[Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 2: el Sistema Nacional de Salud. Informe SESPAS 2024.

In Spain, the compensation model for statutory health personnel is complex, heterogeneous, and more oriented to rewarding complementary functions and activities, than to paying for the actual performance in the position of employee. The various attempts to incorporate incentives have been distorted by a civil service egalitarianist culture, and weak systemic governance. External attractors (private practice, etc.) for healthcare professionals are becoming more important and neutralize many intramural incentives. There are few prospects of relevant or general changes, since the main actors involved are reforms-averse; but some environmental factors can lead to incremental improvements in employment contracts, in the information available to improve benchmarking, and in the creation of islands of good clinical governance and management. The economic scenario, increasingly concerned about inflationary trends and sustainability risks, may have a revitalizing effect of some governance and management reforms.

[Pay for performance in public directly managed healthcare centers. Part 1: General framework. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 1: marco general. Informe SESPAS 2024.

Assessing and compensating performance in professional organizations is extremely difficult in direct public management settings of health services. Performance assessment is technically complex and, more so, with multiplicity of principals influencing goal setting. Incentives are a lever to generate directionality and motivation, both structural (for attracting and retaining workers) and specific ones (rewarding performance and directing behavior towards institutional goals). Incentives influence the behavior of workers in various ways, and their effectiveness seams weak and controversial in publicly run health services. To overcome the problems of deciding and evaluating performance, both good governance models and the revitalization of contractual management are required. To improve the effectiveness of incentive models, it is convenient to: 1) widen the conceptual framework of incentives, to incorporate the structural aspects of employment contract and payment; 2) improve the designs from a greater understanding of the determinants of motivation; and 3) broaden the lens to survey the extra-mural factors that alter the behavior of workers, trying to counter them.

A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.

Extended Computed Tomography Scale Images Provide a Detailed Assessment of Metal Screws and Are Superior to Standard Computed Tomography Scale Images and Digital Radiography at Detecting Experimentally Induced Screw Fractures In Vitro.

OBJECTIVES: (1) To compare the ability of standard computed tomography (CT) scale (SCTS) and extended CT scale (ECTS) images, produced using conventional CT technology, to provide detailed assessment of metal screws in vitro. (2) To assess how screw size, type, and orientation relative to the Z-axis of the gantry affect implant assessment. (3) To test the ability of SCTS, ECTS, and radiography to diagnose screw failure when there is negligible screw fragment displacement. STUDY DESIGN: Part 1: 12 screws of different size, type, and composition were scanned in three orientations (parallel or 0°; oblique or 45°; and perpendicular or 90°) relative to the Z-axis of the gantry. SCTS and ECTS reconstructions were made for each screw, in each plane, to assess implant shape, structure, and diameter. Part 2: fatigue-failure was induced in four screws commonly used to stabilize canine humeral intracondylar fissures. Screws were then reassembled achieving grossly perfect apposition and alignment of the fragments. Ability to detect implant failure was tested using SCTS, ECTS, and radiography. RESULTS: ECTS provided better screw assessment compared with SCTS resulting in clear visualization of the structure in 8/12 versus 0/12 screws and shape in 12/12 versus 11/12 screws; however, results were affected by screw size, type, and orientation. ECTS identified all in vitro screw fractures with negligible screw fragment displacement; however, success was affected by screw orientation: 4/4 fractures identified with a 90° angle, 1/4 for 45°, and 0/4 for 0°. SCTS and radiography did not identify any of them. CONCLUSION: The results indicate that ECTS reconstructions are useful for assessment of metal screws and for detection of nondisplaced screw fractures.

Single-port Laparoscopic Liver Resection in Patients with Previous Abdominal Surgeries: Is it a Feasible Approach?

Single-port laparoscopic liver surgery has become an attractive procedure for many surgeons in order to decrease surgical aggression and the complications related to laparoscopic ports. The aim of this study is to assess the feasibility and efficacy of single-port laparoscopic liver resections in patients with previous upper or lower abdominal surgery. A series of ten patients with history of previous abdominal surgery who underwent single-port laparoscopic surgery for liver metastases, primary liver cancer or benign hepatic tumor, is being presented here. Several clinical and operative parameters were reviewed from a historical database of laparoscopic hepatectomy. Key Words: Laparoscopic liver surgery, Single-port, Previous abdominal surgeries.

Visibility of Transcondylar Screw Fractures in Standard and Extended Scale Computed Tomography Images.

OBJECTIVE: Application of extended computed tomography scale (ECTS) reconstruction to diagnose metal implant failure has been described in a single case report. The purpose of this study was to compare the features and visibility of humeral transcondylar screw fractures in standard CT scale (SCTS) and ECTS images. STUDY DESIGN: Case series: CT images of dogs with fractured transcondylar screws were retrospectively reviewed and described in both SCTS and ECTS images. RESULTS: Five dogs with a total of six transcondylar screw failures (five right and one bilateral) were reviewed. All cases had an ongoing humeral intercondylar fissure with varying degrees of stress remodelling. The fracture was seen in all screws on ECTS images, however only in three implants on SCTS images. The measured fracture gap was larger in ECTS images in all cases (range: + 0.14 mm to + 0.28mm). The three smallest fracture gaps were not seen on SCTS images. A subtle hypoattenuating streak (artefact) was visible adjacent to the screw fracture in 5/6 of cases using SCTS images. All screw fractures occurred parallel and often slightly medial to the humeral intercondylar fissure. CONCLUSION: Implant failure is only seen with larger fracture gaps in SCTS images, with 3/6 screw fractures not visible in SCTS compared with ECTS. A hypoattenuating streak extending perpendicular to the implant in SCTS images is suggestive of screw fracture even if this is not directly visible.

Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial.

BACKGROUND: Approximately 40-70% of people with Parkinson's disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. OBJECTIVE: To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. METHODS: Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. RESULTS: This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. CONCLUSION: In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694443.

Use of an extended CT scale reconstruction to diagnose metal implant failure in a canine elbow.

A Cocker Spaniel presented for recurrence of right forelimb lameness 33 months following transcondylar screw placement for a humeral intracondylar fissure. Elbow radiographs showed no evidence of implant-related complications. Standard CT scale reconstruction images failed to demonstrate implant failure. Extended CT scale reconstruction images revealed a fracture through the mid-portion of the screw. Revision surgery confirmed the implant failure; the screw was replaced and the lameness subsequently resolved. Extended CT scale reconstruction images allow detailed assessment of metal implants and should be considered when implant failure is suspected.

Diagnostic-therapeutic management of bile duct cancer.

Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery; complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.

Vortex revivals and Fermi-Pasta-Ulam-Tsingou recurrence.

We study the self-trapped vortex-ring eigenstates of the two-dimensional Schrödinger equation with focusing Poisson and cubic nonlinearities. For each value of the topological charge l, there is a family of solutions depending on a parameter that can be understood as the relative importance of the cubic term. We analyze the perturbative stability of the solutions and simulate the fate of the unstable ones. For l=1 and l=2, there is an interval of the family of eigenstates for which the initial profile breaks apart but subsequently reconstructs itself, a process that can be interpreted as a nontrivial nonlinear oscillation between the vortex and an azimuthon. This revival provides a compelling realization of a recurrence of the Fermi-Pasta-Ulam-Tsingou type. Outside this interval, the vortices can be stable (for small cubic terms) or unstable and nonrecurrent (for large cubic terms). We argue that there is a crossover between these regimes that resembles a strong stochasticity threshold. For l≥3, all solutions are unstable and nonrecurrent. Finally, we comment on the possible experimental implementation of this phenomenon in the context of nonlinear laser beam propagation in thermo-optical media.

Austeridad, desgobierno, innovación y futuro del Sistema Nacional de Salud español / Austerity, bad-governance, innovation and the future of the Spanish National Health Service

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Sexual dysfunction factors in patients with schizophrenia treated with second generation antipsychotics: not only prolactin.

INTRODUCTION: Despite the high prevalence of sexual dysfunction in patients with schizophrenia, its origins are still unclear. THE AIM OF THIS STUDY: to determine the prevalence and causal factors of sexual dysfunction in a group of outpatients with schizophrenia. METHODS: The study was designed to be cross-sectional and naturalistic, including outpatients with schizophrenia undergoing second generation antipsychotic monotherapy. Patients receiving antidepressants and/or mood stabilisers were excluded. The following data were recorded: sexual functionality, sociodemographic information, sexual history, psychotic and depressive psychopathology, metabolic syndrome and BMI. Psychotropic-Related Sexual Dysfunction Questionnaire (PR SexDQ-Salsex); Positive and Negative Syndrome Scale; Hamilton Depression Rating Scale; Plasma concentrations of prolactin, testosterone, estradiol, progesterone and the International Diabetes Federation diagnostic criteria for metabolic syndrome, were used to complete the study. RESULTS: Of the 57 patients included in the study, 80% exhibited sexual dysfunction, one-third of which suffered severe levels of dysfunction. However, only 30% of patients spontaneously reported this problem. Although there were significant differences in the prevalence of hyperprolactinemia and metabolic syndrome according to the antipsychotic received, multivariant regression analysis did not show a correlation between sexual dysfunction and prolactin, sexual hormones, type of antipsychotic received, psychotic psychopathology or metabolic syndrome. Sexual dysfunction was only associated with age, civil status and depressive psychopathology. CONCLUSIONS: There is a high prevalence of sexual dysfunction in the patients with schizophrenia who participated in the study, but it was only associated with higher age, being single or divorced or having depressive psychopathology; this suggests a multifactorial etiology for sexual dysfunction in schizophrenia.

Colangiopancreatografía retrógrada endoscópica transgástrica con asistencia laparoscópica para el tratamiento de la coledocolitiasis después de un bypassgástrico / Laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis after Roux-en-Y gastric bypass

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