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Santiago assistance. Servicios post hospitalarios : parte estratégico y de mercado P
(Universidad de Chile, 2014-04)
El presente proyecto captura una oportunidad de negocio se encuentra en los distintos centros de atención médica, clínicas y hospitales de la región metropolitana ubicadas en las inmediaciones del eje alameda entre estación metro Pajaritos y metro...
Estudios sobre la práctica del aborto y sus consideraciones éticas : visión chilena e internacional
(Universidad de Chile, 2018)
provocar los
abortos, hallamos:
a) Aborto farmacológico; consistente en utilizar un método farmacológico para probar
la interrupción voluntaria del embarazo.
b) Aborto Quirúrgico; de interrupción de la gestación en el quirófano mediante una
técnica...
grado de Licenciado en Ciencias Jurídicas y Sociales Alumno, Alfredo Loyola Jaque Profesor Guía, Álvaro Tejos Canales Santiago de Chile, 2018 2A mis queridos padres, por apoyarme incondicionalmente en todas las etapas de mi vida y por enseñarme a ser un...
grado de Licenciado en Ciencias Jurídicas y Sociales Alumno, Alfredo Loyola Jaque Profesor Guía, Álvaro Tejos Canales Santiago de Chile, 2018 2A mis queridos padres, por apoyarme incondicionalmente en todas las etapas de mi vida y por enseñarme a ser un...
Evaluación de la utilización de colistín dentro de un hospital de alta complejidad
(Universidad de Chile, 2018)
El aumento de la resistencia microbiana a antibióticos y la escasez de nuevos fármacos ha provocado la reintroducción al contexto clínico de agentes antiguos previamente en desuso, como es el caso de colistín, dejado de lado por su toxicidad...
The increase of microbial resistance to antibiotics and the lack of new drugs has promoted the reintroduction into the clinical context of old antibiotics previously in disuse, such as colistin, put aside before due to its toxicity. Many efforts have been done to optimize the use of colistin in the recent years, including the administration of loading doses, increase of its dosing, and the use of combined therapy, so that its administration has been constantly updated. The objective of the current work was to characterize the use of colistin during 2017 in the Hospital Clínico de la Universidad de Chile, characterizing the treated patients, the treatments administered, the associated microbiology, the response to treatment, and associated adverse effects. Under an observational retrospective study, every patient over 18 years that had used intravenous or nebulized colistin for at least 48 hours during January to October 2017 was studied, and their therapies until December 2017 were characterized, by reading their clinical records. Fifty-five patients were included in the study, equivalent to 114 treatments, with the most of infection sites being respiratory (57.9%). Sixty four percent of the treatments started on the Intensive Care Unit (ICU), and only 7% started on a general ward. Most of the patients had been recently hospitalized (86.8%), and most of them also had a previous antibiotic use (90.4%), including previous colistin therapies in 21.1% of the cases. Within the 114 therapies, 79.8% were intravenous and 20.2% were nebulized. The intravenous therapies were mostly empiric (64.8%), while the nebulized ones where in the most part microbiological (78.3%). The most frequently used dose and frequency was 3 million International Units (MIU) every 8 hours, used in 88 therapies. In only 5 treatments (5,5%) a loading dose was used. The two most identified pathogens were Pseudomonas aeruginosa in 41 therapies and Klebsiella spp. in 16 therapies. The P. aeruginosa isolates had a very high susceptibility to colistin (94.9%) and a susceptibility to amikacin of 56.1%, while the susceptibility to beta lactams was very low, close to 20%. According to the identified microbiology, 31 isolates required a colistin treatment, with a favorable response in 87.1% of the cases. In five therapies colistin was deliberately used against non-colistin susceptible pathogens, presenting three favorable responses to treatment and two unfavorable. Regarding the therapies that didn’t required colistin, an empiric therapy was completed in 13.3% of the cases, while in the rest of the treatments the antibiotic therapy was de-escalated or suspended. Thirteen cases of nephrotoxicity concomitant to colistin were recorded (14.3%), being the only type of adverse effect found. Globally, the colistin consumption on this hospital was 2.4 DDD/100 beds/day, and it was higher during January and February. The department with the most consumption was, by far, the ICU, with 45.5 DDD/100 beds/day. From this data, it can be concluded that, in this center, colistin is mainly used for the treatment of respiratory infections caused by Gram-negative bacilli resistant to other antibiotics, especially Pseudomonas aeruginosa, with a favorable response in 87.1% of the cases. Colistin is administered intravenously or nebulized, generally as 3 MIU each 8 hours, and rarely applying loading doses. Based on this evaluation, colistin use must be limited to when it is necessary. To that end, an appropriate sampling is required, duplicity with meropenem should be avoided and, if it is possible, amikacin should be given a bigger role on therapies, either alone or in combination therapy. In the other side, when colistin therapy is needed, it must be optimized, with appropriate doses and combined therapy, and the addition of loading doses...
The increase of microbial resistance to antibiotics and the lack of new drugs has promoted the reintroduction into the clinical context of old antibiotics previously in disuse, such as colistin, put aside before due to its toxicity. Many efforts have been done to optimize the use of colistin in the recent years, including the administration of loading doses, increase of its dosing, and the use of combined therapy, so that its administration has been constantly updated. The objective of the current work was to characterize the use of colistin during 2017 in the Hospital Clínico de la Universidad de Chile, characterizing the treated patients, the treatments administered, the associated microbiology, the response to treatment, and associated adverse effects. Under an observational retrospective study, every patient over 18 years that had used intravenous or nebulized colistin for at least 48 hours during January to October 2017 was studied, and their therapies until December 2017 were characterized, by reading their clinical records. Fifty-five patients were included in the study, equivalent to 114 treatments, with the most of infection sites being respiratory (57.9%). Sixty four percent of the treatments started on the Intensive Care Unit (ICU), and only 7% started on a general ward. Most of the patients had been recently hospitalized (86.8%), and most of them also had a previous antibiotic use (90.4%), including previous colistin therapies in 21.1% of the cases. Within the 114 therapies, 79.8% were intravenous and 20.2% were nebulized. The intravenous therapies were mostly empiric (64.8%), while the nebulized ones where in the most part microbiological (78.3%). The most frequently used dose and frequency was 3 million International Units (MIU) every 8 hours, used in 88 therapies. In only 5 treatments (5,5%) a loading dose was used. The two most identified pathogens were Pseudomonas aeruginosa in 41 therapies and Klebsiella spp. in 16 therapies. The P. aeruginosa isolates had a very high susceptibility to colistin (94.9%) and a susceptibility to amikacin of 56.1%, while the susceptibility to beta lactams was very low, close to 20%. According to the identified microbiology, 31 isolates required a colistin treatment, with a favorable response in 87.1% of the cases. In five therapies colistin was deliberately used against non-colistin susceptible pathogens, presenting three favorable responses to treatment and two unfavorable. Regarding the therapies that didn’t required colistin, an empiric therapy was completed in 13.3% of the cases, while in the rest of the treatments the antibiotic therapy was de-escalated or suspended. Thirteen cases of nephrotoxicity concomitant to colistin were recorded (14.3%), being the only type of adverse effect found. Globally, the colistin consumption on this hospital was 2.4 DDD/100 beds/day, and it was higher during January and February. The department with the most consumption was, by far, the ICU, with 45.5 DDD/100 beds/day. From this data, it can be concluded that, in this center, colistin is mainly used for the treatment of respiratory infections caused by Gram-negative bacilli resistant to other antibiotics, especially Pseudomonas aeruginosa, with a favorable response in 87.1% of the cases. Colistin is administered intravenously or nebulized, generally as 3 MIU each 8 hours, and rarely applying loading doses. Based on this evaluation, colistin use must be limited to when it is necessary. To that end, an appropriate sampling is required, duplicity with meropenem should be avoided and, if it is possible, amikacin should be given a bigger role on therapies, either alone or in combination therapy. In the other side, when colistin therapy is needed, it must be optimized, with appropriate doses and combined therapy, and the addition of loading doses...
Diseño de un plan estratégico para la creación de un centro tecnológico de ingeniería – salud, albergado en la Facultad de Ciencias Físicas y Matemáticas de la Universidad de Chile
(Universidad de Chile, 2018)
El presente trabajo pretende establecer los cimientos para la creación de un plan estratégico de un centro tecnológico de ingeniería- salud albergado en la Facultad de Ciencias Físicas y Matemáticas (FCFM) de la Universidad de Chile; el cual permita...
Factores de éxito para la acreditación de la calidad en salud: el caso del Hospital Exequiel González Cortés
(Universidad de Chile, 2014)
El presente estudio de caso busca identificar cuáles son los elementos de la gestión que favorecen que un hospital público logre la acreditación de la calidad sanitaria en Chile. Tiene un énfasis práctico, ya que recoge la opinión de actores que...
Vocación v/s Currículum
(Universidad de Chile, 2013-07)
carrera de Medicina. 31
2.2 Investigaciones en la carrera de Enfermería. 37
2.3 Antecedentes empíricos y su relación con la investigación realizada en la carrera de
Tecnología Médica.
40
CAPÍTULO 3: EL PROBLEMA Y SU IMPORTANCIA...
T.M NORMA S. FUENTES LEÓN. Dentro de las carreras de las Ciencias de la Salud, que se imparten en nuestro país, nos encontramos con: 1.- Kinesiología. 2.- Enfermería. 3.- Tecnología Médica. 4.- Obstetricia. 5.- Psicología. 6.- Terapia...
T.M NORMA S. FUENTES LEÓN. Dentro de las carreras de las Ciencias de la Salud, que se imparten en nuestro país, nos encontramos con: 1.- Kinesiología. 2.- Enfermería. 3.- Tecnología Médica. 4.- Obstetricia. 5.- Psicología. 6.- Terapia...
Reconocimiento de la identidad de personas transgénero en el ingreso carcelario: el respeto que merece su dignidad
(Universidad de Chile, 2020)
carcelaria. Debido a ello, los reclusos transgénero son designados a una institución penitenciaria que no es acorde al género con el cual se identifican, convirtiéndose en un grupo expuesto constantemente a discriminaciones, maltratos, humillaciones y...
Prevención e intervenciones tempranas en salud mental: una perspectiva internacional
(Universidad de Chile, Centro Interdisciplinario Estudios Bioética, 2016)
positivos, resolución de conflictos
y habilidades en la toma de decisiones, mostró
eficacia en la reducción de los síntomas depresi-
vos(44). Un ensayo clínico dirigido a estudiantes
de enfermería iraníes reportó que un programa de
orientación educativa...
de frecuencia semanal re- duce la ansiedad en el largo plazo(45). Otro estudio controlado aleatorizado en Nigeria, de programas de prevención en adultos en situa- ción de riesgo para la depresión y la ansiedad, ta- les como pacientes quirúrgicos...
de frecuencia semanal re- duce la ansiedad en el largo plazo(45). Otro estudio controlado aleatorizado en Nigeria, de programas de prevención en adultos en situa- ción de riesgo para la depresión y la ansiedad, ta- les como pacientes quirúrgicos...
Rediseño de los procesos involucrados en el uso y registro de medicamentos para una unidad de paciente crítico pediátrica
(Universidad de Chile, 2014)
actuales procesos para poder diagnosticar la situación presente. Se ha detectado un aumento significativo en los costos relacionados a la mala gestión administrativa de recursos farmacológicos y revisión a fichas clínicas. Este problema se debe en su gran...
Centro Oncológico Hospital Sótero del Río : un espacio para sanar
(Universidad de Chile, 2020)
¿Cómo puede la arquitectura curar a los enfermos? Evidentemente eso no es posible, pero sin duda alguna es capaz de contribuir a acelerar o retardar la recuperación del paciente. En base a esto se pretende generar una arquitectura curativa, más...