Use of amitriptyline for the treatment of chronic tension-type headache. Review of the literature

Amitriptyline is a tricyclic antidepressant, considered the treatment of choice for different types of chronic pain, including chronic myofascial pain. Its antinociceptive property is independent of its antidepressant effect. Although its analgesic mechanism is not precisely known, it is believed that the serotonin reuptake inhibition in the central nervous system plays a fundamental role in pain control. Although this medication is widely used in the prevention of chronic tension-type headache, few studies have investigated the efficacy of this treatment and the published results are contradictory. The objective of this article was to review the literature published on the use of amitriptyline in the prophylactic treatment of chronic tension-type headache, considering the level of scientific evidence of the different studies using the SORT criteria. From this review, 5 articles of evidence level 1, and another 5 articles of evidence level 2 were selected. Following analysis of the 10 studies, and in function of their scientific quality, a level A recommendation was made in favor of using amitriptyline in the treatment of chronic tension-type headache

Individualization process of the standardized care plan in acute care hospitalization units: study protocol

Aim: to understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients. Background: to apply the nursing process, it is advisable to use SCP to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan. Design: a qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach. Methods: multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in‐depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015. Discussion: by knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses' attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research

CFD simulation of explosions in fired combustion chambers

A wide range of equipment (boilers, furnaces, reformers, etc.) in industrial processes use fired combustion chambers to retrieve heat from a fuel. Although these systems have been used since long time and their safety has been significantly improved, explosions related with disturbances in the firing chamber still occur with certain frequency. The experimental testing of these explosions is challenging due to the complex design and large volume of combustion equipment, along with the presence of internal elements (heating tubes, burners, ignitors) and explosion relief panels. Moreover, empirical explosion evaluation methods may lack accuracy by not considering overpressure reflections and the effects of internal elements. Computational Fluid Dynamics (CFD) models are becoming nowadays accessible and runnable with ordinary desktop computers. In the present work, GEXCON FLACS software has been used to evaluate the effects of explosions inside combustion chambers. The results obtained confirm the potential utility of CFD simulations to analyze this type of explosions.Peer ReviewedPostprint (published version

Sperm characters of the digenean Prosorhynchus aculeatus Odhner, 1905 (Bucephalidae), a parasite of the marine fish Conger conger (Linnaeus, 1758) (Congridae)

Within the Digenea, the family Bucephalidae includes numerous species parasitizing mainly marine and freshwater fishes. This family includes five recognized subfamilies, and ultrastructural data on their sperm cells are very scarce. The existing data are restricted to the subfamily Bucephalinae. Thus, the present study is the first complete analysis of the sperm cell of a bucephalid belonging to the subfamily Prosorhynchinae. Herein, we describe the ultrastructure of the mature spermatozoon of Prosorhynchus aculeatus, a parasite of the conger eel Conger conger, assessed by means of transmission electron microscopy (TEM). The spermatozoon of P. aculeatus is a filiform cell that presents two axonemes of the 9?'1' pattern of trepaxonematan Platyhelminthes, parallel cortical microtubules, mitochondrion, nucleus, external ornamentation of the plasma membrane, spine-like bodies and a large amount of glycogen granules. According to the anterior location of the external ornamentation of the plasma membrane, P. aculeatus presents a Quilichini et al.'s type 1 spermatozoon. With respect to the posterior extremity, the sperm cell of P. aculeatus corresponds to the Quilichini et al.'s cryptogonimidean type. Our results are compared with those of the two previously studied bucephalids (Bucephalinae), Prosorhynchoides gracilescens and Pseudorhipidocotyle elopichthys

SEM evidence for existence of an apical disc on the scolex of Clestobothrium crassiceps (Rudolphi, 1819): comparative results of various fixation techniques

The scolex of the bothriocephalidean cestode Clestobothrium crassiceps was studied by means of scanning electron microscopy (SEM). The comparative results of various fixation procedures and techniques are presented. The scolex of C. crassiceps is oval to globular and exhibits two deep bothria which appear in the form of two lobes separated by a longitudinal groove. At the apex of the scolex, resembling a beret, an apical disc is present (oval, flattened and with a sinuous edge). Our results are compared with those previously reported in other species of Clestobothrium. This study represents the first report which highlights the presence of an apical disc in the scolex of C. crassiceps. It describes the effects of different procedures applied to our material during preparation and a comparative analysis results obtained using these various methods

Anisakid Presence in the European Conger, Conger conger, from Spanish Mediterranean Waters

The European conger, Conger conger, is a benthic marine fish species with a geographicaldistribution extending through the northeastern Atlantic and the Mediterranean. Despite beingextensively distributed and widely appreciated by Spanish consumers, studies regarding parasitepresence in this fish are scarce. In the present work, a hundred and eight specimens from theMediterranean coast of northeastern Spain (Catalan waters) were surveyed for the presence ofnematode parasites. Several species were morphologically identified: third-stage larvae of Anisakistype I (sensu Berland, 1961) (n = 131), third-stage larvae of Anisakis type II (sensu Berland, 1961)(n = 18), third- and fourth-stage larvae and adults of Hysterothylacium spp. (n = 48), adults ofCucullanus sp. (n = 391), and adults of Cristitectus congeri (n = 69). Moreover, some fish and decapodespecies were also observed as part of the host’s diet, with the most detected preys being Micromesistiuspoutassou, Sardina pilchardus, Macropipus sp., and Goneplax rhomboides. This represents the first surveyof nematode parasites infecting C. conger from the northeastern Spanish Mediterranean waters.Among the parasite species detected, the presence of Anisakis species should be highlighted as theingestion of C. conger parasitized with these larvae could potentially lead to anisakiasis in consumers</p

Accuracy and completeness of records of adverse events through interface terminology

Objective: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. Method: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. e diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. e record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. Results: e sample evaluated included 459 records. e accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. e accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. e completeness of results is remarkable, except for the risk of bronchoaspiration. Conclusion: e adverse event recorded by nurses with greatest accuracy is pressure ulcers

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest

Objective: Th e purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether diff erences exist in terms of patients' profi les, surveillance measurements and outcomes. Method: A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results: Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Signifi cant diff erences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and fi nal outcomes. Conclusion: Surveillance nursing diagnoses may play a signifi cant role in preventing acute deterioration of adult in-patients in the acute care setting

Care complexity individual factors associated with adverse events and in-hospital mortality

Introduction: Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods: A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results: A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78-0.83). Conclusions: Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes

Newborn physiological immaturity: a concept analysis

Most standardized nursing care plans for healthy neonates include multiple nursing diagnoses to reflect nurses' judgments on the infant's status; however scientific literature concerning this issue is scarce. Newborn physiological immaturity is a concept in the ATIC terminology (architecture, terminology, interface, information, nursing [infermeria], and knowledge [coneixement]) to represent the natural status of vulnerability of the healthy neonate. Purpose: To identify the essential attributes of the concept and provide its conceptual and operational definition, using the Wilsonian approach. Findings: The concept under analysis embeds a natural cluster of vulnerabilities and environmental interactions that enhance the evolving maturation process. Implications for Practice: The use of this diagnosis may simplify the process of charting the nursing care plans and reduce time needed for documentation while maintaining the integrity of the information. Implications for Research: Consistent development and use of nursing concepts is essential for knowledge building. Studies on the actual use of nursing diagnoses are needed to inform decision making