Eventos Adversos Producidos Durante la Asistencia Sanitaria.

El impacto de los Eventos Adversos (EA) durante la asistencia sanitaria es un problema de salud pública de gran actualidad y muy presente a nivel mundial, provocando tres veces más muertes que los accidentes de tráfico. Afecta a todos los niveles sanitarios y perturba de forma relevante la seguridad del paciente. Los objetivos de este trabajo son: conocer la prevalencia de los EA en las unidades asistenciales españolas, comparar el impacto de estos a nivel nacional e internacional, y conocer la forma de notificación así como las estrategias de mejora de los mismos. Para ello, se llevará a cabo una revisión de la literatura bibliográfica en la que se recogerán y se analizaran artículos de carácter científico publicados en revistas indexadas en las bases de datos más consultadas. Se utilizaran artículos escritos tanto en castellano como en inglés, vinculados al área de conocimiento y de interés para esta revisión. Finalmente se han incluido 50 referencias bibliográficas. Así encontramos que los EA en los servicios de hospitalización del ámbito internacional tienen una incidencia máxima de 16.6%, y un 10.11% en España, que aumenta hasta el 25% cuando se trata de unidades especiales. El 4% producen la muerte del paciente. Más del 80% son evitables y el 95% no se notifican. Enfermería es responsable del 33% de EA producidos. Como conclusiones destaca la inexistencia de un mecanismo de prevención eficaz para menguar el impacto de los EA, pese a su gran incidencia. El miedo a represalia y la falta de consciencia de producción del EA por parte de los profesionales de la salud, hacen que se produzca una gran infra-notificación de estos, lo cual dificulta el cumplimiento de las medidas de prevención. Se debe extender la preocupación por el impacto de los EA al ámbito social, sin limitarse solamente al sanitario. Para ello, es necesario concienciar a los profesionales de la salud en primer lugar, trasladándose así a la sociedad en general, con el objetivo de disminuir el impacto en la salud pública de la llamada “Epidemia Oculta de los Errores Sanitarios”.

Safety Traps

Fear of risk provides a rationale for protracted economic downturns. We develop a real business cycle model where investors with decreasing relative risk aversion choose between a risky and a safe technology that exhibit decreasing returns. Because of a feedback effect from the interest rate to risk aversion, two equilibria can emerge: a standard equilibrium and a "safe" one in which investors invest in safer assets. We refer to the dynamics of this second equilibrium as a safety trap because it is self-reinforcing as investors accumulate more wealth and show it to be consistent with Japan's lost decade.

Kassanhallinta kuntasektorilla -sovellus Etelä-Karjalan ydinkuntien likvidimpien varojen osalta

Tutkielmassa analysoidaan kunnan kassanhallinnan likvidimpien varojen prosessien toteuttamista, kun tavoitteena on kustannustehokkuuden parantaminen. Lisäksi selvitetään Etelä-Karjalan ydinkuntien eli Lappeenrannan, Imatran ja Joutsenon mahdollisuuksia tehostaa yhteistyötä taloushallinnon alueella. Työn teoriaosassa tarkastellaan kuntasektorin kassanhallintaa erityisesti myyntisaamisten ja ostovelkojen hallinnan osalta. Keskeistä on löytää prosesseista kustannuksia ja viivettä minimoivia menettelytapoja, joita olisi mahdollista hyödyntää kunnan kassanhallinnassa. Tehokkaassa kassanhallinnassa korostuu yhä enenevissä määrin informaatioteknologian rooli. Tästä johtuen tutkimuksessa kartoitetaan perinteisten menettelytapojen automatisoinnin mahdollisuuksia ja etuja. Empiirisessä osassa tarkastellaan kohdekuntien kassanhallinnan menettelytapoja sekä niiden yhtäläisyyksiä ja eroavuuksia. Lisäksi kartoitetaan yhteistyön lisäämisen mahdollisuuksia ja esteitä sekä määritetään käytetyn aineiston perusteella tehokkaan kassanhallinnan edellyttämät menettelytavat. Tutkimuksesta voidaan päätellä kuntien tavoittelevan joustavampia ja kustannuksia minivoivia kassanhallinnan menettelytapoja vaikka perinteisten menetelmien uudistaminen ei aina olekaan helppoa. Automatisointi ja prosessien virtaviivaistaminen on taloudellisen menestyksen ja kilpailussa mukana pysymisen edellytys. Tehokkuuden etsiminen tiiviimmän yhteistyön kautta olisi järkevää, mutta asenteet ja kontrollin menettämisen pelko estävät yhteistyöhön perustuvien suuruuden etujen saavuttamisen.

Les traitements laser en dermatologie pédiatrique [Laser treatments in pediatric dermatology].

Lasers in pediatric dermatology were developed as a result of the treatment of port-wine stains. Infantile hemangiomas may benefit, in some cases, from laser treatment as well as venous and lymphatic malformations. For certain pigmented lesions, as well as some hamartomas, laser treatments are a credible alternative to surgical resection. Bum scars are improved by lasers which stimulate collagen remodeling. Furthermore, hair removal of congenital and acquired hypertrichosis can relieve psychosocial discomfort and improve quality of life. The management of pain and fear of children undergoing laser treatment, using either topical or general anesthesia, remains of central importance.

Screening and overdiagnosis : public health implications

Overdiagnosis is the diagnosis of an abnormality that bears no substantial health hazard and no benefit for patients to be aware of. Resulting mainly from the use of increasingly sensitive screening and diagnostic tests, as well as broadened definitions of conditions requiring an intervention, overdiagnosis is a growing but still largely misunderstood public health issue. Fear of missing a diagnosis or of litigation, financial incentives or patient's need of reassurance are further causes of overdiagnosis. The main consequence of overdiagnosis is overtreatment. Treating an overdiagnosed condition bears no benefit but can cause harms and generates costs. Overtreatment also diverts health professionals from caring for those most severely ill. Recognition of overdiagnosis due to screening is challenging since it is rarely identifiable at the individual level and difficult to quantify precisely at the population level. Overdiagnosis exists even for screening of proven efficacy and efficiency. Measures to reduce overdiagnosis due to screening include heightened sensitization of health professionals and patients, active surveillance and deferred treatment until early signs of disease progression and prognosis estimation through biomarkers (including molecular) profiling. Targeted screening and balanced information on its risk and benefits would also help limit overdiagnosis. Research is needed to assess the the public health burden and implications of overdiagnosis due to screening activity.

Learning journalistic opinion genres using CLIL methodology

The Faculty of Business and Communication recently started an internationalization process that, in two year’s time, will allow all undergraduate students (studying Journalism, Audiovisual Communication, Advertising and Public Relations, Business and Marketing) to take 25% of their subjects in English using CLIL methodology. Currently, Journalism is the degree course with the greatest percentage of CLIL subjects, for example Current Affairs Workshop, a subject dedicated to analyzing current news using opinion genres. Moreover, because of the lack of other subjects offered in English, ERASMUS students have to take some journalism subjects in order to complete their international passport, and one of the classes they choose is the Current Affairs Workshop. The aim of this paper is to explore how CLIL methodology can be useful for learning journalistic opinion genres (chat-shows, discussions and debates) in a subject where Catalan Communication students –with different levels of English- share their knowledge with European students of other social disciplines. Students work in multidisciplinary groups in which they develop real radio and TV programs, adopting all the roles (moderator, technician, producer and participants), analyzing daily newspapers and other sources to create content, based on current affairs. This paper is based on the participant observation of the lecturers of the subject, who have designed different activities related to journalistic genres, where students can develop their skills according to the role they play in every assignment. Examples of successful lessons will be given, in addition to the results of the course: both positive and negative. Although the objective of the course is to examine professional routines related to opinion genres, and students are not directly graded on their level of English, the Catalan students come to appreciate how they finally overcome their fear of working in a foreign language. This is a basic result of their experience.

La percepció social entorn al delicte i els condicionants que operen en aquesta percepció al municipi de Sant Joan de Vilatorrada

L'objectiu general d'aquesta investigació social és aprofundir en el coneixement de la percepció social entorn al delicte, així com en els condicionants que operen en aquesta percepció al municipi de Sant Joan de Vilatorrada. S'incidirà en el coneixement d'aquesta percepció a partir de la por al delicte i la inseguretat ciutadana, dos fenòmens similars, però no exactament iguals. I els condicionants responen als factors que tenen una influència sobre la por al delicte i la inseguretat ciutadana. D'aquests factors se n'han detectat 34, i només s'estudiaran els nou més rellevants amb la finalitat de saber quin d'ells és el més influent. Tal com s'ha comentat, l'àmbit d'estudi és la població de Sant Joan de Vilatorrada, tot justificant-se pel fet de permetre incorporar el factor de tenir un centre penitenciari al mateix municipi en el qual es resideix. La metodologia escollida és la quantitativa, tot utilitzant la tècnica de l'enquesta. Per altra banda, la mostra és de 2.030 subjectes, tenint present que s'ha obtingut a partir d'una fórmula destinada a calcular les poblacions finites. Finalment, s'han presentat quatre limitacions de l'estudi, tot optant per aportar diverses solucions.

Emotion and Linguistic Diversity

In this paper we shall try to explain why speakers experience their languages so passionately. One explanation is based on the role language plays in the construction of the community and in the fact that it is a clear mark of belonging. Furthermore, we support another reason. Speakers experience their language as something received from their ancestors and that they are obliged to transmit to their descendents, an imperative which carries an extraordinary emotional charge. In fact, fear of the death of a language is experienced as an act of irreparable non-fulfilment. Why? We believe that language is one of the most evident signs of community, much more than the sum of the individuals of which it is composed. Indeed, it is a long-lasting entity projected into both the past and the future and which, moreover, accumulates within the language the whole of the culture. In the survival of the community and the language we find a response, even though it may be illusory, to the need for transcendence: our ancestors live on in our language and we, if we meet our obligations, live on in the language of our descendents

«Me quedaré con lo positivo»: Análisis de blogs de mujeres con cáncer de mama

En este artículo se analizan siete blogs escritos por mujeres con cáncer de mama. En primer lugar, se indaga sobre su forma de concebir el cuerpo en relación, por un lado, al impacto del cáncer en los órganos y procesos corporales ligados a la feminidad y, por el otro, a su carácter mortal. En segundo lugar, se analiza su atribución de agencia en relación a la enfermedad y su curación. Se observa que la responsabilidad en la curación se atribuye principalmente a los médicos, pero aparece con fuerza la idea que la mujer se puede sanar mediante cambios en su estilo de vida y a través del pensamiento positivo. Este establece un marco en el que las afectadas de cáncer encuentran dificultades para reconocer y expresar aspectos considerados negativos del proceso como la rabia, la desesperación o el miedo a la muerte, al mismo tiempo que marca una distinción entre pacientes con trayectorias de éxito en su curación y los que no lo consiguen, que son culpabilizados.

Percepció de la mort en persones grans ingressades en un centre geriàtric: un estudi qualitatiu

La mort sempre ha estat present en tot individu i societat, tot i els grans avenços de les tecnologies i és per la persona un tema de profunda reflexió, tant des de la perspectiva filosòfica com religiosa i la més actual, la científica. No obstant, en les societats industrials avançades cada vegada és més difícil acceptar la simple idea de mort. L’arribada de la vellesa posa a la persona davant de nombrosos canvis i pèrdues que repercuteixen la seva qualitat de vida, la seva estabilitat emocional i porta en sí mateix la consciència de saber que la mort es troba cada vegada més a prop, generant principalment temors i pors. És per això que cal destacar la importància del tema per la infermera que treballa amb gent granObjectiu: Conèixer la percepció sobre la mort que tenen les persones grans ingressades en una residència geriàtrica

Elämänlaatu ja iäkkäiden kaatumisten ehkäisy

Quality of life and fall prevention among the aged Improvement of quality of life is considered to be one of the most important goals of prevention, treatment and rehabilitation among the aged. The study aimed to describe and assess fall prevention interventions as a quality of life indicator, and to describe the social dimension of health-related quality of life among the aged. In addition, it aimed to assess the effects of fall prevention intervention on quality of life among the aged. The study was implemented by using a methodological triangulation. The data in the systematic review was retrieved from the databasis of medical and nursing sciences. Home-dwelling aged (n=19) participated in the qualitative study of a social dimension of quality of life. The data was gathered by the thematic interview method. The quantitative multifactorial fall prevention study comprised 591 participants, either the aged living at home or in sheltered housing, showing an increased risk of falling. Participants were randomized into an intervention or a control group. Follow-up measurements were carried out after a 12 month intervention. The data was collected by the 15D quality of life instrument and a structured questionnaire. Based on the systematic review, only in a few studies fall prevention produced positive effects on dimensions of quality of life (physical function, social function, vitality, mental health, environmental domain). Based on the thematic interview the social dimension of quality of life consisted of three themes: personal values, personal milieu and personal daily life. Based on the fall prevention program, depressive symptoms and distress decreased, managing in usual activities improved, sexual activity and phone contacts increased among men. In women, managing in usual activities improved, socializing increased and discomfort and symptoms decreased. Within the groups, self-perceived health improved among women in the intervention group and among men in the control groups. In addition, fear of falling and feelings of insecurity reduced among women in the intervention group. Personal daily life with its activities opened up new perspectives into the social dimension of good quality of life, which was emphasized especially in the interviews of the oldest participants. Multifactorial fall prevention can affect positively some physical and psychosocial dimensions of quality of life among the community-dwelling aged. Additional studies with larger sample sizes, longer follow-up periods and multiple outcome measures are needed. Fall prevention intervention may affect quality of life by different mechanisms, and the quantitative and qualitative assessment of its effects should also be included in the interventions of randomized controlled trials.

The Innovation Process – Aiming towards Innovativeness in a Construction Company

The bachelor’s thesis concentrates on the innovativeness in the construction industry. The purpose of the thesis is to define the innovation as a concept reflected on a context of the construction industry. The second objective is to examine how the construction companies could foster and increase the innovativeness. The third objective was to find out tools, methods and phases of the front-end of the innovation process. The construction industry is often considered as a traditional and an old-fashioned manufacturing industry. The innovation or the innovativeness rarely linked to the construction industry. Productivity is a common problem in the construction industry. The construction industry needs to increase the productivity to compete in a globalized world. The productivity can be increased by the innovation. The thesis based on a literature review. The findings from the literature include a description of the innovation as a concept, the innovative culture and the innovation process as a context of the construction industry. The phases of the front-end of the innovation process were explained. Customers centered approach was taken into account in the innovation process. The required tools and methods for managing the front-end of the innovation process were illustrated. The thesis ensures the importance of the innovation facing challenges of the construction industry. Managing the front-end of the innovation is the most important aspect to stand out from the less innovative companies. To take a full advantage of the innovation companies cannot fear of changes. The innovation process requires a full support of the top management of the company. Taking into consideration a theoretical aspect of the thesis a further research is required to respond practical needs of the company. Tools and methods should be considered according the company’s needs and activities. Company’s existing state and culture should be examined before implementing the front-end of the innovation process to ensure the functionality.

La invasión en la ciencia ficción y la construcción de la identidad americana

This dissertation examines the issue of invasion as represented in American science fiction. American SF appears as a scenario in which to explore national identity-an identity that has been marked by the imaginary of invasion. The dissertation focuses in particular on the 1983 television series V, which articulates concerns typical of a nation that has established its hegemony on the basis of the separation between oneself and the other. V, as we argue, equals the expression of American identity with the fear of physical otherness, and the fear of the vulnerability of the national borders as the imaginary boundary that separates the American I from everything else

Suunnittelu ja kontrolli kaupunkirohkeiden ja -pelottomien naisten tuottajana

Kirjallisuusarvostelu

Carcinoma Adenoescamoso primário de fígado

Adenosquamous carcinoma of the liver is a rare type of hepatic tumor first described in 1975. It is characterized by both glandular and squamous compounds. We describe a case of adenosquamous carcinoma of the liver. It was discovered in a 42-yr-old female with a 2-month history of vomiting, weight loss (7 kg). A left hepatic lobectomy disclosed an 11 x 9 x 7,5 cm tumor located at I, II, III, IV segments. This tumor is rare entity and is a variant of cholangiocarcinoma whose etiology and prognostic are not well known.