Current and future international patterns of care of neurogenic bladder after spinal cord injury.

PURPOSE: We aim to summarize the literature on international patterns of care for patients with neurogenic bladder (NGB) from spinal cord injury (SCI). METHODS: We performed a PubMed database search, hand review of references, communication with professional societies, and registry evaluations for pertinent data. RESULTS: Established patterns of care, including SCI registries and specialty centers, are available in high-resource countries such as the US and UK. As such, mortality rates from complications of NGB/SCI are lower. Access to intermittent catheterization supplies, among other resources, may be inadequate in many low-income regions. Cultural and religious beliefs may also hinder integration of proper bladder management in SCI patients. While guidelines exist in many parts of the world, it is unclear how rigorously they are disseminated or followed. CONCLUSIONS: While there is a paucity of high-level evidence, the differences in patterns of care are closely related to socioeconomic status and resources of the geographic area. Future research efforts should focus on improving access to diagnostic modalities, supplies, and specialists in these areas.

MODELO INTEGRADO DE GESTIÓN DE ACTIVOS HOSPITALARIOS BASADO EN LA PAS 55 / INTEGRATED MANAGEMENT MODEL OF HOSPITAL ASSETS BASED ON PAS 55 / MODELO INTEGRADO DE GESTÃO DE ATIVOS HOSPITALARES COM BASE NA PAS 55

Este trabajo presenta un modelo de gestión de activos hospitalarios basado en la PAS 55, que se desarrolló a partir de la homologación de los requerimientos legales, de acreditación nacional e internacional y las recomendaciones de la Organización Mundial de la Salud OMS, la Pan American Health Organization PAHO y el Ministerio de la Protección Social. Se busca con este proyecto involucrar el ciclo de vida de los activos hospitalarios, plantear herramientas para la toma de decisiones frente a la adquisición y reposición de activos hospitalarios, plantear de la mano con los criterios del sector salud metodologías de evaluación de criticidad de los activos físicos hospitalarios, y definir metodologías y herramientas que faciliten la adecuada gestión de las instituciones frente al cuidado de los activos físicos y los riesgos asociados a los mismos.

This paper presents a management model on hospital assets based on PAS 55, which evolved from the approval of the legal requirements, national and international accreditation, and the recommendations of the World Health Organization -WHO, the PAHO, Pan American Health Organization and the Ministry of Social Protection of Colombia. This project seeks to include lifecycle of hospital assets, introduce new tools for decision making to the acquisition and replacement of hospital assets, uniting the criteria of health methodologies sector in evaluation of critical hospital critical assets and defining methodologies and tools to facilitate the adequate management of institutions for physical assets care and associated risks.

Neste artigo se apresenta um modelo de gestão de ativos hospitalares baseado na PAS 55, que evoluiu a partir da aprovação dos requisitos legais, de acreditação nacional e internacional e as recomendações da Organização Mundial da Saúde OMS, a Pan American Health Organization PAHO e do Ministério da Proteção Social. Destina-se com este projeto involucrar o ciclo de vida de ativos hospitalários, planejar ferramentas para fazendo para a toma de decisões frente para a aquisição e substituição de ativos hospitalários, planejar da mão para os critérios de avaliação do sector saúde metodologias de avaliação nos ativos físicos hospitalários criticidade e definir metodologias e ferramentas que facilitem o adequada gestão das instituições frente o cuidado de ativos físicos e risos associados a eles.

Hypocomplementemia in systemic lupus erythematosus and primary antiphospholipid syndrome: prevalence and clinical significance in 667 patients.

The objective of the study was to analyse the prevalence and clinical significance of hypocomplementemia in a large series of patients diagnosed either with systemic lupus erythematosus (SLE) or with primary antiphospholipid syndrome (APS) and its association with the main clinical, hematological and immunological features of these diseases. Between 1992 and 2003, complement determinations (C3 and C4 levels, CH50 activity) were performed in 597 consecutive patients diagnosed with SLE (530 women and 67 men, mean age 32.6 years) and 70 with primary APS (57 women and 13 men, mean age 38.7) visited in our department. Complement determinations are routinely made at the first visit of patients and yearly during the follow-up. SLE and primary APS were diagnosed according to current classification criteria. Hypocomplementemia was detected in 371 (62%) of SLE patients. Compared with patients with normal complement values, those with hypocomplementemia showed a higher prevalence of female gender (P < 0.001), fever (P = 0.021), nephropathy (P < 0.001), cutaneous vasculitis (P = 0.023), positive anti-dsDNA antibodies (P = 0.012) and cryoglobulinemia (P < 0.001). In addition, patients with hypocomplementemia showed a higher prevalence of APS-related features such as hemolytic anemia (P = 0.001) and antiphospholipid antibodies (P < 0.001). Hypocomplementemia was prospectively related to accumulated hospitalization in SLE patients but not with the accumulated number of lupus flares or with the survival after follow-up of five years. In contrast, 33 (47%) patients with primary APS presented low complement values, which were associated with a higher prevalence of livedo reticularis (P = 0.022), thrombocytopenia (P = 0.004), lupus anticoagulant (P = 0.013), positive IgM-aCL (P = 0.039), positive ANA (P = 0.002) and anti-dsDNA (P = 0.046). The diagnostic value of hypocomplementemia in patients with SLE is based on the association with disease activity, immune-complex mediated manifestations (glomerulonephritis, cryoglobulinemia) and APS-related features (livedo reticularis, hemolytic anemia and aPL). Hypocomplementemia was found in nearly half of patients with primary APS, and was associated with some APS features (livedo reticularis, thrombocytopenia, aPL) but also with SLE-related immunological markers (ANA and anti-dsDNA), identifying a subset of patients with primary APS with a higher risk of evolving to SLE. These results clearly support the routine determination of complement factors in the clinical follow-up of patients with SLE and primary APS.