Hacia una normalización de la representación de flujogramas en el ámbito hospitalario

This article presents a proposal of standardization for the representation of hospital protocols using flowcharts. In the clinical field, highly complex processes are typically developed. If these processes are not appropriately managed, fatal consequences for patients and the healthcare personnel could appear. Using a clear notation for modelling the tasks to be performed is mandatory to keep the risks under control. In practice, the most widely used flowchart language for years (due to its simplicity and versatility) is defined in ISO 5807:1985 standard. However, this language is insufficiently expressive to represent all the essential aspects of a health protocol. In recent years, this type of protocols has become increasingly sophisticated in order to improve the control of critical aspects that influence the safety of medicines, patients and practitioners. In this way, a widespread practice has been the implementation of the HACCP methodology for hazard analysis and control. During the modelling of these protocols (and because of the expressivity problems of traditional flowchart notation), each hospital has adopted its proposal that complements the elements included in the ISO (International Organization for Standardization) standard. This practice forces practitioners to become familiar with the ad-hoc defined notation for that center. In addition, these adaptations usually fall into ambiguous and non-formal definitions. In the standardization proposal presented in this article, new graphic stereotypes are introduced. These can be easily integrated into the ISO notation and are designed to represent the critical aspects of the HACCP (Hazard Analysis and Critical Control Points) plan. For the definition of these new elements, a series of requirements have been prioritized. First, it is taken into account the tools that are commonly used and the simplicity for final users. Moreover, it is mandatory to avoid ambiguities assuring that the introduced elements do not interfere with the base notation contained in the original ISO standard. This standardization proposal enriches the ISO5807:1985 language with expression mechanisms to represent essential information related to protocol security by reducing ambiguities and proposing a standardized notation.En este artículo se presenta una propuesta de normalización para la representación de protocolos hospitalarios a través de diagramas de flujo. En el ámbito clínico se desarrollan procesos de gran complejidad que, si no se gestionan adecuadamente, podrían dar lugar a consecuencias fatales para los pacientes o el personal sanitario implicado. Utilizar una notación clara que formalice las tareas que deben realizarse es un aspecto fundamental para mantener los riesgos controlados. En la práctica, el lenguaje de flujogramas más utilizado desde hace años debido a su sencillez y versatilidad es el definido por la norma ISO 5807:1985. No obstante, este lenguaje resulta insuficientemente expresivo para representar todos los aspectos importantes de un protocolo sanitario. Durante los últimos años este tipo de protocolos han aumentado su complejidad con el fin de dar un paso hacia adelante en el control de aspectos críticos que influyen en la seguridad de los medicamentos, pacientes y personal sanitario. En esta línea, una práctica muy común ha sido la implantación de la metodología APPCC (Análisis de Peligros y Puntos Críticos de Control). Durante el modelado de estos protocolos (dado que la notación de flujogramas tradicional no es suficientemente expresiva) cada centro hospitalario ha adoptado una propuesta propia que complementa los elementos incluidos en la norma ISO (International Organization for Standardization). Con esta práctica se obliga a que el personal tenga que familiarizarse con la notación definida ad-hoc para ese centro que, además de no estar estandarizada, cae en ocasiones en definiciones ambiguas y poco formales. En la propuesta de normalización presentada en este artículo se plantean nuevos estereotipos gráficos fácilmente integrables en la notación ISO y diseñados para representar los aspectos críticos de la metodología APPCC. Para la definición de estos nuevos elementos se han priorizado una serie de requisitos que tienen en cuenta tanto los aspectos relativos a las herramientas software ya existentes como la simplicidad para los usuarios finales en la práctica diaria. Al mismo tiempo se tratan de evitar ambigüedades asegurando que los elementos introducidos no interfieren con la notación base contenida en la norma ISO original. En definitiva, esta propuesta de normalización consigue enriquecer el lenguaje ISO5807:1985 con mecanismos de expresión suficientes para representar la información básica relacionada con la seguridad de los protocolos reduciendo las ambigüedades y facilitando una notación estandarizada

Plataforma de e-servicios para educación e higiene nutricionales, orientada a la población infantil

 A good diet is one of the pillars for ensuring the proper physical and intellectual development of children. In a society in which schooling is initiated at increasingly early ages, the coordination between school and family acquires a vital role in assuring proper child nourishment and care. This article presents the foundations of a multi-device web platform that fosters the collaboration and nutritional training of the different actors (parents, educators, specialists) involved in the processes of care and education of children. The platform uses the latest advances in the field of semantic technologies to improve the accuracy of the recommendations made automatically by the system.Una buena alimentación es uno de los pilares básicos para el correcto desarrollo tanto físico como intelectual de los niños. En una sociedad en la que cada vez la edad de escolarización de los pequeños es más temprana, la coordinación entre familia y escuela adquiere un rol vital para garantizar una correcta alimentación y cuidado del niño. Este artículo presenta los fundamentos de una plataforma web multidispositivo que favorece la colaboración y formación nutricional de los diferentes agentes involucrados en los procesos de cuidado y educación de los niños (padres, educadores, especialistas), haciendo uso de los últimos avances producidos en el campo de las tecnologías semánticas para mejorar la precisión y adecuación de las recomendaciones realizadas automáticamente por el sistema

QR codes: Outlook for food science and nutrition

Abstract QR codes opens up the possibility to develop simple-to-use, cost-effective-cost and functional systems based on the optical recognition of inexpensive tags attached to physical objects. These systems, combined with Web platforms, can provide us with advanced services that are already currently broadly used on many contexts of the common life. Due to its philosophy, based on the automatic recognition of messages embedded on simple graphics by means of common devices such as mobile phones, QR codes are very convenient for the average user. Regretfully, its potential has not yet been fully exploited in the domains of food science and nutrition. This article points out some applications to make the most of this technology for these domains in a straightforward manner. For its characteristics, we are addressing systems with low barriers to entry and high scalability for its deployment. Therefore, its launching among professional and final users is quite simple. The article also provides high-level indications for the evaluation of the technological frame required to implement the identified possibilities of use

Boosting antimicrobial activity of ciprofloxacin by functionalization of mesoporous silica nanoparticles

Mesoporous silica nanoparticles (MSNs) are very promising nanomaterials for treating bacterial infections when combined with pharmaceutical drugs. Herein, we report the preparation of two nanomaterials based on the immobilization of ciprofloxacin in mesoporous silica nanoparticles, either as the counter-ion of the choline derivative cation (MSN-[Ch][Cip]) or via anchoring on the surface of amino-group modified MSNs via an amide bond (MSN-Cip). Both nanomaterials were characterized by TEM, FTIR and solution 1H NMR spectroscopies, elemental analysis, XRD and N2 adsorption at 77 K in order to provide the desired structures. No cytotoxicity from the prepared mesoporous nanoparticles on 3T3 murine fibroblasts was observed. The antimicrobial activity of the nanomaterials was determined against Gram-positive (Staphylococcus aureus and Bacillus subtilis) and Gram-negative (Klebsiella pneumoniae) bacteria and the results were promising against S. aureus. In the case of B. subtilis, both nanom aterials exhibited higher antimicrobial activity than the precursor [Ch][Cip], and in the case of K. pneumoniae they exhibited higher activity than neutral ciprofloxacin.info:eu-repo/semantics/publishedVersio

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Methodologies, Technologies and Tools Enabling e-Government

Methodologies, Technologies and Tools Enabling e-Governmen

QR codes: Outlook for food science and nutrition

QR codes opens up the possibility to develop simple-to-use, cost-effective-cost and functional systems based on the optical recognition of inexpensive tags attached to physical objects. These systems, combined with Web platforms, can provide us with advanced services that are already currently broadly used on many contexts of the common life. Due to its philosophy, based on the automatic recognition of messages embedded on simple graphics by means of common devices such as mobile phones, QR codes are very convenient for the average user. Regretfully, its potential has not yet been fully exploited in the domains of food science and nutrition. This article points out some applications to make the most of this technology for these domains in a straightforward manner. For its characteristics, we are addressing systems with low barriers to entry and high scalability for its deployment. Therefore, its launching among professional and final users is quite simple. The article also provides high-level indications for the evaluation of the technological frame required to implement the identified possibilities of use.This work was funded by the Spanish Instituto de Salud Carlos III (Grant PI13/00464