CASA CUEVA EN EL BARRANCO DE LA VIRGEN [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

JARDÍN BOTÁNICO [Material gráfico]

ADQUIRIDA POR EL COLECCIONISTA EN INGLATERRA.FOTO SOBRE CARTON DE FUENTE DEL JARDIN BOTANICO (OROTAVA)Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

PORCHE Y JARDÍNES DEL HOTEL SANTA CATALINA [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

SANTA CRUZ, MUELLE Y ALAMEDA [Material gráfico]

ADQUIRIDA POR EL COLECCIONISTA EN INGLATERRA.FOTO DE VISTA DE SANTA CRUZCopia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

An Evaluation of SmokeFree for Kansas Kids: An Intervention to Promote Tobacco Cessation in Pediatric Clinics

Introduction. Smokefree for Kansas Kids is a program designedto train pediatric clinic staff to assess for tobaccoexposure and provide brief smoking cessation interventionsto caregivers and patients. The purpose of this studywas to evaluate the impact of this program and improvefuture tobacco intervention efforts in pediatric clinics. Methods. Eighty-six pediatric physicians and staff attendedat least one of three training sessions. A randomsample of pediatric medical records was selected pre-intervention(n = 49) and post-intervention (n = 150). Electronicmedical records were reviewed to assess for documentationof tobacco use intervention implemented in the clinic. Results. Of the 199 pediatric clinic visits reviewed, 197 metthe study criteria. All but one visit documented an assessmentof tobacco exposure. Among children exposed to tobacco (n= 42), providers were more likely to discuss tobacco use withcaregivers post-intervention (35.7%) compared to pre-intervention(7.1%; p < 0.05). One in five caregivers in the postinterventiongroup were advised to quit (21.4%) compared tothe pre-intervention group (7.1%). In the post-interventiongroup, 14.3% were referred to the state quitline compared tono referrals in the pre-intervention group. The difference inrates for providing advice and referral between pre-interventionand post-intervention were not statistically significant. Conclusions. Implementation of the Smoke Free for Kansas Kidsintervention was associated with modest improvements in clinictobacco intervention efforts, but many patients still failed toreceive optimal assessments or interventions. Additional effortsmay be needed to enhance this program. KS J Med 2017;10(1):7-11

LA ISLETA DESDE LOS JARDINES DEL HOTEL SANTA CATALINA [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

CEMENTERIO Y VALLE DE LA OROTAVA [Material gráfico]

ADQUIRIDA POR EL COLECCIONISTA EN INGLATERRA.FOTO VISTA DEL VALLE DE LA OROTAVACopia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

CALDERA DE BANDAMA [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

The Simplified Geneva Score and the Utilization of the D-Dimer and Computerized Tomography for Assessing Pulmonary Embolism

Background. Pulmonary embolism (PE) is clinically suspected in many patients who complain of shortness of breath or chest pain due to its nonspecific nature. The prevalence of PE, however, is low in this population. To assist physicians in diagnostic decision making, several clinical decision rules (CDR) have been developed. The appropriate use of these CDRs has been proven to decrease the need for expensive, time consuming, and invasive diagnostic imaging procedures. In this study, the appropriateness of D-dimer and CT usage was investigated to rule out pulmonary emboli based on the simplified Geneva score. Methods. A retrospective review was performed on 74 patients with a CT scan ordered through a pulmonary embolism (PE) protocol. Using clinical data, the patients were stratified into “unlikely” and “likely” groups for the presence of PE based on the simplification of the revised Geneva score. Scores of 0-2 were graded as “unlikely” and scores of 3 or greater were “likely.” Results. There were 45/74 (60.8%) patients in the “unlikely” group. Of these, 14/45 (31.1%) received a D-dimer; eight were normal and six elevated. Only one patient in the elevated group had evidence of a PE. Of the remaining 31(39.2%) patients in the “unlikely” group that did not receive a D-dimer, only one had a PE. The “likely” group consisted of 29 (39.2%) patients of whom six received a D-dimer. Three patients had a normal D-dimer and three had an elevated level. Neither of these two groups had a PE. Of the remaining 23 (60.8%) in the “likely” group who did not receive a D-dimer, six had a PE. Conclusions. Diagnosing pulmonary emboli using D-dimer levels and CT scans may be aided by clinical decision rules such as the simplified Geneva system. This process may lead to more effective use of medical resources

Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial

Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. “Warm handoff” is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups