Buenas prácticas de gestión nutricional apoyadas en la logística hospitalaria

Todos y cada uno de los temas abordados y estudiados en el caso del Hospital Universitario Mayor Méderi, son la clara evidencia de como la logística hospitalaria es una herramienta importante dentro de las entidades hospitalarias, pues como puede verse la optimización de los procesos y recursos disponibles, y la integración de las diferentes áreas que intervienen en el desarrollo de los procesos, se da gracias a la aplicación de esta herramienta de gestión, que entiende la organización como un sistema complejo en el cual todas y cada una de las interacciones son vitales y deben ser atendidas con la misma importancia, por la alta dirección. Es entonces cuando la logística hospitalaria se convierte en un arma importante para los profesionales de la salud pues es el puente entre la importancia de unas buenas prácticas médicas y una buena gestión administrativa, que al final se convierten en ventajas competitivas para las instituciones que compiten en un sector que se debate entre la humanidad de su accionar y la rentabilidad obtenida por su funcionamiento.

Legislación y atención medicalizada al nacimiento en el ejercicio de la maternidad y la paternidad en Cuba

El nacimiento de un hijo o una hija constituye un momento transcendental en la vida personal y familiar, en el que se desarticulan o consolidan aspectos de la feminidad y la masculinidad. Objetivo: desde esta perspectiva se realizó una investigación con el fin de comprender la formacomo influyen la representación de la maternidad, el sistema médico en el que se inserta la atención al parto y las legislaciones relacionadas con la maternidad en la concepción y en el ejercicio de la maternidad y la paternidad durante el embarazo, el parto y el puerperio. Metodología: se utilizaron varias técnicas cualitativas de investigación (entrevistas y observación participante) a mujeres atendidas en tres hospitales de maternidad de La Habana y sus compañeros (esposos legales o consensuales). Resultados: los hallazgos develan roles de género en los cuales la mujeres la cuidadora por excelencia y la responsable de la reproducción y los hombres son relegados de ella; se refuerzan y consolidan institucionalmente desde lo legislado y desde la atención médica al proceso. Paralelo a esto, deja al descubierto la emergencia de una nueva masculinidad mediante la mayor implicación de los hombres en este proceso, de su mayor inserción en el espacio privado y de la exteriorización de sentimientos asociados con el nacimiento de su bebé. Conclusión: surge la necesidad de generar políticas orientadas a desmontar la cultura patriarcal en aras de construir relaciones de pareja más igualitarias y democráticas en la sociedad cubana.

Estrategia de servicio en el Ciclo de Preventa-Venta-Posventa en Cruz Blanca EPS En el régimen contributivo en la Ciudad de Santafé de Bogotá

De acuerdo con las tendencias actuales del mercado, enmarcados en un entorno económico lleno de incertidumbre y como consecuencia de la competencia generada por la Ley 100 de 1993 se hace necesario diseñar estrategias que confluyan la identificación

Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer

In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

Reflexões (in)tempestivas sobre qualidade e ética médicas (ou pedaços de nós repartidos em qualidade e ética médicas)

This article adresses the philosophical, ethical and legal aspects of the substantial meaning of the medical act and the parameters to evaluate their quality. Based on an ethics of responsibility, particularly on an “ethics of sharing”, the study concludes that the quality of the medical act must be set according to an objective point of view, the only one compatible with an onto-anthropological understanding of the community and the medical practice.

Poetry on Pre-Raphaelite principles: science, nature and knowledge in William Michael Rossetti’s 'Fancies at Leisure' and 'Mrs. Holmes Grey'

This article demonstrates how early Pre-Raphaelite poetry worked according to the principle that art should be modelled on science theorised by the Pre-Raphaelites in their early essays. As the main theorists (rather than practitioners) of Pre-Raphaelite art, F. G. Stephens and William Michael Rossetti defined the Pre-Raphaelite project in terms of observation, investigation, experiment, the “adherence to fact” and the “search after truth”. In the hands of the early Pre-Raphaelite poets, and particularly Rossetti himself, poetry too becomes a mode of scientific enquiry into the natural world, the nature of observation, human psychology and medical practice.

Living with cancer : an ethnographic study of Thai cancer patients

This thesis is an ethnographic investigation aimed at describing the lived experiences of Thai cancer patients residing in Cancer Hostel, a shelter provided for the needy whilst undergoing radiation treatment at Siam Hospital. All names, including the hospital, the shelter, and all respondents have been altered to preserve anonymity. The practice of withholding the true diagnosis from Thai patients meant that very little was known about their own feelings on cancer and its treatment. That, coupled with entrenched medical practice beliefs, presented an unusual challenge, for which an ethnographic research method was advocated as being most appropriate in helping toward a better understanding of the problem and resolving the existing dilemma. To understand the real experiences of Thai cancer patients, it was extremely important that the researcher get as near as possible to becoming one of them. Therefore, by physically 'being with’, establishing rapport, and gaining patients trust, the researcher was assured of acceptance as an insider, and was thus allowed to share the experiences of their life encounters. Research findings graphically illustrated the flaws in the practice of protecting patients from their diagnosis, who almost universally, wanted to know more about their diagnosis in order to seek help from the medical care system. Towards this, patients created meaning by linking folk beliefs, culturally inherited knowledge and a common sense, albeit naive approach in trying to make sense of their illness and treatment. Although patients saw cancer illness and its treatment, especially radiotherapy, as life threatening, it was the fear of radiation treatment, not cancer illness which turned patients away from medical treatment. As well, uncertainty, fear and frustration through the lack of information and involvement in their treatment saw patients employ strategies of both reciprocal and fatalistic acceptance; stoic resistance; and thinking positively in their efforts at coping with those life threatening situations.

Developing english skills through reflective portfolios in Hong Kong universities

This research concerns the use of portfolios by teachers of English (L2) to assist non-native speakers in Hong Kong universities to complete their studies in English. Portfolios as an English learning tool have yet to win converts from the ranks of language teachers in Hong Kong chiefly because of concerns about reliability and fairness. Two recent initiatives in Hong Kong have, however, prompted a reappraisal of the place of portfolios in English language learning. They include the use of learning portfolios in secondary school and ePortfolios by university students for learning and employment purposes.

As an English (L2) teacher of many years, I initiated my research to investigate the experiences of seven university students in Hong Kong in using reflective portfolios for English learning. Three research questions framed my research: 1) in what ways can reflective portfolios impact on L2 learning strategies? 2) what are the effects of reflective portfolios on progress in L2 acquisition as perceived by students? 3) what are the perceptions of university students towards reflective portfolios as a method of L2 learning?

To gain a holistic understanding of the complex phenomena under scrutiny, a case study methodology and grounded theory were utilised, the former to organise and generate qualitative data, and the latter to analyse data from three sources provided by the seven participating students: semi-structured interviews, portfolio artefacts, and weekly learning diaries.

There were two levels of data analysis. For the first level, analysis focused on coded data from portfolio artefacts, diary entries and interview transcripts as reported by students. The second level involved analysis from the Confucian and sociocultural perspectives. I pursued interpretation and continuous refinement of the data by using techniques drawn from grounded theory. The findings revealed that students generally employed a wide spread of L2 learning strategies in the cognitive, meta-cognitive, and socio-affective domain, reported increased awareness of effective language strategies, and considered portfolios a means of supporting time management and record-keeping, and a site for extended writing practice through reflection.

The findings suggest that students display a cyclical, context-specific shift in learning conception from quantitative to qualitative. Connected to this is students’ apparent ability to formulate strategic responses to externally imposed demands. It is found that such responses are culturally triggered, underpinned by Confucian beliefs. Although the Confucian tradition emphasises respect for established authority, the findings point to students’ creative re-configuration of mental schemata to engender change in role enactment and power relations, with the portfolio as a mediating tool of their experiences.

Based on the findings, I argue that my research has addressed the three research questions and contributed to two crucial aspects of L2 learning. The first pertains to the need for a balanced view of individual effort and social context in second language acquisition, corroborating the significant link between context and learner engagement. Another contribution centres on an enhanced understanding of the relationship between portfolios, reflection and L2, where students’ diaries in English and portfolio artefacts enable them to engage in critical reflection and to identify strategies for L2 improvement.

Devaluation of a constitutional guarantee : the history of section 51(xxiiiA) of the Commonwealth Constitution

This article describes constitutional and socio-historical background to the referendum that led to the inserrion of s 51(xxiijA) into the Commonwealth Constitution. It traces judicial interpretations of the clause 'but not so as to authorise any fonn of civil conscription' through the major cases, including British Medical Association v Commonwealth, General Practitioners Society v Commonwealth, and Alexandra Private Geriatric Hospital Pty Ud v Commonwealth. The issue of the powers of the Commonwealth to regulate private medical practice without infringing the constitutional guarantee against civil conscription is analysed in the context of the development of National Health Care Schemes for financing medical benefits (Health Insurance Commission v Peverill). Constitutional aspects of the 1995 legislation enabling the introduction into Australia of purchaser-provider agreements ('managed care ') are also examined. Finally, the article questions the constitutionality of the Australian Competition and Consumer Commission s powers to regulate the essential elements of the patient-doctor relationship.

Patient and business rules extraction and formalisation using SVN and SBVR for automated healthcare

This paper describes advances in automated health service selection and composition in the Ambient Assisted Living (AAL) domain. We apply a Service Value Network (SVN) approach to automatically match medical practice recommendations to health services based on sensor readings in a home care context. Medical practice recommendations are extracted from National Health and Medical Research Council (NHMRC) guidelines. Service networks are derived from Medicare Benefits Schedule (MBS) listings. Service provider rules are further formalised using Semantics of Business Vocabulary and Business Rules (SBVR), which allows business participants to identify and define machine-readable rules. We demonstrate our work by applying an SVN composition process to patient profiles in the context of Type 2 Diabetes Management.

Demonstrable professionalism : linking patient-centred care and revalidation

The move by the Medical Board of Australia to commence a conversation with the medical profession about revalidation reflects that patient-centred care is at the heart of good medical practice. Patients judge their doctors' commitment to them based on whether their individual interactions with doctors meet their needs. We argue that ensuring that doctors are continuing to perform at a level that the community regards as acceptable is a demonstration of an individual doctor's professionalism and thus their commitment to patient-centred care. This impacts on the profession as a whole, which needs to commit to what we call 'demonstrable professionalism' - the ongoing and active demonstration of performance that the community regards as acceptable. This needs to be supported by organisations in which doctors work, reflecting the importance of organisational context to clinical practice. Revalidation processes thus need both to reflect the work of doctors and be meaningful to the community. The move to consider revalidation of doctors by regulatory authorities should not be seen by the profession as a threat, but more as an opportunity to demonstrate the profession's commitment to patient-centred care

Hierarchical gene selection and genetic fuzzy system for cancer microarray data classification

This paper introduces a novel approach to gene selection based on a substantial modification of analytic hierarchy process (AHP). The modified AHP systematically integrates outcomes of individual filter methods to select the most informative genes for microarray classification. Five individual ranking methods including t-test, entropy, receiver operating characteristic (ROC) curve, Wilcoxon and signal to noise ratio are employed to rank genes. These ranked genes are then considered as inputs for the modified AHP. Additionally, a method that uses fuzzy standard additive model (FSAM) for cancer classification based on genes selected by AHP is also proposed in this paper. Traditional FSAM learning is a hybrid process comprising unsupervised structure learning and supervised parameter tuning. Genetic algorithm (GA) is incorporated in-between unsupervised and supervised training to optimize the number of fuzzy rules. The integration of GA enables FSAM to deal with the high-dimensional-low-sample nature of microarray data and thus enhance the efficiency of the classification. Experiments are carried out on numerous microarray datasets. Results demonstrate the performance dominance of the AHP-based gene selection against the single ranking methods. Furthermore, the combination of AHP-FSAM shows a great accuracy in microarray data classification compared to various competing classifiers. The proposed approach therefore is useful for medical practitioners and clinicians as a decision support system that can be implemented in the real medical practice.

Nutrição parenteral como fator de risco para infecção relacionada a cateter venoso central

O uso de cateteres venosos centrais (CVC) para fins diagnósticos e terapêuticos está incorporado à prática médica diária. Complicações sérias, com elevada morbidade e mortalidade, como a sepse, estão associadas a este procedimento. O diagnóstico das infecções relacionadas a cateter é fundamentado em sinais clínicos e laboratoriais. Os fatores de risco para infecção devem ser considerados por ocasião da utilização de CVC e estão relacionados ao paciente, ao cateter, ao tipo de solução administrada, ao profissional que manipula o cateter e ao agente etiológico. A identificação destes fatores permite a intervenção precoce sobre os mesmos e o manejo adequado do CVC e das complicações clínicas relacionadas.

A percepção de valor de uma biblioteca médica digital para o embasamento das condutos assistenciais adotadas em um hospital privado no Rio de Janeiro

Este estudo foi desenvolvido em um hospital privado, no Rio de Janeiro, com o intuito de demonstrar o valor de uma biblioteca médica digital, como ferramenta de suporte para fundamentação científica das condutas assistenciais adotadas pela equipe médica, que resultaram em glosas técnicas e perda de faturamento para a instituição. Para isso, por meio do método revisão integrativa, foi coletada a literatura clínica referente às glosas, ocorridas durante o período de janeiro a setembro de 2014, e analisada sob a perspectiva do modelo conceitual apresentado pela Cochrane (LEFEBVRE et al., 2011) que identifica o nível da evidência científica e estabelece o seu grau de recomendação para a prática clínica. Durante a análise de conteúdo, considerando as técnicas propostas por Bardin (1977), foram identificadas as evidências científicas que conferem valor à prática assistencial, conforme proposto pelo modelo conceitual. Além disso, o valor dos itens glosados foi incluído na análise dos resultados, reforçando a tendência do estudo para a validação do modelo conceitual que recomenda a prática clínica baseada em evidências científicas para geração de resultados mais efetivos e de melhor custo/benefício na saúde. Com base nos achados, são discutidas as implicações teóricas e práticas, assim como sugestões para futuros estudos sobre o tema.