Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena / Efficacy of the strategy to improve the quality indicators of Diabetes Mellitus 2 Care Process in Advanced Diabetes Centre Macarena

Introducción: La evaluación del Proceso Asistencial Integrado de Diabetes Mellitus 2 (PAI-DM2) mediante el instrumento para la evaluación de modelos de atención ante la cronicidad (IEMAC-Diabetes) permite el diseño de intervenciones para la mejora de la atención. Objetivo: Analizar la calidad de la atención sanitaria prestada a los pacientes con DM2. Diseño: Estudio cuasiexperimental de tipo antes-después con grupo control no aleatorizado. Emplazamiento: Distritos sanitarios de atención primaria de Sevilla. Participantes: Un total de 12 cupos médicos, 5 centros de atención primaria, seleccionados de manera discrecional. Intervención: Los profesionales de medicina y enfermería de los 12 cupos experimentales participaron en un programa formativo, incluida una estancia externa en el Hospital de Día de Diabetes. Mediciones principales: Número de pacientes incluidos, hemoglobina glucosilada (HbA1c), exploración de pies (EP) y fondo de ojo (FO). Resultados: Se analizaron 1.475 pacientes con DM2. La proporción de pacientes incluidos por cupo fue del 8,3%, siendo mujeres el 45,4%. Al inicio del estudio, la proporción de pacientes con HbA1c < 7% fue del 38,9% en 2013 frente al 47,7% en 2014, disminuyendo al 40,2% en 2016. El 33,3% de los pacientes tenía en 2013 realizado un FO frente al 41,77% en 2014. El 51,6% en 2013 tenía una EP frente al 54,7% en el 2014. Tras la intervención se alcanzaron diferencias estadísticamente significativas en el número de HbA1c (p = 0,01) y de retinografías (p = 0,01) solicitadas. Conclusiones: La herramienta IEMAC-Diabetes permite detectar áreas de mejora en el PAI-DM2. La ausencia de diferencias significativas puede deberse a un fenómeno de contaminación y/o al efecto Hawthorne

Introduction: The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness’ care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care. Objective: Analysing the quality of healthcare provided to DM2 patients. Design: Quasiexperimental study before and after intervention with a not randomised control group. Location: Health care district of primary care Sevilla. Participants: 12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way. Intervention: Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital. Main measurements: Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF). Results: 1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c < 7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p = 0.01) and retinography requested (p = 0.01). Conclusions: IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect

[Efficacy of the strategy to improve the quality indicators of Diabetes Mellitus 2 Care Process in Advanced Diabetes Centre Macarena]. / Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena.

INTRODUCTION: The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness' care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care. OBJECTIVE: Analysing the quality of healthcare provided to DM2 patients. DESIGN: Quasiexperimental study before and after intervention with a not randomised control group. LOCATION: Health care district of primary care Sevilla. PARTICIPANTS: 12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way. INTERVENTION: Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital. MAIN MEASUREMENTS: Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF). RESULTS: 1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c<7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p=0.01) and retinography requested (p=0.01). CONCLUSIONS: IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect.

Immobilization of membrane proteins on solid supports using functionalized ß-sheet peptides and click chemistry.

We have developed two functionalized ß-sheet peptides (FBPs) and demonstrated that they can stabilize a variety of integral membrane proteins (IMPs), and most importantly allow covalent crosslinking of the IMPs onto solid supports via the highly selective click chemistry. The FBPs are promising tools for the preparation of IMP-based biomaterials or biosensors.

Effect of the microstructure on the propagation velocity of ultrasound in magnetic powders.

We analyze experimentally and theoretically the sound propagation velocity of P-waves in granular media made of micrometer-size magnetite particles under an external magnetic field. The sound velocity is measured in a coherent (long-wavelength) regime of propagation after a controlled sample preparation consisting of a fluidization and the application of a magnetic field. Several different procedures are applied and result in different but reproducible particle arrangements and preferential contact orientations affecting the measured sound velocity. Interestingly, we find that the sound velocity increases when the magnetic field is applied parallel to the sound propagation direction and decreases when the magnetic field is applied perpendicular to the sound propagation direction. The observed qualitative relationship between the changes in the particle arrangement and the sound velocity is analyzed theoretically based on an effective medium theory adapted to account for the effect of the magnetic field in the preparation procedure and its influence on the medium contact fabric.

Ultrasonic probing of cohesive granular media at very low consolidation.

In this work, we study sound propagation in different granular media made of magnetite particles, steel particles, and glass beads consolidated under their own weight. We used two ultrasonic non invasive methods, which are found in good agreement, to estimate the longitudinal wave velocity Vp. In the first one, the velocity is determined through the resonance peaks of the powder slab. The second method determines the velocity with the time of flight of a short pulse traveling through the medium. Magnetite and steel samples show dispersive properties below a frequency ∼ 10kHz. The increase of attractive forces between particles lead to two competing effects; on one hand the solid fraction decreases and on the other hand the contacts are stiffer. A decrease in solid fraction implies that the number of contacts decreases leading to a decrease in the wave propagation velocity. On the other hand stronger contacts on average lead to an increase of sound velocity. In our experiments an increase in powder cohesion (caused by a decrease of the bead diameter) leads to an increase in sound velocity even though the solid fraction decreases. The same behavior is found in glass beads. These results show the predominant role of cohesive forces on sound propagation in loosely consolidated dry fine powders as well as the accuracy of ultrasonic methods for powder characterization.

Morbimortalidad de la fractura de cadera / Morbimortality of the hip fracture

Las lesiones traumáticas de la cadera ocupan uno de los aspectos más importantes de la cirugía traumatológica por ocurrir con extraordinaria frecuencia, y por ser características del sujeto de avanzada edad constituyen el grupo nosológico de mayor morbimortalidad. Basándonos en esto se realizó un estudio epidemiológico observacional, descriptivo, de tipo longitudinal en pacientes que ingresaron con fractura de cadera en los hospitales “José R. López Tabrane”, de Matanzas, e “Iluminado Rodríguez”, de Jagüey Grande, en el período comprendido entre noviembre del 2001 y marzo del 2006. Nuestro universo estuvo constituido por 129 pacientes en quienes se realizó el tratamiento quirúrgico...(AU)

Morbimortalidad de la fractura de cadera / Morbimortality of the hip fracture

Las lesiones traumáticas de la cadera ocupan uno de los aspectos más importantes de la cirugía traumatológica por ocurrir con extraordinaria frecuencia, y por ser características del sujeto de avanzada edad constituyen el grupo nosológico de mayor morbimortalidad. Basándonos en esto se realizó un estudio epidemiológico observacional, descriptivo, de tipo longitudinal en pacientes que ingresaron con fractura de cadera en los hospitales “José R. López Tabrane”, de Matanzas, e “Iluminado Rodríguez”, de Jagüey Grande, en el período comprendido entre noviembre del 2001 y marzo del 2006. Nuestro universo estuvo constituido por 129 pacientes en quienes se realizó el tratamiento quirúrgico

Traumatic lesions of the hip are one of the most important aspects of the traumatic surgery, because they are very frequently, and because they take place in advanced-aged subjects: the higher morbimortality nosologic group. On that base, we carried out a longitudinal, descriptive, observacional, epidemiologic study in patients entering the hospitals “José R. López Tabrane”, of Matanzas, and “Iluminado Rodríguez”, of Jagüey Grande with hip fractures during the period November 2001 and march 2006. Our universe was constituted of 129 patients, receiving surgical treatment.

Types of gas fluidization of cohesive granular materials.

Some years ago it was shown that gas-fluidized powders may transit from solid-like to fluid-like fluidization prior to bubbling, shedding light on a long-standing controversy on the nature of "homogeneous" fluidization. In this paper it is shown that some gas-fluidized powders may also transit from the fluid-like regime to elutriation, with full suppression of the bubbling regime. We provide a diagram that can be used to predict these types of fluidization exhibited by cohesive powders based on simple phenomenological equations in which particle aggregation due to attractive forces is a key ingredient.

A linear analysis of the effect of Faradaic currents on traveling-wave electroosmosis.

Net fluid flow of electrolytic solutions induced by a traveling-wave potential applied to an array of co-planar interdigitated microelectrodes has been reported. At low applied voltages the flow is driven in the direction of the traveling-wave potential, as expected by linear and weakly nonlinear theoretical studies. The flow is driven at the surfaces of the electrodes by electrical forces acting in the diffuse electrical double layer. The pumping mechanism has been analyzed theoretically under the assumption of perfectly polarizable electrodes. Here we extend these studies to include the effect of Faradaic currents on the electroosmotic slip velocity generated at the electrode/electrolyte interface. We integrate the electrokinetic equations under the thin-double-layer and low-potential approximations. Finally, we analyze the pumping of electrolyte induced by a traveling-wave signal applied to a microelectrode array using this linear model.

High viscosity gas fluidization of fine particles: An extended window of quasihomogeneous flow.

We explore the role of gas viscosity in the behavior of gas-fluidized beds of fine powders by means of experimental measurements using nitrogen and neon as fluidizing gases, and theoretical considerations. The existence of a nonbubbling fluidlike regime has been recently observed in beds of fine powders fluidized with nitrogen. Our experiments with neon reveal a discontinuous transition from heterogeneous fluidization to a highly expanded homogeneous fluidization state. We point out that increasing gas viscosity enhances the coherence of agglomerate swarms, which promotes a local void-splitting mechanism, thus improving the uniformity of fluidization. Our theoretical analysis predicts that further increase of gas viscosity would produce a full suppression of the bubbling regime, i.e., the uniformly fluidized bed would undergo a direct transition to a turbulent regime as seen in beds of nanoparticles fluidized by nitrogen and in liquid-fluidized beds of moderate-density beads.

Effect of compaction history on the fluidization behavior of fine cohesive powders.

Fine particles agglomerate in the fluidized state due to the strength of interparticle attractive forces as compared to particle weight. Interparticle adhesion can be largely increased by consolidation stresses applied during powder handling. As a consequence, fragments of the consolidated powder may persist when the powder is fluidized, which gives rise to large agglomerates of strongly adhered particles in fluidization. This history-dependent effect can be minimized by coating the particles with surface additives such as silica nanoparticles. In this paper, we investigate the effect of high consolidation stresses sigma(c) previously applied to samples of silica-coated fine particles on their fluidization behavior. Our experimental measurements show that, even though homogeneous fluidization is still observed, the average agglomerate size and fractal dimension of the agglomerates increase as sigma(c) is increased. Bed expansion in the fluidized state is hindered by previously applied high consolidations, which we attribute to an increase of the largest stable size of mesoscopic fluid pockets. As a consequence, we observe that the initiation of macroscopic bubbling is delayed up to larger values of the fluid velocity.

[Giant clivus chordomas. Are extensive surgeries really justified?]. / Cordomas gigantes del clivus. Se justifican las cirugías extensas?

Because of their location and biological behavior, clivus chordomas are tumors that still represent a great challenge, mainly when they have reached huge dimensions. In this paper we have selected the patients with the biggest clivus chordomas to analyze if they really can be helped with the current surgical procedures with the morbidity that it implies. Eleven patients with giant clivus chordomas were included. All of them were operated on following the recent criteria of Cranial Base Surgery. It was mainly analyzed, if the degree of the resection had any relation to the postoperative functional outcome and the disease-free survival time; it was also evaluated if there existed a correlation between the pathologic findings and the clinical course. It was possible to get a total resection in 8 patients and partial in 3. In all cases there was an evident improvement in their postoperative functional outcome, specially in those with complete resections. The disease-free survival time was also greater in the patients with more ample resections. There was not any correlation among the histologic variety of tumors (typical or chondroid) and the clinical prognosis.

Cordomas gigantes del clivus: ¿Se justifican las cirugías extensas? / Giant clivus chordomas: Are extensive surgeries really justified?

Debido a su localizacion y comportamiento biológico, los cordomas del clivus son tumores que aún representan un gran reto, principalmente cuando han alcanzado grandes dimensiones. En este artículo, hemos seleccionado a los pacientes con los cordomas del clivus más grandes, a fin de analizar si realmente se pueden beneficiar con procedimientos quirúrgicos extensos, con la morbilidad que ello implica. Once pacientes con cordomas gigantes del clivus fueron incluidos, todos ellos intervenidos de acuerdo a los criterios recientes de cirugía de base de cráneo. Fue analizado principalmente si el grado de resección presentaba alguna relación con el estado funcional postoperatorio y el tiempo de supervivencia libre de enfermedad; también fue evaluado si existía alguna correlación entre los hallazgos histopatológicos y el curso clínico. En este grupo fue posible lograr una resección total del tumor en 8 pacientes y parcial en 3. En todos los casos se observó una evidente mejoría en el estado funcional postoperatorio, pero particularmente en los pacientes con resecciones totales. El tiempo de supervivencia libre de enfermedad fue también mayor en los pacientes con las resecciones más amplias. No se encontró correlación alguna entre la variedad histológica de los tumores (clásico o condroide) y el pronóstico clínico.

Because of their location and biological behavior, clivus chordomas are tumors that still represent a great challenge, mainly when they have reached huge dimensions. In this paper we have selected the patients with the biggest clivus chordomas to analyze if they really can be helped with the current surgical procedures with the morbidity that it implies. Eleven patients with giant clivus chordomas were included. All of them were operated on following the recent criteria of Cranial Base Surgery. It was mainly analyzed, if the degree of the resection had any relation to the postoperative functional outcome and the disease-free survival time; it was also evaluated if there existed a correlation between the pathologic findings and the clinical course. It was possible to get a total resection in 8 patients and partial in 3. In all cases there was an evident improvement in their postoperative functional outcome, specially in those with complete resections. The disease-free survival time was also greater in the patients with more ample resections. There was not any correlation among the histologic variety of tumors (typical or chondroid) andthe clinical prognosis.

The importance of quality of care in perinatal mortality: a case-control study in Chiapas, Mexico.

BACKGROUND: This study was undertaken in order to ascertain the relative importance of different risk factors for perinatal mortality (PM) in a community of Chiapas, Mexico stressing the importance of antenatal and neonatal medical care. METHODS: Cases were stillbirth and early neonatal death (END). Two children born in the same hospital and/or day as the case were randomly selected as controls, in Tapachula, Chiapas, Mexico. Socioeconomic, cultural, maternal, pregnancy, delivery, product and medical care factors were recorded. Two analyses were performed using multiple logistic regression: one for stillbirths, the other for END. RESULTS: PM rate was 46.7/1000; 142 cases and 284 controls were studied. Fifteen cases were excluded due to congenital malformations; 62 stillbirth and 65 END were analyzed. For stillbirth, pregnancy-delivery and maternal medical care factors resulted in the most strongly associated risk factors for PM (OR=27.5 95% CI 6.4-116.8), and within this index insufficient prenatal care had the strongest impact on PM (%population attributable risk (%PAR)=24%). For END, fetal conditions and the newborn medical care index had the strongest association with PM (OR=9.5 95% CI 1.5-60.3), and within the index inappropriate medical care of the newborn (%PAR=27%) was the most important variable. CONCLUSIONS: Our results support the fact that insufficient prenatal care and failure to comply with the standards of care for labor, delivery and for the care of the newborn are strong predictors of PM.

Tratamiento quirúrgico de la pancreatitis aguda: la experiencia mexicana / Mexican experience in surgical treatment of acute pancreatitis

En el tratamiento de la Pancreatitis Aguda no existe acuerdo con respecto a cuáles son las medidas para evitar la progresión de la enfermdad, el tipo de cirugía y el momento oportuno de intervenir quirúrgicamente. En México han existido tres etapas en relación a su tratamiento: la primera, a base de tratamiento médico; la segunda, tiene como alternativa el tratamiento quirúrgico después de 48 a 120 horas de tratamiento médico. La tercera, fundamental del tratamiento, es pancreatectomía del 50 al 90 por ciento. Se realizó una revisión de la literatura nacional de 1970 a 1990, tomando en cuenta aquellos artículos relacionados con Pancreatitis Aguda y su enfoque terapéutico. Se analizaron 41 artículos, de los cuales solamente 10 cumplieron los criterios de inclusión. En los artículos analizados hubo 1200 pacientes diagnósticos de Pancreatitis Aguda; 637 fueron catalogados como Pancreatitis Aguda Grave. La etiología fue biliar en el 70 por ciento y alcohólica en 17 por ciento. El manejo de la Pancreatitis Aguda ha sido heterogéneo con una diversidad de estrategias terápeuticas. La complicación más frecuente fue sepsis persistente; hubo 52.6 por ciento de mortalidad. En 20 años de manejo de la pancreatitis aguda en nuestro país, y después de 1200 casos de este padecimiento la única conclusión es que no existe estrategia razonable para el abordaje de la Pancreatitis Aguda, y que los trabajos analizados no reúnen los criterios metodológicos para evaluar pronósticos y/o tratamiento. Surge la necesidad de desarrollar investigaciones con diseños sólidos que nos permitan concluir la efectividad de todas la intervenciones terapéuticas usadas.

Ritmicidad circadiana del sistema opioide endogeno y otros sistemas relacionados en la función antinociceptiva / Circadian rhythm of endogenous opioid system and other systems related to antinosiceptive function

Se describen las variaciones diarias y anuales que tiene la actividad de cuatro sistemas de neurorreguladores centrales que reconocidamente participan en el mecanismo antinociceptivo, estableciendo una correlación cronoanatomofuncional en las diferentes estructuras que comprende el sistema descendente inhibitorio del dolor. Así mismo, se plantea una serie de consideraciones cronofarmacológicas de los fármacos que directa o indirectamente modifican la actividad de estos sistemas. Se concluye que hay un tiempo del día y del año en que se logra una mejor interacción entre la actividad de los diferentes sistemas de neurorreguladores que participan en el proceso antinociceptivo y la efectividad de los agonistas y antagonistas específicos de dichos sistemas