Sustentabilidad hospitalaria, calidad y seguridad del paciente en el Hospital Clínico Universidad de Chile / Hospital sustainability, quality and patient safety in Hospital Clínico Universidad de Chile

The sustainability of the Universidad de Chile Clinical Hospital must be understood comprehensively; providing higher quality and safety for our patients, ensuring highest standards of medical care. The quality of care must be understood not only in complying with the minimum standards to accredit and grant GES benefits, establish agreements with health insurers and be financially competitive; It must be incorporated into its management the dimensions of quality - effectiveness, efficiency, accessibility, safety, equity and patient-centered care- minimizing the costs of non-quality work. Our Clinical Hospital, as our country's main training center in healthcare professions, must include training at the undergraduate students' curriculum in quality and patient safety issues. (AU)

Estudo proteômico de variedades de milho ( Zea mays L. ) obtidas por melhoramento clássico e por recombinação genética / Proteomic study of maize ( Zea mays L. ) varieties obtained by classical breeding and genetic recombination.

O melhoramento genético clássico de sementes milho (Zea mays L.) permitiu desenvolver inúmeras variedades, incluindo o milho com qualidade proteica melhorada (Quality Protein Maize, QPM), que visava aumentar os teores proteicos e as propriedades nutricionais. Por outro lado, novas variedades comerciais foram obtidas por vegetais geneticamente modificados (GM), com foco em parâmetros agronômicos. Em ambos os casos, a segurança dessas variedades para uso como alimento é uma das principais preocupações dos desenvolvedores e dos órgãos de regulamentação. A Equivalência Substancial é a base do sistema de avaliação da segurança de culturas geneticamente modificadas, no entanto alterações na expressão de proteínas não são devidamente analisadas e esclarecidas. As abordagens proteômicas complementam as técnicas de avaliação de biossegurança para alimentos GM, bem como permitem investigar possíveis efeitos indesejáveis derivados do melhoramento clássico. Os objetivos do presente estudo foram caracterizar e comparar os perfis proteicos de variedades de milhos convencionais melhorados (QPM) e geneticamente modificados (GMs), contra suas respectivas linhas convencionais utilizando técnicas proteômicas como eletroforese bidimensional (2-DE) e bottom up shotgun (gel-free). Num primeiro estudo, foram utilizadas três amostras de milho, sendo duas variedades convencionais com QPM (QP1 e QP2) e uma variedade convencional normal (CN). No segundo estudo, foram analisadas duas cultivares de milho GM (GM1 e GM2) e seus respectivos convencionais genitores (CG1 e CG2). As composições químicas de todas as amostras também foram avaliadas quanto a Equivalência Substancial. O extrato bruto proteico foi submetido à análise de eletroforese unidimensional (1-DE), bidimensional (2-DE) e bottom up shotgun (gel-free). As imagens dos mapas proteicos foram analisadas pelo software Image Master 2D Platinum 7.0 (GE). Os spots diferencialmente expressos e selecionados foram sequenciados por MS. Pela composição química das principais frações das amostras de milho foi possível identificar a equivalência substancial entre as amostras convencionais e GMs, bem como QPMs e sua convencional dentro das faixas de variabilidade esperadas da espécie. Nos géis 1-DE foram observadas bandas proteicas com perfis similares entre os grupos de amostras avaliadas para ambos estudos. Nas imagens dos géis 2-DE não houveram alterações extremas entre as amostras de milhos GMs e seus respectivos convencionais genitores (CGs), mas apenas diferenças na intensidade dos spots proteicos. As variedades QPMs e CN apresentaram diferenças devido à distribuição dos spots. Os mapas proteicos das amostras CG1 x GM1 e CG2 x GM2 apresentaram maior semelhança com porcentagens de matchings superiores a 70 %, enquanto as porcentagens de matchings entre variedades diferentes (QPMs e CN) foram menores. No total foram identificadas 219 proteínas das amostras CGs x GMs e QPMs x CN, classificadas quanto aos seus processos biológicos e função molecular. Em conclusão, foram encontradas diferenças entre os cultivares GMs e CGs, indicando uma variação normal entre variedades de milho, que não comprometem a segurança alimentar das amostras estudadas. Quanto às amostras com QPM e CN as diferenças encontradas são devido à sua distância nas linhagens ou germoplasma

The classic genetic breeding of corn seeds (Zea mays) has enabled the development of many varieties, including corn with improved protein quality (Quality Protein Maize, QPM), which aimed to increase protein levels and nutritional properties. On the other hand, new commercial varieties have been obtained out of genetically modified (GM) vegetables, with a focus in agronomic parameters. In both cases, the safety of these varieties for food use is one of the main concerns for the developers and for the regulatory agencies. Substantial Equivalence is the basis of the safety evaluation system for genetically modified crops, however, alterations in the protein expressions are not been properly analyzed and clarified. The protein approaches complement the techniques of biosafety evaluation for GM foods, as well as allow for possible undesirable effects derived from classic improvement to be investigated. The goals of the current studies were to characterize and compare the protein profiles of the different varieties of conventionally improved (QPM) and genetically modified (GM) corn, against their respective conventional lines using proteomic techniques, such as, two-dimensional electrophoresis (2-DE), bottom up shotgun (gel-free) and masses spectrometry (MS). In a first instance of the study, three samples of corn were used, two of conventional varieties with QPM (QP1 and QP2) and one conventional normal variety (CN). In a second instance of the study, two cultures of GM corn (GM1 and GM2) were analyzed and their respective conventional genitors (CG1 and CG2). The chemical compositions of all the samples were also evaluated for their Substantial Equivalence. The protein raw extract was submitted to analysis of one-dimensional (1-DE), two-dimensional (2-DE) electrophoresis, and bottom up shotgun (gel-free). The protein image maps were analyzed by the Image Master 2D Platinum 7.0 (GE) software. The spots which were expressed and selected differentially were sequenced by MS. By the chemical composition of the main fractions of the samples of corn, it was possible to identify the substantial equivalence between the conventional samples and GMs, likewise with OPMs and their conventional in the ranges of variability which were expected for the species. On the 1-DE gel, it was observed protein bands with similar profiles amongst the groups of evaluated samples for both studies. In the images of the 2-DE gel, there were no alterations between the GM corn and their respective conventional genitors (CGs), but only differences in intensity of the protein spots. The OPM and CN varieties presented differences due to the distribution of the spots. The protein maps of samples CG1 vs. GM1 and CG2 vs. GM2 presented greater similarities with the percentages of matchings superior to 70%, while the percentage of matchings among different varieties (QPMs and CN) were smaller. In total, there were 219 proteins identified in the samples CGs vs. GMs and QPMs vs. CN, classified by the biologic processes and molecular function. In conclusion, there were found differences between the cultures of GMs and CGs, indicating a normal variation among the corn varieties, which do not affect the food security of the studied samples. As per the samples with QPM and CN, the differences found were due to the line distances or germplasm

Major changes and improvements of dialysis therapy in Korea: review of end-stage renal disease registry

The Korean Society of Nephrology (KSN) launched a nationwide end-stage renal disease (ESRD) patient registry in 1985 called the Insan Prof. Byung-Suk Min Memorial ESRD Patient Registry. KSN members voluntarily participate in this registry, which has been collecting data through the Internet since 2000. The KSN ESRD patient registry data were reviewed to elucidate the major changes and improvements in dialysis therapy in Korea. The data review revealed: a rapid increase in the number of patients with ESRD; an increase in the number of patients with diabetic nephropathy; a decrease in the proportion of patients undergoing peritoneal dialysis; an increase in the role of private dialysis clinics; an increase in the number of elderly patients undergoing dialysis and the number of patients undergoing long-term dialysis; a decrease in mean blood pressure and an increase in pulse pressure; improvement in anemia treatment; improvement in dialysis adequacy; and improvement in the survival of patients undergoing dialysis. In conclusion, improvements have been made in blood pressure control, anemia treatment, and dialysis adequacy despite increases in the number of elderly patients, diabetic patients, and patients on long-term dialysis during the last two decades in Korea.

Evaluation of the implementation of a quality system in a basic research laboratory: viability and impacts / Avaliação da implementação de um sistema de qualidade em um laboratório de pesquisa básica: viabilidade e impactos

OBJECTIVE: To evaluate the process of implementing a quality management system in a basic research laboratory of a public institution, particularly considering the feasibility and impacts of this improvement. METHODS: This was a prospective and qualitative study. We employed the norm "NIT DICLA 035 - Princípios das Boas Práticas de Laboratório (BPL)" and auxiliary documents of Organisation for Economic Co-operation and Development to complement the planning and implementation of a Quality System, in a basic research laboratory. In parallel, we used the PDCA tool to define the goals of each phase of the implementation process. RESULTS: This study enabled the laboratory to comply with the NIT DICLA 035 norm and to implement this norm during execution of a research study. Accordingly, documents were prepared and routines were established such as the registration of non-conformities, traceability of research data and equipment calibration. CONCLUSION: The implementation of a quality system, the setting of a laboratory focused on basic research is feasible once certain structural changes are made. Importantly, impacts were noticed during the process, which could be related to several improvements in the laboratory routine.

OBJETIVO: Avaliar o processo de implantação de um sistema de qualidade em um laboratório de pesquisa básica, avaliando a viabilidade e os impactos dessa melhoria. MÉTODOS: Tratou-se de um estudo qualitativo prospectivo. Utilizou-se a norma NIT DICLA 035 - Princípios das Boas Práticas de Laboratório (BPL) e documentos da Organisation for Economic Co-operation and Development para complementar o planejamento e a implantação de um Sistema de Gestão da Qualidade, em um laboratório de pesquisa básica. Em paralelo, utilizou-se a ferramenta PDCA para definir os objetivos de cada etapa de implantação do sistema de qualidade. RESULTADOS: Este trabalho possibilitou ao laboratório atender requisitos solicitados pela norma NT DICLA 035 e implementá-los durante a execução de um projeto, dentre eles a elaboração de documentos, bem como estabelecer rotinas importantes para o andamento do mesmo, como a identificação de não conformidades, rastreabilidade de dados e calibração de equipamentos. CONCLUSÃO: A implantação do Sistema da Qualidade BPL, nesse cenário, é viável, gerando impactos positivos na rotina do laboratório.

Propuesta de una guía de autoevaluación para programas de posgrado / Proposal of a self-evaluation guide for postgraduate programs

En la actualidad el mejoramiento de la calidad de los programas de posgrado es una prioridad para las universidades y los centros de posgrado que se encargan de la formación integral de los educandos y el perfeccionamiento de su competencia y desempeño. Se diseñó una guía de autoevaluación para medir la calidad de la impartición de los programas de posgrado que se realizan en el Centro de Estudios de Posgrado de Cirugía de Mínimo Acceso, de La Habana. La consulta a expertos y el análisis de contenido permitió seleccionar las variables cualitativas, los criterios y la ponderación que se utilizarían para la confección de la guía. La propuesta presentada es novedosa, por cuanto en el centro no existe un instrumento que permita valorar la calidad de la superación profesional, la experiencia institucional y del claustro profesoral para el perfeccionamiento de los recursos humanos(AU)

Nowadays the improvement of postgraduate programs quality is as priority for universities and postgraduate center to be in charge of student integral training and the improvement of its competence and performance. A self-evaluation guide was designed to measure the teaching the postgraduate programs in the Center of Postgraduate Studies on Minimal-Access Surgery of The Habana City. The experts consultation and the content analysis allowed us to select the qualitative variables, criteria and weighting used for designing of this guide. This proposal is novel, but in our center it is not available a tool allowing to value the professional training quality, the institutional experience and the educational staff for the improvement of human resources(AU)