28 research outputs found

    Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

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    Background: All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. Methods: An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. Results: A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample. Conclusions: Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns. © 2023, BioMed Central Ltd., part of Springer Nature

    Efficient Random Access Channel Evaluation and Load Estimation in LTE-A with Massive MTC

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    © 2019 IEEE. Personal use of this material is permitted. Permissíon from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertisíng or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works."[EN] The deployment of machine-type communications (MTC) together with cellular networks has a great potential to create the ubiquitous Internet-of-Things environment. Nevertheless, the simultaneous activation of a large number of MTC devices (named UEs herein) is a situation difficult to manage at the evolved Node B (eNB). The knowledge of the joint probability distribution function (PDF) of the number of successful and collided access requests within a random access opportunity (RAO) is a crucial piece of information for contriving congestion control schemes. A closed-form expression and an efficient recursion to obtain this joint PDF are derived in this paper. Furthermore, we exploit this PDF to design estimators of the number of contending UEs in an RAO. Our numerical results validate the effectiveness of our recursive formulation and show that its computational cost is considerably lower than that of other related approaches. In addition, our estimators can be used by the eNBs to implement highly efficient congestion control methods.This work was supported in part by the Ministry of Economy and Competitiveness of Spain under Grants TIN2013-47272-C2-1-R and TEC2015-71932-REDT. The work of L. Tello-Oquendo was supported in part by the Universitat Politecnica de Valencia under the Programa de Ayudas de Investigacion y Desarrollo (PAID). The work of I. Leyva-Mayorga was supported in part by the CONACYT-Gobierno del Estado de Mexico under Grant 383936. The review of this paper was coordinated by Dr. Y. Ji.Tello-Oquendo, L.; Pla, V.; Leyva-Mayorga, I.; Martínez Bauset, J.; Casares-Giner, V.; Guijarro, L. (2019). Efficient Random Access Channel Evaluation and Load Estimation in LTE-A with Massive MTC. IEEE Transactions on Vehicular Technology. 68(2):1998-2002. https://doi.org/10.1109/TVT.2018.2885333S1998200268

    TGFU vs Instrução Direta: níveis de atividade física no futebol U-12

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    Resumen: El fútbol se ha enseñado desde una perspectiva tradicional, dando prioridad a los componentes técnicos frente a los tácticos. Con el desarrollo de nuevos modelos de iniciación deportiva como el Modelo Comprensivo (MC) del inglés Teaching Games for Understanding, se está cambiando la forma de entrenar al fútbol en la etapa de formación, donde los componentes tácticos y la toma de decisión de los jugadores es lo predominante. El objetivo de este estudio fue comparar los niveles de actividad física (AF) medidos con acelerometría en el Modelo Comprensivo y el Modelo Tradicional. Un total de 30 jugadores de fútbol pertenecientes a la categoría alevín participaron en el estudio con una edad media de 10,3±0,45. Se analizaron cinco sesiones en ambos grupos. El grupo experimental realizaba entrenamientos mediante el modelo comprensivo y el grupo control con una metodología tradicional. Se obtuvieron resultados significativos en la actividad física ligera y moderada, siendo superiores en el modelo comprensivo con respecto al modelo tradicional. El modelo comprensivo parece ser un modelo adecuado para la enseñanza del fútbol en edades escolares, permitiendo que los jugadores acumulen mayores niveles de AF.Abstract: Football has been taught from a traditional perspective, giving priority to the technical components than to the tactical ones. With the development of new models in sport initiation such as Teaching Games For Understanding, the way of training football is being changed, where the tactical components and the decision making of the players is the predominant thing. The objective of this study was to compare the physical activity (PA) levels measured with accelerometry in the Teaching Games for Understanding and the Traditional Model. A total of 30 soccer players belonging U-12 participated in the study with an average age of 10.3 ± 0.45. Five sessions in both groups were analysed. The experimental group carried out training using the direct instruction and the control group a traditional methodology. Significant results were obtained in light and moderate physical activity, being superior in the comprehensive model with respect to the traditional model. The comprehensive model seems to be an appropriate model for teaching football at school ages, allowing players to accumulate higher levels of PA.Resumo: O futebol tem sido ensinado sob uma perspectiva tradicional, dando maior prioridade aos componentes técnicos do que aos táticos. Com o desenvolvimento de novos modelos de iniciação esportiva, como o Modelo Compreensivo (MC), do inglês Teaching Games for Understanding, está sendo modificada a forma de treinar o futebol nas etapas de formação, na qual os componentes táticos, os processos cognitivos de percepção e a tomada de decisões dos jogadores são o mais predominante. O objetivo deste estudo é comparar os níveis de atividade física (AF) mediante a utilização de acelerômetro no Teaching Games for Understanding e no Modelo Tradicional. Participaram do estudo 30 futebolistas pertencentes à categoria pré-mirim, com idade média de 10,3 ± 0,45. Foram analisadas cinco sessões de treinamento em ambos os grupos. O grupo experimental realizou treinamento utilizando o modelo compreensivo e o grupo controle a metodologia tradicional. Os resultados obtidos foram significativos em atividades físicas leve e moderada, sendo superiores no modelo compreensivo em relação ao modelo tradicional. O modelo compreensivo parece ser um modelo apropriado para ensinar futebol nas idades escolares, permitindo que os jogadores acumulem níveis mais altos de AF

    Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

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    Background: Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives: To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants: This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results: A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions: The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact

    Adverse events: an expensive and avoidable hospital problem

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    Introduction: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. Methods: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. Results: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. Conclusions: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient’s death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messages Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization. Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels. Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE

    Performance Analysis and Optimal Access Class Barring Parameter Configuration in LTE-A Networks With Massive M2M Traffic

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    [EN] Over the coming years, it is expected that the number of machine-to-machine (M2M) devices that communicate through long term evolution advanced (LTE-A) networks will rise significantly for providing ubiquitous information and services. However, LTE-A was devised to handle human-to-human traffic, and its current design is not capable of handling massive M2M communications. Access class barring (ACB) is a congestion control scheme included in the LTE-A standard that aims to spread the accesses of user equipments (UEs) through time so that the signaling capabilities of the evolved Node B are not exceeded. Notwithstanding its relevance, the potential benefits of the implementation of ACB are rarely analyzed accurately. In this paper, we conduct a thorough performance analysis of the LTE-A random access channel and ACB as defined in the 3GPP specifications. Specifically, we seek to enhance the performance of LTE-A in massive M2M scenarios by modifying certain configuration parameters and by the implementation of ACB. We observed that ACB is appropriate for handling sporadic periods of congestion. Concretely, our results reflect that the access success probability of M2M UEs in the most extreme test scenario suggested by the 3GPP improves from approximately 30%, without any congestion control scheme, to 100% by implementing ACB and setting its configuration parameters properly.This work was supported in part by the Ministry of Economy and Competitiveness of Spain under Grants TIN2013-47272-C2-1-R and TEC2015-71932-REDT. The work of L. Tello-Oquendo was supported in part by Programa de Ayudas de Investigacion y Desarrollo (PAID), Universitat Politecnica de Valencia. The work of I. Leyva-Mayorga was supported in part by Grant 383936 CONACYT-Gobierno del Estado de Mexico 2014.Tello-Oquendo, L.; Leyva-Mayorga, I.; Pla, V.; Martínez Bauset, J.; Vidal Catalá, JR.; Casares-Giner, V.; Guijarro, L. (2018). Performance Analysis and Optimal Access Class Barring Parameter Configuration in LTE-A Networks With Massive M2M Traffic. IEEE Transactions on Vehicular Technology. 67(4):3505-3520. https://doi.org/10.1109/TVT.2017.2776868S3505352067

    How Does Vaccination against SARS-CoV-2 Affect Hospitalized Patients with COVID-19?

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    Background: The development of effective COVID-19 vaccines has reduced the impact of COVID-19 on the general population. Our study aims to analyze how vaccination modifies the likelihood of death and length of stay in hospitalized patients with COVID-19; (2) Methods: A retrospective cohort study of 1927 hospitalized patients infected with COVID-19 was conducted. Information was gathered on vaccination status, hospitalization episode, and clinical profile of the patients. The effect of vaccination on mortality was analyzed using a multiple logistic regression model, and length of stay was analyzed using linear regression. The performance and fit of the models were evaluated; (3) Results: In hospitalized patients with COVID-19, the risk of dying during admission in vaccinated patients was half that of non-vaccinated (OR: 0.45; CI 95%: 0.25 to 0.84). In patients who were discharged due to improvement, the reduction in hospital stay in vaccinated patients was 3.17 days (CI 95%: 5.88 to 0.47); (4) Conclusions: Patients who, despite having been vaccinated, acquire the infection by SARS-CoV-2, have a significant reduction of the risk of death during admission and a reduction of hospital stay compared with unvaccinated patients

    Selective T3-T4 sympathicotomy versus gray ramicotomy on outcome and quality of life in hyperhidrosis patients : a randomized clinical trial

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    Compensatory hyperhidrosis is the leading cause of patients' dissatisfaction after thoracic sympathicotomy. The study aimed to reduce compensatory hyperhidrosis to increase patients' satisfaction. A prospective randomized study on palmar hyperhidrosis, May 2016-September 2019. Twenty-one patients T3- T4 sympathicotomy and 21 T3- T4 gray ramicotomy. Data prospectively collected. Analysis at study's end. Focus on the sweating, temperature, quality of life baseline and postoperatively, compensatory hyperhidrosis, hand dryness, patients' satisfaction, and if they would undergo the procedure again and recommend it. No baseline differences between groups. Hyperhidrosis was controlled postoperatively in all patients. No mortality, serious complications, or recurrences. Sympathicotomy worse postoperative quality of life (49.05 (SD: 15.66, IR: 35.50-63.00) versus ramicotomy 24.30 (SD: 6.02, IR: 19.75-27.25). After ramicotomy, some residual sweating on the face, hands, and axillae. Compensatory sweating worse with sympathicotomy. Satisfaction higher with ramicotomy. Better results with ramicotomy than sympathicotomy regarding hand dryness, how many times a day the patients had to shower or change clothes, intention to undergo the procedure again or recommend it to somebody else, and how bothersome compensatory hyperhidrosis was. T3-T4 gray ramicotomy had better results than T3-T4 sympathicotomy, with less compensatory sweating and higher patients' satisfaction

    Prevalence, characteristics, and impact of adverse events in 34 Madrid hospitals. The ESHMAD study

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    Introduction: Adverse Events (AE) are one of the main problems in healthcare. Therefore, many policies have been developed worldwide to mitigate their impact. The Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD) measures the results of them in the region. Methods: Cross-sectional study, conducted in May 2019, in hospitalised patients in 34 public hospitals using the Harvard Medical Practice Study methodology. A logistic regression model was carried out to study the association of the variables with the presence of AE, calibrated and adjusted by patient. Results: A total of 9975 patients were included, estimating a prevalence of AE of 11.9%. A higher risk of AE was observed in patients with surgical procedures (OR[CI95%]: 2.15[1.79 to 2.57], vs. absence), in Intensive Care Units (OR[CI95%]: 1.60[1.17 to 2.17], vs. Medical) and in hospitals of medium complexity (OR[CI95%]: 1.45[1.12 to 1.87], vs. low complexity). A 62.6% of AE increased the length of the stay or it was the cause of admission, and 46.9% of AE were considered preventable. In 11.5% of patients with AE, they had contributed to their death. Conclusions: The prevalence of AE remains similar to the previously estimated one in studies developed with the same methodology. AE keep leading to longer hospital stays, contributing to patient's death, showing that it is necessary to put focus on patient safety again. A detailed analysis of these events has enabled the detection of specific areas for improvement according to the type of care, centre and patient
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