Pedro J. Saturno Hernández

Utilización de la nutrición parenteral total en un hospital general: criterios de calidad y factores asociados a su cumplimiento

BACKGROUND AND OBJECTIVE The aim of this study was to analyze the quality in the use of total parenteral nutrition (TPN). PATIENTS AND METHOD Retrospective study of patients treated with TPN during one year in a general hospital (n = 92). Assessment of quality was performed through measurements of compliance using 20 criteria. These were analyzed both individually and gathered in 3 groups: adjusted (correct indication), safe (absence of complications) and exact TPN (when prescribed diet matched to the administered one). Criteria compliance was compared to standards values (% expected compliance for a quality service). Patient (age, sex, diabetes mellitus) and process (TPN indication, patients outcome, type of diet) variables were analyzed (using logistic regression models) as potential factors associated with criteria compliance. RESULTS Compliance of six criteria was significantly below standard values. Simultaneous compliance of all criteria by group was 17% (95% CI: 10-24) in adjusted TPN, 38% (95% CI: 29-47) in safe TPN, and 94% (95% CI: 90-98) in exact TPN. There was a negative association between an age over 65 years and both a correct indication of TPN (OR= 9.4; 95% CI: 1.1-79.8) and the indicator compliance of all criteria in the adjusted TPN group (OR: 2.9 95% CI: 1.03-8.4). The absence of metabolic complications was influenced (p < 0.05) by the use of standardized diets (OR = 0.3; 95% CI: 0.1-0.9). CONCLUSIONS Quality defects were mainly related to the prescription and the frequency of metabolic complications. In general, TPN is used less appropriately when patients are older than 65 years, and metabolic complications are more frequent when standardized diets are used.Fundamento y objetivo Evaluar la calidad de la utilizacion de la nutricion parenteral total (NPT)y sus factores asociados. Pacientes y metodo Estudio retrospectivo a un ano de todos los pacientes tratados con NPT enun hospital general (n = 92). Se analiza el cumplimiento aislado y simultaneo de 20 criteriosdivididos en tres grupos: NPT «ajustada» (correcta indicacion), «segura» (ausencia de complicaciones)y «exacta» (correspondencia de la dieta administrada con la prescrita), y se comparanrespecto de sus estandares. En el analisis de factores asociados, mediante modelos de regresionlogistica, se consideran variables del paciente (edad, sexo, presencia de diabetesmellitus) y del proceso asistencial (motivo de la NPT, destino del paciente y tipo de dieta). Resultados Se encontraron 6 criterios significativamente por debajo del estandar. El cumplimientosimultaneo de todos los criterios fue del 17% (intervalo de confianza [IC] del 95%, 10–24) en NPT «ajustada», del 38% (IC del 95%, 29–47) en «segura» y del 94% (IC del 95%,90–98) en «exacta». La edad mayor de 65 anos influye negativamente (p Conclusiones Las principales anomalias se relacionan con la prescripcion y con la aparicion decomplicaciones metabolicas. En general, la NPT se emplea peor en mayores de 65 anos y aparecenmas complicaciones metabolicas cuando se utilizan dietas estandarizadas.

Effectiveness of internal quality assurance programmes in improving clinical practice and reducing costs

RATIONALE, AIMS AND OBJECTIVES To assess the effectiveness of internal initiatives to improve quality as compared with external feedback, and as compared with a control group. METHOD Ten primary health centres were randomly selected from the centres in the Murcias Region and were randomly assigned into three groups: G1 committed themselves to the improvement; G2 composed by two subgroups: with and without quality improvement (QI) activities - received external feedback; G3 received no intervention. Quality of common cold management was measured in a random sample of 50 patients per centre before and after interventions. Effect was assessed comparing criteria compliance and the cost of treatments for common cold in the three groups. RESULTS G1 and G2 subgroup with internal QI improved significantly in all criteria, and in G1 average treatment cost decreased by 60% (P < 0.01). G3 improved only in one criterion. Estimated yearly savings in treatment costs for common cold, for a centre with internal QI, were euro 12,193.83 and it would be euro 1,817 004.65 for the 30 centres in the Region. CONCLUSIONS Internally assumed QI activities were significantly more effective than external feedback. Besides, the high cost of deficient quality provides a wide margin to invest with benefits in the promotion of internal QI programmes.

An Investigation of the Relationship between Job Characteristics and the Gender Wage Gap

This paper re-examines gender wage differences, taking into account not only worker characteristics but also job characteristics. Consideration of a wide set of “job quality” indicators can explain a fraction of the wage gap that would otherwise be attributed to pure wage discrimination. In any case, the fraction of the wage gap that remains associated to differential rewards for identical factors across sexes is still substantial. Our results suggest that in order to avoid overestimation of the fraction of the wage gap attributable to discrimination, it is necessary to control for job characteristics.

Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument

Long-term care facilities (LTCFs) for the elderly are an important health care alternative in the world, though Brazil does not yet have a valid instrument to monitor the quality of these institutions. This study sought to describe the initial stages of the cross-cultural adaptation of the Observable Indicators of Nursing Home Care Quality (OIQ) instrument used to assess the quality of care in LTCFs. Conceptual equivalence was conducted to assess the relevance and feasibility of the OIQ within the Brazilian context, using the Content Validity Index (CVI). The operational, idiomatic and semantic equivalence was then performed. This item consisted of 5 phases: (1) two translations; (2) the respective back translations; (3) formal appraisal; (4) review; and (5) application of the pre-test in three LTCFs. Significant changes were made to ensure the validity of the OIQ. The CVI instrument for the Brazilian contextwas 94.3% (viability) and 95.3% (relevance). The OIQ proved to be easy to understand and apply in the pre-test. Cross-cultural adaptation of the OIQ contributes to assessing and improving quality in Brazilian LTCFs, though the findings should be complemented by a psychometric evaluation of the instrument.

Patient safety culture and related factors in a network of Spanish public hospitals

Based on experiences and reflections reported by health professionals, the aim of this study was to critically analyze the actions, situations, and decisions in healthcare services that involve breastfeeding, examining aspects that favor or limit its possibilities. This was a qualitative study based on the conceptual framework of vulnerability and healthcare, using focus groups with 25 healthcare professionals participating in the Committee on Breastfeeding in Londrina, Paraná State, Brazil. The material was produced with a comprehensive format, focusing on questions that involved the breastfeeding process and its approaches and decisions. The study raises issues for understanding how the way mothers and families deal with breastfeeding is linked to organization of the practices and individual and social aspects, requiring integration between practical and technical/scientific knowledge. The article portrays the complexity of healthcare for women and children, allowing an enhanced approach to routine healthcare and the related strategies for breastfeeding.