Modelo de gestión clínica para las enfermedades nefrológicas en Aragón. Utilidad de un programa de calidad asistencial

Introducción y objetivos: A través de un grupo de trabajo interdisciplinario se elabora un “Documento Marco sobre el Abordaje de la Enfermedad Renal Crónica en Aragón” en el que se detectan oportunidades de mejora, se determinan objetivos, se fijan planes, programas y acciones a realizar y se considera un horizonte temporal. Pretendemos analizar los principales indicadores de evolución del proceso. Material y método: Se revisa la evolución a 5 años de los principales indicadores de procesos estructurales, organizativos y clínicos. Resultados: Evolución procesos estructurales: Hemodiálisis con agua ultrapura: pasa de 64% a 100%; monitores hemodiálisis con antigüedad mayor de 10 años: 36 % a 2 %. Procesos organizativos: técnicas especiales de hemodiálisis: 12 % a 22 %; inicio programado en ERCA: 70 % a 88 %; ERCA como origen de diálisis: 0 % a 57,4 %; inicio con acceso vascular definitivo: 40 % a 48 %; manejo conservador: no programado al inicio a 20 %; trasplante renal de donante vivo: 5,3 a porcentajes superiores al 15 %; Diálisis Peritoneal: 8,9 a 28,2 %. Procesos clínicos: KTV a 6 meses superior a 1,3: 52 a 78 %; episodios peritonitis: 1/31,2 a 1/43,6 meses. Conclusiones: La Planificación Sanitaria supone un mestizaje entre gestión y conocimiento médico orientado al máximo beneficio del paciente. Una adecuada gestión clínica trae consigo procesos estandarizados con disminución de la variabilidad y garantía de idoneidad de cuidados. Esta política organizativa ha permitido la mejoría de los indicadores de calidad seleccionados, con una mayor eficiencia del proceso sanitario

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Dinámica Litoral-Interior

Actas XV Congreso de Geógrafos Españoles (Santiago, 15-19 setembro 1997

Supernova environments in J-PLUS

We investigated the local environmental properties of 418 supernovae (SNe) of all types using data from the Javalambre Photometric Local Universe Survey (J-PLUS), which includes five broad-band and seven narrow-band imaging filters. Our study involves two independent analyses: (1) the normalized cumulative-rank (NCR) method, which utilizes all 12 single bands along with five continuum-subtracted narrow-band emission and absorption bands, and (2) simple stellar population (SSP) synthesis, where we build spectral energy distributions (SED) of the surrounding 1 kpc2 SN environment using the 12 broad- and narrow-band filters. Improvements on previous works include: (i) the extension of the NCR technique to other filters (broad and narrow) and the use a set of homogeneous data (same telescope and instruments); (ii) a correction for extinction to all bands based on the relation between the g − i color and the color excess E(B − V); and (iii) a correction for the contamination of the [N II] λ6583 line that falls within the Hα filter. All NCR distributions in the broad-band filters, tracing the overall light distribution in each galaxy, are similar to each other. The main difference is that type Ia, II, and IIb SNe are preferably located in redder environments than the other SN types. The radial distribution of the SNe shows that type IIb SNe seem to have a preference for occurring in the inner regions of galaxies, whereas other types of SNe occur throughout the galaxies without a distinct preference for a specific location. For the Hα filter we recover the sequence from SNe Ic, which has the highest NCR, to SNe Ia, which has the lowest; this is interpreted as a sequence in progenitor mass and age. All core-collapse SN types are strongly correlated to the [O II] emission, which also traces star formation rate (SFR), following the same sequence as in Hα. The NCR distributions of the Ca II triplet show a clear division between II-IIb-Ia and Ib-Ic-IIn subtypes, which is interpreted as a difference in the environmental metallicity. Regarding the SSP synthesis, we found that including the seven J-PLUS narrow filters in the fitting process has a more significant effect on the core-collapse SN environmental parameters than for SNe Ia, shifting their values toward more extincted, younger, and more star-forming environments, due to the presence of strong emission lines and stellar absorptions in those narrow bands