Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. METHODS: We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. RESULTS: 253 patients were included, aged 68.9+/-9.8years, FEV1 = 42.1%+/-14.2%, and a Charlson's index = 1.8+/-0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission. CONCLUSIONS: The patients' limitation to perform BADLs and their history of admissions for AECOPD were the best predictive variables for the likelihood of readmission when adjusted for many other social and clinical variables, regardless of the time period considered for such prediction

La gesti?n participativa de los recursos h?dricos en el sector minero Brasile?o.

A ?gua ? um recurso mineral de valor inestim?vel para a economia de qualquer Pa?s. A minera??o ? uma atividade que tem forte depend?ncia da ?gua em seus processos e m?todos. Visando a valoriza??o e o controle sustent?vel de uso da ?gua no territ?rio brasileiro foi estabelecida em 1997 a Lei Federal n?mero 9.433 sobre a "Pol?tica Nacional de Recursos H?dricos". Esta lei estabelece mecanismos de gest?o descentralizada e participativa visando a manuten??o da quantidade e qualidade da ?gua num contexto geral. Por este dispositivo legal foram criadas algumas ferramentas de gest?o de recursos h?dricos, de ?mbito nacional, tais como: - o Sistema Nacional de Gerenciamento de Recursos H?dricos; o Enquadramento dos Corpos de ?gua; a Outorga Pelo Direito de Uso; a Cobran?a Pelo Uso e o Sistema de Informa??es Sobre Recursos H?dricos. Este artigo apresenta os principais pontos da gest?o de recursos h?dricos relacionados ao setor mineral brasileiro e apresenta um exemplo de aplica??o real desta regulamenta??o num empreendimento mineral nacional.El agua es un recurso mineral de valor inestimable para la econom?a de cualquier pa?s. La miner?a es una actividad que tiene una fuerte dependencia del agua en sus procesos y m?todos. En vista de la valorizaci?n y del control sostenible del uso del agua en el territorio brasile?o, se estableci? en 1997 la Ley Federal n?mero 9.433 sobre la "Pol?tica Nacional de Recursos H?dricos". Esta ley establece mecanismos de gesti?n descentralizada y participativa para el mantenimiento de la cantidad y calidad del agua en un contexto general. Por este dispositivo legal se instituyeron algunas herramientas de gesti?n de recursos h?dricos, a nivel nacional, tales como: - el Sistema Nacional de Gesti?n de Recursos H?dricos; el Encuadramiento de los Cuerpos de Agua; la licencia para el Derecho de Uso; el cobro por el uso y el Sistema de Informaci?n sobre Recursos H?dricos. Este art?culo presenta los principales puntos de la gesti?n de recursos h?dricos relacionados al sector minero brasile?o y presenta un ejemplo de aplicaci?n real de esta reglamentaci?n en un emprendimiento minero nacional

Modelo de negocio para la implementaci?n de una central de nutrici?n parenteral en la costa norte del pa?s

En el Per?, la desnutrici?n hospitalaria es un importante determinante en salud por su impacto en la morbimortalidad y en los costos hospitalarios, requiriendo en casos complejos del uso de terapia nutricional por v?a parenteral. No obstante, este tipo de nutrici?n no est? disponible en todas las instituciones de salud que lo necesitan. El presente trabajo tiene por objetivo elaborar un Plan de Negocios para la creaci?n de una Central de Preparaci?n de Mezclas de Nutrici?n Parenteral para la zona de la costa norte del Per?, que despu?s del estudio de mercado, se ha identificado una demanda regional insatisfecha. La propuesta de valor, despu?s de la investigaci?n realizada, es un producto servicio, que consiste en una mezcla de nutrici?n parenteral de preparaci?n individualizada, con entrega r?pida y oportuna, cuyas instalaciones se ubicar?n en Lambayeque, contando con un servicio de asesoramiento permanente al m?dico que la prescriba. Para este plan, se ha calculado una inversi?n de S/.694,093. Las proyecciones han estimado a los 5 a?os, un VAN de S/. 662,093 y TIR de 35%, con recuperaci?n de la inversi?n al cuarto a?o. Se concluye que este proyecto es t?cnica y econ?micamente factible, siendo atractivo para nuevos inversores

High rate of uncovered struts in latest generation drug-eluting stents with durable, biodegradable polymer or lack of it 1 month after implantation

Introduction and objectives: Delayed vascular healing may induce late stent thrombosis. Optical coherence tomography (OCT) is useful to evaluate endothelial coverage. The objective of this study was to compare stent coverage and apposition in non-complex coronary artery lesions treated with durable polymer-coated everolimus-eluting stents (durable-polymer EES) vs biodegradable polymer-coated everolimus-eluting stents ( biodegradable-polymer EES) vs polymer-free biolimus-eluting stents (BES) 1 and 6 months after stent implantation. Methods: Prospective, multicenter, non-randomized study that compared the 3 types of DES. Follow-up angiography and OCT were performed 1 and 6 months later. The primary endpoint was the rate of uncovered struts as assessed by the OCT at 1 month. Results: A total of 104 patients with de novo non-complex coronary artery lesions were enrolled. A total of 44 patients were treated with polymer-free BES, 35 with biodegradable-polymer EES, and 25 with durable-polymer EES. A high rate of uncovered struts was found at 1 month with no significant differences reported among the stents (80.2%, polymer-free BES; 88.1%, biodegradable-polymer EES; 82.5%, durable-polymer EES; P =.209). Coverage improved after 6 months in the 3 groups without significant differences being reported (97%, 95%, and 93.7%, respectively; P =.172). Conclusions: In patients with de novo non-complex coronary artery lesions treated with durable vs biodegradable vs polymer-free DES, strut coverage and apposition were suboptimal at 1 month with significant improvement at 6 months

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

Potential use of near-infrared spectroscopy to predict fatty acid profile of meat from different european autochthonous pig breeds

Autochthonous pig breeds provide products of differentiated quality, among which quality control is difficult to perform and insufficient for current market requirements. The present research evaluates the predictive ability of near?infrared (NIR) spectroscopy, combined with chemometric methods as a rapid and affordable tool to assure traceability and quality control. Thus, NIR technology was assessed for intact and minced muscle Longissimus thoracis et lumborum samples collected from 12 European autochthonous pig breeds for the quantification of lipid content and fatty acid composition. Different tests were performed using different numbers of samples for calibration and validation. The best predictive ability was found using minced presentation and set with 80% of the samples for the calibration and the remaining 20% for the external validation test for the following traits: lipid content and saturated and polyunsaturated fatty acids, which attained both the highest determination coefficients (0.89, 0.61, and 0.65, respectively) and the lowest root mean square errors in external validation (0.62, 1.82, and 1.36, respectively). Lower predictive ability was observed for intact muscles. These results could contribute to improve the management of autochthonous breeds and to ensure quality of their products by traditional meat industry chains.FE1B-06B2-126F | Jos? Pedro Pinto de Ara?joN/