Gestió, qualitat i deshumanització - Jordi VarelaJordi Varela
V Jornada Comitè assistencial: "Una medicina sense sostre? Què ens ha passat? Deshumanització i Medicina: disseccionant les causes" Parc Sanitari Sant Joan de Déu - 24 de maig de 2017
Gestió, qualitat i deshumanització - Jordi VarelaJordi Varela
V Jornada Comitè assistencial: "Una medicina sense sostre? Què ens ha passat? Deshumanització i Medicina: disseccionant les causes" Parc Sanitari Sant Joan de Déu - 24 de maig de 2017
This document discusses trends in mobile development, including different mobile device types, operating systems like Android, and new Android features. It covers tools for project management, collaboration, and continuous delivery. Mobile developers should learn web technologies as well to understand RESTful services and standard data formats. Emerging trends include material design, dependency on UX designers, Android Wear, microservices, and platforms as a service. Revision control systems are important for organizing work and enabling collaboration through features like issue tracking and code merging.
Este documento recomienda varios libros para leer durante las vacaciones. Propone títulos como "Gato y Pez", "Siete ratones ciegos" y "El maravilloso libro de los cuentos chinos", dirigidos a diferentes edades. Finaliza deseando felices vacaciones a los lectores.
Доповідь Василя Масюка - директора медіа-групи "ПромІнфо" на панельній дискусії "Реклама в пресі - об'єктивна ефективність", організованій УАВПП, ММR та видавництвом Еконміка 12 березня 2009 року.
O documento relata as atividades da Secretaria Estadual de Missões no Ceará no último ano, incluindo o lançamento do projeto "Escola Quatro Cântaros" que treinou lideranças e resultou na implantação de uma nova igreja na cidade de Aquiraz com mais de 700 pessoas evangelizadas.
1) Early studies found that men and women were perceived as more effective leaders when occupying positions aligned with traditional gender roles.
2) A 1990 study found that women lost authority employing feminine leadership styles in male-dominated roles, and a later meta-analysis yielded similar results.
3) However, a 2011 survey found that women outscored men in 12 of 16 leadership competencies, including taking initiative and driving results. Men only outscored women in developing strategic perspective. With more women in management over time, stereotypes about gender and leadership are changing.
This document rates a website on several criteria on a scale of 1 to 4 points. It scored 17.67 out of a possible 20 total points. The website content had a good relationship to the target curriculum. Videos were mostly effective in teaching desired content with some interactivity. The site was visually appealing and navigation was good, though some links were not active.
El documento presenta cuatro ejercicios relacionados con mediciones eléctricas utilizando puentes de Wheatstone y métodos para medir potencia trifásica y energía eléctrica. El primer ejercicio determina una resistencia desconocida en un puente de Wheatstone. El segundo calcula la corriente en un galvanómetro de un puente desequilibrado. El tercero encuentra parámetros de un inductor mediante un puente de Maxwell. El cuarto calcula el consumo diario de energía para dos cargas conectadas durante periodos de tiempo diferentes.
This PowerPoint presentation covers several topics related to responsible internet use including plagiarism, netiquette, and copyright. It defines plagiarism as stealing another's work and presenting it as your own. Netiquette is explained as proper etiquette for interacting online. Copyright is described as protecting creative works from being stolen. The presentation concludes with a short quiz to test comprehension.
This document contains information about two students - Enmanuela Urdeneta and Ana Novoa. It includes details about their personal interests, physical descriptions, favorite activities and places. For Enmanuela it provides her age, height, eye color, favorite music, shoes and foods. For Ana it notes her age, where she lives, hobbies like dancing and music, and places she enjoys in the city like the beach and shops. It also outlines sections on feelings, necessary items, vacation activities and things the students like to do.
Pythagoras was born in Samos in 582 BC and traveled to Mesopotamia and Egypt as a young man. When he returned, he founded his first school during the tyranny of Polycrates and died in 507 BC. The Pythagoreans believed that the structure of the universe was based on mathematics and that the earth and planets revolved around the sun, not the center of the universe. The Pythagorean Theorem is named after Pythagoras, who discovered that in any right triangle the square of the hypotenuse equals the sum of the squares of the two legs.
A talk given at the Grange School, the no. 1 private school in Chile about the importance of innovating, idea creating and giving back to the world.
The talk also looks at how good ideas are formed, and a personal look at how my idea came to be.
This document discusses trends in mobile development, including different mobile device types, operating systems like Android, and new Android features. It covers tools for project management, collaboration, and continuous delivery. Mobile developers should learn web technologies as well to understand RESTful services and standard data formats. Emerging trends include material design, dependency on UX designers, Android Wear, microservices, and platforms as a service. Revision control systems are important for organizing work and enabling collaboration through features like issue tracking and code merging.
Este documento recomienda varios libros para leer durante las vacaciones. Propone títulos como "Gato y Pez", "Siete ratones ciegos" y "El maravilloso libro de los cuentos chinos", dirigidos a diferentes edades. Finaliza deseando felices vacaciones a los lectores.
Доповідь Василя Масюка - директора медіа-групи "ПромІнфо" на панельній дискусії "Реклама в пресі - об'єктивна ефективність", організованій УАВПП, ММR та видавництвом Еконміка 12 березня 2009 року.
O documento relata as atividades da Secretaria Estadual de Missões no Ceará no último ano, incluindo o lançamento do projeto "Escola Quatro Cântaros" que treinou lideranças e resultou na implantação de uma nova igreja na cidade de Aquiraz com mais de 700 pessoas evangelizadas.
1) Early studies found that men and women were perceived as more effective leaders when occupying positions aligned with traditional gender roles.
2) A 1990 study found that women lost authority employing feminine leadership styles in male-dominated roles, and a later meta-analysis yielded similar results.
3) However, a 2011 survey found that women outscored men in 12 of 16 leadership competencies, including taking initiative and driving results. Men only outscored women in developing strategic perspective. With more women in management over time, stereotypes about gender and leadership are changing.
This document rates a website on several criteria on a scale of 1 to 4 points. It scored 17.67 out of a possible 20 total points. The website content had a good relationship to the target curriculum. Videos were mostly effective in teaching desired content with some interactivity. The site was visually appealing and navigation was good, though some links were not active.
El documento presenta cuatro ejercicios relacionados con mediciones eléctricas utilizando puentes de Wheatstone y métodos para medir potencia trifásica y energía eléctrica. El primer ejercicio determina una resistencia desconocida en un puente de Wheatstone. El segundo calcula la corriente en un galvanómetro de un puente desequilibrado. El tercero encuentra parámetros de un inductor mediante un puente de Maxwell. El cuarto calcula el consumo diario de energía para dos cargas conectadas durante periodos de tiempo diferentes.
This PowerPoint presentation covers several topics related to responsible internet use including plagiarism, netiquette, and copyright. It defines plagiarism as stealing another's work and presenting it as your own. Netiquette is explained as proper etiquette for interacting online. Copyright is described as protecting creative works from being stolen. The presentation concludes with a short quiz to test comprehension.
This document contains information about two students - Enmanuela Urdeneta and Ana Novoa. It includes details about their personal interests, physical descriptions, favorite activities and places. For Enmanuela it provides her age, height, eye color, favorite music, shoes and foods. For Ana it notes her age, where she lives, hobbies like dancing and music, and places she enjoys in the city like the beach and shops. It also outlines sections on feelings, necessary items, vacation activities and things the students like to do.
Pythagoras was born in Samos in 582 BC and traveled to Mesopotamia and Egypt as a young man. When he returned, he founded his first school during the tyranny of Polycrates and died in 507 BC. The Pythagoreans believed that the structure of the universe was based on mathematics and that the earth and planets revolved around the sun, not the center of the universe. The Pythagorean Theorem is named after Pythagoras, who discovered that in any right triangle the square of the hypotenuse equals the sum of the squares of the two legs.
A talk given at the Grange School, the no. 1 private school in Chile about the importance of innovating, idea creating and giving back to the world.
The talk also looks at how good ideas are formed, and a personal look at how my idea came to be.
Segona part de la intervenció de Jordi Amblàs, Metge de la Unitat Geriàtrica d’Aguts Consorci Hospitalari de Vic /Hospital Sta. Creu de Vic dins la I Jornada d'Atenció Pal•liativa de BSA "El final de la vida no és només una qüestió de temps", Badalona, 10 d'octubre de 2013
Este documento describe tres aspectos clave: 1) El cambio de paradigma en la medicina hacia una perspectiva centrada en el paciente y en el valor, evaluado a partir de los resultados y el coste desde la perspectiva del paciente; 2) La importancia de evaluar la experiencia del paciente a través de métodos como encuestas, grupos focales y narrativas del paciente; y 3) La participación del paciente en aspectos como la toma de decisiones compartidas, la educación terapéutica y la evaluación y mejora continua de los servicios sanitarios.
This document discusses the importance of considering patient experience in healthcare. It makes the following key points:
1. Patient experience should be the driver of healthcare, not just the doctor's perspective. Outcomes that matter to patients like functional status and quality of life are important.
2. Collecting patient experience data is not enough; it must be used to improve care through service design, patient empowerment, and quality improvement.
3. Involving patients in focus groups provided insights into their experiences with various treatments and recommendations to improve education programs, adapt timelines, and address psychological impacts.
La atención a los pacientes crónicos representa un reto para el futuro debido a que la manera actual de ofrecer cuidados ya no es sostenible. El paciente tendrá un papel más activo en su atención manejando su enfermedad por su cuenta con la ayuda de tecnología. Los sistemas de atención necesitarán innovar y adaptarse para satisfacer las necesidades cambiantes de los pacientes crónicos de manera efectiva.
El documento presenta extractos de diferentes autores que tratan sobre temas como la compasión en el cuidado de pacientes, la importancia de ser amable y agradecido, devolver a la sociedad lo que ha hecho por nosotros, prestar atención a los más vulnerables y la idea de justicia, y la importancia de la confianza, simetría, reciprocidad y sinceridad en las relaciones humanas.
Este documento discute la importancia de ir más allá de la satisfacción del paciente y enfocarse en su experiencia. Propone que la experiencia del paciente se mida a través de encuestas, grupos focales y la participación del paciente en la toma de decisiones. También describe iniciativas en un hospital para mejorar la educación terapéutica de los pacientes a través de la creación de un grupo de trabajo, la elaboración de materiales y un curso de capacitación para el personal.
This document discusses implications for the health care system from personalized and population-based approaches. It contains 3 key points:
1) Balancing population and individual interventions can maximize health benefits, minimize harm, and avoid unnecessary costs. This requires considering predictive, preventive, personalized and participatory (P4) perspectives as well as population perspectives (P5).
2) There is significant variability in clinical practice and resource use across regions, indicating uncertainty around effectiveness. Standardizing rates can help address inequalities.
3) Personalization requires considering individual variability, balancing individual needs with population responsibilities, and rethinking business models to focus on coordinated long-term care through facilitated networks rather than one-size-fits-all
1) The document discusses the need for increased patient participation and a virtual health practice model to deal with challenges of an aging population, consumer driven models, and economic constraints.
2) It proposes a virtual health practice strategy that promotes consistent use of technology across the care cycle to increase patient contact, reduce face-to-face visits, and maximize health outcomes in a sustainable way.
3) The key features of virtual health practice are that it is personalized, predictive, preventive, participatory, and relies on disruptive innovations using big data and multiple ICT tools in a systemic approach.
The document discusses the evolution of hospitals from primarily accommodation for sick priests in the 11th-15th centuries to their modern role. It notes hospitals transitioned from 2 buildings with 24 beds to providing specialized services and accommodating more patients. The text advocates for hospitals to have a flexible, innovative and tailored approach focused on population and personalized medicine to improve quality, safety and value. It suggests hospitals should not be confined within walls and emphasizes continuity of care, appropriate medical teams and balancing specialist and generalist care.
1. Seguretat clínica Dr. Joan Escarrabill Pla Director de les Malalties de l’Aparell Respiratori (PDMAR) Institut d’Estudis de la Salut Barcelona [email_address] Barcelona, 6 de maig de 2009
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3. Recherches sur les effets de la saignée dans vuelques maladies inflammatoires, et sur l’action de l’émétique et des vésicatoires dans la pneumonie Lliçó de Claude Bernard (1889) , de León Lhermitte (1.844-1.925). ...l’estadística no portarà mai a la veritat cientítica
5. BMJ 2000;320:785-788 Anesthesiology, 1978;49:399–406 Qual Saf Health Care 2002;11:277–283 Committee on Patient Safety and Risk Management in the American Society of Anesthesiologists (ASA ) 1984 The critical incident technique
8. NEJM 2004;351:2041-3 1 Desconfiaça de la població 2 No hi ha consens sobre el tipus d’intervencions 3 Transparència vs denúncies 4 Canvi cultural Compartir vs ocultar
11. Agenda Què vol dir treballar d’una manera diferent ? Per què gent a ssenyad a pr e n decisions absurdes? De quina manera aprenen els joves professionals ?
12. Agenda Què vol dir treballar d’una manera diferent ? Per què gent a ssenyad a pr e n decisions absurdes? De quina manera aprenen els joves professionals ?
13. ...hi ha forces psicològiques que fan descarrillar el pensament racional
14. SWAY: The irresistible pull of irrational behavior Aversió a la pèrdua Compromisos Valors atribuïts Biaix diagnostic Procediment Incentius Dissident Més que mirar d’incrementar els guanys es concentren en evitar pèrdues Consideren més el valor percebut que les dades objectives Més interessats en el procés que en el resultat Propensió a posar etiquetes basades en la primera impressió Compromisos que ens impedeixen “canviar de vorera”
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17. No s’han de confondre els termes i les situacions.... Excés de feina Tensió per la feina (estrès) Hores Formació Pressió Fatiga Sobrecàrrega Esdeveniment advers Error
18. L’estrès no és una condició necessària ni suficient per a explicar un error cognitiu Hi ha una relació molt important entre la manera de fer front a l’estrès i el risc de cometre errors Fatiga vs estrès Vulnerabilitat a l’estrès
19. L’èxit NO és fruït de l’atzar... ...la major part de les vegades Neutralitzar l’avantatge inicial La norma de les 10.000 hores Moment oportú No mitigar els errors Intel·ligència pràctica
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21. Treball en equip Comunicació La majoria d’accidents es relacionen amb…
22. Agenda Què vol dir treballar d’una manera diferent ? Per què gent a ssenyad a pr e n decisions absurdes? De quina manera aprenen els joves professionals ?
23. Març 2009 … and health professionals (mainly physicians) they prefer the arts to science Estandardització
24. Ambigüitat organitzativa L’ activitat d’un hospital s’organitza per FUNCIONS Es generen AMBIGÜITATS Fixing Health Care from the Inside, Today Stephen J Spear ...si falla la integració
25. Ambigüitat organitzativa … canvien més de 3 vegades de Servei durant l’ingrés 16.8% … dels pacients ingressats… WJ Leander. Patients first, 1996 Als 4 dies d’ingrés el pacient ha “contactat” amb més de… 70 professionals
26. Ann Intern Med 2005;142:121-8 41% ...es reben resultats després de l’alta 9.5% dels resultats requereixen accions immediates Ambigüitat organitzativa Incidents adversos en dos hospitals universitaris de Londres Neale G. J R Soc Med 2001;94:322-330.
35. BMJ 2000;320:745–9 Encara que estigui cansat faig bé les coses en situacions crítiques 70% 26% Els juniors no han de questionar les decisions dels seniors 45% 3% Cirurgià Pilot
42. Porter et al JAMA. 2007;297:1103-1111. 1 2 3 L’objectiu és afegir valor des de la perspectiva del pacient Organització al voltant de processos Mesurar resultats : outcomes ajustats a risc i cost
43. Agenda Què vol dir treballar d’una manera diferent ? Per què gent a ssenyad a pr e n decisions absurdes? De quina manera aprenen els joves professionals ?
44. BMJ 2008;336:456 Els més joves s’equivoquen més? L’acumulació de coneixements no porta “màgicament” al domini de la competència Prof. Esteve Pont
45. Qual Saf Health Care 2009;18:63–68. Components del nou model d’entrenament
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49. La segur etat clínica dep è n m é s de l ’harmonia din à mica entre e ls diferents actors que del nivel l d ’ exce l· l è ncia assolit per separa t en cada dispositiu de l ’ organi t zació Amarberti R. Ann Intern Med 2005;142:756-64
52. 1818-1865 En alguns moments del 1846 la mortalitat havia arribat al 96% El professor ho troba ridícul (i vexatori). Acomiaden Semmelweis 20 d’octubre de 1846 Seemelweis demana al professor Klin que es renti les mans.