Concurs d'idees per a l'ampliació de l'Hospital de Sant Llorenç de Viladecans

Award-winning

Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study.

BACKGROUNDS AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. METHODOLOGY/PRINCIPAL FINDINGS An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. CONCLUSIONS/SIGNIFICANCE The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

Multidisciplinary consensus on the approach to hospital malnutrition in Spain

Rationale: Disease-related malnutrition constitutes a highly prevalent healthcare problem with high costs associated. In Spain, the prevalence of malnutrition in hospitalized patients has been reported from 30% to 50%. Objectives: Main purposes of this consensus document were to establish recommendations that facilitate decision- making and action to prevent and early-diagnose disease-related hospital malnutrition, on the management of nutritional support methods and actions to evaluate nutritional treatment compliance and efficacy. Methods: A systematic bibliographical search of authors was performed, complemented by updated bibliography by author references up to 2010. From this review, some recommendations were defined, modified and critically evaluated by the representatives of scientific societies in a consensus conference (Dec 2010) following a structured brainstorming technique: the Metaplan® technique. A double validation process was undertaken until final recommendations were obtained. Results: 30 consensus recommendations for the prevention and management of hospital malnutrition are presented in this document. Recommendations cover all clinical care settings as well as prevention, screening, diagnosis, treatment and follow-up of disease-related malnutrition. Conclusions: Nutritional screening is strongly recommended at all clinical settings when nutritional risk factors are identified or there is clinical suspicion of malnutrition. Nutritional assessment should be designed and performed according to centers’ resources, but clearly identified protocols should be available.

Health and safety in the construction : subject pending to be included in the curriculum of architecture in Spain

The art of construction is a risky activity that directly affects the life and physical integrity of persons. Since the approval of Law 31/1995, of November 8, Prevention of Occupational Risks was the first legislation that established the current basis in all sectors and then transposed into Spanish law Directive 92/57/CEE called Royal Decree 1627/1997 of October 24, on minimum safety and health dispositions in construction works, measures have been proposed to develop a mixed body of scientific literature composed of researchers and professionals in the field of occupational safety and health, but even today there is still no clear and firm proposal, showing a lack of awareness in the occupational risk prevention and, therefore, a consolidation of the culture of prevention in society. Therefore, the technicians, who make up the building process, can incur in very high responsibilities, such as: Author of the project, Coordinator of Safety and Health during the preparation of the project and during the execution of works, Site Management: Site Manager. This involves the immediate creation of a general training in prevention for all architects starting when still studying, as well as specific training, appropriate and complementary to all the architects that will be devoted to the specialty of occupational safety and health in construction works. That is, first, we must make the responsible bodies aware of the urgent need to integrate risk prevention in the curricula of architecture and later in the continuing education of the profession. It is necessary that our teaching must conform to the laws on safety and health, due to the fact that the law recognizes our academic degrees and professional qualifications to perform functions in that area

Las teorías del gótico y su representación gráfica en España el último tercio del siglo XIX. Un estudio sobre: Some Account of Gothic Architecture in Spain, de George Edmund Street

La tesis se centra en el estudio, descripción y análisis del libro publicado por el arquitecto británico George Edmund Street en 1865, bajo el título Some Account of Gothic Architecture in Spain. El libro dio a conocer una de la colecciones más importantes de dibujos realizada en el siglo XIX sobre la arquitectura gótica española, y por lo tanto fue una primera referencia para su estudio, hasta bien entrado el siglo veinte. El volumen incluyó 107 grabados de diversos tipos de edificios con perspectivas y detalles, y 25 láminas con 45 planos de plantas de iglesias y claustros, muchos de ellos publicados por primera vez. Gracias a varias campañas de verano por la mitad norte del país, la casi inexplorada -desde un punto de vista académico- arquitectura española medieval fue finalmente descubierta. Este hecho conduce a una pregunta intrigante que está en el origen de esta investigación ¿cómo pudo Street en pocos viajes sentar las bases de la historia del gótico español que hasta entonces los estudiosos españoles no habían sido capaces de definir? Esta tesis comienza describiendo la obra de Street en su contexto cultural con un breve repaso a su biografía y a su posición profesional y teórica. También su relación con las personas más representativas que participaron en el estudio de la arquitectura gótica, como Robert Willis, William Whewell, Augustus Pugin, o George G. Scott. Se ha prestado especial atención, en explicar su papel relevante en el Gothic Revival, para entender el significado de su interés en la arquitectura gótica continental. Estos capítulos preliminares son seguidos por una revisión del papel del dibujo como herramienta para la arquitectura de los viajeros en sus rutas en busca de la arquitectura gótica. También se trata la influencia de la Royal Academy y sus académicos, (entre los cuales estuvo Street) y su formación académica. Finalmente la tesis entra en el estudio de los planos arquitectónicos que Street hizo durante sus viajes continentales de arquitectura, seguido por una descripción detallada de sus dibujos de España, analizando su método, su técnica, y las nuevas características aportadas, que fueron una novedad en el contexto español. También se lleva a cabo algunos estudios comparativos de los dibujos de España, gracias a una recopilación exhaustiva de bocetos y dibujos originales de Street, que en su gran mayoría se conservan en los archivos del RIBA, cotejándolos con sus versiones finales, con dibujos de la época de otros autores sobre los mismos edificios, y con fotos recientes. La tesis deja claro por qué y cómo Street, gracias a su soporte teórico y habilidades para el dibujo, pudo realizar algo que había pasado desapercibido para los estudiosos españoles de la época (construcción, historia de los estilos, señalamiento de períodos constructivos), lo que le permitió encontrar el lugar adecuado de la arquitectura gótica española en la historia y en el mapa de la arquitectura gótica europea. ABSTRACT This thesis focuses on the study, description and analysis of the book published by the British architect George Edmund Street in 1865, under the title Some Account of Gothic Architecture in Spain. The book displayed one of the most significant collections of drawings on Spanish Gothic Architecture made in the nineteenth century, and therefore was a first reference for its study, until well into the twentieth century. The book included 107 engravings, the surveying of various types of buildings with perspectives and details, and 25 sheets containing 45 ground plans of churches and cloisters, many of them new and published for the first time. Thanks to several summer campaigns in the north half of the country, the almost unexplored -from a scholar point of view- medieval Spanish architecture was eventually revealed. This fact lead to an intriguing question that is at the origin of this research: how could Street in a few trips lay the foundations of the history of Spanish Gothic that until then Spanish scholars had not been able to define? This thesis begins inscribing this Street's work in his cultural context. A brief review of his biography and professional and theoretical positions has been seen as necessary. Also his debts and relationship with the most representative people involved in the study of Gothic architecture, like Robert Willis, William Whewell, Augustus Pugin, or George G. Scott are discussed. Special attention has been paid, taken into account his relevant role in the Gothic Revival, to understand the significance of his interest in continental Gothic architecture. These preliminary chapters are followed by a review of role of drawing as a tool for Architectural travellers in their Tours in search of the Gothic architecture. The influence of the Royal Academy and its academicians, (among which was Street) and his educational background are here tackled. Eventually this thesis enters into the study of the architectural drawings Street made during his continental architectural journeys, which is followed by a detailed description and analysis of the Spanish ones: his methods, his technique, and the new features which were a novelty in the Spanish context are explored. Also in this thesis is carried out some comparative studies thanks to a previous exhaustive gathering of Street's sketches and original drawings, most of which are preserved in the RIBA archives. Their final versions, drawings of the same buildings from other contemporary draughtsman and pictures of their current state are compared with them. This thesis makes clear why and how Street thanks to his theoretical back-ground and portraying skills could realize what have passed unnoticed by contemporary Spanish scholars (construction, genealogy of forms, dating of periods) allowing him to find the proper place of the Spanish architecture in the history and the map of European Gothic architecture.

Some account of Gothic architecture in Spain,

Mode of access: Internet.

Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN:Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING:A 950-bed teaching hospital in Seville, Spain. PATIENTS:All patients admitted to the hospital during the period from 1995 through 2008. METHODS:Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS:Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION:Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

Nosocomial Outbreak of Infection With Pan-Drug-Resistant Acinetobacter baumannii in a Tertiary Care University Hospital

OBJECTIVE To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact. DESIGN Nested case-control cohort study and a clinical-microbiological study. SETTING A 1,521-bed tertiary care university hospital in Seville, Spain. PATIENTS Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak. RESULTS All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations. CONCLUSIONS We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

L'Hospital de Sant Jaume i Santa Magdalena de Mataró, una institució al servei de la ciutat des del segle XVII

Estudi que repassa la història de l'edifici de l'Hospital de Sant Jaume i Santa Magdalena de Mataró i de la seva institució, i anàlisi de com ha influït en el seu entorn social.

Supplemental nursing staff´s experiences at a Spanish hospital: Qualitative phenomenology research

The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units.

Nou edifici de consultes externes, I+D+I i biblioteca a l'Hospital Universitari Joan XXIII de Tarragona

Award-winning

Ampliación del Hospital Costa del Sol, Marbella

Peer Reviewed

Fernando García Mercadal y el Movimiento Moderno

La tesis plantea el estudio de la figura de Fernando García Mercadal (1896- 1985) y su obra, en el contexto del proyecto moderno perteneciente a la racionalidad teórica colectiva de la segunda generación del Movimiento Moderno en Europa, y explora la vida y circunstancias de un arquitecto que aunque nacido en el XIX, trajo la modernidad a España. El Movimiento Moderno en España, se articula en las décadas de los años 20 y 30 a través del GATEPAC y un grupo de arquitectos racionalistas en Madrid que Carlos Flores denomina Generación del 1925. Fernando García Mercadal, primero de su promoción en 1921 y pensionado en Roma, pertenece a ambos y pronto se convierte junto con Josep Lluis Sert, en una de las figuras más relevantes del panorama moderno español. Único miembro fundador del GATEPAC que había nacido en el siglo XIX, publica habitualmente en la revista AC (1931-1937), y en la revista Arquitectura desde 1920. Organiza en la Residencia de Estudiantes, entre 1928 y 1932, un famoso ciclo de Conferencias que imparten Le Corbusier, Mendelsohn, Van Doesburg, Gropius y Giedion. También asiste a la reunión constituyente de los CIAM en La Sarraz en 1928, al CIAM II en Frankfurt en 1929 y al CIAM III en Bruselas en 1930. Fue profesor en la Escuela de Arquitectura de Madrid y Arquitecto Jefe de la Oficina de Urbanismo y de Parques y Jardines del Ayuntamiento de Madrid, cargo al que accede por oposición en 1932. Tras la guerra fue depurado e inhabilitado profesionalmente, hasta que en 1946 comienza a trabajar en el Departamento de Arquitectura del I.N.P. donde continúa hasta los años 70. En 1979 es nombrado Académico de número de la Real Academia de Bellas Artes de San Fernando y muere en Madrid en 1985. Estos son los datos conocidos y aunque en la tesis se aportan nuevos datos inéditos, es en las premisas para su interpretación donde este trabajo de investigación pone el acento. En la historiografía de nuestra arquitectura moderna, pervive una tendencia a suponer una desconexión entre la vanguardia arquitectónica en los años 20 y 30 y el movimiento moderno internacional. El manto de silencio que cayó sobre la generación anterior a la guerra, una vez terminada esta, contribuye a reforzar la idea, cuyo origen y causas exceden el ámbito de trabajo, aunque se tratarán tangencialmente por ser ineludible hacerlo. La tesis pone en cuestión ese planteamiento desde el convencimiento fundamentado en los datos y en la consulta de fuentes originales, que la arquitectura española anterior a la guerra, aun con las circunstancias particulares del país, estuvo en sintonía con la europea, siendo esta la hipótesis de partida de la investigación. Las aportaciones más significativas que, a mi entender, presenta la tesis doctoral, y tienen mayor originalidad, son las siguientes; 1.Puesta en valor de la arquitectura de FGM, antes y después de la guerra, abandonando la idea de su supuesta renuncia a las ideas modernas a partir de los 30; 2. Puesta en valor, con aportación de datos concretos, de la Intensa relación mantenida por FGM y otros arquitectos españoles del Movimiento Moderno con los arquitectos de igual tendencia en el resto de Europa, a través de contactos recíprocos y continuos; 3. Estudio de la obra de FGM en el marco del Movimiento Moderno como una nueva arquitectura basada no tanto en la epidermis, como en una forma de hacer y encarar los problemas donde el proceso es tan importante como el resultado; con el Urbanismo como una nueva ciencia, y con el desarrollo de nuevos programas funcionales acordes a las necesidades de la sociedad contemporánea como el Rincón de Goya y el Hospital de Zaragoza. Se manejan tres métodos de trabajo. Los dos primeros aportan un nuevo enfoque al análisis crítico de FGM y su obra, situándole en el contexto internacional, además del español. El tercero, de carácter instrumental, permite el manejo y sistematización de la documentación. El primer método, consiste en aplicar el criterio generacional de Pevsner o Giedion entre otros, al Movimiento Moderno en España, situando a Fernando García Mercadal como arquitecto de la segunda generación, para hacer un análisis crítico comparativo de su trayectoria con otros arquitectos europeos de la misma, que permita establecer semejanzas y diferencias. El segundo método, complementario al anterior, consiste en estudiar las relaciones internacionales de FGM con las figuras más próximas a él y sus posibles influencias. Por último, y en relación con la documentación de obras y proyectos, se manejan a su vez dos criterios. Para la obra completa, y debido a la inexistencia de originales del Legado García Mercadal, se utiliza con carácter general el material ya publicado, disperso en libros y revistas. En el caso de las cinco obras seleccionadas, se completa con búsqueda en archivos, toma de datos in situ actualizados cuando es posible, y una recopilación de su repercusión en prensa escrita de su momento. ABSTRACT This research study focuses on Fernando Garcia Mercadal (1896-1985) and his work in the context of the Modern project as part of the collective theoretical rationality of the second generation of European Modern architecture. It explores the life and circumstances of the architect, who even though born in 19th century introduced Modern architecture in Spain. Modern architecture (Modern Movement) in Spain covered two decades between 20's and 30's through GATEPAC and a group of rationalists in Madrid that Carlos Flores named “generation of '25”. Fernando Garcia Mercadal, top of his class in 1921 and granted with the scholarship in Rome, belonged to both groups and early in his career he became, along with Josep Lluis Sert, one of the most relevant figures of Modern Architecture in Spain. He was the only member of GATEPAC who was born in 19th century. He frequently published on the magazine “AC” (1931-1937) and on “Arquitecture” magazine since 1920. He organized a series of famous lectures at “Residencia de Estudiantes” (Madrid) between 1928 and 1932 in which Le Corbusier, Mendelsohn, Van Doesburg, Gropius or Giedion took part. He was a member of the constituent meeting of CIAM in La Sarraz in 1928, CIAM II in Frankfurt in 1929 and CIAM III in Brussels in 1930. Mercadal was a teacher at Escuela de Arquitectura de Madrid and the Chief of the Urban Planning, Parks and Gardens Office of the Council of Madrid. He earned his position by public examination in 1932. After the civil war he was disqualified professionally until 1946, when he started working at the Architecture Department at INP until 70's. In 1979 he was elected as an academic member of “Real Academia de Bellas Artes de San Fernando” and later died in 1985. These are the well-known facts and even though this research study provides unpublished facts, it focuses on the premises to interpret them. Throughout the historiographical discourse of Spanish Modern architecture there is a tendency to assume a disconnection between the Avant-garde architecture movements in 20's and 30's and International Modern architecture (Modern Movement). The generation preceding the war remained silent in regard to this issue and once the war was over, they contributed to support the disconnection. The origin and cause exceed the frame of this work, even though they are incidentally commented due to its importance. This research study questions the approach explained above, based on the facts and the original sources. Its first hypothesis states that Spanish architecture before the civil war was, under its own circumstances, in tune with European architecture. The most important and original contributions of this research study are the following under my point of view: 1. To highlight the architecture of FGM, before and after the war, leaving behind his reputed withdrawal of Modernity after 30's; 2. To highlight the intense relationship between FGM and other Modern Spanish architects and other European architects sharing the same ideas, providing detailed facts; 3. Study of FGM's work in the context of Modern architecture as a new architecture based on its know-how and the way problems are faced. The process is as important as the result, not so much based on the dermis; with urban planning as the new science and with the development of the new functional programs based on the needs of contemporary society as in Rincón de Goya or Hospital de Zaragoza. Three work methods are used. The first two add a new vision of the critical analysis related to FGM and his work, positioning him in the international context in addition to Spain. The third is used as an instrument to manage and systematize the documentation. The first method applies the generational criteria of Pevsner or Giedion (among others) to Modern architecture in Spain, positioning Fernando Garcia Mercadal as a second generation architect. A critical-comparative analysis of his career and contemporary European architects is made to establish similarities and differences. The second method is complementary to the previous one and studies the international relationships of FGM with other recognised architects that were close to him and their possible influences. At last, in relation to his works and projects, two methods are used. For the complete works, due to the lack of originals, published material found on magazines and books is used as the source. In the case of the five selected buildings, it is complemented with archive search, onsite data collection when possible and the impact on the press at that moment.

Spanish Architecture 1992-2008

Architecture in Spain 1992-2008. This Conference (in image format) performs a synthetic tour of the architectural production in Spain during the period that opens with the events of 1992 (Olympics Games and World Expo in Seville) and closed in 2008 (exhibition of MoMA, Global Crisis and Universal Expo of Zaragoza). On the one hand shows the world and Spanish socio-economic context and is a selection of different architectures, grouped into six streams.