Las relaciones entre profesionales en los códigos de deontología de diversas profesiones de la salud

Una buena atención y cuidado de las personas en el ámbito sanitario requiere de la coordinación entre los profesionales responsables de dicha atención, tanto a nivel interdisciplinar como entre niveles asistenciales. Las consideraciones éticas que subyacen, siendo fundamentales, han sido poco estudiadas de manera específica, a pesar de que todos los Códigos de Deontología de las profesiones relacionadas con la salud recogen recomendaciones y sugerencias relativas a las relaciones entre profesionales. En este artículo se desarrolla una revisión reflexiva sobre estas recomendaciones, a partir de los Códigos de las profesiones relacionadas con nuestro ámbito asistencial, y su importancia en el mismo. A good care of people in the health field requires coordination among the professionals responsible for such care, both interdisciplinary and between levels of care. The ethical considerations that underlie, being fundamental, have been little studied in a specific way, although all the Codes of Deontology of the professions related to the health collect recommendations and suggestions regarding the relations between professionals. This article makes a reflective review on these recommendations and their importance in our care environment

Pilot Testing and Psychometric Validation of the Nijmegen Professionalism Scale for Spanish Nursing

Background and purpose: Professional commitment is frequently used as a humanistic care indicator. Thus, it is important to design and validate a tool which is able to measure professional commitment of nurses in Spain. In this study we aimed to analyze the psychometric properties of the Nijmegen Professionalism Scale for Spanish (NPS-S) nursing in order to verify its validity and reliability. Methods: We undertook the pilot testing and psychometric validation of the NPS-S. A total sample of 249 nursing professionals from a variety of areas of expertise took part in this study. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was used for reporting this research. Results: The NPS-S achieved a high degree of content validity, construct validity, internal consistency, temporal stability, and usability; this version is, thus, equivalent to the Nijmegen Professionalism Scale in its original version. Implications for practice: Based on the results obtained from the validation of this tool, it is possible to affirm that the NPS-S is an effective instrument for measuring professional commitment in this population. The NPS-S will evaluate and thus contribute to the promotion of professional commitment in Spanish nursing. Additionally, it will serve to establish correlations between professional commitment and other variables including quality of care and patient satisfaction. Future studies should analyze the evaluation capacity of this tool

Evidence of a new ordered vacancy crystal structure in the compound Cu3In7Te12

The crystal structure of the ordered vacancy compound (OVC) Cu3In7Te12 is analyzed using powder X-raydiffraction data. It is found that this OVC crystallizes with a chalcopyrite-related structure, in the tetragonalspace group P 4 2c (Nº 112), with unit cell parameters and volume a = 6.1720(2) Å, c = 12.3597(8) Å, and V= 470.83(4) Å3. The Rietveld refinement of 28 instrumental and structural parameters led to Rp = 9.27 %, Rwp= 10.30 %, Rexp = 6.95% and S = 1.48, for 4501 step intensities and 130 independent reflections, respectively.This compound is isostructural with Cu3In7Se12, and has a defect adamantane structure.Keywords: semiconductors, ordered vacancy compounds, crystal structure, X-ray diffraction, Rietveld

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure

Altres ajuts: Fundación Interhospitalaria para la Investigación Cardiovascular (FIC Foundation); Abbott.Objective: Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. Methods: This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. Results: IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102). Conclusion: In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (∼10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.

Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102). In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Atomic spectrometry update: Review of advances in the analysis of metals, chemicals and materials

There has been a large increase in the number of papers published that are relevant to this review over this review period. The growth in popularity of LIBS is rapid, with applications being published for most sample types. This is undoubtedly because of its capability to analyse in situ on a production line (hence saving time and money) and its minimally destructive nature meaning that both forensic and cultural heritage samples may be analysed. It also has a standoff analysis capability meaning that hazardous materials, e.g. explosives or nuclear materials, may be analysed from a safe distance. The use of mathematical algorithms in conjunction with LIBS to enable improved accuracy has proved a popular area of research. This is especially true for ferrous and non-ferrous samples. Similarly, chemometric techniques have been used with LIBS to aid in the sorting of polymers and other materials. An increase in the number of papers in the subject area of alternative fuels was noted. This was at the expense of papers describing methods for the analysis of crude oils. For nanomaterials, previous years have seen a huge number of single particle and field flow fractionation characterisations. Although several such papers are still being published, the focus seems to be switching to applications of the nanoparticles and the mechanistic aspects of how they retain or bind with other analytes. This is the latest review covering the topic of advances in the analysis of metals, chemicals and materials. It follows on from last year's review1-6 and is part of the Atomic Spectrometry Updates series

Inteligencia emocional frente a la sobrecarga laboral de los trabajadores administrativos de la sede principal filtro de la municipalidad provincial de Arequipa – Arequipa 2019

La Inteligencia Emocional se ha convertido en una habilidad importante para el buen funcionamiento de las personas, considerando que es una habilidad que proporciona escoger las mejores opciones en la búsqueda de una solución. Por otro lado, la sobrecarga laboral es un riesgo que contribuye a la disminución de la calidad de vida y la productividad laboral, es por ello que tanto empleadores como los trabajadores tengan claro sus deberes y derechos a la hora de desempeñar en un buen ambiente laboral. Es por ello que la investigación se realiza al personal administrativo que labora en la Municipalidad Provincial de Arequipa. Ante esta problemática el propósito que se plantea es determinar la Inteligencia emocional frente a la Sobrecarga Laboral de los trabajadores administrativos, de la sede principal Filtro de la Municipalidad Provincial de Arequipa. El tipo de investigación es correlacional, diseño no experimental, transversal. Para la recolección de datos, se utilizó como método la encuesta y como técnicas el cuestionario. El presente trabajo esta, orientado con profesionalismo y dedicación, para proporcionar información valiosa y de suma de importancia que sea útil para la población objeto de estudio, las Ciencias Sociales y el desarrollo de la carrera profesional de Trabajo Social, asimismo contribuirá a que la Sub Gerencia de Recursos Humanos a través del área de Bienestar Social, ejecuten intervenciones orientadas al mejoramiento de las condiciones de trabajo que propician la sobrecarga laboral, que al ser abordados permitirán que el trabajador pueda desempeñarse eficazmente mejorando su calidad de vid