Ambulatory surgery in orthopedics: experience of over 10,000 patients

PurposeThe concept of day surgery is becoming an increasingly important part of elective surgery worldwide. Relentless pressure to cut costs may constrain clinical judgment regarding the most appropriate location for a patient’s surgical care. The aim of this study was to determine clinical and quality indicators relating to our experience in orthopedic day durgery, mainly in relation to unplanned overnight admission and readmission rates. Additionally, we focused on describing the main characteristics of the patients that experienced complications, and compared the patient satisfaction rates following ambulatory and non-ambulatory procedures.MethodsWe evaluated 10,032 patients who underwent surgical orthopedic procedures according to the protocols of our Ambulatory Surgery Unit. All complications that occurred were noted. A quality-of-life assessment (SF-36 test) was carried out both pre- and postoperatively. Ambulatory substitution rates and quality indicators for orthopedic procedures were also determined.ResultsThe major complication rate was minimal, with no mortal cases, and there was a high rate of ambulatory substitution for the procedures studied. Outcomes of the SF-36 questionnaire showed significant improvement postoperatively. An unplanned overnight admission rate of 0.14 % was achieved.ConclusionsOur institution has shown that it is possible to provide good-quality ambulatory orthopedic surgery. There still appears to be the potential to increase the proportion of these procedures. Surgeons and anesthesiologists must strongly adhere to strict patient selection criteria for ambulatory orthopedic surgery in order to reduce complications in the immediate postoperative term

IAA : Información y actualidad astronómica (36)

Sumario : Púlsares: faros para navegantes cósmicos.-- Espectroscopía: leyendo entre líneas (II).-- Un universo acelerado.-- CIENCIA EN HISTORIAS. Margaret Burbidge.-- DECONSTRUCCIÓN Y otros ENSAYOS. Hola, soy Nikola.-- EL “MOBY DICK” DE... Cristina Rodríguez López (IAA-CSIC).-- ACTUALIDAD.-- ENTRE BASTIDORES.-- SALA LIMPIA.-- CIENCIA: PILARES E INCERTIDUMBRES. La Vía Láctea.-- AGENDA/RECOMENDADOS.--N

Sarcomas de partes blandas. Análisis de 42 casos

El objetivo de este estudio es valorar el pronóstico a largo plazo de una serie de pacientes tratados en nuestro hospital en relación con diversos factores clínicos, diagnósticos y terapéuticos que podrían condicionarlo. Se revisaron 123 pacientes tratado por tumores malignos de partes blandas entre los años 1979 y 1999, de estos solo 42 cumplieron las características para incluirles en nuestro estudio. Se valoró su evolución teniendo en cuenta las variables pronosticas identificadas en trabajos previamente publicados y nuestra propia experiencia y se realizó el estudio estadístico de las mismas. En el análisis estadístico del estudio se utilizó el programa SPSS versión 8.0WIN y se realizó el análisis de supervivencia mediante el método de Kaplan-Meier. El tiempo de supervivencia total descrito según este método para el total de los casos estudiados presenta una mediana de 33 meses con un error estándar de 8 y un intervalo de confianza del 95% de (17,49), el tiempo libre de enfermedad presenta una mediana de 9 meses con un error estándar de 2 y un intervalo de confianza del 95% de (6,12) y el tiempo de aparición de metástasis presenta una mediana de 26 meses con un error estándar de 5 y un intervalo de confianza del 95% de (17,35). A su vez se realizó el análisis bivariante de las múltiples variables pronosticas. El gran número de variables y la dispersión de la muestra hacen aconsejable estudios multicéntricos prospectivos más numerosos para obtener conclusiones definitivas sobre este tipo de tumores.The aim of this study is to evaluate the long-term prognosis of a series of patients treated in our hospital with regard to various clinical, diagnostic and therapeutic factors. A total of 123 patients who had been treated for malignant soft tissue tumours between 1979 and 1999 were reviewed. Of these, only 42 fulfilled the requirements to be included in our study. The outcome was evaluated taking into account prognostic variables identified in previously published studies and our own experience, and a statistical study of these factors as carried out with the Kaplan-Meier survival analysis method. The total survival time for all the cases studied was 33+8 (median + SE) months with a 95% confidence interval of 17.49 months. The time free of illness was 9+2 (median + SE) months with a 95% confidence interval of 6.12 months. The time-period until metastasis appeared was 26+5 (median + SE) months with a 95% confidence interval of 17.35 months. At the same time, the bivariant analysis of the many prognostic variables was performed. The high number of variables and the dispersion of the sample group suggest that it would be advisable to carry out more prospective, multicentric studies to reach definitive conclusions about this type of tumour

Improvement of the drought indicators system in the Jucar River Basin, Spain

[EN] Droughts are one of the gravest natural threats currently existing in the world and their occurrence and intensity might be exacerbated in the coming years due to climate change. The severe impacts that droughts cause to inland water resources and to the associated socio-economic activities justify the continuous monitoring of the drought. The case study presented shows a practical application of a distributed drought monitoring system implemented in a real river basin district, the Jucar River Basin District (43,000 km(2)), where drought periods of marked intensity have occurred historically and the climate ranges from humid in the north to semiarid in the south. Five drought indices have been applied: Standardised Precipitation Index (SPI) for meteorological drought; Palmer Drought Severity Index (PDSI) and a newsoilmoisture index (HI), for edaphic drought; Normalised Difference Vegetation Index (NDVI) for the vegetation activity; and Spanish Status Index (SI), for the operational drought. All indices are standardised to compare them. The relationship between the standardised operational drought index SI and the long-term meteorological indices, SPI-12 or SPI-24, show that in a medium size basin the concept of "prolonged drought" required by the European Commission under the Water Framework Directive could be defined by the use of accumulated precipitation indices. The number of months to be accumulated depends on the size of the basin and the water management system properties. In large basins, such as the Jcar river basin (22,000 km(2)), there are significant deviations due to the spatial distribution of the drought. The use of a unique aggregated indicator could hide a significant drought in a specific area, or on the other hand showa non-real drought. Evolution of drought indices for eachwater management systemmust be accompanied by spatially distributed drought maps to better understand the drought status and its evolution.Tatiana Ortega; Pérez-Martín, MÁ.; Estrela Monreal, T. (2018). Improvement of the drought indicators system in the Jucar River Basin, Spain. The Science of The Total Environment. 610:276-290. https://doi.org/10.1016/j.scitotenv.2017.07.250S27629061

Terre, droits de l'homme et développement: cas et visions d'Afrique et d'Amérique

[ES] Es indudable que para los editores de este libro es una satisfacción contar con aportaciones de tan amplia y variada procedencia. La temática elegida, tierra, derechos humanos y desarrollo, alude a una problemática central en la actual sociedad internacional. Sabemos los grandes datos, preocupantes, que se ciernen sobre la tierra y su aprovechamiento. Es una cuestión general pero que necesita ser enfocada en cada lugar concreto y, a ser posible, por análisis cercanos a tales situaciones, lo que se ha pretendido hacer en este trabajo, subtitulándose, por tanto, la obra como visiones desde África y América. Ciertamente, el trabajo se divide en tres grandes capítulos, dos dedicados a dichas áreas geográficas y un tercero sobre cuestiones transversales

Resting-state functional connectivity and socioemotional processes in male perpetrators of intimate partner violence against women

Intimate partner violence against women (IPVAW) is a serious and overwhelming public concern. Neuroimaging techniques have provided insights into the brain mechanisms underlying IPVAW perpetration. The purpose of this study is to examine the resting-state functional connectivity (rsFC) involving the process of social decision-making of male perpetrators. Twenty-six male perpetrators convicted for an IPVAW crime were compared to 29 men convicted for crimes other than IPVAW (other offenders) and 29 men with no criminal records (non-offenders) using a seed-based approach. Seeds were located in areas involved in reflective (prefrontal), impulsive (amygdala and striatum) and interoceptive (insula) processing. Then, as an exploratory analysis, the connectivity networks on male perpetrators were correlated with measures of executive functions and socioemotional self-report measures. Male perpetrators in comparison to other offenders and non-offenders, presented higher rsFC between prefrontal, limbic, brainstem, temporal and basal ganglia areas. Also male perpetrators showed higher rsFC between insula, default mode network and basal ganglia, while lower rsFC was found between prefrontal and motor areas and between amygdala, occipital and parietal areas. Exploratory correlations suggest that the specific rsFC in male perpetrators might be more related to socioemotional processes than to executive functions. These results showed that male perpetrators present a specific rsFC in brain systems that are essential for an adaptive social decision-making

Sistema de Simulación de Transformación Lluvia-Caudal (SSTLC)

Se presenta un modelo de simulación del proceso de transformación lluvia-caudal. El sistema permite elegir el mejor conjunto de algoritmos en cada fase del proceso, en función de la información disponible. Se diseñó y desarrolló el sistema computacional, programando los diferentes algoritmos involucrados, con su testeo correspondiente. Se aplicó el modelo a la cuenca superior del río Gualeguaychú, obteniéndose un buen ajuste entre los caudales observados y calculados.Eje: Ingeniería de software y base de datosRed de Universidades con Carreras en Informática (RedUNCI

Sistema de Simulación de Transformación Lluvia-Caudal (SSTLC)

Se presenta un modelo de simulación del proceso de transformación lluvia-caudal. El sistema permite elegir el mejor conjunto de algoritmos en cada fase del proceso, en función de la información disponible. Se diseñó y desarrolló el sistema computacional, programando los diferentes algoritmos involucrados, con su testeo correspondiente. Se aplicó el modelo a la cuenca superior del río Gualeguaychú, obteniéndose un buen ajuste entre los caudales observados y calculados.Eje: Ingeniería de software y base de datosRed de Universidades con Carreras en Informática (RedUNCI

Sistema de Simulación de Transformación Lluvia-Caudal (SSTLC)

Se presenta un modelo de simulación del proceso de transformación lluvia-caudal. El sistema permite elegir el mejor conjunto de algoritmos en cada fase del proceso, en función de la información disponible. Se diseñó y desarrolló el sistema computacional, programando los diferentes algoritmos involucrados, con su testeo correspondiente. Se aplicó el modelo a la cuenca superior del río Gualeguaychú, obteniéndose un buen ajuste entre los caudales observados y calculados.Eje: Ingeniería de software y base de datosRed de Universidades con Carreras en Informática (RedUNCI