PASSOS EVOLUTIVOS NA IMPLEMENTAÇÃO DE UM SERVIÇO DE PRÉ-HABILITAÇÃO: DA CRIAÇÃO DO CONHECIMENTO À PRÁTICA CLÍNICA

The surgical population is becoming increasingly older, with complex medical needs (including deconditioning from sedentary lifestyles)1. This phenomenon represents a challenge for the perioperative team, because it leads to a significant increase in surgery-related morbidity and mortality rates. Poor physical condition and functional status reduces the ability to cope, mentally and physically, with hospitalization and surgery and may compromise postoperative functional recovery, potentially leading to postoperative complications and death2. Multimodal prehabilitation has emerged in recent years as an innovative intervention that focuses on optimizing physiological and psychological resilience to withstand the upcoming stress of surgery. It involves a comprehensive, preventive, short-term, patient-centred programme lasting around four weeks designed to improve the patient’s aerobic capacity, nutritional balance, and psychological status, and to optimize existing multimorbidities3,4. Its ultimate aim is to enhance the patient’s functional capacity in order to minimize postoperative morbidity and accelerate recovery. Several studies assessing prehabilitation have shown it to be an effective and highly advantageous strategy to prevent postoperative complications and reduce hospital length of stay in different populations5-8. However, despite the expected benefit, emerging recommendations from experts, and its cost-saving potential, the implementation of prehabilitation programmes in clinical practice is a major unmet need and an ongoing challenge for most hospitals. A comprehensive assessment of the implementation process is critical to identify the factors that can ensure success, and to generate recommendations for service transferability. In this paper, we report our experience in imple- menting a multimodal prehabilitation programme as a mainstream service at the Hospital Clínic de Barcelona (HCB). The project started with a randomised clinical trial (RCT) carried out between 2013 and 2016, which showed the efficacy and cost-saving potential of prehabilitation. This was followed by the present multimodal programme, which has been adapted over time in accordance with the available resources and the feedback received from clinicians and patients. Over the years, we have identified the factors needed to scale-up the prehabilitation service. For successful, large scale implementation of a prehabilitation service more evidence of the effectiveness of such a programme in real-world scenarios is needed, the service needs to be standardised and modularised, and digital platforms and portable devices are required to improve patient access and empower self-management.A população cirúrgica está cada vez mais envelhecida, com necessidades médicas comple- xas (incluindo o descondicionamento físico resultante do estilo de vida sedentário)1. Este panorama vem colocar um importante desafio à equipa perioperatória, na medida em que se antecipa um aumento significativo das taxas de morbimortalidade pós-operatória. A baixa condição física e capacidade funcional reduz a capacidade de tolerar, mental e fisicamente, a hospitalização e a cirurgia, comprometendo a recuperação funcional pós-operatória e podendo levar ao desenvolvimento de complicações pós-operatórias e morte2. A pré-habilitação multimodal surgiu nos últimos anos como uma intervenção inovadora que visa a otimização da resiliência fisiológica e psicológica para tolerar o impacto da cirurgia. Envolve um programa abrangente, preventivo, de curto prazo e centrado no doente, com duração de cerca de quatro semanas, desenvolvido para melhorar a capacidade aeróbia, o estado nutricional e psicológico do doente, e para otimizar as multimorbidades existentes3,4. O seu objetivo final é aumentar a capacidade funcional do doente, com o intuito de minimizar a morbilidade pós-operatória e de garantir uma recuperação mais rápida. Vários estudos têm vindo a demonstrar que a pré-habilitação é uma estratégia segura e eficaz para prevenir complicações pós-operatórias e reduzir o tempo de hospitalização em diferentes populações cirúrgicas5-8. No entanto, apesar dos benefícios esperados, das recomendações emergentes de vários especialistas e do seu potencial na redução dos custos associados, a pré-habilitação encontra-se ainda sub- utilizada na prática clínica e a sua implementação impõe alguns desafios consideráveis para a maioria dos hospitais. Torna-se assim fundamental realizar uma avaliação abrangente do processo de implementação dos programas, com a finalidade de identificar os fatores essenciais para o seu sucesso e gerar recomendações para que a utilização deste tipo de serviços possa ser generalizada. Neste artigo, descrevemos a nossa experiência na implementação de um programa de pré-habilitação multimodal como um serviço regular no Hospital Clínic de Barcelona (HCB). O projeto começou no contexto de um ensaio clínico randomizado (RCT) realizado entre 2013 e 2016, que mostrou a eficácia e o potencial na redução de custos da pré-habilitação. Seguiu-se o desenvolvimento do presente programa multimodal, que foi adaptado ao longo do tempo de acordo com os recursos disponíveis e o feedback fornecido pelos médicos e doentes. Ao longo dos anos, identificamos os fatores necessários para ampliar (scale-up) o serviço de pré-habilitação. Entendemos que para uma implementação bem-sucedida e alargada dos programas de pré-habilitação, são necessárias mais evidências sobre a sua eficácia em cenários mais próximos do mundo real, o programa deve ser padronizado e modularizado, e as plataformas digitais e dispositivos portáteis deverão ser exploradas para melhorar o acesso ao programa e garantir o empoderamento do doente na gestão do seu próprio processo de tratamento

Reseña: Lupicinio Íñiguez (Ed.) (2006). Análisis del Discurso. Manual para las ciencias sociales

Im Folgenden wird ein Sammelband diskutiert, der sich – bestehend aus Beiträgen unterschiedlicher Autor(inn)en – als Handbuch zur Diskursanalyse präsentiert und den Anspruch erhebt, sowohl in theoretisch-methodologische Grundlagen einzuführen wie auch als Forschungsleitfaden zu dienen. Die Rezension nimmt dabei a) den ursprünglichen Entstehungsrahmen des Buches – die kritische Sozialpsychologie – zum Ausgangspunkt, um die interdisziplinären Bezüge des Bandes auszuweisen, und bietet b) somit ein Orientierungsraster zu den enthaltenen unterschiedlichen Beiträgen; schließlich werden c) deren gemeinsame Grundlagen gezeigt, ohne dabei über die einzelnen Beiträge hinweg die Komplexität des Feldes unzulässig zu simplifizieren. Der Sammelband leistet – so das Fazit – über die Vielfalt der einzelnen Themen hinweg eine kohärente Perspektive auf Diskursanalyse, die – entlang eines an FOUCAULT angelehnten Diskursverständnisses und dessen politischen Implikationen – eine Verknüpfung von linguistischen und ethnomethodologischen Herangehensweisen leistet. URN: urn:nbn:de:0114-fqs0702187This review evaluates the contributions of a book which, in spite of being a compilation of several authors, presents itself as a handbook of discourse analysis, understood as both a theoretical-methodological perspective and a research tool. Thus, this review a) sets the proposal of this book in its original context, that of critical social psychology, while pointing at its interdisciplinary sources; b) offers a map of contexts of the different contributions; c) analyses the common ground which confers unity upon these different chapters, that show the complexity of the field without over-simplification. This review argues that the book is able to render a coherent perspective despite its plurality, precisely because of this common, unifying core: the contributions of the linguistic turn and of ethnomethodology and, above all, the FOUCAULTian notion of discourse and its political implications. URN: urn:nbn:de:0114-fqs0702187Esta reseña valora los aportes de un libro que, a pesar de ser una compilación de diversas contribuciones, se presenta con vocación de manual de análisis del discurso, entendido como perspectiva teórico-metodológica y como herramienta de investigación. Así, la reseña a) enmarca la propuesta, que, a pesar de beber de fuentes interdisciplinares, emerge de la psicología social crítica; b) ofrece un mapa de los contenidos de las distintas contribuciones; c) analiza el bagaje común que otorga unidad de sentido a estas diversas aportaciones, que muestran la complejidad del campo sin simplificarla. Se argumentará que si el libro es capaz de sostener una visión coherente, a pesar de su pluralidad, es porque tiene un eje vertebrador común en las aportaciones del giro lingüístico, de la etnometodología y, sobre todo, en la noción FOUCAULTiana de discurso y sus implicaciones políticas. URN: urn:nbn:de:0114-fqs070218

Reseña: Lupicinio Íñiguez (Ed.) (2006). Análisis del Discurso. Manual para las ciencias sociales

Im Folgenden wird ein Sammelband diskutiert, der sich - bestehend aus Beiträgen unterschiedlicher Autor(inn)en - als Handbuch zur Diskursanalyse präsentiert und den Anspruch erhebt, sowohl in theoretisch-methodologische Grundlagen einzuführen wie auch als Forschungsleitfaden zu dienen. Die Rezension nimmt dabei a) den ursprünglichen Entstehungsrahmen des Buches - die kritische Sozialpsychologie - zum Ausgangspunkt, um die interdisziplinären Bezüge des Bandes auszuweisen, und bietet b) somit ein Orientierungsraster zu den enthaltenen unterschiedlichen Beiträgen; schließlich werden c) deren gemeinsame Grundlagen gezeigt, ohne dabei über die einzelnen Beiträge hinweg die Komplexität des Feldes unzulässig zu simplifizieren. Der Sammelband leistet - so das Fazit - über die Vielfalt der einzelnen Themen hinweg eine kohärente Perspektive auf Diskursanalyse, die - entlang eines an FOUCAULT angelehnten Diskursverständnisses und dessen politischen Implikationen - eine Verknüpfung von linguistischen und ethnomethodologischen Herangehensweisen leistet.This review evaluates the contributions of a book which, in spite of being a compilation of several authors, presents itself as a handbook of discourse analysis, understood as both a theoretical-methodological perspective and a research tool. Thus, this review a) sets the proposal of this book in its original context, that of critical social psychology, while pointing at its interdisciplinary sources; b) offers a map of contexts of the different contributions; c) analyses the common ground which confers unity upon these different chapters, that show the complexity of the field without over-simplification. This review argues that the book is able to render a coherent perspective despite its plurality, precisely because of this common, unifying core: the contributions of the linguistic turn and of ethnomethodology and, above all, the FOUCAULTian notion of discourse and its political implications.Esta reseña valora los aportes de un libro que, a pesar de ser una compilación de diversas contribuciones, se presenta con vocación de manual de análisis del discurso, entendido como perspectiva teórico-metodológica y como herramienta de investigación. Así, la reseña a) enmarca la propuesta, que, a pesar de beber de fuentes interdisciplinares, emerge de la psicología social crítica; b) ofrece un mapa de los contenidos de las distintas contribuciones; c) analiza el bagaje común que otorga unidad de sentido a estas diversas aportaciones, que muestran la complejidad del campo sin simplificarla. Se argumentará que si el libro es capaz de sostener una visión coherente, a pesar de su pluralidad, es porque tiene un eje vertebrador común en las aportaciones del giro lingüístico, de la etnometodología y, sobre todo, en la noción FOUCAULTiana de discurso y sus implicaciones políticas

Review: Lupicinio Íñiguez (Ed.) (2006). Análisis del Discurso. Manual para las ciencias sociales [Discourse Analysis. Textbook for Social Sciences]

This review evaluates the contributions of a book which, in spite of being a compilation of several authors, presents itself as a handbook of discourse analysis, understood as both a theoretical-methodological perspective and a research tool. Thus, this review a) sets the proposal of this book in its original context, that of critical social psychology, while pointing at its interdisciplinary sources; b) offers a map of contexts of the different contributions; c) analyses the common ground which confers unity upon these different chapters, that show the complexity of the field without over-simplification. This review argues that the book is able to render a coherent perspective despite its plurality, precisely because of this common, unifying core: the contributions of the linguistic turn and of ethnomethodology and, above all, the FOUCAULTian notion of discourse and its political implications. URN: urn:nbn:de:0114-fqs070218

Geología ecológica, geodiversidad, geoconservación y Patrimonio Geológico de la Declaración de Girona

This work presents a new way of understanding the geological science: the Ecological Geology. It is based on the clasical vision of the Geology as well as on some new concepts, as Geodiversity and Geoconservation. An aplication of these perspective to the Geological Heritage is also included, in a list of ten points, called Declaración de Girona, because it is concibed in this cit

Gastrotomy closure with a new tissue anchoring device: A porcine survival study

AIM: To evaluate the feasibility, reproducibility and efficacy of a new tissue anchoring device in a porcine survival model

Perioperative Nursing as the Guiding Thread of a Prehabilitation Program

Multimodal preoperative prehabilitation has been shown to be effective in improving the functional capacity of cancer patients, reducing postoperative complications and the length of hospital and ICU stay after surgery. The availability of prehabilitation units that gather all the professionals involved in patient care facilitates the development of integrated and patient-centered multimodal prehabilitation programs, as well as patient adherence. This article describes the process of creating a prehabilitation unit in our center and the role of perioperative nursing. Initially, the project was launched with the performance of a research study on prehabilitation for gastrointestinal cancer surgery. The results of this study encouraged us to continue the implementation of the unit. Progressively, multimodal prehabilitation programs focusing on each type of patient and surgery were developed. Currently, our prehabilitation unit is a care unit that has its own gym, which allows supervised training of cancer patients prior to surgery. Likewise, the evolution of perioperative nursing in the unit is described: from collaboration and assistance in the integral evaluation of the patient at the beginning to current work as a case manager; a task that has proven extremely important for the comprehensive and continuous care of the patient