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La creciente demanda del mercado de la salud sumado a la incapacidad del sistema público por cubrir la demanda de forma satisfactoria ha generado un aumento particular de la demanda en el sistema privado. Para recibir este aumento de pacientes se requiere de una capacidad adicional, debido a la baja holgura existente respecto a los recursos. Adicionalmente, existe incertidumbre respecto al futuro de las isapres, y con esto, el funcionamiento del sistema privado de salud. Dado el riesgo asociado, las entidades privadas prefieren absorber esta demanda sin inversiones de infraestructura, por lo que se requiere utilizar de forma más eficiente los recursos. Por medio de una revisión bibliográfica se muestra el impacto que genera la implementación de vías clínicas respecto a la reducción del tiempo de estadía de los pacientes, así utilizando de forma más eficiente los recursos para la atención. En primer lugar, se plantea una metodología para levantar procesos clínicos a través de un equipo multidisciplinario. A partir de los procesos clínicos, se desarrollan vías clínicas, estandarizando y restringiendo procesos según estándares internacionales y fundamentos clínicos. Este proceso de levantamiento es validado a través de la simulación del proceso atencional modelado como el desarrollo de una serie de posibles actividades con distintas probabilidades de ocurrencia, tiempos de procesos y de espera de acuerdo con variables propias del paciente. Los resultados del modelo de simulación se comparan con los tiempos totales de estadía de los pacientes para cada modelo atencional con los datos históricos, cumpliendo estos con los estándares de validación a un intervalo de confianza del 95%. Validada la metodología, se considera la simulación de las vías clínicas construidas a partir de esta misma, con el fin de comparar la disminución del LOS que pudiese alcanzar la clínica respecto a otros estudios revisados. Siendo este resultado positivo y, de similares magnitudes a la experiencia internacional, se revisa una serie de estudios para conocer el impacto que tienen estos en la reducción de los tiempos de estadía y su influencia en la clínica según el número de pacientes que pudiese pertenecer a la vía. Así, se simula el impacto de la implementación de una serie de vías clínicas, particularmente en la ocupación de la clínica, considerando los ingresos, traslados entre unidades, estadías y altas de los pacientes de la clínica. Se consideran 232 camas, clasificadas en 15 grupos distintos según comportamiento de altas y traslados de los pacientes, para simular un horizonte de un año, para distintas vías clínicas implementadas, con distinto grado de adaptación. En los escenarios propuestos se observa una reducción considerable de la ocupación, de 78,3% a 71,7% al tercer año de estudio en el caso del escenario con implementación de 23 vías. Esto se traduce en una disminución de la espera de 3,9 a 2,8 horas, dada por la disponibilidad mayor de camas. La aplicación de 45 vías sólo logra una reducción adicional de ocupación de 2%, siendo la ocupación simulada del 69,7%. Esto deja entrever el aporte significativo de las primeras vías consideradas, siendo las de mayor impacto. Por el contrario, las últimas vías implementadas generar una diferencia mucho menor, concluyendo que hay incrementos marginales decrecientes en el aporte de la reducción de LOS con la implementación de vías clínicas. Finalmente, se concluye que la implementación de vías clínicas se debe realizar de acuerdo con algún indicador operacional, eligiendo aquellas de mayor impacto, considerando el porcentaje de pacientes y la capacidad de reducción de la vía. Adicionalmente, la implementación de vías, pasado cierto punto, tiene un bajo impacto en la operación debido a su poca influencia por tener bajo porcentaje de pacientes en la vía o ser vías que generen pocos cambios en el indicador.
This Child-Friendly Schools (CFS) Manual was developed during three-and-a-half years of continuous work, involving the United Nations Children's Fund education staff and specialists from partner agencies working on quality education. It benefits from fieldwork in 155 countries and territories, evaluations carried out by the Regional Offices and desk reviews conducted by headquarters in New York. The manual is a part of a total resource package that includes an e-learning package for capacity-building in the use of CFS models and a collection of field case studies to illustrate the state of the art in child-friendly schools in a variety of settings.
This book constitutes the revised selected papers of the 9th International Conference on Cloud Computing, Big Data & Emerging Topics, JCC-BD&ET 2021, held in La Plata, Argentina*, in June 2021. The 12 full papers and 2 short papers presented were carefully reviewed and selected from a total of 37 submissions. The papers are organized in topical sections on parallel and distributed computing; machine and deep learning; big data; web and mobile computing; visualization.. *The conference was held virtually due to the COVID-19 pandemic.
In Computer-Integrated Surgery leading researchers and clinical practitioners describe the exciting new partnership that is being forged between surgeons and machines such as computers and robots, enabling them to perform certain skilled tasks better than either can do alone.The 19 chapters in part I, Technology, explore the components -- registration, basic tools for surgical planning, human-machine interfaces, robotic manipulators, safety -- that are the basis of computer-integrated surgery. These chapters provide essential background material needed to get up to speed on current work as well as a ready reference for those who are already active in the field.The 39 chapters in part II, Applications, cover eight clinical areas -- neurosurgery, orthopedics, eye surgery, dentistry, minimal access surgery, ENT surgery, craniofacial surgery, and radiotherapy -- with a concluding chapter on the high-tech operating room. Each section contains a brief introduction as well as at least one "requirements and opportunities" chapter written by a leading clinician in the area under discussion.
Operating theatres are very private workplaces. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. Behavioural scientists have been encouraged by clinicians to bring research techniques used in other industries into the operating theatre in order to study the behaviour of surgeons, nurses and anaesthetists. Safer Surgery presents one of the first collections of studies designed to understand the factors influencing safe and efficient surgical, anaesthetic and nursing practice. The book is written by psychologists, surgeons and anaesthetists, whose contributions combine to offer readers the latest research techniques and findings from some of the leading investigators in this field. It is designed for practitioners and researchers interested in understanding the behaviour of operating theatre team members, with a view to enhancing both training and practice. The material is also suitable for those studying behaviour in other areas of healthcare or in high-risk work settings. The aims of the book are to: a) present the latest research on the behaviour of operating theatre teams b) describe the techniques being used by psychologists and clinicians to study surgeons, anaesthetists and theatre nurses' task performance c) outline the safety implications of the research to date.
This book explores the sense in which the uncanny may be a distinctively modern experience, the way these unnerving feelings and unsettling encounters disturb the rational presumptions of the modern world view and the security of modern self-identity, just as the latter may themselves be implicated in the production of these experiences as uncanny.
Phosphorus in Environmental Technology: Principles and Applications, provides a definitive and detailed presentation of state-of-the-art knowledge on the environmental behaviour of phosphorus and its applications to the treatment of waters and soils. Special attention is given to phosphorus removal for recovery technologies, a concept that has emerged over the past 5-6 years. The book features an all-encompassing approach: the fundamental science of phosphorus (chemistry, geochemistry, mineralogy, biology), key aspects of its environmental behaviour and mobility, industrial applications (treatment, removal, recovery) and the principles behind such applications, novel biotechnologies and, importantly, it also addresses socio-economic issues which often influence implementation and the ultimate success of any new technology. A detailed subject index helps the reader to find their way through the different scientific and technological aspects covered, making it an invaluable reference work for students, professionals and consultants dealing with phosphorus-related environmental technologies. State-of-the-art knowledge on the behaviour of phosphorus and its applications to environmental science and technology. Covers all aspects of phosphorus in the environment, engineered and biological systems; an interdisciplinary text.
Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources. Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake. Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.