Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Graphene Oxide: A Comparison of Reduction Methods

This paper presents a comparison of traditional thermal and chemical reduction methods with more recent ionizing radiation reduction via gamma rays and electron beams (e-beams). For GO, all synthesis protocols were adapted to increase production scale and are a contribution of this work. The typical Raman D-band of the GO was prominent (ID/IG ratio increased sixfold). When comparing the GO reduction techniques, dramatic differences in efficiency and GO particle characteristics were observed. Although thermal and chemical reduction are effective reduction methods, as shown through the use of FTIR spectroscopy and the C/O ratio from EDS chemical analysis, the thermal process renders great weight losses, whereas chemical processing may involve the use of hazardous chemical compounds. On the other hand, comparing the gamma rays and e-beam for 80 kGy, the Raman spectra and chemical analysis suggested that the e-beam caused a greater GO reduction: C/O ratio from EDS of 5.4 and 4.1, respectively. In addition to being fast and effective, ionizing radiation reduction processes allow easier control of the reduction degree by adjusting the radiation dose. When the dose increased from 40 to 80 kGy, the Raman spectra and EDS showed that the ID/IG and C/O ratios increased by 15 and 116%, respectively

Aspectos socioeconómicos, mejoramiento, nutrición y sanidad en cuyes (Cavia porellus) tipo carne

IP 1104-07-006-85v.1. Primera parte del informe final del programa de investigacion estudio de aspectos socio-economicos, nutricion, mejoramiento genetico y sanidad en cuyes tipo carne/ AlbertoCaycedo V. -- v.2. Composicion quimica de los principales forrajes utilizados en cuyes (Caviaporcellus)en clima frio, medio y calido / Alvaro Burgos Arcos, Edmundo Apraez Guerrero, Alberto CaycedoVallejo --v.3. Estimacion de la heredabilidad y repetibilidad de algunas caracteristicas en cuyes (Caviaporcellus) / Luis Ernesto Viteri S. v.4. Digestibilidad aparente de los forrajes kikuyo, vaina de haba,ramio y king grass en cuyes tipo carne (Cavia porcellus) / Alberto Caycedo Vallejo, Alvaro Almeida Delgado,Susana Cordoba Angulo -- v.5. Diagnostico de la explotacion cuyicula en Nariño y perfil del proyecto sobrelaorganizacionde una cooperativa de productores, para mejorar la comercializacion / Nelson E. Arturo -- v.6. Evaluacion mineral en suelo -planta-animal utilizando cuyes (Cavia porcellus) de engorde / Alberto CaycedoVallejo, Nestor Julio Jaramillo Aguilera, Jeannett Yolanda Moncayo Jiminez -- v.7. Contribucion alingreso familiarde las explotaciones de cuyes en el municipio de Pasto, Nariño / Ramon Correa Nieto, Luis A. SolartePortilla,Carlos H. Portilla Eraso -- v.8. Inventario y analisis quimico de malezas utilizadas en laalimentacion decuyes en siete municipios del Departamento de Nariño / Roberto Antonio Beltran Guzman, AlbertoCaycedo Vallejo -- v.9. Respuesta del pasto aubade (Lolium sp) a la fertilizacion quimica y organica en unsuelo del Altiplano de Pasto, Nariño / Hernan B Vallej

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology