The Results Centre is the name of a project that, since 2012, has been openly publishing the results of each healthcare centre in Catalonia, with the idea of promoting benchmarking among centres and ...transparency toward society. As the project evolves, it has become increasingly necessary to adapt its contents and formats. The objective of this study is to identify the preferences and expectations of healthcare leaders regarding the Results Centre.
A qualitative study was conducted using the nominal group technique. Five nominal groups were created with the participation of 58 professionals (26 from hospital care, 16 from primary care, and 16 from long-term care centres). The areas of analysis were: (1) what the Results Centre of the future should be like; (2) what information needs should be addressed; and (3) what novelties should be incorporated to stimulate quality improvement. The spontaneity of ideas, intensity of recommendations, and intergroup consistency were analysed. The study was conducted in April 2019.
The requirements reported by the participants to be met by the Results Centre included: being a tool for benchmarking and strategic decision-making; adjusted and segmented indicators; non-clinical information (patient experience, socio-economic status, etc.); and data accessible to all stakeholders, including citizens. The ideas were consistent across the different levels of care, although the intensity of recommendations varied depending on their content.
Regional agencies that are accountable for health outcomes should be consistently committed to adapting to the needs of different stakeholders in the health system. This project is an example of how this requirement has been addressed in Catalonia.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors.
A qualitative study was ...conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients.
Thirty-three relevant studies were identified, with a majority conducted in Europe using questionnaires. They pointed out a very high level of satisfaction of callers and patients. Delay with the assistance and the ability for resolution of the case are the elements that overlap in fostering satisfaction. The published studies reviewed with satisfaction neither the overall care process nor related the measurement of the real time in responding to an emergency. The patients and professionals concurred in their assessments about the most relevant elements for patient satisfaction, although safety was not a predictive factor for patients. Response capacity and perceived capacity for resolving the situation were crucial factors for satisfaction.
Published studies have assessed similar dimensions of satisfaction and have shown high patient satisfaction. Expanded services resolving a wide number of issues that can concern citizens are also positively assessed. Delays and resolution capacity are crucial for satisfaction. Furthermore, despite the fact that few explanations may be given due to a lack of face-to-face attention, finding the patient's location, taking into account the caller's emotional needs, and maintaining phone contact until the emergency services arrive are high predictors of satisfaction.
Increasing evidence has pointed to the important function of T cells in controlling immune homeostasis and pathogenesis after myocardial infarction (MI), although the underlying molecular mechanisms ...remain elusive. In this study, a broad analysis of immune markers in 283 patients revealed significant CD69 overexpression on Tregs after MI. Our results in mice showed that CD69 expression on Tregs increased survival after left anterior descending (LAD) coronary artery ligation. Cd69.sup.-/- mice developed strong IL-17.sup.+ gammadeltaT cell responses after ischemia that increased myocardial inflammation and, consequently, worsened cardiac function. CD69.sup.+ Tregs, by induction of AhR-dependent CD39 ectonucleotidase activity, induced apoptosis and decreased IL-17A production in gammadeltaT cells. Adoptive transfer of CD69.sup.+ Tregs into Cd69.sup.-/- mice after LAD ligation reduced IL-17.sup.+ gammaST cell recruitment, thus increasing survival. Consistently, clinical data from 2 independent cohorts of patients indicated that increased CD69 expression in peripheral blood cells after acute MI was associated with a lower risk of rehospitalization for heart failure (HF) after 2.5 years of follow-up. This result remained significant after adjustment for age, sex, and traditional cardiac damage biomarkers. Our data highlight CD69 expression on Tregs as a potential prognostic factor and a therapeutic option to prevent HF after MI.
Antigen-specific cognate interaction of T lymphocytes with antigen-presenting cells (APCs) drives major morphological and functional changes in T cells, including actin rearrangements at the immune ...synapse (IS) formed at the cell-cell contact area. Here we show, using cell lines as well as primary cells, that clathrin, a protein involved in endocytic processes, drives actin accumulation at the IS. Clathrin is recruited towards the IS with parallel kinetics to that of actin. Knockdown of clathrin prevents accumulation of actin and proteins involved in actin polymerization, such as dynamin-2, the Arp2/3 complex and CD2AP at the IS. The clathrin pool involved in actin accumulation at the IS is linked to multivesicular bodies that polarize to the cell-cell contact zone, but not to plasma membrane or Golgi complex. These data underscore the role of clathrin as a platform for the recruitment of proteins that promote actin polymerization at the interface of T cells and APCs.
A partir de los datos obtenidos de un trabajo previo en el que se analizan las percepciones sobre los riesgos ambientales y las concepciones sobre el medio ambiente en dos grupos de estudiantes ...(Maestro y Ciencias Ambientales), se ha realizado un diagnóstico sobre los principales obstáculos y dificultades que suponen la construcción de este concepto. Estos se encuentran en torno a la construcción del concepto de medio y sus repercusiones educativas y sociales, aspectos fundamentales para el desarrollo de su práctica profesional como docente. Para este análisis se ha reformulado la Hipótesis de Progresión inicial sobre la percepción de los riesgos y las concepciones sobre el medio ambiente, partiendo de que si queremos aproximarnos a las concepciones (estructuras mentales complejas), es necesario indagar en las percepciones (proceso mental básico) como medio para poder acceder a las primeras. Palabras clave: Percepción, concepción, medio ambiente, riesgos ambientales e Hipótesis de Progresión.
La enseñanza de las Ciencias de la Naturaleza en la Educación Secundaria Obligatoria (ESO) debe orientarse a través de un enfoque sistémico y holístico que permita el tratamiento de la Biología y la ...Geología desde una perspectiva integradora y evolutiva desde el denominado currículo en espiral que asegure aprendizajes significativos. Esta perspectiva evolutiva y sistémica cobra mayor importancia para cuarto curso de la ESO (15-16 años) donde se trabajan los dos grandes paradigmas de la Biología y Geología (la Evolución de las Especies y la Tectónica de Placas). Presentamos por tanto, una propuesta metodológica específica que permita la integración y cohesión de la Biología y la Geología a través de una visión sistémica de los procesos naturales, donde el ser humano es otro elemento más que influye e interactúa sobre su medioambiente.
Guía práctica del vértigo posicional paroxístico Trinidad Ruiz, Gabriel; Santos Gorjón, Pablo; García-Purriños García, Francisco José ...
Revista ORL (Salamanca),
2017, Letnik:
8
Journal Article
Recenzirano
Odprti dostop
Benign paroxysmal positional vertigo (BPPV) is the most common
peripheral vertigo, characterized by brief attacks of rotatory vertigo associated with nystagmus,
which are elicited by specific changes ...in head position relative to gravity. The observation of
positional nystagmus is essential for the diagnosis of BPPV. The treatment consists in maneuvers
of canalith repositioning procedure to move otoconial debris from the affected semicircular
canal to the utricle. These guidelines are intended for all who treat the BPPV in their work, with
an intention to assist in the diagnosis and application of an appropriate therapeutic method.
Method: The experience and analysis of different national and international consensus on
BPPV, has allowed to a large group of ENT specialists carry out this guide. Results: The different
clinical entities are reviewed. BPPV of the posterior semicircular canal, horizontal canal and
anterior canal, BPPV affecting several canals, atypical and central BPPV, subjective BPPV and
the characteristics of this process in the elderly. Canalith repositioning procedures have been
illustrated with explanatory drawings. Discussion and conclusions: Although the pathophysiology
of BPPV is canalolithiasis comprising free-floating otoconial debris within the endolymph
of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula,
there are still many issues to be resolved. We think that the best way to find answers is part of
using a common methodology in the diagnosis and treatment of these patients.
El vértigo periférico más frecuente es el Vértigo Posicional Paroxístico
Benigno (VPPB), caracterizado por bruscos ataques de sensación rotatoria, que aparecen
como consecuencia de determinados cambios en la posición de la cabeza con relación a la
gravedad. La observación del nistagmo posicional es fundamental para el diagnóstico de
VPPB. El tratamiento consiste en aplicar maniobras de reposición, para intentar trasladar los
restos otoconiales libres, desde el conducto semicircular (CS) afectado hasta el utrículo. Esta
guía, está orientada para quienes tratan el VPPB, con la intención práctica de ayudarles en el diagnóstico y tratamiento de esta enfermedad. Método: La experiencia y el análisis de diferentes
acuerdos nacionales e internacionales sobre el VPPB, han permitido a un amplio grupo de
especialistas ORL llevar a cabo esta guía. Resultados: Se revisan las diferentes entidades
clínicas. VPPB del conducto semicircular posterior (CSP), horizontal (CSA) y anterior (CSA),
incluyéndose también el VPPB multicanal, VPPB atípico y central, VPPB subjetivo y las características
de este proceso en el anciano. Las maniobras de reposición se han ilustrado con
dibujos explicativos. Discusión y conclusiones: Aunque la fisiopatología del VPPB se explica
por la presencia de restos otoconiales libres en la endolinfa de uno o varios conductos semicirculares
(canalitiasis) y en algunos casos por su adherencia a la cúpula del CS (cupulolitiasis),
aún quedan muchas cuestiones por resolver. Pero creemos que la mejor manera de encontrar
respuestas parte de utilizar una metodología común en el diagnóstico y tratamiento de
estos pacientes
Candida albicans cell wall components were analyzed by ethylenediamine (EDA) treatment. Based on their different solubility properties, the cell wall components produced three fractions (A, B, and ...C). Fractions B (EDA-soluble, water-insoluble) and C (EDA-insoluble) contained glucan, chitin, and protein in different proportions. After zymolyase (mainly a beta-glucanase complex) or chitinase treatment of fractions B and C, more polysaccharides and proteins were solubilized by a second EDA treatment, suggesting that the solubility of the polymers in EDA depends on the degree of polymer interactions. Western blot analysis using two monoclonal antibodies (1B12 and 4C12) revealed electrophoretic patterns that were similar in mycelial and yeast morphologies, except that in material obtained from mycelial walls, an additional band was detected with MAb 1B12. Fluorescence microscopy of cell wall fractions treated with FITC-labeled Con-A, Calcofluor white, and FITC-labeled agglutinin showed that glucan and mannoproteins are uniformly distributed in fractions B and C, while chitin is restricted to distinct patches. Transmission electron microscopy demonstrated that fraction C maintained the original shape of the cells, with an irregular thickness generally wider than the walls. When fraction C was treated with chitinase, the morphology was still present and was maintained by an external glucan layer, with an internal expanded fibrillar material covering the entire cellular lumen. Degradation of the glucan skeleton of fraction C with zymolyase resulted in the loss of the morphology.
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