The influence of environmental distraction on cognitive abilities in ADL performance after frontal brain injured.

Background: Previous studies have reported errors in Activities of Daily Living (ADL) under the presence of distracting objects in dementia and brain injury patients. However, little is known about which distractor-target objects relation might be more harmful for performance. Method: We compared the ADL execution in frontal brain injured patients and control participants under two conditions: One in which target objects were mixed with distractor objects that constituted an alternative semantically related but non-required task (contextual condition) and another in which target objects were mixed with related but isolated distractors that did not constituted a coherent task (non-contextual condition). We separately analyzed ADL commission errors (repetitions, substitutions, objects manipulations, failures in sequence, extra actions) and omissions. In addition, the participants were evaluated with a neuropsychological protocol including a very specific executive functions task (Selective attention, Stimulus-Stimulus and Stimulus-Response conflict). Results: We found that frontal patients produced more commission errors compared to control participants, but only under the contextual condition. No between groups significant differences were found in omissions in both conditions or commission errors in non-contextual conditions. Scores in the Stimulus-Response conflict was significantly correlated with commission errors in the contextual condition. Conclusion: The presence of different non-target objects in ADL performance could require different cognitive process. Contextual ADL conditions required a higher level of executive functions, especially at the level of response (Stimulus-Response conflict). Application to Practice: Occupational therapists should control the presence of objects related to the target task according to the intervention objectives with the patients.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Guía de recomendaciones de autocuidado al alta del paciente geriátrico intervenido quirúrgicamente de fractura de cadera

La elevada incidencia de la fractura de cadera en ancianos, unida a la dependencia que ésta genera y a la afectación en todas las esferas del individuo, hace necesaria la elaboración de una guía de recomendaciones de enfermería al alta hospitalaria. De esta manera, se conseguirá aumentar las capacidades del anciano y sus cuidadores para el autocuidado, manteniendo la máxima independencia en la realización de las actividades de la vida diaria, y por otro lado, se asegurará la continuidad de los cuidados entre el hospital y atención primaria. Esta guía está realizada sobre la base del caso real de un paciente geriátrico intervenido de fractura de cadera, en el momento del alta hospitalaria, que sirve como modelo para llevar a cabo las diferentes etapas del proceso de enfermería, teniendo como referente la teoría del autocuidado de Dorothea Orem. Abstract The high incidences of hip fractures among elderly people, joined with the dependency they generate and their interference in every aspect of daily routine, make necessary the creation of a program of recommendations after hospital discharge. In this way, patient abilities for self care will be increased. Maximum independence will be achieved, although professional healthcare, either in a hospital or in a health centre, will also continue. This program has been created from a real case: A geriatric patient who had his hip operated on was discharged. This case will exemplify the different stages of the nursing process, according to the theory of selfcare of Dorothea Orem. Centro de Trabajo: Estudiantes de 3º curso de enfermería. E.U.E. La Paz Fecha del Trabajo: 01/06/2005 Palabra Clave: Autocuidado, paciente geriátrico, fractura de cadera, alta hospitalaria, intervención enfermera. Key Words: Selfcare, geriatric patient, hip fracture, hospital discharge, nurse intervention

Guía de recomendaciones de autocuidado al alta del paciente geriátrico intervenido quirúrgicamente de fractura de cadera

The high incidences of hip fractures among elderly people, joined with the dependency they generate and their interference in every aspect of daily routine, make necessary the creation of a program of recommendations after hospital discharge. In this way, patient abilities for self care will be increased. Maximum independence will be achieved, although professional healthcare, either in a hospital or in a health centre, will also continue. This program has been created from a real case: A geriatric patient who had his hip operated on was discharged. This case will exemplify the different stages of the nursing process, according to the theory of selfcare of Dorothea Orem.La elevada incidencia de la fractura de cadera en ancianos, unida a la dependencia que ésta genera y a la afectación en todas las esferas del individuo, hace necesaria la elaboración de una guía de recomendaciones de enfermería al alta hospitalaria. De esta manera, se conseguirá aumentar las capacidades del anciano y sus cuidadores para el autocuidado, manteniendo la máxima independencia en la realización de las actividades de la vida diaria, y por otro lado, se asegurará la continuidad de los cuidados entre el hospital y atención primaria. Esta guía está realizada sobre la base del caso real de un paciente geriátrico intervenido de fractura de cadera, en el momento del alta hospitalaria, que sirve como modelo para llevar a cabo las diferentes etapas del proceso de enfermería, teniendo como referente la teoría del autocuidado de Dorothea Orem

Claves para el trabajo en equipo: una propuesta del funcionamiento de la asociación “Ocupación Con Sentido”

The association Ocupación con Sentido (AOS) (Occupation with Sense) is a professional organization formed by occupational therapists. It aims at reporting unfair working and educational conditions, as well as proposing alternatives based on social responsibility, self-analysis and the use of meaningful occupation. In this paper, we show some of the findings that we have discovered about teamwork as a means to achieve specific goals. These findings highlight the relevance of encouraging the connection between collective and personal interests. They recover both the human need to respond to what happens in society and the existence of individual priorities and sensitivities. In so doing, we use models of occupational therapy, namely the Model of Human Occupation, and pedagogical methodologies of social transformation, namely the See-Judge-Act (review). Professional organizations are essential to enhance professional identity and to contribute to society. For that reason, it is necessary to study, analyze and be aware of the functioning of teams composing such organizations.La Asociación Ocupación con Sentido (AOS) es una asociación profesional de terapeutas ocupacionales, cuyos objetivos fundamentales son posicionarnos y denunciar condiciones laborales y de formación injustas, y proponer alternativas basadas en la responsabilidad social, el autoanálisis y el uso de la ocupación significativa. En este artículo, pretendemos dar a conocer algunos de los hallazgos que hemos ido descubriendo sobre el trabajo en equipo como un medio para conseguir determinados objetivos. Este tipo de descubrimientos destaca la importancia de impulsar la unión entre los intereses grupales y personales, rescatando tanto la necesidad humana de responder a lo que ocurre en la sociedad, como la existencia de prioridades y sensibilidades individuales. Para ello, usamos modelos propios de terapia ocupacional, como el Modelo de Ocupación Humana, o metodologías pedagógicas de transformación social, como el Ver-Juzgar-Actuar (revisar). Puesto que las organizaciones profesionales son elementos clave tanto para potenciar la identidad profesional como para contribuir a la sociedad y beneficiar a las personas que la habitan, es fundamental estudiar, analizar y cuidar minuciosamente el funcionamiento de los equipos que las componen

Trace metal concentrations in sediments from the southwest of the Iberian Peninsula

Metal sediment concentrations (As, Cd, Cu, Hg, Ni, Pb and Zn) in surface sediments (0 to 5 cm) from 11 sampling stations in the southwest of the Iberian Peninsula (the Ria Formosa and the Guadiana River, the Ría de Huelva and the Bay of Cadiz) were determined in two seasonal periods (autumn 2006 and spring 2007). No seasonal metal concentration pattern was identified, as similar values were found in both periods. The highest concentrations of copper, zinc, lead and cadmium were reported in the Ria of Huelva area, and those of mercury and nickel in the Bay of Cadiz. The hazard potential index (HPiM) was determined to assess the potential risk associated with metal contamination (Cu, Cd, Pb and Zn), taking into account extractable (presumed bioavailable) fractions of these metals and site-specific sediment quality values. When the HPiM is >1 there is risk, and according to this index Ría de Huelva is polluted whereas the Bay of Cadiz is not.info:eu-repo/semantics/publishedVersio

De humilde e ilustre cuna: retratos familiares de la España Moderna (siglos XV-XIX)

La complejidad que entraña el estudio de la Historia de la Familia hace que esta línea de investigación se postule como un espacio todavía abierto y cambiante, que se encuentra en continua revisión, lo cual demuestra que el análisis e interpretación de los núcleos familiares en la historiografía del sur de Europa no está cerrado. Por ello, el objetivo que marcamos con la presente obra colectiva es aportar datos para la reflexión, a través de los cuales pretendemos proyectar dicha problemática en el espacio geográfico comprendido entre el Atlántico y el Mediterráneo. Para alcanzar este propósito en la larga duración, el libro reúneuna decena de trabajos deinvestigadores pertenecientes a nueve universidades españolas,a través de los cuales se amplían teorías y se consolidan ideas entorno alciclo de vida, las estrategias matrimoniales y los modelos de reproducción social desarrollados en el seno de la sociedad del Antiguo Régimen en la Península Ibérica, englobando los siglos XV-XIX

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research