HISTORIA CLÍNICA INFORMATIZADA DE ENFERMERÍA EN EL DEPARTAMENTO DE TORREVIEJA SALUD COMO INSTRUMENTO DE GESTIÓN DE CALIDAD

In the information society of the 21st century, it is a fact that the Electronic Clinical History (ECH) is not developed in every country. In Torrevieja Salud Health Department, Alicante (Spain), they work with a unique ECH that includes all divisions, including the nursing ones and an advanced operability level in regards to data management.    Objectives: 1.- To develop all the information sources to facilitate the communication at all levels of care, so any professional in the community or at the hospital can retrieve information about the patient. 2.- To gather the nursing staff and computer technicians knowledge by working together. Methodology: In order to improve the nursing records, they have used a computer program named “FLORENCE”, which is a model of a unique clinical history for the Health Department of Torrevieja. Florence is divided in two environments: Florence Gestión (accountant,-financial, and HH RR scopes) and FLORENCE (clinical assitance scope). This program comes as the result of the teamwork from IT and nursing staff who are knowledgeable of the concerns of the professionals. A product with double value because it combines the nursing methodology and state-of-art technological advances. Conclusions:  Nursing records are valued as an effective instrument to empower the continuation of nursing care and coordinate that care at the best quality, as they are registered in a unique and single program. On the other hand, it ensures constant availability of all the information of the health-disease episodes of a patient, and most importantly, the information is kept confidential.  En la sociedad de la información del siglo XXI, la historia clínica electrónica (HCE) es un hecho que no está por igual desarrollado en todos los países. En el Departamento de Salud de Torrevieja, Alicante, se trabaja con un modelo de HCE único que engloba a todas las áreas incluida  enfermería y en un nivel avanzado de operabilidad en cuanto a manejo de datos.   Objetivos: 1.- Desarrollo de los sistemas de información con el fin de facilitar la comunicación e intercambio de datos entre los distintos profesionales de atención especializada y primaria que componen el Departamento de Salud. 2.- Aunar y optimizar los conocimientos propios  de los profesionales enfermeros e informáticos, a través del trabajo en conjunto.   Metodología: Para llevar a cabo esta mejora en los registros  de enfermería se ha utilizado la aplicación informática, “Florence”, modelo de Historia Clinica Electrónica única y global para el Departamento de Salud de Torrevieja que consta de dos entornos: Florence Gestión (área financiera- contable y  área de recursos humanos) y Florence clínico (área clínico-asistencial).   A través del trabajo en equipo de Informáticos y profesionales de enfermería que conocen el sistema e inquietudes de los profesionales se obtiene un producto doblemente valorado en cuanto a metodología enfermera y suma de los últimos conocimientos tecnológicos. Conclusiones:  Los registros de enfermería se consideran un instrumento efectivo para reflejar toda la información necesaria para poder coordinar y proporcionar unos cuidados de enfermería de máxima calidad al estar almacenados de forma integral. Por otro lado se asegura la disponibilidad de toda la información de los procesos salud-enfermedad de un individuo, asegurando la confidencialidad.

Educational psychology in latin america: with linear hierarchical models

Research in clinical psychology, since its inception, has been aimed at analyzing, predicting and explaining the effect of treatments, by studying the change of patients in the course of them. To study the effects of therapy, research based on quantitative analysis models has historically used classical methods of parametric statistics, such as Pearson correlations, least squares regressions Student’s T-Tests and Variance Analysis (ANOVA). Hierarchical linear models (HLMs) represent a fundamental statistical strategy for research in psychotherapy, as they allow to overcome dependence on the observations usually presented in your data. The objective of this work is to present a guide to understanding, applying and reporting HLMs to study the effects of psychotherapy

Charged particle-like branes in ABJM

We study the effect of adding lower dimensional brane charges to the 't Hooft monopole, di-baryon and baryon vertex configurations in $AdS_4 \times \mathbb{P}^3$. We show that these configurations capture the background fluxes in a way that depends on the induced charges, and therefore, require additional fundamental strings in order to cancel the worldvolume tadpoles. The study of the dynamics reveals that the charges must lie inside some interval in order to find well defined configurations, a situation familiar from the baryon vertex in $AdS_5 \times S^5$ with charges. For the baryon vertex and the di-baryon the number of fundamental strings must also lie inside an allowed interval. Our configurations are sensitive to the flat $B$-field recently suggested in the literature. We make some comments on its possible role. We also discuss how these configurations are modified in the presence of a non-zero Romans mass.Comment: 31 pages, 14 figures, discussion of charges improved, published versio

Mitochondrial impairment increases FL-PINK1 levels by calcium-dependent gene expression.

Mutations of the PTEN-induced kinase 1 (PINK1) gene are a cause of autosomal recessive Parkinson's disease (PD). This gene encodes a mitochondrial serine/threonine kinase, which is partly localized to mitochondria, and has been shown to play a role in protecting neuronal cells from oxidative stress and cell death, perhaps related to its role in mitochondrial dynamics and mitophagy. In this study, we report that increased mitochondrial PINK1 levels observed in human neuroblastoma SH-SY5Y cells after carbonyl cyanide m-chlorophelyhydrazone (CCCP) treatment were due to de novo protein synthesis, and not just increased stabilization of full length PINK1 (FL-PINK1). PINK1 mRNA levels were significantly increased by 4-fold after 24h. FL-PINK1 protein levels at this time point were significantly higher than vehicle-treated, or cells treated with CCCP for 3h, despite mitochondrial content being decreased by 29%. We have also shown that CCCP dissipated the mitochondrial membrane potential (Δψm) and induced entry of extracellular calcium through L/N-type calcium channels. The calcium chelating agent BAPTA-AM impaired the CCCP-induced PINK1 mRNA and protein expression. Furthermore, CCCP treatment activated the transcription factor c-Fos in a calcium-dependent manner. These data indicate that PINK1 expression is significantly increased upon CCCP-induced mitophagy in a calcium-dependent manner. This increase in expression continues after peak Parkin mitochondrial translocation, suggesting a role for PINK1 in mitophagy that is downstream of ubiquitination of mitochondrial substrates. This sensitivity to intracellular calcium levels supports the hypothesis that PINK1 may also play a role in cellular calcium homeostasis and neuroprotection

Dietary regulation of VEGFb gene expression is related to its promoter DNA methylation levels

Motivación: Recientemente se ha descrito la implicación del factor de crecimiento del endotelio vascular B (VEGFb) en la absorción de los ácidos grasos (AGs) en los tejidos y su relación con el desarrollo de diferentes enfermedades metabólicas tal como la obesidad y la diabetes tipo 2. El objetivo de este estudio es investigar el efecto de la composición de los AGs de la dieta en la regulación de la expresión génica del VEGFb en los tejidos adiposos de rata, y si este efecto está relacionado mediante modificación por metilación del DNA en el promotor del VEGFb. De esta forma la modificación de la dieta puede ser una nueva estrategia para modular la acumulación patológica de los lípidos en la obesidad o en la diabetes. Métodos: A cada grupo de ratas fue asignado una de tres diferentes dietas isoenergéticas, cada una con una concentración diferente de AGs saturados, mono y poliinsaturados (dieta de aceite de coco, aceite de oliva y de girasol). Los animales fueron alimentados durante un mes. Las muestras de tejido adiposo visceral (VAT) y subcutáneo (SAT) se tomaron inmediatamente para estudios de metilación y  expresión génica. También de estos tejidos se tomaron mediciones de la composición de los AGs de los triglicéridos y la acumulación total de los tejidos adiposos. Resultados: Ni los pesos de los animales ni de los depósitos adiposos ni la acumulación lípidica del tejido cambiaban con las dietas. La composición en AGs de ambos tejidos fue significativamente diferente en función de la dieta consumida(p <0,0001 para todos los AGs estudiados). El nivel de expresión del gen VEGFb se correlaciona directamente con la acumulación de lípidos de cada tejido y con la composición de AGs del tejido. En ambos tejidos, los niveles de expresión génica del VEGFb y de metilación del promotor fueron diferentes con respecto a la dieta consumida, estando la expresión génica y los niveles de metilación del promotor del VEGFb inversamente correlacionados. Los valores más altos de expresión génica, y los más bajos de metilación del promotor, se encontraron en las ratas alimentadas con la dieta rica en aceite de coco. Conclusiones: La expresión del gen Vegfb en el tejido adiposo se asocia con el aumento en la acumulación de grasa. El estudio presentado muestra que la expresión génica del Vegfb está regulada por los AGs de la dieta, y esta regulación está relacionada con el nivel de metilación de la región promotora del Vegfb

Radiogenic backgrounds in the NEXT double beta decay experiment

Natural radioactivity represents one of the main backgrounds in the search for neutrinoless double beta decay. Within the NEXT physics program, the radioactivity- induced backgrounds are measured with the NEXT-White detector. Data from 37.9 days of low-background operations at the Laboratorio Subterráneo de Canfranc with xenon depleted in 136Xe are analyzed to derive a total background rate of (0.84±0.02) mHz above 1000 keV. The comparison of data samples with and without the use of the radon abatement system demonstrates that the contribution of airborne-Rn is negligible. A radiogenic background model is built upon the extensive radiopurity screening campaign conducted by the NEXT collaboration. A spectral fit to this model yields the specific contributions of 60Co, 40K, 214Bi and 208Tl to the total background rate, as well as their location in the detector volumes. The results are used to evaluate the impact of the radiogenic backgrounds in the double beta decay analyses, after the application of topological cuts that reduce the total rate to (0.25±0.01) mHz. Based on the best-fit background model, the NEXT-White median sensitivity to the two-neutrino double beta decay is found to be 3.5σ after 1 year of data taking. The background measurement in a Qββ±100 keV energy window validates the best-fit background model also for the neutrinoless double beta decay search with NEXT-100. Only one event is found, while the model expectation is (0.75±0.12) events. [Figure not available: see fulltext.]

Energy calibration of the NEXT-White detector with 1% resolution near Q ββ of 136Xe

Excellent energy resolution is one of the primary advantages of electroluminescent high-pressure xenon TPCs. These detectors are promising tools in searching for rare physics events, such as neutrinoless double-beta decay (ββ0ν), which require precise energy measurements. Using the NEXT-White detector, developed by the NEXT (Neutrino Experiment with a Xenon TPC) collaboration, we show for the first time that an energy resolution of 1% FWHM can be achieved at 2.6 MeV, establishing the present technology as the one with the best energy resolution of all xenon detectors for ββ0ν searches. [Figure not available: see fulltext.

Clinical experience with integrase inhibitors in HIV-2-infected individuals in Spain.

Background: HIV-2 is a neglected virus despite estimates of 1–2 million people being infected worldwide. The virus is naturally resistant to some antiretrovirals used to treat HIV-1 and therapeutic options are limited for patients with HIV-2. Methods: In this retrospective observational study, we analysed all HIV-2-infected individuals treated with inte- grase strand transfer inhibitors (INSTIs) recorded in the Spanish HIV-2 cohort. Demographics, treatment modal- ities, laboratory values, quantitative HIV-2 RNA and CD4 counts as well as drug resistance were analysed. Results: From a total of 354 HIV-2-infected patients recruited by the Spanish HIV-2 cohort as of December 2017, INSTIs had been given to 44, in 18 as first-line therapy and in 26 after failing other antiretroviral regimens. After a median follow-up of 13 months of INSTI-based therapy, undetectable viraemia for HIV-2 was achieved in 89% of treatment-naive and in 65.4% of treatment-experienced patients. In parallel, CD4 gains were 82 and 126cells/mm3, respectively. Treatment failure occurred in 15 patients, 2 being treatment-naive and 13 treatment-experienced. INSTI resistance changes were recognized in 12 patients: N155H (5), Q148H/R (3), Y143C/G (3) and R263K (1). Conclusions: Combinations based on INSTIs are effective and safe treatment options for HIV-2-infected individ- uals. However, resistance mutations to INSTIs are selected frequently in failing patients, reducing the already limited treatment options

Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial

BackgroundHypertension can be prevented by adopting healthy dietary patterns. Our aim was to assess the 4-year effect on blood pressure (BP) control of a randomized feeding trial promoting the traditional Mediterranean dietary pattern.MethodsThe PREDIMED primary prevention trial is a randomized, single-blinded, controlled trial conducted in Spanish primary healthcare centers. We recruited 7,447 men (aged 55 to 80 years) and women (aged 60 to 80 years) who had high risk for cardiovascular disease. Participants were assigned to a control group or to one of two Mediterranean diets. The control group received education on following a low-fat diet, while the groups on Mediterranean diets received nutritional education and also free foods; either extra virgin olive oil, or nuts. Trained personnel measured participants’ BP at baseline and once yearly during a 4-year follow-up. We used generalized estimating equations to assess the differences between groups during the follow-up.ResultsThe percentage of participants with controlled BP increased in all three intervention groups (P-value for within-group changes: P<0.001). Participants allocated to either of the two Mediterranean diet groups had significantly lower diastolic BP than the participants in the control group (−1.53 mmHg (95% confidence interval (CI) −2.01 to −1.04) for the Mediterranean diet supplemented with extra virgin olive oil, and −0.65 mmHg (95% CI -1.15 to −0.15) mmHg for the Mediterranean diet supplemented with nuts). No between-group differences in changes of systolic BP were seen.ConclusionsBoth the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP. However, we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group.Trial registrationCurrent Controlled Trials ISRCTN3573963