Resumo Objetivo. Determinar os efeitos de um Programa de Auto-liderança (PAL), composto por oito workshops e uma abordagem de aprendizagem experiencial, em estudantes de mestrado que têm uma pontuação alta no antagonismo TP. O objetivo é proporcionar uma aprendizagem mais abrangente aos estudantes por meio da incorporação do desenvolvimento de competências emocionais (DCE), e assim facilitar a atuação de um estilo de liderança mais pró-social. Metodologia. Foi conduzido um estudo quase experimental (n=126). Foram aplicados instrumentos de auto-relato de desenvolvimento de competências emocionais (DCE) (QDE_A35) de Bisquerra e Pérez-Escoda, bem como a subescala de amabilidade-antagonismo dos Big Five. Resultados. Os resultados dos testes ANCOVA revelaram mudanças significativas nos participantes com TP antagônicos, quando comparados ao outro grupo de estudantes que, tendo o mesmo traço de personalidade, não participaram no programa (grupo de controlo). As mudanças significativas foram observadas no (i) DCE total, e (ii) as subdimensões de consciência emocional (CoE), regulação emocional (ER) e autonomia emocional (EA). Pelo contrário, não foram observadas diferenças em competências sociais (CS) e bem-estar emocional (BE). Conclusão. O Programa de Autoliderança analisado mostra-se como uma formação que contribui claramente para o DCE de estudantes com notas altas em antagonismo.

Resumen Objetivo. Determinar los efectos de un programa de autoliderazgo (PAL), formado por ocho talleres y un enfoque de aprendizaje experiencial, en estudiantes de nivel máster que tienen una puntuación elevada en el RP antagonismo. Con la finalidad de procurar un aprendizaje más integral del alumnado, incorpora el desarrollo competencial emocional (DCE) y facilita, con ello, el desempeño de un estilo de liderazgo más prosocial. Metodología. Diseño cuasi experimental ex post facto (n=126), se aplican los instrumentos autoinformados de desarrollo competencial emocional (DCE) (QDE_A35) de Bisquerra y Pérez-Escoda, así como la subescala de amabilidad-antagonismo del Big Five. Resultados. Las pruebas ANCOVA revelan cambios significativos en las personas participantes con RP antagónico, al compararlas con otro grupo de estudiantes que teniendo el mismo rasgo de personalidad no participaron en el programa (Grupo de Control), en: (i) DCE total, y (ii) las subdimensiones de consciencia emocional (CoE), regulación emocional (RE), y autonomía emocional (AE). Por el contrario, no se apreciaron diferencias en: competencias sociales (CS) y bienestar emocional (BE). Conclusión. El programa de autoliderazgo analizado demuestra ser una formación que contribuye de manera clara al DCE del alumnado con puntuaciones altas en antagonismo.

Abstract Objective. This study aims to understand the effects of an eight-workshop self-leadership program using an experiential learning approach on master’s students with high antagonistic personality traits scores. The study seeks to examine, more comprehensively, the impact of incorporating emotional competence development into a restricted technical competence approach, as a method to facilitate antagonistic students to develop prosocial leadership styles. Methodology. The quasi-experimental ex post facto design (n=126) study implemented self-reported instruments, including the Bisquerra and Pérez-Escoda for the Emotional Competences questionnaire (QDE_A35) and the agreeableness-antagonism sub-scale of the Big Five. Results. The ANCOVA tests revealed significant changes in antagonistic students who attended the self-leadership program (experimental group) compared to those who did not and formed part of the control group. Specifically, the experimental group showed changes in total emotional competence, as well as in the sub-dimensions of emotional awareness, emotional regulation, and emotional autonomy. However, no differences were reported in social competencies and emotional well-being. Conclusion. The self-leadership program analyzed in this study contributes to the development of emotional competence in students with high scores in antagonism.

Resumen Introducción: el burnout es un síndrome de estrés crónico, descrito como un proceso de cansancio emocional, despersonalización y falta de realización personal. Tiene elevado impacto tanto a nivel personal como en calidad y seguridad asistencial, y su prevalencia es elevada. El presente estudio pretende determinar la prevalencia de este síndrome en pediatras de Lleida, analizar su relación con diversas variables y comparar los resultados actuales con los del estudio previo en 1998. Método: estudio descriptivo transversal observacional, que valora información sociodemográfica y cuestionario de burnout de Maslach. Se comparan los datos con los del estudio de 1998, en el que se recogieron los mismos datos. Resultados: han participado 42 pediatras (64%), 66% de mujeres, edad media de 42,1 años. Un 36% presentaban puntuaciones sugestivas de síndrome burnout en cansancio emocional. No había diferencias respecto a las horas trabajadas, el género, el estado civil ni el lugar de trabajo. Los pediatras con más desgaste profesional presentaban mayor decepción y depresión en relación con el trabajo, así como también mayor presencia de enfermedad física o psíquica. Por otro lado, aquellos que concebían el trabajo como una vocación y disfrutaban de reconocimiento institucional tenían valores más altos de realización personal. Se comparan los datos con los del estudio de 1998. Conclusiones: la prevalencia de desgaste profesional elevado es del 36%. Se confirma la cifra de aproximadamente un tercio de los pediatras con niveles significativos de burnout, que está presente de forma estructural y que requiere de estrategias de abordaje, no solo individual sino también del equipo y de las organizaciones.

Abstract Introduction: burnout is a chronic stress syndrome, described as a process of emotional exhaustion, depersonalization, and reduced personal accomplishment. It has a high impact both on a personal level and on healthcare quality and safety, and its prevalence is high. The present study aimed to determine the prevalence of this syndrome in paediatricians in Lleida, analyse its association with different variables and compare current results with the results of a previous study conducted in 1998. Method: we conducted a descriptive, cross-sectional observational study analysing sociodemographic data and Maslach burn-out questionnaire scores. We compared these data to the results of the 1998 study, in which the same information was collected. Results: a total of 42 paediatricians (64%) participated in the survey, 66% were female, and the mean age was 42.1 years. Thirty-six percent had scores suggestive of burnout syndrome with emotional exhaustion. There were no differences associated with the number of hours worked, sex, marital status, or the work setting. The paediatricians with the highest level of burnout were more likely to express disappointment and depression in relation to work and or have physical and/or mental illness. On the other hand, respondents who perceived their work as a calling and felt recognised by their organizations had higher scores in the dimension of personal accomplishment. We compared the data of this sample to the data of the 1998 study. Conclusions: We found a high level of burnout in 36% of respondents. The data confirmed that approximately one third of paediatricians have significant levels of burnout, which is a structural problem and therefore must be addressed with strategies not only at the individual level, but also at the level of the team and the institution.

Resumo Objetivo: Conhecer a distribuição dos partos de neonatos com muito baixo peso ao nascer durante a semana e se essa distribuição afeta a morbidez e a mortalidade nesse grupo de pacientes. Método: Esta é uma análise retrospectiva de dados coletados prospectivamente na rede espanhola SEN1500 (2002-2011). Foram excluídos neonatos nascidos em outro local, pacientes com grandes anomalias congênitas e pacientes falecidos na sala de parto. Os partos foram agrupados em “Dias úteis” e “Final de semana”. Foi realizada uma análise de regressão logística multivariada para avaliar o efeito independente do parto sobre os resultados e uma regressão de Cox para avaliar a sobrevida. Resultados: Do total de 27.205 neonatos com muito baixo peso ao nascer nascidos e/ou internados nos centros participantes, 22.961 (84,4%) atenderam aos critérios de inclusão. Houve uma redução de 24% no número de partos no “Final de semana” em comparação com os “Dias úteis”. Na análise bruta, os pacientes nascidos em finais de semana apresentaram maior morbidez e mortalidade (Taxa de mortalidade: 14,2% em comparação a 16,5%, p < 0,001), porém as diferenças não eram mais significativas após o ajuste aos fatores de confusão. Conclusões: Nossos resultados sugerem que as práticas atuais de atendimento reduzem a proporção de partos em finais de semana e tendem a agrupar alguns partos de alto risco nesse período, aumentando a morbidez e mortalidade brutas. Contudo, após o ajuste aos fatores de risco, as diferenças desaparecem, sugerindo que a cobertura de atendimento geral em nossos centros é adequada.

Abstract Objective: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. Methods: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002–2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into “weekdays” and “weekends.” A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. Results: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the “weekends” compared with “weekdays”. In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p < 0.001), but differences were no longer significant after adjusting for confounding factors. Conclusions: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.

The present study evaluated the concentrations of Total Suspended Particles (TSP) and associated metals in three distinct regions of Ribeirão Preto city (Center City, Campus and Airport) in the dry and rainy seasons. There were no significant differences (p < 0.05) in TSP and metals concentrations between the sampling sites, except for Cu, Cr and Zn. Seasonal variation was observed for TSP and the following associated metals: As, Be, Cu, Mn, Ni, Pb, Sn and V, being the highest concentrations observed in the dry period. The TSP concentrations did not exceed the air quality standards in São Paulo state, but these can cause harm to the population health, especially in the dry season. Cadmium was the only element that exceeded the WHO air quality guidelines in two consecutive samplings in the Center City and the Airport during the dry season. In this way, preventive measures should be taken through public policies to improve local air quality control and reduce the health risks to the population.

Background and objective: The Anemia Working Group of ERBP in 2010 recommended a target hemoglobin (Hb) level in the range of 11-12 g/dL, without intentionally exceeding 13g/dL during the treatment with erythropoiesis stimulating agents (ESAs). This study evaluated if there was a clinical impact of this statement in the anemia management of chronic kidney disease (CKD) patients treated with ESAs not on dialysis in routine clinical practice in Spain. Methods: This was an observational and cross-sectional study carried out in CKD patients not on dialysis in Spain who initiated ESA treatment (naïve), or were shifted from a previous ESA to another ESAs (converted) since January 2011. Results: Of 441 patients evaluated, 67.6% were naïve and 32.4% were converted. At the study visit, 42.5% of naïve patients achieved the Hb target of 11-12 g/dL, with a mean Hb of 11.3±1.3 g/dL (vs 10.1±0.9 g/dL at the start of ESA therapy). Only 35.3% of converted patients maintained Hb levels within the recommended target at the study visit. Yet, 8.2% of naïve patients and 7.9% of those converted had Hb levels >13 g/dL. Hb levels were similar across subgroups of patients, regardless of the presence of significant comorbidities. Conclusions: Anemia management in CKD patients treated with ESAs by Spanish nephrologists seems to be aimed at preventing Hb levels <11 g/dL, while <50% of patients were within the narrow recommended Hb target range. This, together with the lack of individualization in Hb targets according to patients' comorbidities show that there is still room for improvement in renal anemia management in the clinical setting.

Introducción y objetivo: El grupo de trabajo europeo en anemia-ERBP recomendó en 2010 mantener los niveles de Hb entre 11-12 g/dL sin exceder intencionadamente de 13 g/dL durante el tratamiento con agentes estimuladores de la eritropoyesis (AEE). Este estudio evaluó si se produjo un impacto clínico de esta declaración en el tratamiento de la anemia en la enfermedad renal crónica (ERC) con AEE en la práctica clínica. Metodología: Estudio transversal, observacional y multicéntrico en pacientes con anemia secundaria a ERC y no sometidos a diálisis, que iniciaron tratamiento de la anemia (nuevos) o pasaron de unos AEE a otros (transición de AEE) a partir de enero de 2011. Resultados: De los 441 pacientes evaluados, el 67,6% eran nuevos y el 32,4% estaban en situación de transición. En la visita de estudio, el 42,5% de los pacientes nuevos habían alcanzado el rango de Hb de 11-12 g/dL (niveles medios de 11,3 ± 1,3 g/dL frente a 10,1 ± 0,9 g/dL al inicio del tratamiento con AEE), y el 35,3% de pacientes en situación de transición mantuvieron los niveles de Hb dentro del rango recomendado. A pesar de ello, el 8,2% de los pacientes nuevos y el 7,9% de aquellos en situación de transición tenían niveles de Hb > 13 g/dL. Los niveles de Hb fueron similares, independientemente de la presencia o no de comorbilidades significativas. Conclusiones: En las Unidades de Nefrología de España, el manejo de la anemia en pacientes con ERC no en diálisis en tratamiento con AEE parece dirigido a evitar niveles de Hb < 11 g/dL, aunque menos del 50% de los pacientes se encuentran dentro del estrecho rango recomendado. Ello, junto a la falta de individualización del objetivo de Hb en función de la presencia de comorbilidades, muestra que aún queda margen de mejora en el tratamiento de la anemia en la ERC con AEE en la práctica clínica.

Introduction: Anaemia is a common complication of chronic kidney disease (CKD). The aim of this study was to determine the prevalence and clinical management of anaemia in patients with stages 3-5 CKD not on dialysis treated in outpatient Nephrology clinics (OC) in Catalonia. Methods: Epidemiological, cross-sectional cohort, multicentre study under routine clinical practice conditions. Data collection by electronic data collection log-book (e-DCL) including personal information and data related to anaemia (haemoglobin, iron status, treatment with erythropoiesis-stimulating agents [ESA] and other anaemia treatments). Anaemia was defined as haemoglobin levels <13.5g/dL in males or <12g/dL in females or patients who receive treatment with ESA. Results: We included 504 patients (56.4% male, mean age of 67.8±15.5 years): 61.5% had stage 3 CKD, 30.2% stage 4 and 8.3% stage 5. The main causes of CKD were vascular and diabetic nephropathy. The prevalence of anaemia was 58.5% (n=295), however, only 14.9% of patients had haemoglobin levels <11g/dL. Mean haemoglobin levels decreased and ESA treatment was more common as CKD progressed, but no significant differences were observed regarding the prescription of iron, according to CKD stages. ESA and intervals most frequently prescribed were darbepoetin alfa with a median dose of 40μg/biweekly, followed by C.E.R.A. with a median dose of 75μg/month and epoetin beta with a median dose of 5,000IU/week. Among the patients with anaemia (n=295), 36.3% (n=107) had iron deficiency and only 53.3% of these patients were treated with iron supplements. Conclusions: This study demonstrates the high prevalence of anaemia, which increases as the disease progresses and its good control in a CKD patient population treated in Nephrology outpatient clinics in Catalonia. This control is achieved with moderate doses of ESA and iron supplements prescribed in more than 50% of anaemic CKD patients.

Introducción: La anemia es una complicación frecuente de la enfermedad renal crónica (ERC). El objetivo de este estudio fue conocer la prevalencia de anemia en pacientes con ERC estadios 3-5 no en diálisis atendidos en consultas externas (CCEE) de Nefrología en Cataluña y su manejo clínico. Metodología: Estudio epidemiológico, de cohorte transversal, multicéntrico, en condiciones de práctica clínica habitual. Recogida de datos mediante un e-CRD que incluía datos de filiación y aquellos relacionados con la anemia (hemoglobina, estatus férrico, tratamiento con agentes estimuladores de la eritropoyesis [AEE] y con otros coadyuvantes). Se definió anemia como unos niveles de hemoglobina < 13,5 g/dl en varones o < 12 g/dl en mujeres o pacientes que recibieran tratamiento con AEE. Resultados: Se incluyeron 504 pacientes (56,4 % varones, edad media de 67,8 ± 15,5 años): 61,5 % presentaban ERC estadio 3, 30,2 % estadio 4 y 8,3 % estadio 5. Las principales causas de ERC fueron la vascular y la nefropatía diabética. La prevalencia de anemia fue del 58,5 % (n = 295); sin embargo, solo un 14,9 % de los pacientes tenían niveles de hemoglobina < 11 g/dl. Los niveles medios de hemoglobina disminuían y el tratamiento con AEE era más frecuente a medida que progresaba la ERC, pero no se observaron diferencias significativas respecto a la prescripción de hierro, según estadios. Los AEE e intervalos más frecuentemente prescritos fueron darbepoetina alfa con una dosis mediana de 40 μg/bisemanal, seguida por C.E.R.A., con una dosis mediana de 75 μg/mensual y epoetina beta con una dosis mediana de 5000 UI/semanal. De los pacientes con anemia (n = 295), un 36,3 % (n = 107) presentaban ferropenia y de ellos solo un 53,3 % recibía tratamiento con suplementos de hierro. Conclusiones: Este estudio demuestra la alta prevalencia de anemia, la cual aumenta a medida que progresa la enfermedad, así como el buen control de la misma en la población de pacientes con ERC atendidos en CCEE de Nefrología en Cataluña. Este control se consigue con dosis moderadas de AEE y prescripción de suplementos de hierro en más del 50 % de los pacientes anémicos.

Metformin is a drug widely used in type 2 diabetic patients. The metformin-associated lactic acidosis (MALA) in diabetic patients is rare but can be serious. However, the relationship between metformin and lactic acidosis has been controversial. We present seven cases of patients with ALAM who came to our centre over a period of one year and who were treated early with haemodiafiltration. There are some risk factors that appear to predispose to this pathology, such as: acute renal failure, hypoxemia and sepsis situations, cardiac or respiratory failure, previous history of lactic acidosis, liver disease and dehydration boxes. That is why their use is discouraged in patients with GFR below 30ml/min/1.73m². All patients described were treated early with haemodiafiltration. The mortality in our series was 16.6%. We believe that ALAM is a serious condition that requires prompt diagnosis and early treatment. Renal replacement therapy is not the solution for all patients, but can improve prognosis in more severe if started early. We should limit the use of metformin in diabetic patients with impaired renal function, although there is still controversy in the various published studies.

La metformina es un fármaco muy utilizado en pacientes con diabetes tipo 2. La acidosis láctica asociada a metformina (ALAM) en pacientes diabéticos es poco frecuente, pero puede llegar a ser grave. De todas formas, la relación entre metformina y acidosis láctica ha sido muy controvertida. Presentamos siete casos de pacientes con ALAM que llegaron a nuestro centro en un período de un año y que fueron tratados de forma precoz con hemofiltración. Existen algunos factores de riesgo que parecen predisponer a esa patología, como fracaso renal agudo, situaciones de hipoxemia y sepsis, insuficiencia cardíaca o respiratoria, historia previa de acidosis láctica, hepatopatía y en cuadros de deshidratación. Es por ello por lo que se desaconseja su utilización en pacientes con filtrado glomerular inferior a 30 ml/min/1,73 m². Todos los pacientes que presentamos fueron tratados de forma precoz con hemofiltración. La mortalidad de nuestra serie fue del 16,6%. Consideramos que la ALAM es una enfermedad grave que requiere un diagnóstico y un tratamiento precoces. El tratamiento renal sustitutivo no es la solución para todos los pacientes, pero puede mejorar el pronóstico en aquellos que están más graves si se inicia de forma precoz. Creemos importante limitar el uso de la metformina en los pacientes diabéticos con función renal alterada, a pesar de que todavía existe controversia en los distintos estudios publicados.

La manipulación de objetos micrométricos a nivel individual es uno de los campos de investigación mas relevantes, ya que estas técnicas se pueden aplicar al manejo de material biológico. El objetivo de este artículo es el de presentar un microsistema disentilde;ado para la micromanipulación de partículas. El principio de funcionamiento de este dispositivo es la dielectroforésis, la cual consiste en el movimiento lateral de material eléctricamente neutro bajo la influencia de campos eléctricos no uniformes. En la práctica, el dispositivo se fabricó sobre un substrato de silicio en el cual se depositaron microelectrodos interdigitados hechos de platino. Además, las paredes de la microcámara fueron fabricadas con una resina fotocurable, lo cual permite un volumen constante de la muestra bajo estudio durante la experimentación. Igualmente, el circuito integrado se probó con microesferas de poliestireno de 4,2μm de diámetro. En este trabajo se presentan algunos resultados de dielectroforésis común y aglomerado de partículas. El patrón de los microagregados es consistente con la distribución del campo eléctrico sobre los electrodos, el cual se calculó con el método de los elementos finitos.

Manipulation of micrometric objects at the single level is one of the most important research fields because these techniques can be applied to handle biological material. The objective of this paper consists of presenting a microsystem designed for particle microhandling. The operating principle of the device hinges upon dielectrophoresis, which is the lateral motion of electrical neutral matter under the influence of non-uniform electric fields. In practice, the device was made on a silicon substrate onto which interdigitated castellated microelectrodes made of platinum were patterned by lift-off. Moreover, the microchamber walls were patterned in a photocurable resin which allows a constant sample volume during the experiments. Besides this, the chip was tested with polystyrene microspheres of 4.2 μm in diameter and some results of common dielectrophoresis and particle clustering are also presented. Microparticle aggregation patterns are consistent with the electric field profile calculated by the finite element method over the electrode surface.

Este artigo descreve a modelagem e teste experimental de uma rede de microeletrodos em cremalheira cujo objetivo é o manuseio de células biológicas, com base em dieletroforese comum. O microsistema proposto foi desenvolvido empregando eletrodos de platina depositados por técnicas de 'lift-off', micro-usinagem em silício e litografia com foto-resina. Uma vez fabricado o microdispositivo, este foi testado utilizando a Escherichia coli como modelo de biopartículas. Dieletroforese positiva pode ser observada com as células selecionadas para freqüências acima de 100kHz, e efeitos eletro-hidrodinâmicos foram observados como o fenômeno dominante para menores freqüências. Como resultado, a dieletroforese negativa não pode ser observada pois sua ocorrência se sobrepõe a efeitos eletro-hidrodinâmicos; i.e. a força de arraste viscoso atuando sobre as partículas é superior à força dieletroforética para freqüências em que a dieletroforese negativa deveria ocorrer. Os experimentos ilustram a conveniência deste tipo de micro-dispositivo para o micromanuseio de objetos biológicos, abrindo a possibilidade de uso destas micro-redes com outras partículas biológicas. Além disto, o movimento líquido como resultado dos efeitos eletro-hidrodinâmicos deve ser levado em conta ao se desenhar micromanipuladores de partículas biológicas, e pode ser utilizado como mecanismo para limpar as superfícies dos eletrodos, que é um dos problemas mais importantes relacionados a este tipo de dispositivo.

This paper describes the modeling and experimental verification of a castellated microelectrode array intended tohandle biocells, based on common dielectrophoresis. The proposed microsystem was developed employing platinumelectrodes deposited by lift-off, silicon micromachining, and photoresin patterning techniques. Having fabricated the microdevice it was tested employing Escherichia coli as bioparticle model. Positive dielectrophoresis could be verified with the selected cells for frequencies above 100 kHz, and electrohydrodynamic effects were observed as the dominant phenomena when working at lower frequencies. As a result, negative dielectrophoresis could not be observed because its occurrence overlaps with electrohydrodynamic effects; i.e. the viscous drag force acting on the particles is greater than the dielectrophoretic force at frequencies where negative dielectrophoresis should occur. The experiments illustrate the convenience of this kind of microdevices to micro handling biological objects, opening the possibility for using these microarrays with other bioparticles. Additionally, liquid motion as a result of electrohydrodynamic effects must be taken into account when designing bioparticle micromanipulators, and could be used as mechanism to clean the electrode surfaces, that is one of the most important problems related to this kind of devices.

La micromanipulación de partículas biológicas es una operación frecuente en medicina y microbiología, y se ha dedicado una gran cantidad de trabajo para desarrollar técnicas de manipulación mas rápidas, baratas y eficientes. En este sentido, la tecnología de microsistemas juega un papel importante ya que se puede utilizar para fabricar manipuladores de micropartículas. En este articulo se describe el diseño y fabricación de un microsistema para la manipulación de objetos biológicos, basado en el efecto dielectroforetico. También se discute la selección de la alternativa tecnológica mas adecuada dentro de las disponibles. El diseño propuesto, es un microsistema completo que incluye interfases eléctrica, óptica y fluidica, y se desarrolló empleando oro y platino como metales para los electrodos, micro mecanizado del silicio y técnicas de fotocurado de resinas fotosensibles. De la misma forma se describe la estructura de los microelectrodos desarrollados al igual que el circuito integrado resultante.

Biological particle microhandling is a common operation in medicine and microbiology, and a lot of research work has been addressed to develop faster, cheaper and more efficient manipulation techniques. In this way, microsystem technologies play an important role because they can be used to fabricate microparticle manipulators. This paper describes the design and fabrication of a microsystem to handle biological objects, based on the dielectrophoretic effects. The development of the right technological option among the possibilities at disposal is also discussed. The proposed design, a whole microsystem including electrical, optical and fluidic interfaces, was developed employing gold and platinum metals, silicon micromachining, and photoresin patterning techniques. Furthermore, the structure of the utilized microelectrode arrays, as well as the resulting microchip are also reported.

Travelling-wave dielectrophoretic phenomena involving cell detection and manipulation are very interesting for biomedical and biotechnological applications. However, electrohydrodynamic phenomena may interfere with the action of dielectrophoresis. The main goal of our study is to calculate the interplay of these effects. In so doing, we have been able to go beyond the order-of-magnitude estimations, which were available in the literature. In this framework we have taken into account the effects of using square signals, which calls for a calculation of the combined polarisability effects due to the superposition of different frequencies. Thermal gradients are also a triggering agent of electrohydrodynamic effects. We have undertaken the pertinent thermal simulations with a concern for the influence of different boundary conditions. The dynamics of the thermal fields were also assessed in order to estimate the characteristic times of electrohydrodynamic phenomena. All these results have been used in a study of the fluid flow pattern motion at different frequencies and its influence on the particle behaviour.

Objective: To assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs). Methods: The cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood). Results: ESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (-2.65 €/SI avoided), followed by syringes with protective shield (869.79 €/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes, short catheter and needleless administration sets. Conclusions: Savings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.

Objetivo: Evaluar la eficiencia de sustituir algunos dispositivos médicos por otros diseñados para prevenir exposiciones percutáneas (EP). Métodos: Se han estimado las relaciones coste-efectividad de sustituir algunos dispositivos por otros diseñados para prevenir EP: se han considerado los costes de adquisición y de la asistencia a una EP; el número de EP prevenibles por cada dispositivo se ha estimado a partir de las 252 exposiciones ocupacionales notificadas por el personal de un hospital de 1.300 camas de marzo de 2002 a febrero de 2003. Se ha calculado la relación entre el coste adicional de los dispositivos alternativos y el número de EP evitables de alto riesgo (las que cumplían 2 o más de los siguientes: EP moderadamente profunda o profunda, por objeto insertado en vaso, o por objeto expuesto a la sangre). Resultados: Orden de los dispositivos según la relación coste-efectividad: aguja con resguardo para catéter implantado (-2,65 €/EP evitada), seguida por jeringa con resguardo (869,79 €/EP), aguja con aletas con resguardo, equipo de perfusión con válvulas y catéter endovenoso periférico con retracción del fiador. Orden según relación entre coste adicional y número de EP de alto riesgo evitadas: aguja para acceso a catéter implantado, seguida por aguja con aletas, jeringa para aguja hipodérmica, catéter endovenoso y equipo de infusión con válvulas. Conclusiones: El ahorro en asistencia a EP compensa el coste adicional de algunos dispositivos diseñados para prevenirlas. Un análisis coste-efectividad ayuda a establecer prioridades, pero debe tener en cuenta el riesgo de las EP asociadas con cada dispositivo.

Objective: To assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs). Methods: The cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood). Results: ESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (-2.65 €/SI avoided), followed by syringes with protective shield (869.79 €/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes, short catheter and needleless administration sets. Conclusions: Savings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.

Objetivo: Evaluar la eficiencia de sustituir algunos dispositivos médicos por otros diseñados para prevenir exposiciones percutáneas (EP). Métodos: Se han estimado las relaciones coste-efectividad de sustituir algunos dispositivos por otros diseñados para prevenir EP: se han considerado los costes de adquisición y de la asistencia a una EP; el número de EP prevenibles por cada dispositivo se ha estimado a partir de las 252 exposiciones ocupacionales notificadas por el personal de un hospital de 1.300 camas de marzo de 2002 a febrero de 2003. Se ha calculado la relación entre el coste adicional de los dispositivos alternativos y el número de EP evitables de alto riesgo (las que cumplían 2 o más de los siguientes: EP moderadamente profunda o profunda, por objeto insertado en vaso, o por objeto expuesto a la sangre). Resultados: Orden de los dispositivos según la relación coste-efectividad: aguja con resguardo para catéter implantado (-2,65 €/EP evitada), seguida por jeringa con resguardo (869,79 €/EP), aguja con aletas con resguardo, equipo de perfusión con válvulas y catéter endovenoso periférico con retracción del fiador. Orden según relación entre coste adicional y número de EP de alto riesgo evitadas: aguja para acceso a catéter implantado, seguida por aguja con aletas, jeringa para aguja hipodérmica, catéter endovenoso y equipo de infusión con válvulas. Conclusiones: El ahorro en asistencia a EP compensa el coste adicional de algunos dispositivos diseñados para prevenirlas. Un análisis coste-efectividad ayuda a establecer prioridades, pero debe tener en cuenta el riesgo de las EP asociadas con cada dispositivo.

This study describes the implementation of a management plan for surgical joint replacement waiting lists and its results after 3 years. The plan was based on the following: unification of information and scheduling, periodic review, clinical guidelines, management of demand, prioritization according to need, and increasing the services provided. During the first year, the plan succeeded in revealing the real waiting list, with 23% more patients than previously included. Three years later, 16% of the patients had not turned up for surgery after being scheduled; the mean length of hospital stay for joint replacements had been reduced by 4 days; 59.5% of the patients joining the list had been assessed with a prioritization instrument, and the number of joint replacements had increased by 16% with a reduction of 14.7% in patients waiting for joint replacements. The resolution time for these procedures had also deceased by 3 months for knee arthroplasty and by 1 month for hip arthroplasty.

Se describe un plan de gestión de las listas de espera quirúrgicas de prótesis articulares de cadera y rodilla y sus resultados a los 3 años. El plan de gestión se basó en la unificación de la información y programación, depuración periódica, guía clínica, gestión de la demanda, priorización por necesidad e incremento de la oferta. Durante el primer año se consiguió aflorar la lista de espera real, con un 23% más de pacientes de los contabilizados hasta entonces. A los 3 años, se depuró la lista en un 16% de los pacientes, se disminuyó la estancia media de estos procedimientos en 4 días, se evaluó el 59,5% de los pacientes con un instrumento de priorización y se incrementó la actividad de artroplastias en un 16%. Se redujo en un 14,7% los pacientes en espera de prótesis articulares y el tiempo de resolución de estos procedimientos disminuyó en 3 meses para las artroplastias de rodilla y en un mes para las de cadera.