RESUMO
Introducción: La seguridad del paciente es considerado como un patrón integrado de comportamiento individual y organizacional, basado en creencias y valores compartidos que continuamente busca minimizar el daño al paciente, que resulta de la atención. Objetivo: Analizar la correlación de percepción de cultura de seguridad del paciente, y grado de seguridad percibido en funcionarios de una Institución de Salud de tercer nivel de atención (2015-2017-2019). Materiales y Métodos: Estudio cuantitativo correlacional, con una muestra intencional derivada del registro de una base de datos de cultura de seguridad del paciente, con un total de 402 registros. La medición se realizó mediante el cuestionario Hospital Survey on Patient Safety Culture. Resultados: En los resultados globales el mayor porcentaje de encuestados correspondió al personal asistencial (73,4%). El principal servicio asistencial es unidad de cuidado intensivo (18,2%) y la mayor participación correspondió al rol de enfermeras y auxiliares de enfermería (45,7%). Según las respuestas positivas para los datos globales se determina 2 de 12 dimensiones clasificadas como fortaleza en el componente de Aprendizaje organizacional (81,5%) y Trabajo en equipo (85,5%) y el grado de seguridad percibido con correlaciones (p: 0,000) que se identifican en seis dimensiones entre ellas notificación de eventos, y aprendizaje organizacional. Discusión: La correlación del grado de seguridad percibido con las dimensiones del cuestionario guarda similitud en especial la notificación de eventos. Conclusión: La seguridad del paciente y el grado de seguridad percibido guardan correspondencia en la medida que en las instituciones realizan intervenciones en diferentes componentes entre ellos la notificación de eventos y trabajo en equipo.
Introduction: Patient safety is defined as an integrated pattern of individual and organizational behavior based on shared beliefs and values that continuously seeks to minimize harm to patients. Objective: To analyze the correlation between the perception of patient safety culture and the degree of safety perceived by healthcare workers in a tertiary hospital in 2015, 2017 and 2019. Materials and Methods: A quantitative correlational study was conducted with a purposive sample of 402 records obtained from a patient safety culture database. The Hospital Survey on Patient Safety Culture was used for assessment. Results: The global results show that the highest percentage of respondents corresponded to healthcare workers (73.4%). The main healthcare service provided is the intensive care unit (18.2%) in which most participants were nurses (45.7%). According to positive responses received for global data, 2 out of the 12 dimensions are classified as strengths in the Organizational Learning (81.5%) and Teamwork (85.5%) components, as well as the degree of safety perceived through correlations (p: 0.000) is found in five dimensions such as event notifications and organizational learning, among others. Discussion: The correlation between the perceived degree of safety and survey dimensions shows similarity, especially for event notifications. Conclusion: Patient safety and the perceived degree of safety are correlated as institutional interventions are made for different components, including organizational learning and teamwork.
Introdução: A segurança dos pacientes é definida como um padrão integrado de comportamento individual e organizacional baseado em crenças e valores compartilhados que busca continuamente minimizar os danos aos pacientes. Objetivo: Analisar a correlação entre a percepção da cultura de segurança do paciente e o grau de segurança percebido pelos profissionais de saúde em um hospital de nível terciário em 2015, 2017 e 2019. Materiais e Métodos: Um estudo correlacional quantitativo foi realizado com uma amostra proposital de 402 registros obtidos de um banco de dados de cultura de segurança do paciente. A Pesquisa sobre Cultura de Segurança dos Pacientes em Hospitais foi utilizada para a avaliação. Resultados: Os resultados globais mostram que a maior porcentagem de entrevistados correspondeu a trabalhadores da área de saúde (73,4%). O principal serviço de saúde prestado é a unidade de terapia intensiva (18,2%) e a maioria dos participantes eram enfermeiros (45,7%). De acordo com as respostas positivas recebidas para os dados globais, 2 das 12 dimensões são classificadas como pontos fortes nos componentes Aprendizagem Organizacional (81,5%) e Trabalho em Equipe (85,5%), assim como o grau de segurança percebido através de correlações (p: 0,000) é encontrado em cinco dimensões, tais como notificações de eventos e aprendizagem organizacional, entre outras. Discussão: A correlação do grau de segurança percebido com as dimensões da pesquisa é particularmente semelhante à notificação de eventos. Conclusão: A segurança do paciente e o grau de segurança percebido são correspondentes à medida que são feitas intervenções institucionais para diferentes componentes, incluindo o aprendizado organizacional e o trabalho em equipe.
Assuntos
Humanos , Qualidade da Assistência à Saúde , Cultura Organizacional , Pessoal de Saúde , Segurança do PacienteRESUMO
Introducción: el envejecimiento de la población genera un incremento de la prevalencia de distintos procesos patológicos, generando un aumento de la estancia de los pacientes hospitalizados y demanda de atención ambulatoria. Estos mismos procesos patológicos se clasifican como factores de riesgos de caídas. Reportándose las caídas como el tercer evento adverso más notificado por la Joint Commission International para el año 2015. Objetivo: identificar los factores de riesgos, determinar las principales recomendaciones dadas por la literatura y correlacionar cuatro intervenciones NIC para disminuir las caídas. Metodología: revisión sistemática de literatura, con formato PICOT (Problema, Intervención, Comparador, Resultado y Tiempo) utilizando terminología DeCS y MeSH, Búsqueda en 5 bases de datos online e inclusión de estudios de los últimos 5 años, en tres idiomas. Inclusión de estudios secundarios, criterio de valoración crítica metodológica de la literatura CASPe, escala JADAD y AGREE. Resultados: se identifican 588 estudios, 83 cumplen con criterios de inclusión, valoración crítica de 55 y 31 estudios fueron seleccionados. Conclusión: la valoración del riesgo de caídas y las intervenciones de identificación del riesgo, son la piedra angular de prevención en la atención integral de seguridad del paciente hospitalizado y ambulatorio.
Introduction: The aging of population generates an increase in prevalence of different pathological processes, generating an increase in the stay of hospitalized patients and demand for outpatient care. These same pathological processes are classified as risk factors of fall. Reporting the falls as the third most reported adverse event by Joint Commission International for 2015. Objective: Identify risk factors, determine the main recommendations given by the literature and correlate four NIC interventions to reduce falls. Methods: Systematic review of literature, with PICOT format (Problem, Intervention, Comparator, Outcome and Time) using DeCS and MeSH terminology, Search in 5 online databases and inclusión of studies from the last 5 years, in three languages. Inclusión of secondary studies, criterion of critical methodological assessment of CASPe literature, JADAD and AGREE scale. Results: 588 studies are identified, 83 meet inclusión criteria, critical assessment of 55 and 31 studies were selected. Conclusión: The risk assessment of falls and risk identification interventions are the cornerstone of prevention in the integral safety care of the hospitalized and outpatient patient.
Assuntos
Humanos , Pacientes , Acidentes por Quedas , Joint Commission on Accreditation of Healthcare Organizations , Fatores de Risco , Bases de Dados Bibliográficas , Guia de Prática Clínica , Revisão Sistemática , Prevenção de Acidentes , ColômbiaRESUMO
Imitating natural lakes, pond treatment systems inherit a high complexity with interconnected web of biochemical reactions and complex hydraulic processes. As such, its simulation requires a large and integrated model, which has been a challenge for pond engineers. In this study, we develop an all-encompassing model to gain a quantitative and comprehensive understanding of the hydraulic, physicochemical and microbiological conversion processes in the most common pond, a facultative pond. Moreover, to deal with an evitable issue of large mechanistic models as overparameterization leading to poor identifiability, a systematic parameter estimation was implemented. The application of sensitivity analysis reveals the most influential parameters on pond performance. Particularly, physical parameters, such as vertical eddy diffusivity, water temperature, and maximum growth rate of heterotrophs induce the most changes of organic matters while microbial assimilation and ammonia volatilization appear to be main processes for nutrient removal. In contrast, the efficiency of phosphate precipitation and nutrient biological removal via polyphosphate accumulating organisms and denitrifying bacteria is limited. Identifiability problems are addressed mainly by the characterization of light dependence of algal growth, interaction between water temperature and its coefficient, and the growth of autotrophic bacteria while based on the determinant measures, the most important parameter subsets affecting model outputs are related to physical processes and algal activity. After the establishment of the influential and identifiable parameter subset, an automatic calibration with the data collected from Ucubamba pond system (Ecuador) demonstrates the effect of high-altitude climatic conditions on pond behaviors. An aerobic prevailing condition is observed as a result of high light intensity causing accelerated algal activities, hence, leading to the limitation of hydrolysis, anaerobic processes, and the growth of anoxic heterotrophs for denitrification. Furthermore, the output of uncertainty analysis indicates that a large avoidable uncertainty as a result of vast complexity of the applied model can be reduced greatly via a systematic approach for parameter estimation.
Assuntos
Lagoas , Eliminação de Resíduos Líquidos , Desnitrificação , Equador , IncertezaRESUMO
BACKGROUND: The Colombian National Food and Drug Surveillance Institute (INVIMA) is responsible for monitoring the safety and efficacy of medicines circulating the Colombian market. DISCUSSION: This article summarizes the three key strategies the institution has implemented to strengthen the National Pharmacovigilance Program: improving the interaction and working relationship with regional health authorities, expanding the National Pharmacovigilance Network and implementing the electronic submission of adverse events. CONCLUSION: The number of adverse events reported in Colombia increased from 5,447 in 2013 to 95,658 in 2017, reaching a population-based reporting ratio within international standards (563 in 2016).
Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Farmacovigilância , Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Colômbia/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , HumanosRESUMO
Algal photosynthesis plays a key role in the removal mechanisms of waste stabilization ponds (WSPs), which is indicated in the variations of three parameters, dissolved oxygen, pH, and chlorophyll a. These variations can be considerably affected by extreme climatic conditions at high altitude. To investigate these effects, three sampling campaigns were conducted in a high-altitude WSP in Cuenca (Ecuador). From the collected data, the first application of structure equation modeling (SEM) on a pond system was fitted to analyze the influence of high-altitude characteristics on pond performance, especially on the three indicators. Noticeably, air temperature appeared as the highest influencing factors as low temperature at high altitude can greatly decrease the growth rate of microorganisms. Strong wind and large diurnal variations of temperature, 7-20 °C, enhanced flow efficiency by improving mixing inside the ponds. Intense solar radiation brought both advantages and disadvantages as it boosted oxygen level during the day but promoted algal overgrowth causing oxygen depletion during the night. From these findings, the authors proposed insightful recommendations for future design, monitoring, and operation of high-altitude WSPs. Moreover, we also recommended SEM to pond engineers as an effective tool for better simulation of such complex systems like WSPs.
Assuntos
Lagoas , Eliminação de Resíduos Líquidos/estatística & dados numéricos , Purificação da Água/estatística & dados numéricos , Tempo (Meteorologia) , Altitude , Equador , Modelos Biológicos , Oxigênio/metabolismo , Energia Solar , TemperaturaRESUMO
Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007-2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States-countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18-64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.
Assuntos
Inquéritos Epidemiológicos/métodos , Projetos de Pesquisa , Pesquisa/normas , Adolescente , Adulto , Brasil , Chile , Colômbia , Inglaterra , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Escócia , Estados Unidos , Adulto JovemRESUMO
Aerated lagoons (ALs) are important variants of the pond wastewater treatment technology that have not received much attention in the literature. The hydraulic behaviour of ALs and especially the Facultative aerated lagoons (FALs) is very complex since the aeration in these systems is designed for oxygen transfer but not necessarily to create complete mixing. In this work, the energy expenditure of the aerators was studied by means of a scenario analysis. 3D CFD models (one phase and multiphase) of a 3 ha FAL in a waste stabilization pond system in Cuenca (Ecuador) were built for different configurations of aerators. The thrust produced by the aerators was modelled by an external momentum source applied as velocity vectors into the pond fluid. The predictions of a single phase model were in satisfactory agreement with experimental results. Subsequently, a scenario analysis assessing several aeration schemes with different numbers of aerators in operation were tested with respect to velocity profiles and residence time distribution (RTD) curves. This analysis showed that the aeration scheme with all 10 aerators switched on produces a similar hydraulic behaviour compared to using only 6 or 8 aerators. The current operational schemes comprise of switching off some aerators during the peak hours of the day and operating all 10 aerators during night. This current practice could be economically replaced by continuously operating 4 or 6 aerators without significantly affecting the overall mixing. Furthermore, a continuous mixing regime minimises the sediment oxygen demand enhancing the oxygen levels in the pond.
Assuntos
Hidrodinâmica , Lagoas , Eliminação de Resíduos Líquidos , Aerobiose , Simulação por Computador , Modelos Teóricos , Oxigênio/análise , Termodinâmica , Fatores de TempoRESUMO
Sludge management in waste stabilization ponds (WSPs) is essential for safeguarding the system performance. Sludge accumulation patterns in WSPs are strongly influenced by the pond hydrodynamics. CFD modeling was applied to study the relation between velocity profiles and sludge deposition during 10 years of operation of the Ucubamba WSP in Cuenca (Ecuador). One tracer experiment was performed and three sludge accumulation scenarios based on bathymetric surveys were simulated. A residence time distribution (RTD) analysis illustrated the decrease of residence times due to sludge deposition. Sludge accumulation rates were calculated. The influence of flow pattern on the sludge deposition was studied, enabling better planning of future pond operation and desludging.
Assuntos
Hidrodinâmica , Modelos Teóricos , EsgotosRESUMO
The advancement of experimental and computational resources has facilitated the use of computational fluid dynamics (CFD) models as a predictive tool for mixing behaviour in full-scale waste stabilization pond systems. However, in view of combining hydraulic behaviour with a biokinetic process model, the computational load is still too high for practical use. This contribution presents a method that uses a validated CFD model with tracer experiments as a platform for the development of a simpler compartmental model (CM) to describe the hydraulics in a full-scale maturation pond (7 ha) of a waste stabilization ponds complex in Cuenca (Ecuador). 3D CFD models were validated with experimental data from pulse tracer experiments, showing a sufficient agreement. Based on the CFD model results, a number of compartments were selected considering the turbulence characteristics of the flow, the residence time distribution (RTD) curves and the dominant velocity component at different pond locations. The arrangement of compartments based on the introduction of recirculation flow rate between adjacent compartments, which in turn is dependent on the turbulence diffusion coefficient, is illustrated. Simulated RTD's from a systemic tanks-in-series (TIS) model and the developed CM were compared. The TIS was unable to capture the measured RTD, whereas the CM predicted convincingly the peaks and lags of the tracer experiment using only a minimal fraction of the computational demand of the CFD model. Finally, a biokinetic model was coupled to both approaches demonstrating the impact an insufficient hydraulic model can have on the outcome of a modelling exercise. TIS and CM showed drastic differences in the output loads implying that the CM approach is to be used when modelling the biological performance of the full-scale system.
Assuntos
Modelos Biológicos , Eliminação de Resíduos Líquidos/métodos , Movimentos da Água , Equador , HidrodinâmicaRESUMO
El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.
Exercise-induced syncope is a condition that should alert the treating physician; structural cardiac abnormalities that predispose to sudden death should be discarded, and the presence of arrhythmias that may potentially cause this condition are evaluated. In patients over 35 years, coronary and valvular disease are ruled-out as a possible cause of syncope associated with exercise. In subjects who train frequently, increased vagal tone is a common adaptive condition that may sometimes cause cardio-inhibitory syncope associated with exercise, whose presentation may vary from bradyarrhythmia to asystolia, thereby providing a diagnostic challenge.