ABSTRACT
En Argentina hay coincidencia sobre la necesidad de mejorar la calidad de vidade los pacientes con cáncer y otras enfermedades amenazantes para la vida,pero no se ha desarrollado todavía un sistema de monitoreo y medición de lacalidad de los servicios de cuidados paliativos (CP), basado en un consensosobre estándares de calidad.ObjetivosDesarrollar un panel de indicadores para evaluar los niveles de desempeño delos servicios de CP.MétodosSe realizó una búsqueda sistemática de bibliografía sobre indicadores yestándares de calidad en CP y se seleccionó un panel de 23 indicadores deestructura, proceso y resultado. El panel fue aplicado en una prueba pilotoen tres servicios de CP: Hospital General de Agudos Bouquet Roldán (HBR)de la provincia de Neuquén, Instituto de Investigaciones Médicas AlfredoLanari (IDIM) de la Ciudad Autónoma de Buenos Aires y Hospital NacionalDr. Baldomero Sommer (HNBS) de General Rodríguez, Provincia de BuenosAires, para conocer el comportamiento de estos indicadores en contextosespecíficos, disímiles tanto por su ubicación geográfica como por su estructuraorganizacional y modelos de atención. Se analizaron 120 historias clínicas.ResultadosLas disidencias en la interpretación y alcance de unos pocos indicadores fueronsuperadas. Tras la redefinición, quedaron incluidos en el panel definitivo 23indicadores de estructura, proceso y resultado.ConclusionesDado el carácter progresivo que requiere la construcción de un panel deindicadores adecuado al contexto local, se hizo mayor hincapié en las etapas deprocesos y estructuras para que, una vez aplicados y validados estos indicadores,se puedan consensuar indicadores de resultado. El estudio demostró lafactibilidad de aplicación del panel para medir la calidad de atención en losdiferentes servicios de CP participantes y se constituyó en un sólido punto departida de cara a la ampliación de la experiencia a nivel nacional.
Subject(s)
Fellowships and Scholarships , Palliative Care , Health Management , Quality Indicators, Health CareABSTRACT
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are represented by rare but life-threatening cutaneous adverse reactions to different drugs. Previous studies have found that in a Han Chinese population from Taiwan and other Asian Countries, a strong genetic association between HLA-class I alleles (B*15:02, B*58:01) and SJS and TEN was induced by carbamazepine and allopurinol, respectively. To identify genetic markers that covered the MHC region, we carried out a case-control association enrolling 20 Caucasian patients with SJS/TEN. Our patient series included 10 cases related to paracetamol, 7 to allopurinol and 3 to different drugs (plaquenil, itraconazol, nabumetone). Healthy controls were represented by 115 Caucasian bone marrow or stem cell donors. The HLA-A*, B*, C*, DRB1*, DQB1*, DQA1* and DPB1* genotyping were determined. The frequencies of HLA-A*33:03 as well as C*03:02 and C*08:01 were significantly higher in SJS/TEN patient subgroup showing allopurinol drug-induced severe cutaneous adverse reactions (SCAR) as compared to controls (28.6% vs 0%, P=0.00002, Pc=0.0011; 28.6% vs 0%, P=0.00002, Pc=0.001; 28.6% vs 0%, P=0.00002, Pc=0.001, respectively). In the same subgroup the frequencies of B*58:01, DRB1*15:02 and DRB1*13:02 alleles, although considerably higher than in control group (42.8% vs 5.2%, P=0.003; 28.6% vs 1.7%, P=0.005; 28.6% vs 3.5%, P=0.037, respectively), appeared no more statistically different after P correction (Pc=0.248; Pc=0.29; Pc=1.00, respectively). In addition, in 10 of the 20 SJS/TEN patient subgroup with paracetamol-induced SCAR no statistically significant association with HLA alleles could be found. However, in the same SJS/TEN patient subgroup showing allopurinol drug-induced SCAR, haplotype analysis indicated that B*58:01, DRB1*13:02 and DRB1*15:02 alleles, that in a single allele analysis lost statistical significance after P correction, may still confer susceptibility, because the B*58:01-DRB1*13:02 and DRB1*15:02-DQB1*05:02 are positively associated with the disease (14.2% vs 0.43%, P= 0.00001, Pc=0.00028; 14.2% vs 0.43%, P=0.00001, Pc=0.00028, respectively). Our results show that in contrast to SCAR-related to paracetamol, where HLA alleles do not appear to be involved, HLA molecules behave as a strong risk factor for SCAR-related to allopurinol even when a limited number of patients are considered.
Subject(s)
Alleles , Histocompatibility Antigens Class II/genetics , Histocompatibility Antigens Class I/genetics , Stevens-Johnson Syndrome/genetics , Adult , Aged , Case-Control Studies , Female , Gene Frequency/genetics , Haplotypes , Humans , Italy , Male , Middle Aged , Risk Factors , Stevens-Johnson Syndrome/immunology , Young AdultABSTRACT
New systems for collection of platelet concentrate (PC) and platelet poor plasma (PPP) are presently available. The aim of our work was to test the possibility of preparing PC routinely from normal plasma donors in a minimum amount of time and, at the same time, providing a second product that can be used as source-plasma or fresh-frozen plasma. Over a 3 year period (from 1990 to 1992) we performed 3503 procedures using 2 Haemonetics PCS machines (1236 procedures) and 3 Autopheresis-C (2267 procedures). With the PC produced we were able to satisfy all the requests coming from the hospitals of our region. The platelet yield was 1.95 x 10(11) with PCS and 3.2 x 10(11) with Auto-C in a PC volume of 150 and 200 ml respectively; collection times were quite similar (56 and 63 min). The results show that plasma-plateletpheresis is an efficient and competitive system. Regarding platelet yield, the best results were obtained with the Auto-C.
Subject(s)
Plasmapheresis , Plateletpheresis , Humans , Plasmapheresis/instrumentation , Plasmapheresis/methods , Platelet Count , Platelet Transfusion , Plateletpheresis/instrumentation , Plateletpheresis/methodsABSTRACT
The authors evaluated the performance of four modern, commercially available hematology analyzers for imprecision and inaccuracy in determining the leukocyte differential count. The evaluation was performed according to International Committee for Standardization in Haematology protocols and the National Committee for Clinical Laboratory Standards H20-T standard, using the same group of patients simultaneously. Imprecision was very low among all the analyzers for neutrophils and lymphocytes (coefficient of variation maximum = 4.12%), whereas for the other leukocyte populations it tended to increase as their presence percentage decreased. The imprecision of the analyzers was still lower than that of the microscopic method. The correlation with the manual 800 cell count (inaccuracy) was good for neutrophils, lymphocytes, and eosinophils (r = 0.974 to 0.888), less so for monocytes (r = 0.757 to 0.490), whereas it was poor for basophils (r = 0.532 to 0.078).
