ANÁLISIS INFORME CONTINUIDAD DE CUIDADOS SEGÚN CRITERIO ENFERMERO.

Consensuar qué pacientes deben salir del Hospital con Informe Continuidad de Cuidados es una discusión sin solucionar dentro del foro enfermero, y cada vez son más las voces que avalan que debe ponderar el criterio enfermero y la situación específica del paciente. Objetivos:Analizar el perfil de los pacientes que salen del Hospital con Informe Continuidad de Cuidados identificando las indicaciones más prevalentes. Ver el número total de altas con Informe Continuidad de Cuidados estratificado por especialidades. Metodología: Estudio observacional descriptivo cualitativo y cuantitativo, analizando todos los informes realizados de septiembre a diciembre de 2006 en unidades Médico-Quirúrgicas. Metodología cualitativa y cuantitativa. Fuente de datos: Servidor Gestión pacientes/Gestión de cuidados e Informe de Continuidad de Cuidados. Resultados: Cuantitativos: Emitidos 234 informes sobre un total de 676 altas, supone un 35% de pacientes con Informe de Continuidad de Cuidados. El 59,4% corresponden al área médica y el 40,5% quirúrgica, siendo Urología (57%) la unidad con más informes. Cualitativos: El 57% son mujeres y el 78% mayores de 65 años. Necesidades humanas no cubiertas más prevalentes: Movilidad 29%, Piel/Mucosa 28%, Eliminación 14%, Oxigenación/Respiración 12%, Nutrición 10%, Aprendizaje 7%.. Se presentan las situaciones y diagnósticos al alta más prevalentes. Conclusiones: Tras revisión bibliográfica, el porcentaje de pacientes con Informe de Continuidad de Cuidados es alto en nuestra área (35%). Perfil: podemos decir mujer, mayor de 65 años, con deterioro importante en la movilidad e intolerancia a la actividad (encamado), con UPP o herida quirúrgica, con anticoagulantes por vía subcutánea, insulinodependiente, con sonda vesical y/o sonda nasogástrica

Relationships between heavy metal concentrations in three different body fluids and male reproductive parameters: a pilot study

<p>Abstract</p> <p>Background</p> <p>Animal studies have shown the reproductive toxicity of a number of heavy metals. Very few human observational studies have analyzed the relationship between male reproductive function and heavy metal concentrations in diverse biological fluids.</p> <p>Methods</p> <p>The current study assessed the associations between seminal and hormonal parameters and the concentration of the 3 most frequent heavy metal toxicants (lead, cadmium and mercury) in three different body fluids. Sixty one men attending infertility clinics that participated in a case-control study to explore the role of environmental toxins and lifestyles on male infertility were analyzed. Concentration of lead, cadmium and mercury were measured in blood and seminal plasma and whole blood using anodic stripping voltammetry and atomic absorption spectrophotometry. Serum samples were analyzed for follicle-stimulating hormone, luteinizing hormone and testosterone. Semen analyses were performed according to World Health Organization criteria. Mann-Whitney test and Spearman's rank correlations were used for unadjusted analyses. Multiple linear regression models were performed controlling for age, body mass index and number of cigarettes per day.</p> <p>Results</p> <p>There were no significant differences between cases and controls in the concentrations of heavy metals in any of the three body fluids. In multivariate analyses using all subjects no significant associations were found between serum hormone levels and metal concentrations. However there was a significant positive association between the percentage of immotile sperms and seminal plasma levels of lead and cadmium.</p> <p>Conclusions</p> <p>Our results suggest that the presence of lead and cadmium in the reproductive tract of men may be related to a moderate alteration of their seminal parameters.</p

Randomised controlled clinical trial to determine the effects of the use of birth balls during labour

Objetivo. Determinar los efectos del uso de la pelota de parto (PdP) durante el trabajo de parto en relación al tiempo de dilatación y expulsivo, la integridad perineal, la percepción de la intensidad del dolor y la seguridad. Método. Ensayo clínico controlado y aleatorizado. Participantes: nulíparas de 18 a 35 años, bajo riesgo, a término. Intervención: realización de movimientos sentadas sobre PdP durante el parto. Variables resultado: tiempo de dilatación y expulsivo; integridad perineal; percepción del dolor, recuerdo del dolor en el puerperio y pre-post intervención; tipo de parto; motivo de distocia; Apgar; ingreso en UCI neonatal. Análisis: comparación de grupos: t-Student para variables contínuas y Ji-cuadrado para categóricas. Significación p≤0,05. Resultados. 58 participantes (34 grupo experimental y 24 grupo control). El tiempo de dilatación y expulsivo, y la integridad perineal fue similar entre grupos. A los 4 cm el grupo experimental refirió menos dolor que el grupo control; 6,9 puntos vs 8,2 (p = 0,039). La diferencia en la percepción del dolor recordada en el puerperio inmediato fue de 1,48 puntos mayor en el grupo control (p = 0,003). La medición del dolor en el grupo experimental antes del uso de la PdP fue de 7,45 puntos y tras la intervención de 6,07 puntos (p < 0,001). En las variables relacionadas con la seguridad no hubo diferencias entre los grupos. Conclusión. El uso de pelotas de parto disminuye la percepción del dolor de parto y es segura.Objective. To determine the effects of using birth balls (BB) during the first and second stage of labour, perineal integrity, perception of pain intensity, and safety. Method. Randomised controlled trial. Participants: 18 to 35 years, nulliparous, low-risk, at term. Intervention: Performing movements sitting on a BB during obstetric labour. Main outcomes: Duration of first and second labour stages; perineal integrity; pain perception during the postpartum period and pre-post intervention, type of delivery, cause of dystocia, Apgar, neonatal ICU admission. Analysis: Comparison of groups: Student-t for continuous variables and chi-squared test for categorical ones. Significance if P ≤.05. Results. A total of 58 patients (34 experimental and 24 controls) were included. Times of first and second stage, and perineal integrity were similar between groups. At 4 cm. the experimental group referred less pain than the control group, 6.9 points vs 8.2 (P=.039). Difference in the perception of pain in the immediate postpartum period was 1.48 points higher in the control group (P=.003). The measurement of pain in the experimental group before the use of the BB was of 7.45 points, and after the intervention of 6.07 points (P<.001). In There were no differences between groups as regards safety-related variables. Conclusion. The use of a Birth Ball decreases obstetric labour pain perception and is safe

GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19

Data availability: Downloadable summary data are available through the GenOMICC data site (https://genomicc.org/data). Summary statistics are available, but without the 23andMe summary statistics, except for the 10,000 most significant hits, for which full summary statistics are available. The full GWAS summary statistics for the 23andMe discovery dataset will be made available through 23andMe to qualified researchers under an agreement with 23andMe that protects the privacy of the 23andMe participants. For further information and to apply for access to the data, see the 23andMe website (https://research.23andMe.com/dataset-access/). All individual-level genotype and whole-genome sequencing data (for both academic and commercial uses) can be accessed through the UKRI/HDR UK Outbreak Data Analysis Platform (https://odap.ac.uk). A restricted dataset for a subset of GenOMICC participants is also available through the Genomics England data service. Monocyte RNA-seq data are available under the title ‘Monocyte gene expression data’ within the Oxford University Research Archives (https://doi.org/10.5287/ora-ko7q2nq66). Sequencing data will be made freely available to organizations and researchers to conduct research in accordance with the UK Policy Framework for Health and Social Care Research through a data access agreement. Sequencing data have been deposited at the European Genome–Phenome Archive (EGA), which is hosted by the EBI and the CRG, under accession number EGAS00001007111.Extended data figures and tables are available online at https://www.nature.com/articles/s41586-023-06034-3#Sec21 .Supplementary information is available online at https://www.nature.com/articles/s41586-023-06034-3#Sec22 .Code availability: Code to calculate the imputation of P values on the basis of SNPs in linkage disequilibrium is available at GitHub (https://github.com/baillielab/GenOMICC_GWAS).Acknowledgements: We thank the members of the Banco Nacional de ADN and the GRA@CE cohort group; and the research participants and employees of 23andMe for making this work possible. A full list of contributors who have provided data that were collated in the HGI project, including previous iterations, is available online (https://www.covid19hg.org/acknowledgements).Change history: 11 July 2023: A Correction to this paper has been published at: https://doi.org/10.1038/s41586-023-06383-z. -- In the version of this article initially published, the name of Ana Margarita Baldión-Elorza, of the SCOURGE Consortium, appeared incorrectly (as Ana María Baldion) and has now been amended in the HTML and PDF versions of the article.Copyright © The Author(s) 2023, Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte–macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).GenOMICC was funded by Sepsis Research (the Fiona Elizabeth Agnew Trust), the Intensive Care Society, a Wellcome Trust Senior Research Fellowship (to J.K.B., 223164/Z/21/Z), the Department of Health and Social Care (DHSC), Illumina, LifeArc, the Medical Research Council, UKRI, a BBSRC Institute Program Support Grant to the Roslin Institute (BBS/E/D/20002172, BBS/E/D/10002070 and BBS/E/D/30002275) and UKRI grants MC_PC_20004, MC_PC_19025, MC_PC_1905 and MRNO2995X/1. A.D.B. acknowledges funding from the Wellcome PhD training fellowship for clinicians (204979/Z/16/Z), the Edinburgh Clinical Academic Track (ECAT) programme. This research is supported in part by the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant MC_PC_20029). Laboratory work was funded by a Wellcome Intermediate Clinical Fellowship to B.F. (201488/Z/16/Z). We acknowledge the staff at NHS Digital, Public Health England and the Intensive Care National Audit and Research Centre who provided clinical data on the participants; and the National Institute for Healthcare Research Clinical Research Network (NIHR CRN) and the Chief Scientist’s Office (Scotland), who facilitate recruitment into research studies in NHS hospitals, and to the global ISARIC and InFACT consortia. GenOMICC genotype controls were obtained using UK Biobank Resource under project 788 funded by Roslin Institute Strategic Programme Grants from the BBSRC (BBS/E/D/10002070 and BBS/E/D/30002275) and Health Data Research UK (HDR-9004 and HDR-9003). UK Biobank data were used in the GSMR analyses presented here under project 66982. The UK Biobank was established by the Wellcome Trust medical charity, Medical Research Council, Department of Health, Scottish Government and the Northwest Regional Development Agency. It has also had funding from the Welsh Assembly Government, British Heart Foundation and Diabetes UK. The work of L.K. was supported by an RCUK Innovation Fellowship from the National Productivity Investment Fund (MR/R026408/1). J.Y. is supported by the Westlake Education Foundation. SCOURGE is funded by the Instituto de Salud Carlos III (COV20_00622 to A.C., PI20/00876 to C.F.), European Union (ERDF) ‘A way of making Europe’, Fundación Amancio Ortega, Banco de Santander (to A.C.), Cabildo Insular de Tenerife (CGIEU0000219140 ‘Apuestas científicas del ITER para colaborar en la lucha contra la COVID-19’ to C.F.) and Fundación Canaria Instituto de Investigación Sanitaria de Canarias (PIFIISC20/57 to C.F.). We also acknowledge the contribution of the Centro National de Genotipado (CEGEN) and Centro de Supercomputación de Galicia (CESGA) for funding this project by providing supercomputing infrastructures. A.D.L. is a recipient of fellowships from the National Council for Scientific and Technological Development (CNPq)-Brazil (309173/2019-1 and 201527/2020-0)