Using capstone approach to develop a curriculum in healty ageing: SIENHA Project

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SIENHA Project - Strategic and Innovative European Network for Education in Healthy Aging: project update

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Promoção de competências para o envelhecimento saudável: projeto SIENHA

Introdução: Face aos desafios sociais e de saúde de uma população em envelhecimento, é necessário a atualização das políticas sociais e de saúde na Europa (WHO, 2020; Rudnicka, 2020). O paradigma do Envelhecimento Saudável (HA) sublinha a necessidade de inovação nos sectores educativo, de saúde e social e a devida formação dos profissionais implicados. Objectivos: O projecto Strategic Innovative Educational Network for Healthy Ageing (SIENHA) - www.sienha.eu, visa desenvolver educação a nível superior e o desenvolvimento de competências em estudantes e profissionais dos sectores de saúde e social na Europa. Este projeto envolveu uma cooperação académica multilateral ao longo de 36 meses entre sete Instituições de Ensino Superior (IES) europeias, e foi financiado pelo programa ERASMUS+. Material e Métodos: Foram estabelecidos quatro principais resultados intelectuais: 1) Identificação de um quadro de competências profissionais em HA; 2) Desenvolvimento de um currículo de ensino superior; 3) Criação de um kit de ferramentas para inovação e investigação em HA; e 4) Produção de uma ferramenta de disseminação, um Manual em Envelhecimento Saudável. Com base numa revisão exploratória, foram estabelecidas listas de competências fundamentais e desenvolvido as estratégias de avaliação e o programa de estudos. Foi também elaborado um kit de ferramentas com vista à aplicação de investigação de implementação e estratégias pedagógicas inovadoras. Resultados: O projeto culminou na identificação de competências relevantes, na conceção de um kit de ferramentas baseado nas melhores práticas e na criação de um currículo educacional centrado no envelhecimento saudável ao longo da vida. Este currículo foi concebido para melhor preparar os profissionais de saúde e sociais, incluindo fisioterapeutas, promovendo a saúde e bem-estar ao longo da vida. Conclusões: O projeto SIENHA proporciona uma abordagem integrada e estratégica para enfrentar os desafios do envelhecimento saudável na Europa, trazendo inovações na formação e prática profissional. Esta colaboração pode representar um avanço significativo para a melhoria da formação e preparação de profissionais nos sectores de saúde e social na Europa.N/

Projeto SIENHA – Rede europeia estratégica e inovadora para a educação no envelhecimento saudável

info:eu-repo/semantics/publishedVersio

Low test-retest reliability of a protocol for assessing somatosensory cortex excitability generated from sensory nerves of the lower back.

In people with chronic low back pain (CLBP), maladaptive structural and functional changes on a cortical level have been identified. On a functional level, somatosensory cortical excitability has been shown to be reduced in chronic pain conditions, resulting in cortical disinhibition. The occurrence of structural and/or functional maladaptive cortical changes in people with CLBP could play a role in maintaining the pain. There is currently no measurement protocol for cortical excitability that employs stimulation directly to the lower back. We developed a protocol for the measurement of single pulse somatosensory evoked potential (SEP) waveforms and paired-pulse behavior (PPB) generated from sensory nerves of the lower back and quantified its test–retest reliability in a sample of 30 healthy individuals to gain insights into the normal variability of cortical responses, which could then be compared to results from people with CLBP. We investigated cortical excitability by measuring SEPs and PPB. PPB was defined as the ratio of the amplitude of the second cortical response (A2s) divided by the first cortical response (A1). A2s was determined by subtracting the response to single-pulse stimuli from the paired pulse stimuli response to account for linear superposition effects. The test–retest reliability of the protocol was very poor with no evidence of systematic bias but a high amount of random variability between sessions. There was no significant difference in the right side PPB for session 1 (Mean ratio A2s/A1 = 0.66, SD = 0.54) and session 2 (Mean ratio A2s/A1 = 0.94, SD = 1.56); mean session difference [(95% CI) = −0.44 (−1.23 to 0.34); t (22) = −1.17, p = 0.26]. The ICC(3).(1) (absolute agreement) for the outlier-removed right side PPB were 0.19 (95% CI: −0.84 to 0.66) and 0.43 for left side PPB (95% CI: −0.37 to 0.76). This finding potentially has wider implications for PPB protocols. If these findings were replicated in other groups and other nerves, it would question the validity of this measure more generally. However, these findings are restricted to healthy people and sensory nerves of the lower back and may not be generalizable

Incidences of Infectious Events in a Renal Transplant Cohort of the German Center of Infectious Diseases (DZIF)

Background Infectious complications are a major cause of morbidity and mortality after kidney transplantation. Methods In this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections. Results Of 804 renal transplant recipients (65.2% male, 51 +/- 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first 3 months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9% [281/972]) and fungal (4.7% [46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was the most frequently isolated bacterium (20.9%), followed by E. coli (17.6%) and Klebsiella (12.5%). E. coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least 1 infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281 [49.8%]), and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was the most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis, were rare. Conclusions Renal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups, and resistant bacteria were identified in 10% of recipients

Non-Invasive Ventilation as a Therapy Option for Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Acute Cardiopulmonary Oedema in Emergency Medical Services

In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course