Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis

Background Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients. Methods Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis. Results Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient’s stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017). Conclusions The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the reassessment of these instruments with respect to hospitalized adult patients, and to consider the real compliance by healthcare personnel with procedures related to patient safety, and in particular concerning the prevention of falls

Expresión de oncogenes, receptores hormonales esteroideos y marcadores de proliferación en el carcinoma endometrial

Para la realización de nuestro estudio, revisamos todas las historias clínicas del servicio de Anatomía Patológica del hospital "Lozano Blesa" de Zaragoza, desde Enero de 1994, hasta Diciembre de 1996 incluidos. Se seleccionaron 99 casos de adenocarcinoma de endometrio y en ellos se utilizaron tanto técnicas de rutina como inmunohistoquímicas, valorando la expresión de diferentes marcadores que se han visto relacionados con el desarrollo del cáncer, como son los receptores hormonales, el marcador de proliferación Ki-67, la proteína P53 y los oncogenes bcl-2 y c-erbB-2. Algunos de estos marcadores se conoce que están implicados en el mecanismo íntimo del ciclo celular, por lo que sus alteraciones conllevan a las células hacia la cancerización. Hemos observado, que tanto los receptores hormonales (R. Estrogénicos y R. Progesterona), como la proteína bcl-2 tienen una mayor expresión cuanto menor es el grado tumoral, y cuando el patrón histológico es de baja agresividad. Mientras que la proteína P53, Ki-67 (Mib-1) y el oncogén c-erbB-2 su expresión aumenta conforme el grado tumoral aumenta y cuando el tipo histológico de éstos es más agresivo. Podemos decir, que la presencia o ausencia de determinados marcadores, están implicados en la biología molecular del cáncer y nos parece de gran interes su valoración, dadas las medidas terapéuticas que puedan desarrollarse

Factores psicosociales de riesgo y burnout en policías: un análisis de redes

Work stress has been identified as a critical factor affecting mental health in police officers. Psychosocial factors increase the impact of work stress on police officers and,in the long run,contribute to the onset of burnout symptoms. In this research asample of 323 was studied to study the relationship between psychosocial risk factors and the probability of suffering burnout symptoms. The participant’s answers to the MBI-GSandF-PSICO(version4.0) were analysed by using network analysis.There sults show that psychosocial risk factors are strongly associated in network models when higher level of cynicism and emotional exhaustion are observed. Additionally, higher levels of burnout in police officers were observed when lower autonomy,higher psychological demands, role ambiguities and alower perceived social support were present. Results are discussed considering its theoretical and applied relevance to design healthier work environments an defficient psychologicalinterventionsEl estrés laboral crónico ha sido identificado como uno de los riesgos laborales más importantes que afecta a la salud mental de los agentes de policía. Existen ciertos factores psicosociales que incrementan el estrés laboral en la policía y que, a largo plazo, desencadenan síntomas compatibles con el burnout. En este trabajo se ha utilizado una muestra integrada por 323 policías para valorar la relación que se establece entre los factores psicosociales de riesgo y la probabilidad de experimentar síntomas compatibles con el burnout. Las respuestas de los participantes al MBI-GS y al F-PSICO (versión 4.0) fueron examinadas utilizando análisis de redes. Los resultados muestran que existen redes de factores psicosociales de riesgo más cohesionadas cuando los niveles de cinismo y agotamiento emocional son más elevados. Además, se observa mayor nivel de burnout asociados con una baja autonomía, altas demandas psicológicas, conflictos en el desempeño de rol y un bajo apoyo social percibido. Los resultados son discutidos en términos de su implicación teórica y de su utilidad práctica frente al diseño de entornos de trabajo más saludables, así como frente a la intervención psicológica

Actividad de ceftolozano-tazobactam en aislados clínicos de Pseudomonas aeruginosa multirresistente y extremadamente resistente en un hospital español

Objetivos: Nuestro objetivo fue evaluar la sensibilidad in vitro de ceftolozano-tazobactam en aislados clínicos de P. aeruginosa multirresistente (MDR) y extremadamente resistente (XDR) desde Febrero de 2016 a Octubre de 2017 en el Hospital Universitario Miguel Servet, Zaragoza (España). Material y métodos: Evaluamos la actividad in vitro de ceftolozano-tazobactam y otros antibióticos anti-pseudomónicos en 12 aislados de P. aeruginosa MDR y en 117 aislados XDR, no productores de metalo-ß-lactamasas. Se determinó la concentración mínima inhibitoria (CMI) de ceftolozano-tazobactam mediante tiras de difusión en gradiente. Resultados: Entre los 129 aislados MDR/XDR incluidos, 119 (92, 2%) fueron sensibles a ceftolozano-tazobactam, y diez (7, 8%) presentaron resistencia. La CMI50 fue de 2 mg/L, y la CMI90 de 4 mg/L. Ceftolozano-tazobactam fue el segundo antibiótico más activo después de colistina, superando a amikacina. Conclusiones: Ceftolozano-tazobactam es una opción de tratamiento válida para infecciones causadas por P. aeruginosa MDR y XDR en nuestro entorno. Objectives: Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-ß-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. Material and methods: We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-ß-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. Results: Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC 50 was 2 mg/L, and MIC 90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. Conclusions: Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting

Antimicrobial activity of ceftolozane-tazobactam against multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa clinical isolates from a Spanish hospital

Objectives. Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-ß-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. Material and methods. We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-ß-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. Results. Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. Conclusions. Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting. Objectives. Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-beta-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. Material and methods. We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-beta-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. Results. Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. Conclusions. Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting

Clinical and genetic characterization of RDH12-retinal dystrophy in a South American cohort

Purpose: To characterize the largest cohort of individuals with RDH12-retinal dystrophy to date, and the first one from South America. // Design: Retrospective multicenter international study. // Subjects: 78 patients (66 families) with an inherited retinal dystrophy and biallelic variants in RDH12. // Methods: Review of clinical notes, ophthalmic images, and molecular diagnosis. // Main outcome measures: Visual function, retinal imaging and characteristics were evaluated and correlated. // Results: Thirty-seven individuals self-identified as Latino (51%) and 34 as White (47%). Mean age at the baseline visit was 19.8 ± 13 years old (6 months – 46 years old, median 18.5); 41 (53%) were children. Thirty-nine patients (50%) had subsequent visits, with mean follow-up of 6.8 + 7.3 years (0 – 29). Sixty-nine individuals (88%) had Leber congenital amaurosis/early onset severe retinal dystrophy (LCA/EOSRD). Macular and mid-peripheral atrophy was seen in all patients from 3 years of age. A novel retinal finding was a hyperautofluorescent ring in 2 young children with LCA. Eight variants (21%) were previously unreported and the most frequent variant was c.295C>A, p.Leu99Ile, present in 52 alleles of 32 probands. Individuals with LCA homozygous for p.Leu99Ile (31%) had a later age of onset, slower rate of BCVA decrease, the largest percentage of patients with mild visual impairment, and were predicted to reach legal blindness at an older age than the rest of the cohort. // Conclusions: By describing the largest molecularly confirmed cohort to date, improved understanding of disease progression was possible. Our detailed characterization aims to support research and the development of novel therapies that may have the potential to reduce or prevent vision loss in individuals with RDH12-associated retinal dystrophy

Cambios en el currículum de la Educación Física chilena: voces desde el territorio

El objetivo de la investigación fue analizar el desarrollo del currículum en los últimos años y la didáctica que utilizan profesores de Educación Física en una región del centro sur de Chile. La metodología del estudio es de tipo cualitativa, a través de entrevistas a docentes con al menos cinco años de permanencia en el sistema educacional. Los resultados dan cuenta de que los profesores abordan el proceso de enseñanza-aprendizaje analizando el contexto en que están inmersos. Al momento de planificar sus clases se apoyan en las bases curriculares dispuestas por el Ministerio de Educación y las características de los estudiantes. Se concluye que, respecto a los desafíos actuales, buscan llevar a la práctica un modelo constructivista, procurando que el estudiante sea parte del proceso educativo, tomando en cuenta su integridad y bienestar. Asimismo, se espera que el currículum incorpore las problemáticas actuales que emergen en la sociedad

Weighing stars from birth to death: mass determination methods across the HRD

The mass of a star is the most fundamental parameter for its structure, evolution, and final fate. It is particularly important for any kind of stellar archaeology and characterization of exoplanets. There exists a variety of methods in astronomy to estimate or determine it. In this review we present a significant number of such methods, beginning with the most direct and model-independent approach using detached eclipsing binaries. We then move to more indirect and model-dependent methods, such as the quite commonly used isochrone or stellar track fitting. The arrival of quantitative asteroseismology has opened a completely new approach to determine stellar masses and to complement and improve the accuracy of other methods. We include methods for different evolutionary stages, from the pre-main sequence to evolved (super)giants and final remnants. For all methods uncertainties and restrictions will be discussed. We provide lists of altogether more than 200 benchmark stars with relative mass accuracies between $[0.3,2]\%$ for the covered mass range of M\in [0.1,16]\,\msun, $75\%$ of which are stars burning hydrogen in their core and the other $25\%$ covering all other evolved stages. We close with a recommendation how to combine various methods to arrive at a "mass-ladder" for stars.Comment: Invited review article for The Astronomy and Astrophysics Review. 146 pages, 16 figures, 11 tables. Accepted version by the Journal. It includes summary figure of accuracy/precision of methods for mass ranges and summary table for individual method

Weighing stars from birth to death : mass determination methods across the HRD

Funding: C.A., J.S.G.M., and M.G.P. received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 670519: MAMSIE). N.B. gratefully acknowledge financial support from the Royal Society (University Research Fellowships) and from the European Research Council (ERC-CoG-646928, Multi-Pop).The mass of a star is the most fundamental parameter for its structure, evolution, and final fate. It is particularly important for any kind of stellar archaeology and characterization of exoplanets. There exist a variety of methods in astronomy to estimate or determine it. In this review we present a significant number of such methods, beginning with the most direct and model-independent approach using detached eclipsing binaries. We then move to more indirect and model-dependent methods, such as the quite commonly used isochrone or stellar track fitting. The arrival of quantitative asteroseismology has opened a completely new approach to determine stellar masses and to complement and improve the accuracy of other methods. We include methods for different evolutionary stages, from the pre-main sequence to evolved (super)giants and final remnants. For all methods uncertainties and restrictions will be discussed. We provide lists of altogether more than 200 benchmark stars with relative mass accuracies between [0.3 ,2 ]% for the covered mass range of M ∈[0.1 ,16 ] M⊙ , 75 % of which are stars burning hydrogen in their core and the other 25 % covering all other evolved stages. We close with a recommendation how to combine various methods to arrive at a "mass-ladder" for stars.PostprintPeer reviewe