[Recruitment, selection and retention of health professionals in indirect management and private management entities]. / Captación, selección y retención de profesionales sanitarios en entidades de gestión indirecta y de gestión privada. Informe SESPAS 2024.

The recruitment and retention of professionals in indirectly managed and privately managed health care institutions is governed by a different regulatory framework than in directly managed institutions. That legal framework is the Workers' Statute, which contains its own regulatory elements in terms of bargaining power and general basic conditions, among others. The regulatory framework of the Workers' Statute allows for a broad capacity for management, negotiation and agreement in the field of human resources management, and specifically in the processes of recruitment, selection and retention, but for some years now basic legislation and interventions by public control bodies have been incorporated which have modified this discretionarily for indirect management entities, bringing them closer and closer to the system of administrative management for civil servants/statutory employees, and consequently limiting the capacity for decision making and adaptation typical of business/private management. This article attempts to explain the similarities and differences between the different areas of management and to explore the weaknesses and opportunities of each of them in terms of recruitment, selection, and retention policies, offering a specific reflection on the selection of executives and managers, as well as an analysis and assessment of the retention of professionals in healthcare institutions.

Actualización del manejo de la diverticulitis aguda no complicada en nuestro centro. Igualmente efectivo, más eficiente / Update on the management of uncomplicated acute diverticulitis at our centre. Equally effective, more efficient

OBJETIVOS: La tendencia actual en el tratamiento de la diverticulitis aguda no complicada es el manejo ambulatorio de los pacientes con pautas cortas de antibiótico o incluso con antiinflamatorios en casos seleccionados. Presentamos una comparativa de los resultados obtenidos en nuestro hospital con distintos protocolos aplicados en 2016 y 2017. MATERIAL Y MÉTODOS: Todos los pacientes seleccionados para este estudio fueron diagnosticados de diverticulitis grado Ia de la clasificación de Hinchey, según los hallazgos radiológicos en la TC abdominal. Hemos analizado dos cohortes retrospectivas: 100 pacientes tratados en 2016 según protocolo antiguo y 104 pacientes tratados en 2017 con protocolo nuevo. En el año 2016 los pacientes candidatos a tratamiento ambulatorio permanecieron en observación durante 24 horas antes de ser dados de alta. El tratamiento consistió en 14 días de ciprofloxacino y metronidazol. En 2017 solo se observaron durante 24 horas los pacientes con sintomatología más aguda y se prescribió amoxicilina-clavulánico durante solo cinco días. RESULTADOS: La persistencia de la enfermedad en 2016 fue del 6% y en 2017 solo alcanzó el 5,77% (p = 0,944). La recidiva durante el primer año fue del 13% en el primer grupo, mientras que en el segundo fue del 5,7%, aunque esta diferencia no fue estadísticamente significativa. Asimismo, se consiguió una significativa reducción del coste sanitario. CONCLUSIONES: El tratamiento ambulatorio de la diverticulitis aguda no complicada con pauta corta de antibiótico oral parece ser una estrategia terapéutica segura y efectiva en pacientes seleccionados con escasa comorbilidad

GOALS: The current trend in the treatment of non-complicated diverticulitis is the outpatient management with antibiotic or even anti-inflammatory regimens in selected cases. We present a comparison of the results in our hospital with different protocols applied in 2016 and 2017. MATERIAL AND METHODS: All patients selected for this study were diagnosed with diverticulitis grade Ia of Hinchey's classification according to radiological findings on abdominal CT. We have analyzed two retrospective cohorts: 100 patients treated in 2016 according to the old protocol and 104 patients treated in 2017 with a new protocol. In 2016, the candidates for ambulatory treatment remained under observation for 24 hours before being discharged. The treatment consisted of 14 days of ciprofloxacin and metronidazole. In 2017, only patients with more acute symptoms were observed 24 hours and amoxicillin-clavulanic acid was prescribed for only 5 days. RESULTS: The persistence of the disease in 2016 was 6% and in 2017 was only 5.77% (p = 0.944). Recurrence during the first year was 13% in the first group, while in the second it was 5.7%, although this difference was not statistically significant. Likewise, a significant reduction in health costs was achieved. CONCLUSIONS: Outpatient treatment of acute uncomplicated diverticulitis with oral treatment seems to be a safe and effective therapeutic strategy in selected patients with low comorbidity

Update on the management of uncomplicated acute diverticulitis at our centre. Equally effective, more efficient. / Actualización del manejo de la diverticulitis aguda no complicada en nuestro centro. Igualmente efectivo, más eficiente.

GOALS: The current trend in the treatment of non-complicated diverticulitis is the outpatient management with antibiotic or even anti-inflammatory regimens in selected cases. We present a comparison of the results in our hospital with different protocols applied in 2016 and 2017. MATERIAL AND METHODS: All patients selected for this study were diagnosed with diverticulitis grade Ia of Hinchey's classification according to radiological findings on abdominal CT. We have analyzed two retrospective cohorts: 100 patients treated in 2016 according to the old protocol and 104 patients treated in 2017 with a new protocol. In 2016, the candidates for ambulatory treatment remained under observation for 24 hours before being discharged. The treatment consisted of 14 days of ciprofloxacin and metronidazole. In 2017, only patients with more acute symptoms were observed 24 hours and amoxicillin-clavulanic acid was prescribed for only 5 days. RESULTS: The persistence of the disease in 2016 was 6% and in 2017 was only 5.77% (p = 0.944). Recurrence during the first year was 13% in the first group, while in the second it was 5.7%, although this difference was not statistically significant. Likewise, a significant reduction in health costs was achieved. CONCLUSIONS: Outpatient treatment of acute uncomplicated diverticulitis with oral treatment seems to be a safe and effective therapeutic strategy in selected patients with low comorbidity.

[Management of jejunal diverticulitis. Experience in our center]. / Manejo de la diverticulitis yeyunal. Experiencia en nuestro centro.

Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.

La enfermedad diverticular yeyunal es una condición clínica muy poco frecuente y habitualmente asintomática. Las complicaciones asociadas aparecen en menos del 30% de los pacientes y pueden manifestarse como inflamación de los divertículos, obstrucción intestinal, hemorragia digestiva, malabsorción intestinal, formación de abscesos intraabdominales y perforación. La clínica de los pacientes es muchas veces inespecífica, requiriendo un alto grado de sospecha para llegar al diagnóstico. El tratamiento de las complicaciones de la enfermedad diverticular es variado, incluyendo reposición de volumen o transfusiones, antibioticoterapia, drenaje percutáneo o intervención quirúrgica. Presentamos un estudio observacional retrospectivo de los casos tratados en nuestro hospital entre 2007 y 2016.

Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009 / Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009

Introducción: Describir la complejidad clínica de los pacientes al ingreso en unidades de larga estancia sociosanitaria en Cataluña entre los años 2003 y 2009. Material y métodos: Análisis transversal de 47.855 ingresos registrados en el sistema de información Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris. Las variables analizadas fueron agrupaciones diagnósticas, las comorbilidades y los procedimientos médicos, estado funcional y cognitivo, categorías de uso de recursos del Resource Utilization Groups III (RUG-III), la cobertura y la intensidad de las terapias rehabilitadoras. Se realizó un análisis descriptivo de la información. Resultados: Las agrupaciones diagnósticas más frecuentes en el periodo de estudio fueron demencia y enfermedad cerebrovascular aguda, que mostraron un descenso continuado (descenso del 8,8 y el 2,3%). El mayor aumento correspondió a ingresos por descanso familiar y fractura (7,7% y 1,9%). El estado funcional y cognitivo promedio se mantuvo estable, aunque aumentó el porcentaje de individuos con dependencia en todas las actividades de la vida diaria. Las categorías RUG-III más frecuentes fueron rehabilitación, funciones físicas reducidas, complejidad clínica y cuidados especiales. Durante el periodo estudiado, la categoría «rehabilitación» se incrementó marcadamente (20,3%), mientras las otras categorías disminuyeron. Las terapias rehabilitadoras incrementaron su cobertura durante el periodo (20,8%), especialmente la fisioterapia (25,4%) y la terapia ocupacional (17,4%). Conclusiones: La complejidad clínica de la población atendida en unidades de larga estancia aumentó en el periodo 2003-2009. El uso de recursos y terapias indican un creciente esfuerzo rehabilitador, como posible respuesta a cambios en la complejidad clínica atendida, los estándares de práctica clínica o las prácticas establecidas en el registro y notificación de la información (AU)

Introduction: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. Material and methods: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. Results: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). Conclusion: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices (AU)

[Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009]. / Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009.

INTRODUCTION: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. MATERIAL AND METHODS: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. RESULTS: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). CONCLUSION: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices.

Análisis cinescológico de un gesto habitual en enfermería / Kinesiological analysis of an usual gesture in nurses. Comparisonwith an alternative gesture

Objetivos: Estudiar cinemática y cinéticamente un gesto habitual en el personal de enfermería y auxiliar de un centro sociosanitario, para identificar riesgos de lesión lumbar. Estudiar cinemática y cinéticamente un gesto habitual en el personal de enfermería y auxiliar de un centro Sociosantiario, para identificar riesgos de lesión lumbar. Paralelamente, se propone un gesto alternativoy se evalúa si reduce este riesgo de lesión. Métodos: la muestra de voluntarios del personal del Centro en estudio, sin factores de riesgo ni patologías relacionadas con el estudio, es de 27 profesionales (34,9 + 8,2 años de edad; 61,0 + 18,1 Kp de peso, 161,8 + 9,7 cm de altura). Mediante una encuesta al personal se determina el gesto de mayor riesgo subjetivo para este colectivo que será objeto de estudio. Se realiza en laboratorio la grabación cinemática y de actividad muscular de los individuos cuando realizan un traslado de una silla a otra silla de un paciente con hemiplejia derecha. Este gesto se realiza según la forma seguida en el centro y también según una propuesta . Los traslados se desglosan en fase de giro, estabilización y descarga en el destino, ésta última constituye el objeto del estudio. Basado en el modelo biomecánico, cinemáticamente se analiza la postura y el movimiento usado, y cinéticamente se recoge la mediana de la actividad electromiográfica en toda la fase, normalizada a la contracción voluntaria máxima. Paciente y profesional comparan subjetivamente los dos gestos. Resultados: la encuesta de valoración de riesgos indica que es el gesto más escogido con ochenta y ocho respuestas (22,3%) pero con diferencias entre turnos (p=0,02). La sensación del control del enfermo es buena con independencia del método y del gesto utilizados. La postura de contrapeso es la más persistente. En un mismo gesto, ya sea el normal o el alternativo, los auxiliares utilizan diferentes técnicas para transferir al paciente. En ocasiones, en el momento de repetir el gesto, tampoco reproducen de forma exacta la misma técnica o patrón de movimiento. Los cambios introducidos en el ene l gesto alternativo se reflejan en un mayor rango de desplazamiento vertical de S1 y en una mayor inclinación del tronco con respecto a la vertical. No se manifiestan diferencias significativas con respecto a la actividad de los músculos paravertebrales entre los dos gestos propuestos. Conclusiones: La acción considerada de mayor riesgo subjetivo es la reorientación del enfermo hacia otro lugar en una transferencia. La sensación de buen control del paciente es persistente con independencia del gesto utilizado por el auxiliar. Los individuos que practican una postura de contrapeso (comprobada como de bajo riesgo) durante la ejecución del gesto normal persistente en la misma incluso cuando intentan el método alternativo, pero bajan más la posición de la pelvis si comparamos su postura con la del resto de los auxiliares. Este descenso se correlaciona con una disminución de la actividad electromiográfica paravertebral. El gesto alternativo muestra en todos los casos una mayor inclinación de tronco sin un mayor grado de flexión lumbo-pélvico (AU)

Objetives: to define the biomechanical characteristics of a usual gesture in the nursing profession, considered as a risk factor for low back pain. And to compare it with an alternative gesture designed to carry out the same task. Method: Through direct observation and interviewing the personnel, the task and gesture to be studied are selected. A sample of 27 volunteers is gathered for kinematic and muscle activity recording when transferring a patient with right hemiplegia from chair to chair. This gesture is performed as it is “usually practiced” and also in a proposed “alternative”. The movement is divided into turning, stabilizing and unloading phases, the latter being the object of our study. Both patient and professional compare the two gestures subjectively. Results: The risk evaluation survey shows that “reorienting the standing patient towards another place when transferring a patient” is the first choice gesture in 88 responses (22,3%), but with some differences among workshifts (p=0,02). The patient´s control sensation is good, regardless of method and gesture used. The counterweight posture is the most persistent. Within one same gesture, either the usual or alternative gesture, health workers use different techniques to transfer the patient. Those changes introduced in the alternative gesture have resulted in a greater S1 vertical movement range and in a higher trunk tilt in relation to the vertical. Conclusions. The action considered as having higher subjective risk is reorienting the patient towards another place when transferring a patient. People who practice a counterweight posture (defined as low risk) during performance of the usual gesture persist in the same one even when trying the alternative method, lowering the pelvis position if compared with the rest of health workers. This lowering is correlated with a decrease in paraspinal electromyographic activity (lower muscle effort). The correct performance of the alternative method implies greater trunk tilt, allowing the patient to be closer to the health worker, and thus avoiding lumbar flexion, and presenting lower lumbar segment effort (AU)