretende potenciar más el compromiso entre los niveles políticos, técnicos y civiles incidiendo en valores sociales de respeto para una vida más saludable.AbstractWe describe priority issues and some of the results obtained from the implementation of the «Prevention and Reduction of Traffic Accident Injuries» program in a health area. Since 1999 the public health center has made a priority of identifying and recruiting partners from other sectors (the local police association and the local education authority), increasing its capacity for working together, and setting up an intersectorial working group. Teaching activities and meetings were held. A network of people was created from 17 of a total of 39 town halls that participate in activities supported by the intersectorial group. Ten are involved in educational activities and a further seven focus on ensuring compliance with the law. The intersectorial group promoted their visibility through the local media. These activities are not aimed at reducing injuries from road traffic accidents, but rather at creating an action framework through which all the sectors involved can be mobilized. The aim is to strengthen commitment among political, technical and civil sectors by focussing on social values of respect for a healthier life

Fracturas periprotésicas de fémur en pacientes portadores de prótesis total de cadera: Tratamiento mediante doble placa

Una técnica de osteosíntesis, combinación de placa metálica atornillada en cara externa del fémur y placa-cerclaje de Partridge en cara anterior, ha sido aplicada con criterio selectivo en 6 pacientes mayores de 60 años con fracturas periprotésicas tipo III de Johanson y vástago femoral estable. En cuatro, la fractura consolidó en un tiempo medio de 4 meses, y los otros dos se produjo una rotura de la placa metálica, que requirió una nueva intervención. Un hecho relevante fue el hallazgo en estos pacientes de una gran reacción fibrosa alrededor de la placa-cerclaje de Partridge, atribuible al nylon con que está fabricado este implante. Por lo que, aunque la asociación de placas, constituya una aportación en el tratamiento de estas fracturas, no recomendamos la utilización de este tipo de implantes. En nuestra serie 5 de las 6 fracturas correspondían a prótesis con vástago cementado, y el tiempo entre el implante de la prótesis y la fractura fue muy corto, entre 1 y 3 meses, inferior al descrito en la literatura; y en todos los casos la fractura se produjo inmediatamente por debajo del tapón para el cemento. Estas observaciones nos hacen considerar la existencia de una posible relación causal.An osteosynthesis technique, combination o fan ASIF plate on the lateral surface of the femur and one Partridge plate on the anterior, has been used with selective criteria in 6 patients over 60 years old with type III Johanson's periprosthetic femoral fracture and stable prosthesis. In four patients, primary union was achieved at an average time of four months, in the other two the plate were broken and a new surgery was needed. A relevant fact was the finding in these patients of a great fibrous reaction around the Partridge plate, attributable to the nylon with which the implant was manufactured. Therefore, although the plates association, constitute a contribution in the treatment of these fractures, we do not recommend the used of this implant. In our series five of the six fractures were corresponding to cemented prostheses, and the time to fracture after implantation was very short, between 1 and 3 months, inferior to the literature have described; and in all cases the fracture was produced immediately below of the cement plug. These observations make us to consider the existence of a possible casual relationship

Direct correlation of crystal structure and optical properties in wurtzite/zinc-blende GaAs nanowire heterostructures

A novel method for the direct correlation at the nanoscale of structural and optical properties of single GaAs nanowires is reported. Nanowires consisting of 100% wurtzite and nanowires presenting zinc-blende/wurtzite polytypism are investigated by photoluminescence spectroscopy and transmission electron microscopy. The photoluminescence of wurtzite GaAs is consistent with a band gap of 1.5 eV. In the polytypic nanowires, it is shown that the regions that are predominantly composed of either zinc-blende or wurtzite phase show photoluminescence emission close to the bulk GaAs band gap, while regions composed of a nonperiodic superlattice of wurtzite and zinc-blende phases exhibit a redshift of the photoluminescence spectra as low as 1.455 eV. The dimensions of the quantum heterostructures are correlated with the light emission, allowing us to determine the band alignment between these two crystalline phases. Our first-principles electronic structure calculations within density functional theory, employing a hybrid-exchange functional, predict band offsets and effective masses in good agreement with experimental results

Structural and functional characterization of (110)-oriented epitaxial La2/3Ca1/3MnO3 electrodes and SrTiO3 tunnel barriers

La2/3Ca1/3MnO3 (LCMO) films have been deposited on (110)-oriented SrTiO3 (STO) substrates. X-ray diffraction and high-resolution electron microscopy reveal that the (110) LCMO films are epitaxial and anisotropically in-plane strained, with higher relaxation along the [1¿10] direction than along the [001] direction; x-ray absorption spectroscopy data signaled the existence of a single intermediate Mn3+/4+ 3d-state at the film surface. Their magnetic properties are compared to those of (001) LCMO films grown simultaneously on (001) STO substrates It is found that (110) LCMO films present a higher Curie temperature (TC) and a weaker decay of magnetization when approaching TC than their (001) LCMO counterparts. These improved films have been subsequently covered by nanometric STO layers. Conducting atomic-force experiments have shown that STO layers, as thin as 0.8 nm, grown on top of the (110) LCMO electrode, display good insulating properties. We will show that the electric conductance across (110) STO layers, exponentially depending on the barrier thickness, is tunnel-like. The barrier height in STO (110) is found to be similar to that of STO (001). These results show that the (110) LCMO electrodes can be better electrodes than (001) LCMO for magnetic tunnel junctions, and that (110) STO are suitable insulating barriers