Diagnóstico de shunt portosistémico mediante gammagrafía per-rectal y trans-esplénica en el perro

La gammagrafía permite el diagnóstico de shunt portosistémico de manera rápida y no invasiva mediante la técnica per-rectal o la trans-esplénica. En este estudio se describen y comparan los resultados obtenidos en el perro mediante las dos técnicas. La trans-esplénica se considera más adecuada debio a la obtención de imágenes de mayor calidad.

PROCESO DE MUERTE: EXPERIENCIA DE UN REGISTRO ENFERMERO COMO SOPORTE AL PROFESIONAL DE CUIDADOS PALIATIVOS

Cancer patients' last days’ condition has been described as multiple, multi-faceted and changing symptoms that mean high emotional, social and spiritual impact and requires specific attention from palliative care professionals. Since the starting period of the Palliative Care Unit at the Institut Català of Oncology (ICO) in Barcelona, the necessity of a record sheet was discovered, in order to record the whole process of the agony condition. The study has a double objective; on one hand to describe the complexity of last days’ condition that is recorded in the nursing records and how these records are useful for the following-up of the mourning period and the intervention of other professionals. On the other hand, it asses, from a qualitative point of view, its validity for the professionals themselves. This descriptive study was designed in three stages following a different methodology in each. During the first stage, records were analyzed of the condition of the last days of 150 patients that died in the unit over a year, so as to detect the need of following-up on mourning. In the second stage, by consensus in a meeting, the points that should be contained in the record sheet that were going to be used were defined and the modifications were written In the third stage, filling out, satisfaction and utility as an instrument of a specific record were assessed. As a result, it was discovered that one of every four conditions of death registered in our sample were "complex processes” with a high emotional impact for the team. A percentage of 27 % required mourning tracking by the social worker or a professional from the Psychiatry Department for pathologic cases. Regarding the satisfaction of the record itself, nursing professionals stated it was useful, particularly for this condition and that it could be improved. Being involved in the practice of these results allows us to better approach the process of the last days, to dictate complex conditions, and to prepare future actions for the mourning period.La situación de últimos días se caracteriza por la presencia de síntomas múltiples, multifactoriales y cambiantes, con alto impacto emocional, social y espiritual que precisa de atención específica del profesional en Cuidados Paliativos. Desde el inicio de su funcionamiento como Unidad de Cuidados Paliativos en el Instituto Catalán de Oncología, se detectó la necesidad de tener una hoja de registro donde plasmar todo el proceso de la situación de agonía. El objetivo de nuestro estudio es doble, por un lado describir la complejidad de la situación de últimos días que se refleja en los registros de Enfermería y cómo estos registros resultan de utilidad para el seguimiento posterior de duelo e intervención de otros profesionales, y por otro valorar de manera cualitativa su validez para los propios profesionales. Este estudio descriptivo se diseñó en tres fases, con diferente metodología en cada una de ellas. En la primera fase, se analizaron los registros de la situación de últimos días de 150 enfermos durante 1 año que fallecieron en la unidad para detectar su necesidad de seguimiento del duelo. En la segunda fase se definen, en reuniones de consenso, los puntos que debe contener la hoja de registro que se va a utilizar y se diseñan sus cambios. En la tercera fase se evalúa de manera cualitativa la cumplimentación, satisfacción y utilidad como instrumento de registro específico. Como resultante se detecta que una de cada cuatro situaciones de muerte recogidas en nuestra muestra son “procesos con complejidad”, con alto impacto emocional para el equipo. 27% requirió seguimiento de duelo, bien por trabajadora social o por profesional de Psiquiatría en casos patológicos. Con respecto a la satisfacción del propio registro, los profesionales enfermeros valoran que sí resultaba útil, específico para esta situación y mejorable. La implicación en la práctica de estos resultados permite abordar mejor el proceso de últimos días, dictaminar situaciones complejas y elaborar unas actuaciones posteriores en el duelo

A review of undulated sediment features on Mediterranean prodeltas: distinguishing sediment transport structures from sediment deformation

Most Mediterranean prodeltas show undulated sediment features on the foresets of their Holocene wedges. These features have been described all along the Mediterranean for the last 30 years and interpreted as either soft sediment deformation and incipient landsliding, and more recently, as sediment transport structures. We perform a review and detailed analysis of these undulated sediment features using ultrahigh-resolution seismic and bathymetric data as well as geotechnical information and hydrodynamic time series and hydrographic transects. In this study we show that the characteristics of the sediment undulations (configuration of the reflections down section and between adjacent undulations and overall morphologic characteristics) are incompatible with a genesis by sediment deformation alone and do not show evidence of sediment deformation in most cases. Various processes in the benthic boundary layer can be invoked to explain the variety of features observed in the numerous areas displaying sediment undulations

Survival of a submarine canyon during long-term outbuilding of a continental margin

Net-depositional submarine canyons are common in continental slope strata, but how they survive and prograde on constructional margins is poorly understood. In this study we present field evidence for the coevolution of a submarine canyon and the adjacent continental slope. Using a three-dimensional seismic data cube that images the Ebro margin (northwest Mediterranean), we identify a preserved canyon on a middle Pleistocene paleosurface and relate it directly to its expression on the present-day seafloor. A subparallel stacking pattern of seismic reflectors, similar to that seen between prograding clinoforms in intercanyon areas, is observed between the modern and paleocanyon thalwegs. The concavity of the modern long profile differs from the convex-concave long profile on the middle Pleistocene surface, suggesting a long-term change in canyon sedimentation. We interpret this change as a shift to a canyon dominated by turbidity currents from one strongly influenced by the pattern of sedimentation that built the open-slope canyon interfluves. We find support for our interpretation in previous studies of the Ebro margin

Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre) : protocol for a multicentre, observational study followed by randomised controlled feasibility trial

Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial. We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes. The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethics Committee at each participating site. The results will be used to design a large, definitive trial. Trial registration number NCT03244514

Death process: nursing record experience as a support of the professional in the palliative care unit

La situación de últimos días se caracteriza por la presencia de síntomas múltiples, multifactoriales y cambiantes, con alto impacto emocional, social y espiritual que precisa de atención específica del profesional en Cuidados Paliativos. Desde el inicio de su funcionamiento como Unidad de Cuidados Paliativos en el Instituto Catalán de Oncología, se detectó la necesidad de tener una hoja de registro donde plasmar todo el proceso de la situación de agonía. El objetivo de nuestro estudio es doble, por un lado describir la complejidad de la situación de últimos días que se refleja en los registros de Enfermería y cómo estos registros resultan de utilidad para el seguimiento posterior de duelo e intervención de otros profesionales, y por otro valorar de manera cualitativa su validez para los propios profesionales. Este estudio descriptivo se diseñó en tres fases, con diferente metodología en cada una de ellas. En la primera fase, se analizaron los registros de la situación de últimos días de 150 enfermos durante 1 año que fallecieron en la unidad para detectar su necesidad de seguimiento del duelo. En la segunda fase se definen, en reuniones de consenso, los puntos que debe contener la hoja de registro que se va a utilizar y se diseñan sus cambios. En la tercera fase se evalúa de manera cualitativa la cumplimentación, satisfacción y utilidad como instrumento de registro específico. Como resultante se detecta que una de cada cuatro situaciones de muerte recogidas en nuestra muestra son “procesos con complejidad”, con alto impacto emocional para el equipo. 27% requirió seguimiento de duelo, bien por trabajadora social o por profesional de Psiquiatría en casos Enfermería Global Nº 16 Junio 2009 Página 2 patológicos. Con respecto a la satisfacción del propio registro, los profesionales enfermeros valoran que sí resultaba útil, específico para esta situación y mejorable. La implicación en la práctica de estos resultados permite abordar mejor el proceso de últimos días, dictaminar situaciones complejas y elaborar unas actuaciones posteriores en el duelo.ABSTRACT Cancer patients' last days’ condition has been described as multiple, multi-faceted and changing symptoms that mean high emotional, social and spiritual impact and requires specific attention from palliative care professionals. Since the starting period of the Palliative Care Unit at the Institut Català of Oncology (ICO) in Barcelona, the necessity of a record sheet was discovered, in order to record the whole process of the agony condition. The study has a double objective; on one hand to describe the complexity of last days’ condition that is recorded in the nursing records and how these records are useful for the following-up of the mourning period and the intervention of other professionals. On the other hand, it asses, from a qualitative point of view, its validity for the professionals themselves. This descriptive study was designed in three stages following a different methodology in each. During the first stage, records were analyzed of the condition of the last days of 150 patients that died in the unit over a year, so as to detect the need of following-up on mourning. In the second stage, by consensus in a meeting, the points that should be contained in the record sheet that were going to be used were defined and the modifications were written In the third stage, filling out, satisfaction and utility as an instrument of a specific record were assessed. As a result, it was discovered that one of every four conditions of death registered in our sample were "complex processes” with a high emotional impact for the team. A percentage of 27 % required mourning tracking by the social worker or a professional from the Psychiatry Department for pathologic cases. Regarding the satisfaction of the record itself, nursing professionals stated it was useful, particularly for this condition and that it could be improved. Being involved in the practice of these results allows us to better approach the process of the last days, to dictate complex conditions, and to prepare future actions for the mourning period

Diagnóstico de shunt portosistémico mediante gammagrafía per-rectal y trans-esplénica en el perro

La gammagrafía permite el diagnóstico de shunt portosistémico de manera rápida y no invasiva mediante la técnica per-rectal o la trans-esplénica. En este estudio se describen y comparan los resultados obtenidos en el perro mediante las dos técnicas. La trans-esplénica se considera más adecuada debio a la obtención de imágenes de mayor calidad.

A review of undulated sediment features on Mediterranean prodeltas: distinguishing sediment transport structures from sediment deformation

Most Mediterranean prodeltas show undulated sediment features on the foresets of their Holocene wedges. These features have been described all along the Mediterranean for the last 30 years and interpreted as either soft sediment deformation and incipient landsliding, and more recently, as sediment transport structures. We perform a review and detailed analysis of these undulated sediment features using ultrahigh-resolution seismic and bathymetric data as well as geotechnical information and hydrodynamic time series and hydrographic transects. In this study we show that the characteristics of the sediment undulations (configuration of the reflections down section and between adjacent undulations and overall morphologic characteristics) are incompatible with a genesis by sediment deformation alone and do not show evidence of sediment deformation in most cases. Various processes in the benthic boundary layer can be invoked to explain the variety of features observed in the numerous areas displaying sediment undulations