La gestión por procesos en la Farmacia Hospitalaria para la mejora de la seguridad del paciente / Process management in the Hospital Pharmacy for the improvement of the patient safety

Objetivos. Definir un modelo de gestión por procesos de una Farmacia Hospitalaria para medir, analizar y realizar la mejora continúa en seguridad y calidad asistencial. Material y métodos. En el marco de implantación de la gestión por procesos, el Hospital de Igualada se dividió en varios procesos, uno de los cuales fue el proceso de Farmacia Hospitalaria. Primero se nombró un equipo de gestión para cada proceso. Después se definió un pequeño grupo de trabajo para cada subproceso con su respectivo responsable. Con la ayuda de estos grupos se realizaron el análisis de riesgos aplicando el Análisis Modal de Fallos y Efectos (AMFE) y la implantación de las acciones de mejora resultantes. Se definieron indicadores para cada subproceso y se establecieron diferentes mecanismos de gestión por procesos. Resultados. Primero, el análisis de riesgos con AMFE generó más de una treintena de acciones preventivas para mejorar la seguridad del paciente. Después, tanto el análisis semanal de incidencias como el análisis mensual de los indicadores nos permitió la monitorización y gestión basada en datos objetivos de los resultados claves. Además, el tener a una persona responsable de los resultados de cada subproceso nos permitió la implicación y compromiso del personal creándose la cultura de excelencia. Conclusiones. La introducción de diferentes mecanismos de gestión por procesos, con la participación del personal responsable para cada subproceso, introduce una herramienta de gestión participativa para la mejora continua de la seguridad y calidad asistencial(AU)

Objectives. To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. Material and methods. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. Results. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. Conclusions. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality(AU)

Dynamics of cohesin subunits in grasshopper meiotic divisions.

The cohesin complex plays a key role for the maintenance of sister chromatid cohesion and faithful chromosome segregation in both mitosis and meiosis. This complex is formed by two structural maintenance of chromosomes protein family (SMC) subunits and two non-SMC subunits: an α-kleisin subunit SCC1/RAD21/REC8 and an SCC3-like protein. Several studies carried out in different species have revealed that the distribution of the cohesin subunits along the chromosomes during meiotic prophase I is not regular and that some subunits are distinctly incorporated at different cell stages. However, the accurate distribution of the different cohesin subunits in condensed meiotic chromosomes is still controversial. Here, we describe the dynamics of the cohesin subunits SMC1α, SMC3, RAD21 and SA1 during both meiotic divisions in grasshoppers. Although these subunits show a similar patched labelling at the interchromatid domain of metaphase I bivalents, SMCs and non-SMCs subunits do not always colocalise. Indeed, SA1 is the only cohesin subunit accumulated at the centromeric region of all metaphase I chromosomes. Additionally, non-SMC subunits do not appear at the interchromatid domain in either single X or B chromosomes. These data suggest the existence of several cohesin complexes during metaphase I. The cohesin subunits analysed are released from chromosomes at the beginning of anaphase I, with the exception of SA1 which can be detected at the centromeres until telophase II. These observations indicate that the cohesin components may be differentially loaded and released from meiotic chromosomes during the first and second meiotic divisions. The roles of these cohesin complexes for the maintenance of chromosome structure and their involvement in homologous segregation at first meiotic division are proposed and discussed.

[Process management in the hospital pharmacy for the improvement of the patient safety]. / La gestión por procesos en la farmacia hospitalaria para la mejora de la seguridad del paciente.

OBJECTIVES: To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. MATERIAL AND METHODS: In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. RESULTS: The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. CONCLUSIONS: The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality.

Incomplete synapsis and chiasma localization: the chicken or the egg?

In the present study, and as a sincere tribute from the Cytogenetics teams from Madrid to Professor Máximo Drets on his 80th birthday, we have analyzed and compared 3 different grasshopper species with different synaptic patterns, a standard pattern, a second pattern with synapsis restricted to the proximal regions, and a third pattern with synapsis restricted to the distal regions. In the 3 species we have thoroughly analyzed the relationships among cohesin axis morphogenesis, formation of double strand breaks (DSBs) and recombination initiation. Our results demonstrate that in every case recombination initiation precedes synapsis, and that there is a direct relationship between the absence of meiotic recombination and the existence of particular unsynapsed chromosomal regions during prophase I. Based on our results we propose and discuss the mechanisms underlying the existence of incomplete synapsis and the localization of chiasma in wild species.

X and B chromosomes display similar meiotic characteristics in male grasshoppers.

We have analysed the chromosome organisation and the location and temporal appearance of different proteins in X and B chromosomes in the grasshopper Eyprepocnemis plorans throughout the first meiotic prophase. We have used adult males that carry a B chromosome collected in natural Spanish populations. The scaffold organisation has been analysed by means of silver stained chromatid cores. In addition, we have detected by immunolabelling the presence of phosphoepitopes, the ensemble of cohesin axes, the location of histone gamma-H2AX, and recombinase Rad51. Our observations demonstrate that X and B chromosomes share similarities in chromatin organisation and in the expression of the tested proteins, which strongly differ from those of the autosomes. These results could be interpreted either as a support to the hypothesis that the Bs analysed here originated from the X chromosome, and/or that their chromatin composition and precocious condensation could determine their meiotic behaviour.

Fístula aorto-cava en aneurisma de aorta abdominal roto / Aorto-caval fistula in ruptured abdominal aorta aneurysm

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Full phase analysis of portland clinker by penetrating synchrotron powder diffraction.

Fabrication of portland cements commonly depends on X-ray fluorescence (XRF), which measures the elemental compositions. XRF is used to adjust the raw material proportions and to control the process conditions. However, to predict the mechanical strength of the resulting concrete, it is essential to know the phase composition which is, so far, indirectly inferred by the Bogue method. Here, we report a phase analysis of an industrial portland clinker containing six crystalline phases, Ca3SiO5, Ca2SiO4, Ca4Al2Fe2O10, Ca3Al2O6, NaK3(SO4)2, and CaO, by Rietveld refinement of synchrotron X-ray powder diffraction data (lambda = 0.442377 A). Even the minor component, CaO 0.45(2)%, was readily analyzed. We have also carried out a phase study of the same clinker with laboratory X-rays to characterize the changes in the detection limit and errors. Furthermore, by adding a suitable crystalline standard to the same clinker, we have determined the overall amorphous phase content. The procedure established for this state-of-the-art phase analysis shows the high precision that can be achieved by using penetrating X-rays, which is of interest not only in cement chemistry but in other industrially important multiphase systems such as slags, superalloys, or catalysts.