Getting the right patient on the right renal replacement therapy

[Abstract] Adequate selection of the modality of renal replacement therapy (RRT), ideally based on well-planned predialysis care, informed decision by the patient and timely initiation of dialysis, is essential to optimize the outcome of patients with chronic kidney disease. However, there are important practical limitations to the success of this process. A major consequence is the underutilization of home-based dialysis therapies, including peritoneal dialysis (PD). A wide array of medical and social factors have been invoked as contraindications to PD, but well-designed studies have shown that most patients (probably >70%) starting dialysis are suitable for this technique. PD is feasible and may be preferred by a significant proportion of patients in many claimed unfavorable settings. The practicing nephrologist should be able to: disclose which are insurmountable barriers to PD, clarify the significance of relative contraindications in individual cases, and identify favorable and unfavorable settings for home dialysis. These abilities will permit quality education, justified advice, well-targeted informed decision and, predictably, successful selection of the modality of RRT. This article provides some clues to approach these issues in three different settings: planned start of RRT after predialysis care, unplanned start of dialysis and programmed changes of modality during follow-up

La calidad de los medios y el uso de fuentes periodísticas. Una evolución del VAP

Las fuentes de información usadas por los periodistas son uno de los principales indicadores de la calidad de los textos informativos. La mayoría de los estudios que se han realizado sobre calidad periodística apuntan en alguno de sus apartados más relevantes al uso que los medios hacen de las fuentes informativas. No sería osado, pues, afirmar que a fecha de hoy es un lugar común que el uso que se hace de las mismas es escaso y parcial y aunque hay estudios que así lo confirman, ninguno se ha centrado en la información de proximidad. Las investigaciones desarrolladas aplicando el método del Valor Agregado Periodístico (VAP) apuntan el gran peso que las fuentes tienen en la medición de los criterios de calidad periodística y han alcanzado conclusiones como que en general el número de las mismas es insuficiente, así, como su diversidad e independencia, escasa. Que los medios delegan en las fuentes la selección de los temas sobre los que informan, lo que supone una clara pérdida de autonomía. Además de que se produce un uso abusivo de fuentes personales e institucionales, en detrimento de las documentales. No obstante, entendemos que no se llega a perfilar o definir las distingas categorizaciones posibles que para un completo estudio de fuentes son precisas. Por todo ello, pretendemos, partiendo de esta investigación previa de revisión completa de esta metodología, avanzar en la definición de una ficha de análisis que permita evaluar la calidad de las fuentes utilizadas por los periodistas, para de este modo poder medir la calidad de los textos informativos en función del uso que hacen los profesionales de las mismas. En los momentos actuales, cuando el sello de la calidad se está convirtiendo en la tabla de salvación del periodismo, resulta más que oportuno, imprescindible, diagnosticar los valores informativos en función de las fuentes; y hacer propuestas de mejora

The Value of Music Therapy in the Expression of Emotions in Children with Cancer

Background. Children with cancer are subjected to aggressive tests and treatments that can affect their emotional states. Studies available in the academic literature analyse the effect of music therapy on the emotions of these patients are scarce. Objectives. The objective of this study was to explore and transform the emotional responses that may arise with the application of music therapy (MT) in children with oncological pathology. Methods. The methodology of this study was based on the participatory action research approach. Semistructured interviews were conducted with 27 children with cancer who participated in 65MT sessions. Interviews were also conducted with their families. Results. We conducted a thematic analysis using MAXQDA software. Three main categories emerged from this process as follows: (1) expression: children with cancer stated that MT made it easier for them to express their emotions, with indirect benefits to families; (2) participation: patients showed interest in the sessions; and (3) experiences: MT was valued and created a positive environment. The results of this research demonstrate the positive transformative power MT had on children with cancer in terms of their emotions. Conclusions. Positive results were achieved through MT that encouraged the expression of emotions by children with cancer and favoured and improved their moods. In addition, it also encouraged social interactions in the hospital and helped the children to better cope with their illness through self-awareness. Their families also benefited. Therefore, we encourage healthcare professionals to support the use of MT in paediatric oncology settings

Effect of low-GDP bicarbonate–lactate-buffered peritoneal dialysis solutions on plasma levels of adipokines and gut appetite-regulatory peptides: a randomized crossover study

This is a pre-cpyedited, author-produced version of an article accepted for publication in "Nephrology Dialysis Transplantation" following peer review. The version of record is avaliable online at Oxford Academic web page.Instituto de Salud Carlos III; PI051024Instituto de Salud Carlos III; PI070413Red de Grupos RGTO; G03/028Red de Grupos RGTO; PI050983Xunta de Galicia; PS07/12Xunta de Galicia; PGIDT05PXIC91605PNXunta de Galicia; INCITE08ENA916110E

Does prior abdominal surgery influence peritoneal transport characteristics or technique survival of peritoneal dialysis patients?

[Abstract] Introduction: Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated. Methods: Following an observational, retrospective design, we studied 171 incident PD patients, with the main objective of analyzing the influence of prior abdominal surgical procedures (main study variable) on baseline and evolutionary peritoneal transport characteristics (main outcome) and PD patient and technique survival (secondary outcomes). Abdominal surgeries were categorized according to the degree of presumed injury to the peritoneal membrane. We also considered the additive effect of aggressions to the membrane during the first year on PD therapy. Results: All patients had a baseline peritoneal equilibration test with complete drainage at 60′, and 113 patients had a second study at the end of the first year. Sixty-one patients (35.7%) had a record of prior abdominal surgery, including 29 patients with at least one major intraperitoneal surgery, 22 having undergone minor intraperitoneal procedures, and 21 with a background of major abdominopelvic extraperitoneal surgery. We did not observe differences, at baseline or after 1 year, among patients with or without previous abdominal procedures regarding small solute transport, overall capacity of ultrafiltration, free water transport, small pore ultrafiltration, or peritoneal protein excretion. Stratified analysis, considering prior and first-year-on-PD peritoneal aggressions, did not reveal any differences, although in this case our analysis was hampered by a limited statistical power. Abdominal surgical events did not influence patient or PD technique survival. Conclusion: Prior abdominal surgical procedures do not appear to compromise peritoneal membrane function or technique survival in patients successfully started on PD

Detection of the most influential variables for preventing postpartum urinary incontinence using machine learning techniques

Background: Postpartum urinary incontinence (PUI) is a common issue among postnatal women. Previous studies identified potential related variables, but lacked analysis on certain intrinsic and extrinsic patient variables during pregnancy. Objective: The study aims to evaluate the most influential variables in PUI using machine learning, focusing on intrinsic, extrinsic, and combined variable groups. Methods: Data from 93 pregnant women were analyzed using machine learning and oversampling techniques. Four key variables were predicted: occurrence, frequency, intensity of urinary incontinence, and stress urinary incontinence. Results: Models using extrinsic variables were most accurate, with 70% accuracy for urinary incontinence, 77% for frequency, 71% for intensity, and 93% for stress urinary incontinence. Conclusions: The study highlights extrinsic variables as significant predictors of PUI issues. This suggests that PUI prevention might be achievable through healthy habits during pregnancy, although further research is needed for confirmation

Proyecto de actuación sobre el fondo fotográfico del Museo Arqueológico Provincial de Sevilla

Actas de las Segundas Jornadas Imagen, Cultura y Tecnología celebradas entre el 1 y el 3 de julio de 2003 en la Universidad Carlos III de MadridPublicad

The role of affect in the development of entrepreneurial intentions

Producción CientíficaAdvances on the study of entrepreneurial intention among students from universities motivate to further investigate the factors behind this intention. In this paper, we focus on the effect of affective traits (positive and negative) on the entrepreneurial intention antecedents proposed by Ajzen’s theory of planned behavior drawing on the arguments of affect priming. Using a sample of 597 students from Spain, we use structural equation model to test our hypotheses. Our results show that positive affective traits have a positive impact on the attitude toward entrepreneurship (ATE), perceived behavioral control of entrepreneurship (PBC), and social norms toward entrepreneurship (SN). Negative affective traits negatively influence ATE and SN, but not PBC. In addition, using a K-means clustering analysis and an analysis of variance, our study further explores how different affective personalities relate to a particular level of entrepreneurial intention. Our results contribute to understand of the psychological processes that influence entrepreneurial intention. Overall, our research contributes to the literature on affect and entrepreneurial cognition by evaluating the interaction of affect and the cognitive antecedents of entrepreneurial intention

Decreased incidence of pressure ulcers in intensive care: a program goal of improving care

INTRODUCCIÓN. En sanidad, la aparición de úlceras por presión (upp), es considerado un fracaso asistencial y un gran reto al que se enfrenta el profesional de Enfermería. En cuidados intensivos, objetivamos una serie de factores que aumentan el riesgo de aparición y desarrollo de upp. Como enfermeros, tomamos conciencia de nuestro papel en la prevención y tratamiento de las upp en nuestra unidad de cuidados intensivos (UCI-1, Hospital Universitario Central de Asturias) y emprendimos medidas para disminuirlas y mejorar la calidad asistencial proporcionada. OBJETIVOS. Aumentar la calidad asistencial Disminuir las tasas de úlceras por presión MATERIAL Y MÉTODO. Estudio descriptivo, prospectivo. Muestra, N: 1265 enfermos. Realizándose seguimiento diario de enfermos a través de hoja de valoración específica. Los enfermos valorados presentaban riesgo medio- alto de padecer upp por escala Braden y riesgo bajo por dicha escala pero con condiciones particulares de riesgo objetivables. Se introducen medidas preventivas consensuadas por el equipo investigador (descritas en el trabajo de investigación). RESULTADOS. Bajada significativa de las tasas de incidencia a los cuatro meses de introducir medidas estandarizadas de prevención y mejora asistencial. CONCLUSIONES. La concienciación y unificación de criterios preventivos y de tratamiento resultó ser decisiva en la bajada significativa de la incidencia de upp y en el logro de aumento de la calidad asistencial real percibida por todo el equipo interdisciplinar.INTRODUCTION. In health, the occurrence of pressure ulcers (PU) is considered a failure of care and major challenge facing the nursing professional. In intensive care, objectify a series of factors that increase the risk of occurrence and development of PU. As nurses, we realize our role in the prevention and treatment of pressure ulcers in our intensive care unit (ICU-1, Hospital Universitario Central de Asturias) and we took measures to reduce and improve quality of care provided. OBJECTIVES. To augment quality of care To diminish rates of pressure ulcers MATERIALS AND METHODS. Prospective descriptive study. Sample, n = 1265 patients. Performing daily monitoring of patients through specific assessment sheet. The patients had rated medium-high risk of developing upp by Braden scale and low risk for this scale but with risk conditions to measure. Agreed preventive measures are introduced by the research team (described in the research). RESULTS. Llower incidence rates for four months to introduce standardized measures of prevention and improved care. CONCLUSIONS. The unification of awareness and prevention and treatment criteria proved to be instrumental in the significant decline in the incidence of PU and the achievement of increased quality of care received by all real interdisciplinary team

Expanding the Clinical and Molecular Heterogeneity of Nonsyndromic Inherited Retinal Dystrophies

A cohort of 172 patients diagnosed clinically with nonsyndromic retinal dystrophies, from 110 families underwent full ophthalmologic examination, including retinal imaging, electrophysiology, and optical coherence tomography, when feasible. Molecular analysis was performed using targeted next-generation sequencing (NGS). Variants were filtered and prioritized according to the minimum allele frequency, and finally classified according to the American College of Medical Genetics and Genomics guidelines. Multiplex ligation-dependent probe amplification and array comparative genomic hybridization were performed to validate copy number variations identified by NGS. The diagnostic yield of this study was 62% of studied families. Thirty novel mutations were identified. The study found phenotypic intra- and interfamilial variability in families with mutations in C1QTNF5, CERKL, and PROM1; biallelic mutations in PDE6B in a unilateral retinitis pigmentosa patient; interocular asymmetry RP in 50% of the symptomatic RPGR-mutated females; the first case with possible digenism between CNGA1 and CNGB1; and a ROM1 duplication in two unrelated retinitis pigmentosa families. Ten unrelated cases were reclassified. This study highlights the clinical utility of targeted NGS for nonsyndromic inherited retinal dystrophy cases and the importance of full ophthalmologic examination, which allows new genotypeephenotype associations and expands the knowledge of this group of disorders. Identifying the cause of disease is essential to improve patient management, provide accurate genetic counseling, and take advantage of gene therapyebased treatments. (J Mol Diagn 2020, 22: 532e543; https:// doi.org/10.1016/j.jmoldx.2020.01.003)Supported by grants from the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health, including the Center for Biomedical Research Network on Rare Diseases (CIBERER), Fondo de Investigacion Sanitaria grant PI16/00539; the Spanish National Organization for the Blind (Fundación ONCE); and Fundación Mutua Madrileña. G.G.-G. is sponsored by the CIBERER, and A.R.-M. is supported by the Río Hortega program from ISCIII.Medicin