El ámbito de la mediación, como mecanismo de autocomposición de las partes en la resolución de conflictos, en la Universidad Complutense de Madrid

En este artículo, el autor sostiene que la actuación disciplinaria de las universidades, siempre sometida al principio de legalidad, es incompatible con la mediación u con otros alternativos de resolución de conflictos (ADR). Esta labor sancionadora, que suele ser coordinada por los Servicios de Inspección, e irrenunciable para cualquier universidad pública, no puede amparar, ni mucho menos potenciar, la solución negociada de una infracción punible. En concreto, la mediación, como forma de solución de controversias, solo puede tener una función preventiva en el ámbito universitario, y debe ser gestionada, con mucha prudencia, por otros órganos o unidades administrativas, en ámbitos en los que previsiblemente no debe aplicarse, ex lege, ninguna actuación sancionadora. La institución de la mediación (o de otros ADR, como la conformidad o la conciliación) cohonesta muy mal con el principio de legalidad, característico del Derecho sancionador, tanto en su vertiente sustantiva como procesal. Si toda conducta infractora debe ser castigada, tras la prosecución del correspondiente procedimiento administrativo, pero resulta que, por una negociación más o menos disimulada, se soslaya la aplicación del texto sancionador (total o parcialmente) –en función de que la Inspección de Servicios decida «acusar» de una u otra forma sobre la base de la previsible, o segura, actitud posterior del infractor–, se está haciendo saltar por los aires dicho principio de legalidad, que se ve desplazado por el «principio de oportunidad; siendo el de «legalidad» el único principio que debe regir la actuación de la Administración, tal y como establecen los artículos 25.1 y 103 de nuestra Carta Magna. Muchas veces olvidamos que el interés público constituye la razón de ser del procedimiento administrativo disciplinario, verdadero instrumento para el ejercicio del ius puniendi delegado por el Estado, donde no debiera tener cabida sustancial el principio dispositivo, ya que las partes no tienen ningún margen de negociación.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Relações de gênero e produção científica de pensadoras da Embrapa.

Para concluir a primeira etapa da análise do perfil das pensadoras da Embrapa de modo a descrever em estudo exploratório as relações de gênero e a produção científica indexada de pensadoras (Pesquisadoras I, II, III) em agropecuária na Embrapa desde a sua criação (1973), procedeu-se a coleta de dados para a caracterização etnográfica e os procedimentos para análise dos dados da produção científica indexada de pensadoras de três unidades distintas da Embrapa. Para analisar e comparar o trabalho das pensadoras da Embrapa de modo a descrever em estudo exploratório as relações de gênero nesta instituição, estabeleceu-se alguns procedimentos estatísticos processados em SAS onde S=sexo, PQ=número representativo do pesquisador, AGR=ano da graduação, ADR=ano de término do doutorado, BDPA=número de ocorrências encontradas na base BDPA, WS=número de ocorrências encontradas na base WofS, CIT=número de citações indicadas em cada um dos registros bibliográficos para um determinado pesquisador, TIT=título do periódico do registro bibliográfico, ANO=ano de publicação do registro bibliográfico, FI=fator de impacto do título do periódico indicado no relatório JCR2006 e registrado no Portal da CAPES. As perguntas formuladas de modo a responder alguns dos objetivos específicos da pesquisa estão relacionadas abaixo: 1. Diferença entre os anos da formação da graduação e do doutorado (AGR) (ADR) ? variável; ANODIF=ADR-AGR; 2. Diferença entre o número de registros na BDPA (BDPA) e número de registros no Web of Science (WS); DIFPU=BDPA-WS; 3. Diferença entre o ano do doutorado (ADR) e o ano das publicações (ANO) ? variável; DIFADR= Ano-ADR; 4. Número de títulos de periódicos diferentes (TIT) e fator de impacto (FI) por sexo; 5. Ano de término do doutorado (ADR) versus número de registros no Web of Science (WS); 6. Número de citações (CIT) por registro (TIT) ? título de periódico ? e fator de impacto (FI) por sexo; Table CIT* TIT; 7. Número total de citações (CIT) por (DIFADR) por sexo.

Uso de milheto e sorgo como forragem no período seco do ano em integração lavoura e pecuária e seu impacto na matéria orgânica do solo na Região Amazônica.

O objetivo é avaliar a produtividade e qualidade alimentar de milheto e sorgo em iLP, com plantio direto ou convencional em terra firme e seu impacto na matéria orgânica do solo. Parcelas de 5 m x 5 m de ADR 300 e ADR 500 (milheto) e BRS 802 e BRS 810 (sorgo), arranjadas em fatorial, seguindo delineamento inteiramente casualizado com quatro repetições, serão semeadas em plantio direto e convencional em área antes cultivada com milho.