Programa de comunicación a distancia. Elaboración de indicadores cuali-cuantitativos para su evaluación / Outreach education program. Development of qualitative and quantitative assessment markers.

La Oficina de Comunicación a distancia (OCD) es una estructura creada en 1997 en el Hospital de Pediatría Juan P. Garrahan, con el objetivo de responder consultas a distancia y facilitar el seguimiento de pacientes, con la intención de evitar los traslados innecesarios. Ha dado respuesta a más de 25000 consultas. Actualmente, en el marco del Programa de Comunicación a Distancia (PCD), funcionan 88 OCD distribuidas en 12 de las 23 provincias argentinas. Se presentan resultados sobre una muestra de 148 consultas realizadas al Hospital Garrahan desde 6 provincias, que participaron de un estudio de tipo descriptivo, retrospectivo, cuali-cuantitativo. Éste permitió formular nuevas formas de registro de la tarea y elaborar indicadores cualicuantitativos para evaluar el PCD: consultas, motivo de consulta, tipo de paciente consultado, necesidad de la consulta, duración de la enfermedad al momento de la consulta, derivación sugerida, tiempo de respuesta. Se analizó el número de consultas y las sugerencias de derivación, mostrando las primeras un progresivo y significativo incremento desde la implementación del PCD. Con relación a los motivos de consulta, 84% correspondió a definición de diagnóstico y tratamiento, 16% a motivos de seguimiento e intercurrencias. 62% presentaba patologías crónicas. 95% de los pacientes fueron definidos como complejos. 79% correspondió a consultas definidas como imprescindibles. La derivación fue sugerida en el 54% de las consultas. La mediana del tiempo de respuesta fue de 48 horas. El bajo porcentaje atribuido a "motivos de seguimiento" evidencia la necesidad de profundizar estrategias para promoverlo. El PCD oficializó una modalidad de comunicación que canaliza prácticas anteriormente realizadas a través de vías informales, resignificando la gestión como acto asistencial. Contribuyó a la implementación de metodologías de evaluación conjunta de los indicadores considerados, que contemplan el contexto de la población con la que se trabaja (AU)

In 1997, the Outreach Communication Office (OCO) was created at the Pediatric Hospital Juan P. Garrahan with the aim of responding to consultations from remote places and facilitating follow-up of patients while avoiding unnecessary patient transportations. More than 25,000 consultations have been responded. Currently, within the framework of the Program of Outreach Communication (POC), 88 OCO's are operating distributed over 12 of the 23 Argentine provinces. Here we present the results of a sample of 148 consultations made at the Garrahan Hospital from six provinces that participated in a descriptive, retrospective, qualitative and quantitative study. The study allowed formulation of new methods of task registration and the development of qualitative and quantitative indicators to evaluate the POC: consultations, reason for consultation, type of patient, urgency of the consultation, disease duration until the moment of consultation, suggested referral, and time to response. The number of consultations and suggestions for referral were analyzed showing a progressive and significant increase of the former since the implementation of the POC. Of the reasons for consultation, 84% was related to definition of diagnosis and treatment, 16% to follow-up and intercurrencies. Of all patients, 62% had chronic diseases and 95% were considered complex patients. Of the consultations, 79% were defined as essential and 54% of the patients were referred to specialists. Mean time to response was 48 hours. The low percentage of consultations for "reasons of follow-up" reveals the need to develop strategies to encourage this modality. The POC has officialized a means of communication channeling practices that previously were informal giving a new meaning to the concept management in health care. The POC has contributed to the implementation of methodologies for the assessment of global markers taking into account the context of the population in question (AU)

Lead uptake and the effects of EDTA on lead-tissue concentrations in the desert species mesquite (Prosopis spp.).

Experimental results have shown that the desert plant species mesquite (Prosopis spp.) is capable of accumulating high levels of lead in the roots, translocating it to the aerial portion of the plant. One-week-old mesquite seedlings were treated for 7 d in a hydroponic culture using a modified Hoagland solution. Six treatments were used; three treatments contained only Pb [as Pb(NO3)2] at 25-, 50-, and 75-mg L(-1) levels and three treatments contained the same levels of Pb, but with equimolar concentrations of disodium ethylenediamine tetraacetic acid (EDTA). Our results showed that the plants exposed to 25-, 50-, and 75-mg Pb L(-1) treatments without EDTA concentrated in stems 524, 3726, and 1417 mg kg(-1), respectively. However, the plants treated with Pb-EDTA concentrated in stems 480-, 607-, and 1247-mg Pb kg(-1) for the 25-, 50-, and 75-mg Pb L(-1) treatments, respectively. Results for the roots followed a similar trend; without EDTA the Pb levels ranged from 16,055, 89,935, and 63,396 for the 25-, 50-, and 75-mg Pb L(-1) treatments, respectively, and with EDTA these levels were 9,562, 49,902, and 39,181 mg kg(-1) for the three treatments. However, the addition of EDTA increased lead movement to the leaves. The levels of Pb without EDTA were 20, 35, and 51 mg kg(-1) for the 25-, 50-, and 75-mg Pb L(-1) levels, respectively. Treatments with EDTA showed uptake levels of 105, 124, and 313 for the 25-, 50-, and 75-mg Pb L(-1) treatments. Further, the percent Pb in dry leaf tissues for all EDTA treatments were greater than 0.1%. However, only the 25-mg Pb L(-1) treatment was greater than 0.1%, compared to 0.04 and 0.08% for the 50- and 75-mg Pb L(-1) treatments, respectively. Preliminary transmission and scanning electron microscopy corroborate the presence of lead.

Phenol biodegradation using a repeated batch culture of Candida tropicalis in a multistage bubble column.

As in many other microorganisms, the growth rate of C. tropicalis is affected by phenol. Besides, when the yeast is aerobically cultivated in a medium containing phenol, using a bubble column, the yeast cell flotation phenomenon occurs, which makes the continuous operation of this type of reactor difficult. Therefore, a system of phenol degradation, which recycles the biomass separated by flotation, was devised in this work. In order to reduce the substrate toxicity observed at high phenol concentrations, the bubble column used in the biodegradation studies was fed in a semibatch mode. So, a semicontinuous system was implemented to treat effluents with relatively high concentrations (> 9,000 ppm) of phenol, by replacing periodically about 22% of the bioreactor operational volume. The phenol removal efficiencies obtained with this system were higher than 98.7%.