Multidimensional characteristics of complex chronic patients in emergency services in primary care

Background: In Spain, people between 65 and 74 years old have an average of 2.8 chronic problems or diseases, rising to 3.2 among people aged 75 and older. Aims: We aimed to describe the multidimensional characteristics of complex chronic patients who sought urgent care. Design: We conducted a descriptive, cross-sectional, retrospective study, drawing on a large electronic health record database in primary care in Barcelona, Spain. Methods: We used health record data about subjects' clinical state, functional state, mental health state, social state, nutritional state, and movement. A descriptive analysis was carried out to determine percentages and means, given a standard deviation. Finding: In 2019, 3,732 complex chronic patients sought urgent care at the centres under study. Subjects had a mean age of 82.5 ± 9.8 years, and 58.7% (n = 2,189) were women. Frailty was present in 69.3% (n = 2,586), and 81.7% (n = 3,050) were adherent to therapy. There were 2,470 visits to hospital emergency rooms (66.2%) and 1,651 hospital admissions (44.2%). Malnutrition was evident in 46.5% (n = 1,623) and 27.9% (n = 1,042) had low risk of social exclusion. Discussion: Having such descriptive information can help health services from all areas and levels of care to use comprehensive, collaborative practices to care for complex chronic patients and their noninstitutional caregivers. Conclusion: We noted a high proportion of emergency room visits and hospital admissions among complex chronic patients. Low-level depression and malnutrition were detected. Proactive multidisciplinary interventions could improve the situation of these patients

Desarrollo de un sistema web y aplicaciones móviles, para la gestión de horarios de asignaturas, utilizando arquitectura distribuida, en la Universidad Nacional Autónoma de Nicaragua, FAREM – Chontales durante el segundo semestre del año 2016

El presente documento presenta las técnicas metodológicas, procesos de desarrollo y herramientas de implementación utilizadas para la automatización de los procesos de asignación de horarios de la UNAN FAREM Chontales e igualmente se presenta como una herramienta de comunicación educativa entre educador y educando. - Parte de los problemas encontrados con el proceso son: 1. Falta de comunicación entre encargados 2. Poca o nula organización y comunicación 3. Creación de horarios de forma manual Como modelo para el desarrollo de un Software, nuestro proyecto está siguiendo las técnicas que encontramos en el modelo de desarrollo del sistema que sugiere Iam sommerville en el libro de ingeniería de software, encaminamos nuestro proyecto cumpliendo con los cuatro pasos que propone este paradigma: Análisis, diseño, desarrollo y validación. Para conocer a fondo los factores que influencian el proceso de asignación de horarios se utilizaron técnicas de recolección de información tanto para conocer la naturaleza del problema, si en verdad existe una necesidad automatización de las tareas y las necesidades que debe cumplir el software. La evaluación del costo de desarrollo del software final se detalla mediante técnicas de evaluación de costos para proyectos de desarrollo de programación, COCOMO es el estándar aplicado. Para el análisis de los requerimientos funcionales y no funcionales, que son todas las necesidades, roles y característicos que requiere el cliente y los usuarios para el correcto funcionamiento del sistema, se utilizó un documento de especificación de requerimientos (SRS) el cual está basado en el Estándar IEEE 830 – 1998. A través del estándar IEEE830, la recolección de todos los requerimientos funcionales y no funcionales que son las necesidades del cliente y lo que el cliente espera que el software realice. Mediante las herramientas de trabajo como Visual Studio.Net, SQL Server, entre otras, se logró el desarrollo del software y sus funciones en base a los requisitos solicitados por el cliente

A proof-of-concept clinical trial using mesenchymal stem cells for the treatment of corneal epithelial stem cell deficiency

Producción CientíficaOcular stem cell transplantation derived from either autologous or allogeneic donor corneoscleral junction is a functional cell therapy to manage extensive and/or severe limbal stem cell deficiencies that lead to corneal epithelial failure. Mesenchymal stem cells have been properly tested in animal models of this ophthalmic pathology, but never in human eyes despite their potential advantages. We conducted a 6- to 12-month proof-of-concept, randomized, and double-masked pilot trial to test whether allogeneic bone marrow-derived mesenchymal stem cell transplantation (MSCT], n = 17) was as safe and as equally efficient as allogeneic cultivated limbal epithelial transplantation (CLET), (n = 11) to improve corneal epithelial damage due to limbal stem cell deficiency. Primary endpoints demanded combination of symptoms, signs, and the objective improvement of the epithelial phenotype in central cornea by in vivo confocal microscopy. This proof-of-concept trial showed that MSCT was as safe and efficacious as CLET. Global success at 6–12 months was 72.7%–77.8% for CLET cases and 76.5%–85.7% for MSCT cases (not significant differences). Central corneal epithelial phenotype improved in 71.4% and 66.7% of MSCT and CLET cases, respectively at 12 months (P = 1.000). There were no adverse events related to cell products. This trial suggests first evidence that MSCT facilitated improvement of a diseased corneal epithelium due to lack of its stem cells as efficiently as CLET. Consequently, not only CLET but also MSCT deserves more preclinical investigational resources before the favorable results of this proof-of-concept trial could be transformed into the larger numbers of the multicenter trials that would provide stronger evidence. (ClinicalTrials.gov number, NCT01562002.)Ministerio de Sanidad, Consumo y Bienestar Social (project SAS/2481/2009)Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León (grant SAN 1178/200)Red de Terapia Celular TerCel (project RD12/0019/0036

Gestión del dolor en pacientes del programa Rapid Recovery (RR) en artroplastia total de rodilla (ATR)

La artroplastia total de rodilla (ATR) es una cirugía consisten­te en la sustitución artificial de la articulación, debido a una lesión traumática o bien a un proceso degenerativo o de ar­trosis, con un dolor importante asociado que en ocasiones afecta de forma negativa a la recuperación del paciente. La elección de la prótesis dependerá de las características ana­tómicas del paciente y del criterio del cirujano. El concepto de «cirugía de recuperación rápida» fue intro­ducido en 1997 por Khelet y significó el inicio del modelo Fast Track o de Rapid Recovery (RR), ligado a una rehabilitación acelerada, un alta precoz y la optimización de todos los as­pectos de la experiencia del paciente pre, intra y posoperato­ria. La recuperación rápida es un proceso quirúrgico que pre­tende conseguir la máxima autonomía del paciente mediante la educación, el control del dolor y la movilización precoz. El instrumento fundamental para la recuperación rápida es conseguir la implicación del paciente mediante el empodera­miento, es decir, por medio de la educación preoperatoria del paciente, que contribuirá a reducir la ansiedad y facilitará que se involucre en su propia recuperación. Así, será partícipe de una terapia física posoperatoria eficaz, utilizando todas aque­llas herramientas necesarias para aumentar su capacidad de gestionar los problemas de salud. El empoderamiento del paciente forma parte del modelo de enfermería del Hospital Clínic de Barcelona (HCB) adoptado por la Dirección de Enfer­mería en diciembre del año 2012. La cirugía convencional de ATR en Cataluña hasta el ini­cio de la cirugía RR ocasionó 14 132 intervenciones en el año 2008, con hospitalización convencional posterior. Este artículo describe los cuidados y los resultados de las intervenciones enfermeras, definidas en la vía clínica RR de ATR dirigidas a la minimización del dolor, y las repercusiones sobre la movilización de los pacientes. Se efectuó en una uni­dad monográfica de un hospital terciario de Barcelona en el año 2013

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

Aim and objectives The aim of this study is to identify preoperative indicators and/or predictors of complications or inefficiencies in the surgical process that can be modified within nursing practice. Background Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care. Design We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA-ScR Checklist. Methods Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011–2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained. Results The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation. Conclusion The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes. Relevance to clinical practice The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.Funding for open access charge: Universidad de Málaga / CBU

Keys to understand the invasive success of Rugulopteryx okamurae (Dictyotales, Ochrophyta).

Since its first records in the Strait of Gibraltar in 2015, the Pacific brown algae Rugulopteryx okamurae has produced important environmental and socioeconomic impacts that have attracted media attention to a seaweed in Spain for the first time and have led to its inclusion in the Spanish checklist of invasive alien species. Since then, this research group has studied the basic biology and the potential distribution of the species, the results of which are part of the present communication in the body of theoretical knowledge of invasion hypotheses. To begin with, the species exhibits a series of vegetative, reproductive and physiological attributes that confer it a high invasiveness. Morphologically the species is an example of a cryptic invasion due to its similarity with native species of the genus Dictyota; furthermore, the species exhibits seasonal changes in its morphology, alternating thin, thick and intermediate thalli, that altogether make its correct identification difficult. Although sexual cycle of the species has not been confirmed yet in its introduced area, it is able to maintain a rapid and abundant recruitment of new clonal individuals along the year, by vegetative propagules and asexual monospores, which produce a constant propagule pressure. Furthermore, it presents a high adaptation capacity to a wide range of the main environmental factors such as temperature, light and nutrients, that allows it colonizing a wide bathymetric and community range. To this we must add the high invasibility of ecosystems that are suffering for more than 20 years an invational meltdown process, due to previous arrivals of other invasive species of macroalgae, such as those of the genus Asparagopsis and Caulerpa racemosa, that have altered their functions and the resources availability. All this together with a high environmental favorability of the Mediterranean Sea and European Atlantic coasts, explain the wide potential distribution area of the species.FUNDACIÓN BIODIVERSIDAD, MITECO FONDOS FEDER UNIVERSIDAD DE MÁLAG

Projecte campus multimodal: pilotatge del suport de veu en lectura. Memòria final

El projecte va ser acceptat a la convocatòria PID 2011-2012Memòria final del projecte d'innovació docent "Campus multimodal" en el què es va experimentar amb dues eines de suport de veu en la lectura en una assignatura de Tècniques de Treball en diverses carreres associades amb Dret. Les eines van ser ClaroRead, un programari de PC que llegeix en veu alta tot el contingut de l'ordinador ressaltant la paraula llegida i amb altres utilitats de resum i creació de mapes conceptuals; i ReadSpeaker, una eina instal.lada al campus virtual que llegeix en veu alta el contingut web i contingut dels fitxers PDF. S'explica l'experiència i els resultats. Es conclou amb la necessitat de facilitar eines de suport a la lectura per als alumnes amb necessitats especials.ReadSpeaker, Integrate

Policy challenges for agroforestry implementation in Europe

Agroforestry (AF) is a sustainable land use practice and system that increases the ecosystem services delivery from agricultural lands compared with treeless systems. Agroforestry can be considered a practice when linked to plot scale (silvoarable, silvopasture, homegarden, woody linear landscape strips, and forest farming), and a system when associated with the global farm scale. The enhancement of the ecosystem services is associated with the use and promotion of the biodiversity caused by the presence of trees that optimizes the use of the resources if adequate species are mixed. Agroforestry can be implemented at temporal and spatial scales. At the temporal scale, the use of woody perennials to increase soil fertility is a traditional technique that improves soil health and reduces the need of using herbicides (e.g., the legume Ulex sown for 10 years in between crop cultivation). Five agroforestry practices can be implemented at the plot level: silvopasture, silvoarable/alley cropping, homegardens/kitchengardens, woody linear landscape strips, and forest farming. A farm including these practices is considered an agroforestry system working at the landscape level when several farms are mixed. In spite of the acknowledgment that AF has at the European level for being included as part of Pillars I and II, the spread of AF is limited across Europe. Four challenges, linked with technical, economic, educational, and policy development, have been identified by the AFINET thematic network that, if addressed, may foster policy adoption across the EU. This article proposes 15 different policy recommendations to overcome them and the need of developing an AF strategy for the EU.We acknowledge funding through Grant 101086563 from the European Commission (Project AF4EU, HEUROPE). This study was supported by National Funds by the FCT—Portuguese Foundation for Science and Technology, under the project UIDB/04033/2020. NF-D was funded by the Pilot Program of the University of Santiago de Compostela (USC) for the hiring of distinguished research staff—call 2021, funded under the collaboration agreement between USC and Banco Santander, for the years 2021–2024. JJS-F was supported by the USC and the Spanish Ministry of Universities through the “Convocatoria de Recualificación del Sistema Universitario Español” on its modality “Margarita Salas”; Ministry of Universities - Recovery Transformation and Resilience Plan (funded by the European Union through the NextGenerationEUS

Endocannabinoid regulation of amyloid-induced neuroinflammation

The modulation of endocannabinoid (EC) levels and the activation of cannabinoid receptors are seen as promising therapeutic strategies in a variety of diseases, including Alzheimer’s disease (AD). We aimed to evaluate the effect of the pharmacological and genetic inhibiton of anandamide (AEA)-degrading enzyme in a mouse model of AD (5xFAD). Pharmacological inhibition of the fatty acid amide hydrolase (FAAH) had little impact on the expression of key enzymes and cytokines as well as on the cognitive impairment and plaque deposition and gliosis in 5xFAD mice. CB1 blockade exacerbated inflammation in this transgenic mouse model of AD. The genetic inactivation of FAAH led to increases in the expression of inflammatory cytokines. At the same time, FAAH-null 5xFAD mice exhibited a behavioral improvement in spatial memory that was independent of the level of anxiety and was not CB1-mediated. Finally, mice lacking FAAH showed diminished soluble amyloid levels, neuritic plaques and gliosis. These data reinforce the notion of a role for the endocannabinoid system in neuroinflammation and open new perspectives on the relevance of modulating endocannabinoid levels in the inflammed brain.pre-print687 K

Policy challenges for agroforestry implementation in Europe

Agroforestry (AF) is a sustainable land use practice and system that increases the ecosystem services delivery from agricultural lands compared with treeless systems. Agroforestry can be considered a practice when linked to plot scale (silvoarable, silvopasture, homegarden, woody linear landscape strips, and forest farming), and a system when associated with the global farm scale. The enhancement of the ecosystem services is associated with the use and promotion of the biodiversity caused by the presence of trees that optimizes the use of the resources if adequate species are mixed. Agroforestry can be implemented at temporal and spatial scales. At the temporal scale, the use of woody perennials to increase soil fertility is a traditional technique that improves soil health and reduces the need of using herbicides (e.g., the legume Ulex sown for 10 years in between crop cultivation). Five agroforestry practices can be implemented at the plot level: silvopasture, silvoarable/alley cropping, homegardens/kitchengardens, woody linear landscape strips, and forest farming. A farm including these practices is considered an agroforestry system working at the landscape level when several farms are mixed. In spite of the acknowledgment that AF has at the European level for being included as part of Pillars I and II, the spread of AF is limited across Europe. Four challenges, linked with technical, economic, educational, and policy development, have been identified by the AFINET thematic network that, if addressed, may foster policy adoption across the EU. This article proposes 15 different policy recommendations to overcome them and the need of developing an AF strategy for the EU.We acknowledge funding through Grant 101086563 from the European Commission (Project AF4EU, HEUROPE). This study was supported by National Funds by the FCT—Portuguese Foundation for Science and Technology, under the project UIDB/04033/2020. NF-D was funded by the Pilot Program of the University of Santiago de Compostela (USC) for the hiring of distinguished research staff—call 2021, funded under the collaboration agreement between USC and Banco Santander, for the years 2021–2024. JJS-F was supported by the USC and the Spanish Ministry of Universities through the “Convocatoria de Recualificación del Sistema Universitario Español” on its modality “Margarita Salas”; Ministry of Universities - Recovery Transformation and Resilience Plan (funded by the European Union through the NextGenerationEU).info:eu-repo/semantics/publishedVersio