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Pacientes como informadores de eventos adversos: Resultados en diabetes y enfermedad renal Patients informing of adverse events: Results in diabetes and kidney disease
J.J. Mira,J. Vitaller,S. Lorenzo,C. Royuela
Anales del Sistema Sanitario de Navarra , 2012,
Abstract: Fundamento. Diabetes y enfermedad renal son factores de riesgo de sufrir eventos adversos (EA). No contamos con estudios sobre la percepción del riesgo de estos pacientes. En este estudio se analiza la frecuencia con la que los pacientes diabéticos y renales describen indicios de un posible EA y su percepción de seguridad de la atención que reciben. Material y métodos. Estudio descriptivo basado en entrevistas a pacientes seleccionados al azar. Estudio de campo realizado entre febrero y mayo de 2010 en 3 centros de salud y 2 hospitales de Alicante y Madrid. Resultados. Respondieron 199 pacientes, 98 diabéticos y 101 con enfermedad renal. Estos últimos acumularon mayor número de indicios de EA (21,8% refirió un EA, 17,8% dos y un 3% 3 o más) que los diabéticos (16,3% un EA, 7,1% dos y 7,1% se aló 3 o más). En el último a o, 6/98 diabéticos y 10/101 enfermos renales precisaron un tratamiento adicional. La probabilidad que el paciente cree tener de ser víctima de un error con consecuencias graves fue establecida en 1:10. Las mujeres con enfermedad renal creyeron tener una mayor probabilidad de sufrir un error (Chi2=12,7, p=0,002). Los errores clínicos se atribuyeron a la falta de tiempo para atender a todos los pacientes y a la insuficiencia de medios y recursos, sin diferencias estadísticamente significativas entre las submuestras. Los pacientes entrevistados consideraron similar el riesgo de error clínico, accidente de tráfico, atraco. Conclusiones. La información que proporcionan los pacientes puede contribuir a mejorar la seguridad de los procedimientos de trabajo. Background. Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. Material and methods. Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. Results. A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being
Calidad de la atención al paciente oncológico: Tiempos asistenciales recomendables entre sospecha clínica y definición del plan terapéutico en cáncer de mama y colorrectal Quality assurance in cancer: Acceptable delays in deciding the therapeutic plan in breast cancer and colorectal cancer
J.J. Mira,V. Pérez-Jover,J. Iba？ez,M. Guilabert
Anales del Sistema Sanitario de Navarra , 2012,
Abstract: Fundamento. Determinar tiempos recomendables para el tratamiento desde la sospecha clínica fundada en los procesos asistenciales de cáncer de mama y colorrectal considerando factibilidad y situación personal del paciente. Método. Estudio cualitativo de búsqueda de consenso entre profesionales. Primero, se revisaron mediante 4 sesiones grupales (N=19), los procesos asistenciales de cáncer de mama y cáncer colorrectal y se fijaron los tiempos deseables de ambos procesos. Segundo, mediante una modificación de la técnica Delphi (N=49), se validó la propuesta de tiempos de atención recomendables para cada proceso asistencial. Resultados. La tasa de respuesta en el estudio Delphi fue del 69% en el proceso de cáncer colorrectal y del 58% en el de mama. El tiempo recomendado entre sospecha clínica y plan terapéutico en el caso de cáncer de mama no infiltrante fue entre 5 y 6 semanas, dependiendo de la vía de acceso: atención primaria, especializada o unidad de prevención de cáncer de mama. Si el cáncer detectado fuese infiltrante y se recurriera a medicina nuclear para el estudio del ganglio centinela o vaciamiento axilar se recomendó de 5 a 7 semanas. En el caso de cáncer de colon y recto se consideró necesario un plazo de respuesta entre 7 a 13 semanas según la vía de acceso, tipo de tumor y curso. Conclusiones. El tratamiento en cáncer mama debe iniciarse antes de transcurrir mes y medio. En cáncer colorrectal podría precisarse hasta tres meses. La revisión de los procesos asistenciales contando con los profesionales y de forma interdisciplinaria favorece establecer criterios de calidad realistas. Background. To determine recommended delays for treatment once there is well-founded clinical suspicion in care processes for breast and colorectal cancer, taking into account resources and the psychological well-being of the patients. Method. A qualitative study among professionals. The study was conducted in two phases. Firstly, during 4 sessions (N=19) we conducted a revision of the care processes of breast cancer and colorectal cancer and fixed desirable times. Secondly, through a modification of the Delphi technique (N=49), the proposed times for each care process were validated. Results. Delphi response rates of 69% and 58% for colorectal and breast processes respectively. The recommended time in the case of non-invasive breast cancer was 5 to 6 weeks. If the cancer was invasive and nuclear medicine was used for sentinel node study or axillary clearance 5 to 7 weeks were recommended. In the case of cancer of the colon and rectum 7 to 13 weeks were considered
Estudo clínico e laboratorial da pneumonia de bezerros induzida pela inocula？？o intrabronquial de Mannheimia haemolytica
Fagliari, J.J.;
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2003, DOI: 10.1590/S0102-09352003000100002
Abstract: seven control holstein calves were inoculated intrabronchially with 5.0ml of dulbecco？s phosphate-buffered saline solution (dpbs). other seven calves were inoculated with 5′ 109 mannheimia haemolytica organisms/5.0 ml of dpbs. bronchoalveolar fluid and blood samples were collected immediately before and at 4, 6, 12, and 24 hours after inoculation. clinical examination was performed at the same time points. histologically haemorragic and fibrinotic pneumonia was observed. seven sick calves had lethargy, abdominal respiratory pathern, altered respiratory sounds, hypertemia, increased heart and respiratory rates, and cardiac arrhythmia. pneumonic calves showed higher packed cell volume and red cell count, suggesting hemoconcentration. pneumonic calves also had decreased po2 and increased pco2 suggesting poor pulmonary ventilation. neutrophilia and high neutrophil and monocyte counts in bronchoalveolar fluid were detected due to pulmonar inflammation. blood ph and plasma concentrations of hco3, na, and k had no significant changes.
Effect of hyperoxia on the intestinal IgA secretory component in neonatal rats and on intestinal epithelial cells in vitro
Li, J.J.;
Brazilian Journal of Medical and Biological Research , 2010, DOI: 10.1590/S0100-879X2010007500106
Abstract: oxygen therapy is essential for the treatment of some neonatal critical care conditions but its extrapulmonary effects have not been adequately investigated. we therefore studied the effects of various oxygen concentrations on intestinal epithelial cell function. in order to assess the effects of hyperoxia on the intestinal immunological barrier, we studied two physiological changes in neonatal rats exposed to hyperoxia: the change in intestinal iga secretory component (sc, an important component of siga) and changes in intestinal epithelial cells. immunohistochemistry and western blot were used to detect changes in the intestinal tissue sc of neonatal rats. to detect intestinal epithelial cell growth, cells were counted, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (mtt) and giemsa staining were used to assess cell survival. immunohistochemistry was used to determine sc expression. the expression of intestinal sc in neonatal rats under hyperoxic conditions was notably increased compared with rats inhaling room air (p < 0.01). in vitro, 40% o2 was beneficial for cell growth. however, 60% o2 and 90% o2 induced rapid cell death. also, 40% o2 induced expression of sc by intestinal epithelial cells, whereas 60% o2did not; however, 90% o2 limited the ability of intestinal epithelial cells to express sc. in vivo and in vitro, moderate hyperoxia brought about increases in intestinal sc. this would be expected to bring about an increase in intestinal siga. high levels of sc and siga would serve to benefit hyperoxia-exposed individuals by helping to maintain optimal conditions in the intestinal tract.
Evaluation of the Haemoglobin Colour Scale and comparison with the HemoCue haemoglobin assay
Paddle,J.J.;
Bulletin of the World Health Organization , 2002, DOI: 10.1590/S0042-96862002001000010
Abstract: objective: to evaluate the haemoglobin colour scale developed by who for estimating haemoglobin concentration and to compare the results obtained using it and the hemocue assay with those determined using a reference method, the technicon h3 analyser. methods: the colour scale and hemocue assay were used to test 408 blood samples. subsequently, bland-altman plots were determined and the proximity of the test results to those obtained using the reference method was determined. findings: the mean difference between the haemoglobin colour scale and the reference method was 0.19 g/dl (95% confidence interval: 3.50 g/dl below to 3.11 g/dl above); the corresponding value for the hemocue assay was 0.50 g/dl (1.16 g/dl below to 0.16 g/dl above). only 46.08% of the results obtained by means of the colour scale were within 1.0 g/dl of the reference method, whereas 95.34% of the hemocue results fell within this limit; 22.79% of the colour scale results but none of the hemocue results lay more than 2.0 g/dl from the reference method. conclusion: the haemoglobin colour scale test is too inaccurate for general use, particularly if devices such as the hemocue are available.
Estudo clínico e laboratorial da pneumonia de bezerros induzida pela inocula o intrabronquial de Mannheimia haemolytica
Fagliari J.J.
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2003,
Abstract: Foram utilizados 14 bezerros da ra a Holandesa entre 15 e 30 dias de idade, sete inoculados com 5ml de solu o salina fosfato-tamponada Dulbecco (DPBS) e sete inoculados com 5x10(9) UFC de Mannheimia haemolytica/5 ml de DPBS, via intrabronquial. O exame clínico e as colheitas de sangue e de lavado broncoalveolar foram realizados antes e 4, 6, 12 e 24 horas após a inocula o. O exame histopatológico dos pulm es revelou les es de pneumonia fibrinosa hemorrágica. Os sinais clínicos surgiram quatro horas após a inocula o das bactérias. Os sete bezerros enfermos apresentavam apatia, respira o abdominal, altera o dos ruídos respiratórios, hipertermia, eleva o das freqüências cardíaca e respiratória e arritmia cardíaca. Os exames de laboratório mostraram aumento na contagem de hemácias e do volume globular, indicando hemoconcentra o. A diminui o de PO2 e a eleva o de PCO2 sugerem inadequada ventila o pulmonar. Observaram-se neutrofilia e alto número de neutrófilos e monócitos no fluido broncoalveolar. O pH do sangue e as concentra es plasmáticas de HCO3, Na e K n o apresentaram altera es significativas.
OPTIMAL DISTRIBUTION OF REPLICATED DATA IN COMPUTER NETWORKS
J.J. Strasheim
South African Journal of Industrial Engineering , 2012,
Abstract: ENGLISH ABSTRACT: The rapid development in computer networks has enabled the implementation of new methods of data distribution. There are however, no available tools for supportinq decision making and planning in this application area and operators have to rely on manual methods to design schedules for data and software distribution. This manual approach takes long and typically results 'In distribution projects that are both costly and slow. This article presents 'o new approach to the data distribution scheduling problem that produces schedules for implementation based on minimum distribution cost or minimum distribution time. AFRIKAANSE OPSOMMING: Die snelle ontwikkeling van rekenaarnetwerke het die implementering van nuwe metodes vir datadistribusie moontlik gemaak. Daar is ongelukkig geen beskikbare hulpmiddels om besluitneming en beplanning in hierdie toepassingsveld te ondersteun nie en gebruikers moet staat maak op handmetodes vir die opstel van data- en programmatuur verspreidingsskedules. Hierdie handmetodes neem lank en resulteer in verspreidingsprojekte wat beide tydsaam en duur is. Hierdie artikel stel 'n nuwe benadering tot die probleem voor wat skedules lewer vir implementering gebaseer op minimum verspredingskoste of minimum verspreidingstyd.
DEMAND FORECASTING FOR MOTOR VEHICLE SPARE PARTS
J.J. Strasheim
South African Journal of Industrial Engineering , 2012,
Abstract: ENGLISH ABSTRACT: Reordering motor vehicle spare parts for the purposes of stock replenishment is an important function of the parts manager in the typical motor dealership. Meaningful reordering requires a reliable forecast of the future demand for items. A variety of alternative forecasting techniques were evaluated for this purpose with the aim of selecting one optimal technique to be implemented in an automatic reordering module of a real time computerized inventory management system. AFRIKAANSE OPSOMMING: Aanvulling van onderdeelvoorraad is 'n belangrike funksie van die onderdelebestuurder in die tipiese motorhandelsaak. Sinvolle herbestelling vereis 'n betroubare vooruitskatting van die toekomstige vraag na items. 'n Verskeidenheid alternatiewe vooruitskattingstegnieke is evalueer ten einde 'n optimale tegtniek te vind vir implementering in die outomatiese herbestelmodule van 'n intydse gerekenariseerde voorraadbestuurstelsel.
A creative humane university – coping with the business model
J.J. Venter
Koers : Bulletin for Christian Scholarship , 2006, DOI: 10.4102/koers.v71i2-4.243
Abstract: In this article it is attempted to indicate that the economistic application of economy of scale in the context of a university pushes a university, even in its reigning epistemology, ideologically in the direction of technicism, scientism, and economism (imposed by neo-pragmatist managerialism). Economistic application of economy of scale includes minimising academic staff and their support systems, but combined with the maximum intake in student numbers. This managerial system introduces stereotypical forms of innovation, and inhibits risk-taking, although, disciplined playfulness is indeed needed for creative scholarship. It is also attempted to analyse creative possibilities in terms of the spectrum of possible scholarly problem statements with their proportionate risks. The basic forms of abstraction are also outlined in order to give some indication of how scholars are to support the development of a responsible spirit of renewal of knowledge in their students.
Mechanistic individualism versus organistic totalitarianism
J.J. Venter
Koers : Bulletin for Christian Scholarship , 1997, DOI: 10.4102/koers.v62i1.558
Abstract: Mechanistic individualism versus organistic totalitarianism In this article it is argued that the organistic world picture, when functioning as a world view, is associated with a totalitarian view of social relationships, usually promoting the interests o f the state or the ethnic group as the interests which should dominate. This is illustrated by referring to the social ideas of Hobbes, Rousseau, D.H. Lawrence and Mussolini. The mechanistic world picture, however, when functioning as a world view, is associated with individualism, according to which the individuals have a relatively independent existence; it suggests that justice and morality are the automatic products of the equilibrating process. Cases in point: Hobbes, Adam Smith, Kant, Darwin, New-Classical and Monetarist economics. Finally (in Neo-Calvinist vein) it is argued that the application o f such worldviewish metaphors should be limited, so that justice can be done to both the differentiation of social relationships and their integration.
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