Mobilizar: Capturing User Behavior with Mobile Digital Diaries

In this paper we present Mobilizar, a web-based mobile tool that facilitates the implementation and data collection of self-reported user behavior. Mobilizar was designed with both the researcher and the participant in mind. It provides investigators with a way to setup a new diary study in a matter of minutes and to electronically collect diary data from participants by using internet-enabled mobile devices. These devices promise to alleviate the burden of carrying a paper-and-pencil diary by instead using the participant’s own device. It also gives participants the flexibility to report their behavior in different ways such as making text, voice, or picture entries that fit their current situational constraints. In this paper, we describe the user interface design of Mobilizar and how it may be used to conduct diary studies with mobile devices

Fijación externa RALCA con montaje monopolar doble en las fracturas abiertas de tibia

A work on open tibial fractures that were treated as emergencies with dual monopolar external fixation at the Arnaldo Milian Castro Clinical-Surgical Hospital in Santa Clara, Villa Clara, from January 2011 to January 2012 is presented in this article. The Basic Working Group treated a total of 25 patients with the diagnosis of open tibial fracture. As a method of surgical treatment, they underwent emergency dual monopolar external fixation with RALCA system, with or without other means for osteosynthesis. With the use of the monopolar, it was achieved a minimally invasive early stabilization of the fracture within the first 24 hours. The evolution and hospital stay were favorable, there was a better performance on soft tissue and in early rehabilitation of the patients, with faster reincorporation into society. The use of this type of external fixation in open tibial fractures is recommended.Se presenta un trabajo sobre fracturas abiertas de tibias tratadas de urgencia con fijación externa monopolar doble en el Hospital Clínico Quirúrgico “Arnaldo Milián Castro” de Santa Clara, Villa Clara, entre los meses de enero de 2011 y enero de 2012. Se trataron, por el Grupo Básico de Trabajo, un total de 25 pacientes con el diagnóstico de fractura abierta de tibia a los que se les aplicó, como método de tratamiento quirúrgico, el uso de la fijación externa monopolar doble de urgencia con el sistema Rodrigo Álvarez Cambras asociado o no a otros medios de osteosíntesis. Se logró, con el uso del monopolar, una estabilización precoz de la fractura con un mínimo de invasión en las primeras 24 horas; la evolución y el tiempo de estadía fueron favorables; hubo una mejor actuación sobre partes blandas y una rehabilitación temprana del paciente, con una incorporación más rápida a la vida social. Se recomienda el uso de este tipo de fijación externa en las fracturas abiertas de tibia

Knowledge of informed consent in surgical services

Introducción: el conocimiento informado constituye un elemento esencial de la relación médico paciente actualmente. Objetivo: diagnosticar el conocimiento que sobre el consentimiento informado tienen los miembros de los servicios quirúrgicos así como los pacientes que en esta etapa de la investigación se le practicó alguna intervención quirúrgica.   Método: se realizó un estudio en los servicios quirúrgicos del Hospital Clínico Quirúrgico Docente  Dr. León Cuervo Rubio de Pinar del Río en el período de Enero a Marzo del 2012, para ello se encuestaron profesionales de los servicios de cirugía y anestesiología así como a pacientes que fueron intervenidos quirúrgicamente en igual período de tiempo. Con un universo de 73 profesionales médicos y 253 pacientes, con una muestra de 45 médicos e igual cantidad de personal de enfermería así como 220 pacientes Resultados: existe un dominio incompleto del consentimiento informado en los pacientes, en la mayoría de los cirujanos y enfermeros no tienen dominio y no aplican correctamente el mismo, sin embargo  habían recibido perfeccionamiento sobre dicho tema. Conclusiones: el reconocimiento de la autonomía del paciente y el proceso provocó un cambio en la relación médico paciente en la práctica de la cirugía. Además de la profundización en el estudio de los principios bioéticos y su aplicación, se hace necesaria la búsqueda de respuestas útiles a los problemas bioéticos en estos servicios que afectan la propia relación médico paciente así como la seguridad que les debemos brindar a los pacientes para respaldar el procedimiento quirúrgico.Introduction: current knowledge of informed consent constitutes an essential element of doctor-patient relationship. Objective: to identify knowledge of informed consent in the members of surgical services and in patients who underwent surgeries during the period of investigation. Method: a study was conducted in the surgical services at “Dr. Leon Cuervo Rubio” University General Hospital, Pinar del Rio from January to March 2012; surgery, anesthesiology personnel and patients operated on during the period were polled. The target group involved 73 doctors and 253 patients, with a sample of 45 doctors and the same number of nursing personnel along with 220 patients. Results: incomplete knowledge of patients regarding informed consent was observed, the majority of surgeons and nurses had no knowledge of informed consent, and its application was not correct, though they had taken training courses on the topic. Conclusions: the recognition of patient’s autonomy and the process allowed a change in doctor-patient relationship concerning surgical practice. Together with the deepening on bioethical principles and their application, plus the search of useful responses towards the bioethical problems is necessary in this service, since doctor-patient relationship and the safety offered to the patients are important to support the surgical procedure

Conocimiento del consentimiento informado en servicios quirúrgicos

Introduction: current knowledge of informed consent constitutes an essential element of doctor-patient relationship. Objective: to identify knowledge of informed consent in the members of surgical services and in patients who underwent surgeries during the period of investigation. Method: a study was conducted in the surgical services at “Dr. Leon Cuervo Rubio” University General Hospital, Pinar del Rio from January to March 2012; surgery, anesthesiology personnel and patients operated on during the period were polled. The target group involved 73 doctors and 253 patients, with a sample of 45 doctors and the same number of nursing personnel along with 220 patients. Results: incomplete knowledge of patients regarding informed consent was observed, the majority of surgeons and nurses had no knowledge of informed consent, and its application was not correct, though they had taken training courses on the topic. Conclusions: the recognition of patient’s autonomy and the process allowed a change in doctor-patient relationship concerning surgical practice. Together with the deepening on bioethical principles and their application, plus the search of useful responses towards the bioethical problems is necessary in this service, since doctor-patient relationship and the safety offered to the patients are important to support the surgical procedure.Introducción: el conocimiento informado constituye un elemento esencial de la relación médico paciente actualmente. Objetivo: diagnosticar el conocimiento que sobre el consentimiento informado tienen los miembros de los servicios quirúrgicos así como los pacientes que en esta etapa de la investigación se le practicó alguna intervención quirúrgica.   Método: se realizó un estudio en los servicios quirúrgicos del Hospital Clínico Quirúrgico Docente  Dr. León Cuervo Rubio de Pinar del Río en el período de Enero a Marzo del 2012, para ello se encuestaron profesionales de los servicios de cirugía y anestesiología así como a pacientes que fueron intervenidos quirúrgicamente en igual período de tiempo. Con un universo de 73 profesionales médicos y 253 pacientes, con una muestra de 45 médicos e igual cantidad de personal de enfermería así como 220 pacientes Resultados: existe un dominio incompleto del consentimiento informado en los pacientes, en la mayoría de los cirujanos y enfermeros no tienen dominio y no aplican correctamente el mismo, sin embargo  habían recibido perfeccionamiento sobre dicho tema. Conclusiones: el reconocimiento de la autonomía del paciente y el proceso provocó un cambio en la relación médico paciente en la práctica de la cirugía. Además de la profundización en el estudio de los principios bioéticos y su aplicación, se hace necesaria la búsqueda de respuestas útiles a los problemas bioéticos en estos servicios que afectan la propia relación médico paciente así como la seguridad que les debemos brindar a los pacientes para respaldar el procedimiento quirúrgico

HERRAMIENTAS QUE REFUERZAN LA ENSEÑANZA DEL DISEÑO ELECTRÓNICO (TOOLS THAT STRENGTHEN THE TEACHING OF ELECTRONIC DESIGN)

Resumen En este documento, se habla de algunas herramientas que pueden apoyar las estrategias de enseñanza y que ayudan a reforzar los conocimientos que adquieren los estudiantes de ingeniería en el área de diseño electrónico. Este trabajo se apoya en tres herramientas que consideramos fundamentales: Notas de curso, programas de cómputo y memorias basadas en videos. Estos elementos, son parte de un proyecto que inició a principios de 2019 y aunque no ha concluido, se puso en práctica en la contingencia sanitaria del presente año. Si bien, el proyecto se planteó como un apoyo para algunos cursos curriculares en una carrera de Ingeniería Electrónica, en los resultados se describe el desempeño que se obtuvo por los estudiantes, ante la necesidad de dar uno de estos cursos a distancia, dando lugar a una reflexión sobre la viabilidad y limitaciones de impartir cursos de ingeniería bajo un esquema de educación abierta. Palabras Clave: Diseño electrónico, estrategia de enseñanza, educación a distancia, enseñanza virtual. Abstract In this document, we discuss some tools that can support teaching strategies for electronic design, which can help to reinforce the knowledge that engineering students acquire. This work is supported by three tools that we consider fundamental: Course notes, support computing programs and tutorials based on videos. These elements are part of a project that began in early 2019 and, although it has not been completed, it was put into practice during health contingency of this year. Although the project was proposed as a support for some curricular courses of Electronic Engineering, the results describe the performance obtained by the students because of the necessity of teaching these courses in remotely form, leading to a reflection on the feasibility and limitations of teaching engineering courses under an open education scheme. Keywords: Distance education, electronic design, e-learning, taching strategy

Use of plasma rich in growth factors in patients with knee osteoarthritis

Introducción: la osteoartritis es uno de los principales problemas de salud a nivel mundial debido a su alta prevalencia. Objetivo: determinar la efectividad y la seguridad del tratamiento con plasma rico en factores de crecimiento en la osteoartritis de rodilla. Métodos: se realizó una investigación en sistemas y servicios de salud, con enfoque sistémico pre experimental, prospectivo multicéntrico abierto. La muestra quedó conformada por 152 pacientes sometidos a este procedimiento en el Hospital “Arnaldo Milián Castro” de Santa Clara durante el período comprendido entre marzo de 2014 a diciembre de 2015. El seguimiento fue al mes, a los seis meses y al año. Se evaluaron variables clínicas y hematológicas que conforman el protocolo para este procedimiento y se emplearon escalas y exámenes de laboratorio especializados. Los datos obtenidos fueron sometidos al análisis estadístico-matemático. Resultados: la osteoartritis de rodilla predominó en el sexo femenino y en la tercera edad, la comorbilidad estuvo presente en la mayoría de los enfermos (la hipertensión arterial resultó la más frecuente), predominaron los grados II y III, sin asociación con la lateralidad y la presencia de deformidad, fueron significativas la reducción del consumo de medicamentos al año del tratamiento y la presencia de dolor, el peso corporal no mostró reducción y hubo escasas complicaciones. Conclusiones: la aplicación del plasma rico en factores de crecimiento autólogo es viable y segura en el tratamiento de la osteoartritis de rodilla.Introduction: Osteoarthritis is one of the main health problems worldwide due to its high prevalence. Objective: Determine the effectiveness and safety of the treatment with plasma rich in growth factors in knee osteoarthritis. Methods: A study was conducted in health systems and services with a pre-experimental, prospective, open and multicentre systemic approach. The sample consisted of 152 patients who underwent this procedure at the Arnaldo Milián Castro Hospital in Santa Clara from March 2014 to December 2015. The follow-up was carried out at one month, six months and one year. The clinical and hematological variables of the protocol for this procedure were assessed, and specialized scales and laboratory tests were used. The collected data underwent a statistical-mathematical analysis. Results: Knee osteoarthritis predominated in females and in third-age patients; comorbidity was present in most of the patients (arterial hypertension was the most frequent); grades II and III predominated, without association with laterality and the presence of deformity; at one year of treatment, there was a significant reduction in drug consumption, as well as a significant reduction of pain; body weight showed no reduction and there were few complications. Conclusions: The use of plasma rich in autologous growth factors is viable and safe in the treatment of knee osteoarthritis

En la costa aún sin mar

Los trabajos que conforman este volumen son una muestra de la presencia y actualidad de la obra de César Vallejo. Su poesía aún da lugar a nuevas y diversas interpretaciones; también a ciertas reconsideraciones. Asimismo, la narrativa del escritor peruano, poco atendida, está presente y exige estudio además de revalorización. La persona y obra de César Vallejo, en fin, son actuales incluso como un fenómeno metapoético.César Vallejo es un escritor esencial en el ámbito de la literatura contemporánea. Su obra literaria, escrita a principios del siglo pasado, sigue vigente. En su poesía, en particular, captó la sensibilidad de toda una época. Asimismo, supo traducir lo que él llamaba “el ritmo interior y el espíritu que se desprende de la realidad actual”. En cuanto a su obra en prosa, los estudios recientes dan muestra de su importancia, valor social y artístico. A casi cien años de la publicación de libros como Trilce y Los heraldos negros, la obra de César Vallejo sigue siendo fuente de goce estético y, por su complejidad, de búsqueda de conocimiento profundo de la realidad social y humana

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations