Intensidad de Cuidados Durante las Estancias Hospitalarias Inapropiadas: Project Research in Nursing y Appropriateness Evaluation Protocol

ReseumenObjetivoDeterminar la proporción de las estancias inapropiadas y la tipología e intensidad de cuidados de enfermería en las mismas, en determinados grupos de diagnósticos relacionados (GDR).MétodosEn una cohorte de pacientes ingresados entre los meses de febrero a julio del año 1997, se estudió la intensidad de cuidados de enfermería y la adecuación del penúltimo día de estancia. La población de estudio fueron 494 pacientes ingresados en el Consorci de l'Hospital de la Creu Roja de l'Hospitalet de Llobregat, que al alta se clasificaron en uno de los 10 GDR más frecuentes. La información utilizada se obtuvo a partir de la historia clínica y de las hojas de registro del sistema PRN. Se evaluaron variables datos sociodemográficos del paciente, actividades de cuidados de enfermería y la adecuación del uso de la hospitalización con el AEP, el día anterior al alta. Para la comparación de las estancias inapropiadas con las apropiadas, se realizó un análisis de ji cuadrado para la comparación de variables categóricas y la t de Student para las continuas. Mediante un modelo de regresión logística se estudiaron los factores asociados de forma independiente con la inadecuación de la estancia.ResultadosDe los 417 procesos válidos, en 269 (64,5%) se consideró la estancia apropiada y en 148 (35,5%) inapropiada. La edad media de las estancias inapropiadas fue significativamente superior a las estancias apropiadas (70,06 ± 13,84 vs 61,57 ± 15,07, p < 0,05). La intensidad de cuidados para las estancias inapropiadas fue mayor que en las apropiadas (mediana 137 (valor mínimo 45, valor máximo 355) vs mediana 95 (valor mínimo 35, valor máximo 1310) p < 0,001). Las estancias inapropiadas presentaron un tiempo de cuidar significativamente mayor que las estancias apropiadas, en las actividades de movilización, eliminación e higiene. En un modelo de regresión logística, la edad, la intensidad de cuidados en la alimentación, en los tratamientos y el GDR asignado a cada proceso, fueron factores predictivos independientes de estancia inapropiada. La aplicación del AEP se pudo hacer en el 56,9% de los procesos con las hojas de registro del PRN y el 43,1% se revisaron mediante la historia clínica.ConclusionesEn los GDR estudiados, los pacientes que presentan estancias inapropiadas, consumen una mayor intensidad de cuidados básicos de enfermería, por lo que serían candidatos de recibir una asistencia a domicilio y/o sociosanitaria. Las hojas de registro del PRN permiten disminuir el tiempo de revisión al aplicar el AEP.AbstractsObjectiveTo determine the proportion of inappropriate hospital stays, their typology and the level of nursing care in Diagnosis Related Groups(DRG). To evaluate the use of the PRN (Project Research in Nursing)register forms, when determining AEP (Appropriateness Evaluation Protocol).MethodA cross-sectional study was performed on 494 patients classified with one of the 10 more frequent DRG in the hospital from February to July 1997. Information from patient clinical histories, PRN register forms, sociodemographic data, and nursing care activities were used. The appropriateness of hospital stay to AEP was assessed on the day prior to discharge. Comparison of inappropriate stays with appropriate stays was performed by chi-square test for categorical variables and Student t-test for continuous variables. The independent associated factors with inappropriateness of hospital stay, were estimated using a log regression model.ResultsOut of 417 valid cases, hospital stay was considered appropriate in 269 (64.5%) patients and inappropriate in 148 (35.5%) patients. Mean-age of inappropriate stays was significantly higher than that of appropriate stays (70.06±13.84 vs 61.57 ± 15.07, p < 0.05). Care intensity for inappropriate stays was larger than that of appropriate stays (median 137 [minimal value 45, maximal value 355] vs median 95 [minimal value 35, maximal value 131] p < 0.001). Care time in mobilization, elimination and hygiene activities was longer in inappropriate stays than in appropriate stays. In a log regression model, the age, feeding care intensity, therapy care intensity and DRG assigned to each process were independent predictive factors of inappropriate stays. For application of AEP, 56.9% of cases were reviewed using PRN register forms and 43.1% were reviewed using the case history.ConclusionsFrom the DRG examined, patients who undertook inappropriate stays consumed a large intensity of nursing basic activities; therefore, they may be candidates for receiving home care and/or sociosanitary care. PRN register forms afforded a decreased review time on applying the AEP

Morpho-environmental characterization of the genus Baldellia Parl. (Alismataceae) in the Iberian Peninsula, Balearic islands and North Morocco

The genus Baldellia Parl. has always been a complex taxon. Three species and three subspecies have been proposed for the Iberian Peninsula. The morphological variation of this genus in the Iberian Peninsula, Balearic islands and northern Morocco, and its thermo-pluviometric and altitudinal correlation are the focus of this contribution. Twenty-eight morphological variables were examined and subjected to a multivariate statistical analysis. The three morphotypes observed (Form 1, which includes B. ranunculoides subsp. repens and B. alpestris; Form 2, which includes B. ranunculoides and Form 3 for the new combination B. ranunculoides subsp. ranunculoides var. tangerina (Pau) J. Rocha, A. Crespi, M. Garcia-Barriuso, R. Almeida, J. Honrado, comb. nova proposed here for the first time) seem to represent different reproductive strategies. Morphological variables related with the presence or absence of stolons and the architecture of the inflorescence; the size and number of fruits are the most discriminating variables. Form 1 represents the asexual morphotype; Forms 2 and 3 correspond to morphotypes for which sexual reproduction is preferential. The environmental approach revealed that the asexual form (Form 1) grows in temperate, in more humid conditions, and within a broad altitudinal range. In contrast, the two sexual forms are more common in warmer and drier conditions, and occur over a narrower interval of altitudes

Disnea progresiva en varón de 47 años

We report the case of a 47 year old male whose cardinal symptom was progressive dyspnea. We describe the diag- nostic process highlighting the usefulness of pulmonary and cardiac ultrasound. We stress the importance in this patient to take into account their personal history (Hodgkin’s lymphoma treated more than 10 years earlier) and the finding of a left bundle branch block in the electrocardiogram.Presentamos el caso de un varón de 47 años cuyo síntoma cardinal era la disnea progresiva. Describimos su proceso diagnóstico destacando la utilidad de la ecografía pulmonar y cardíaca. Resaltamos la importancia en este enfermo de tener en cuenta sus antecedentes (linfoma de Hodgkin tratado hacía más de 10 años) y el hallazgo de un bloqueo de rama izquierda en el electrocardiograma

The Earth Observation Data for Habitat Monitoring (EODHaM) system

To support decisions relating to the use and conservation of protected areas and surrounds, the EU-funded BIOdiversity multi-SOurce monitoring System: from Space TO Species (BIO_SOS) project has developed the Earth Observation Data for HAbitat Monitoring (EODHaM) system for consistent mapping and monitoring of biodiversity. The EODHaM approach has adopted the Food and Agriculture Organization Land Cover Classification System (LCCS) taxonomy and translates mapped classes to General Habitat Categories (GHCs) from which Annex I habitats (EU Habitats Directive) can be defined. The EODHaM system uses a combination of pixel and object-based procedures. The 1st and 2nd stages use earth observation (EO) data alone with expert knowledge to generate classes according to the LCCS taxonomy (Levels 1 to 3 and beyond). The 3rd stage translates the final LCCS classes into GHCs from which Annex I habitat type maps are derived. An additional module quantifies changes in the LCCS classes and their components, indices derived from earth observation, object sizes and dimensions and the translated habitat maps (i.e., GHCs or Annex I). Examples are provided of the application of EODHaM system elements to protected sites and their surrounds in Italy, Wales (UK), the Netherlands, Greece, Portugal and India

GrassPlot v. 2.00 – first update on the database of multi-scale plant diversity in Palaearctic grasslands

Abstract: GrassPlot is a collaborative vegetation-plot database organised by the Eurasian Dry Grassland Group (EDGG) and listed in the Global Index of Vegetation-Plot Databases (GIVD ID EU-00-003). Following a previous Long Database Report (Dengler et al. 2018, Phyto- coenologia 48, 331–347), we provide here the first update on content and functionality of GrassPlot. The current version (GrassPlot v. 2.00) contains a total of 190,673 plots of different grain sizes across 28,171 independent plots, with 4,654 nested-plot series including at least four grain sizes. The database has improved its content as well as its functionality, including addition and harmonization of header data (land use, information on nestedness, structure and ecology) and preparation of species composition data. Currently, GrassPlot data are intensively used for broad-scale analyses of different aspects of alpha and beta diversity in grassland ecosystems

Lympho-vascular invasion in BRCA related breast cancer compared to sporadic controls

<p>Abstract</p> <p>Background</p> <p>Germline mutations in the BRCA1 gene predispose to the development of breast cancer, exhibiting a specific histological phenotype. Identification of possible hallmarks of these tumors is important for selecting patients for genetic screening and provides inside in carcinogenetic pathways.</p> <p>Since BRCA1-associated breast cancers have pushing borders that prevent them from easily reaching vessels and are often of the medullary (like) type that is known to have a low rate of lympho-vascular invasion (LVI), we hypothesized that absence of LVI could characterize BRCA1 related breast cancer.</p> <p>Methods</p> <p>A population of 68 BRCA1 related invasive breast cancers was evaluated for LVI by an experienced breast pathologist blinded to mutation status, and compared to a control group matched for age, grade and tumor type.</p> <p>Results</p> <p>LVI was present in 25.0% of BRCA1 related cases, compared to 20.6% of controls (P = 0.54, OR = 1.29, CI 0.58-2.78).</p> <p>Conclusion</p> <p>LVI is frequent in BRCA1 germline mutation related breast cancers, but seems to occur as often in sporadic controls matched for age, grade and tumor type. Apparently, these hereditary cancers find their way to the blood and lymph vessels despite their well demarcation and often medullary differentiation.</p

Selecting for BRCA1 testing using a combination of homogeneous selection criteria and immunohistochemical characteristics of breast cancers

<p>Abstract</p> <p>Background</p> <p>BRCA1 gene-related tumours are more frequently estrogen receptor (ER) and progesterone receptor (PR) negative with a lower prevalence of human epidermal growth factor receptor 2 (HER2) overexpression or amplification. We evaluated the effectiveness of a combination of homogeneously selected criteria and immunohistochemical (IHC) characteristics of Familial Breast Cancers (FBCs) in detecting BRCA1 mutation carriers.</p> <p>Methods</p> <p>Primary breast tumours from 93 FBC patients defined by specific eligibility criteria, based on personal and familial tumour history, were evaluated by Allred's method. The BRCA1 molecular analysis, including Multiplex Ligation-dependent Probe Amplification (MLPA), was considered as the gold standard assay.</p> <p>Results</p> <p>A total of 10 BRCA1 pathogenetic mutations was found. With the exclusion of the tumours characterized by double positive receptorial status and/or strong HER2 positivity (3+), we identified 22 patients, 10 of whom resulted as BRCA1 mutation carriers. The sensitivity, specificity, positive and negative predictive values were 100%, 83.3%, 45.4% and 100% respectively.</p> <p>Conclusion</p> <p>Our findings suggest that the IHC analysis by Allred's method improves our ability to select patients for BRCA1 testing.</p

Expression of the stem cell marker ALDH1 in BRCA1 related breast cancer

Introduction The BRCA1 protein makes mammary stem cells differentiate into mature luminal and myoepithelial cells. If a BRCA1 mutation results in a differentiation block, an enlarged stem cell component might be present in the benign tissue of BRCA1 mutation carriers, and these mammary stem cells could be the origin of BRCA1 related breast cancer. Since ALDH1 is a marker of both mammary stem cells and breast cancer stem cells, we compared ALDH1 expression in malignant tissue of BRCA1 mutation carriers to non-carriers. Methods Forty-one BRCA1 related breast cancers and 41 age-matched sporadic breast cancers were immunohistochemically stained for ALDH1. Expression in epithelium and stroma was scored and compared. Results Epithelial (P=0.001) and peritumoral (P=0.001) ALDH1 expression was significantly higher in invasive BRCA1 related carcinomas compared to sporadic carcinomas. Intratumoral stromal ALDH1 expression was similarly high in both groups. ALDH1 tumor cell expression was an independent predictor of BRCA1 mutation status. Conclusion BRCA1 related breast cancers showed significantly more frequent epithelial ALDH1 expression, indicating that these hereditary tumors have an enlarged cancer stem cell component. Besides, (peritumoral) stromal ALDH1 expression was also more frequent in BRCA1 mutation carriers. ALDH1 may therefore be a diagnostic marker and a therapeutic target of BRCA1 related breast cancer

Epigenetic silencing and deletion of the BRCA1 gene in sporadic breast cancer

INTRODUCTION: BRCA1 or BRCA2 germline mutations increase the risk of developing breast cancer. Tumour cells from germline mutation carriers have frequently lost the wild-type allele. This is predicted to result in genomic instability where cell survival depends upon dysfunctional checkpoint mechanisms. Tumorigenic potential could then be acquired through further genomic alterations. Surprisingly, somatic BRCA mutations are not found in sporadic breast tumours. BRCA1 methylation has been shown to occur in sporadic breast tumours and to be associated with reduced gene expression. We examined the frequency of BRCA1 methylation in 143 primary sporadic breast tumours along with BRCA1 copy number alterations and tumour phenotype. METHODS: Primary sporadic breast tumours were analysed for BRCA1α promoter methylation by methylation specific PCR and for allelic imbalance (AI) at BRCA1 and BRCA2 loci by microsatellite analysis and TP53 (also known as p53) mutations by constant denaturing gel electrophoresis. The BRCA1 methylated tumours were analysed for BRCA1 copy alterations by fluorescence in situ hybridisation and BRCA1 expression by immunostaining. RESULTS: BRCA1 methylation was found in 13/143 (9.1%) sporadic breast tumours. The BRCA1 methylated tumours were significantly associated with estrogen receptor (ER) negativity (P = 0.0475) and displayed a trend for BRCA1 AI (P = 0.0731) as well as young-age at diagnosis (≤ 55; P = 0.0898). BRCA1 methylation was not associated with BRCA2 AI (P = 0.5420), although a significant association was found between BRCA1 AI and BRCA2 AI (P < 0.0001). Absent/markedly reduced BRCA1 expression was observed in 9/13 BRCA1 methylated tumours, most of which had BRCA1 deletion. An elevated TP53 mutation frequency was found among BRCA1 methylated tumours (38.5%) compared with non-methylated tumours (17.2%). The BRCA1 methylated tumours were mainly of tumour grade 3 (7/13) and infiltrating ductal type (12/13). Only one methylated tumour was of grade 1. CONCLUSION: BRCA1 methylation is frequent in primary sporadic breast tumours. We found an indication for BRCA1 methylation to be associated with AI at the BRCA1 locus. Almost all BRCA1 methylated tumours with absent/markedly reduced BRCA1 expression (8/9) displayed BRCA1 deletion. Thus, epigenetic silencing and deletion of the BRCA1 gene might serve as Knudson's two 'hits' in sporadic breast tumorigenesis. We observed phenotypic similarities between BRCA1 methylated and familial BRCA1 tumours, based on BRCA1 deletion, TP53 mutations, ER status, young age at diagnosis and tumour grade