Rationale and design of a randomised controlled trial evaluating the effectiveness of an exercise program to improve the quality of life of patients with heart failure in primary care : the EFICAR study protocol

Background: Quality of life (QoL) decreases as heart failure worsens, which is one of the greatest worries of these patients. Physical exercise has been shown to be safe for people with heart failure. Previous studies have tested heterogeneous exercise programs using different QoL instruments and reported inconsistent effects on QoL. The aim of this study is to evaluate the effectiveness of a new exercise program for people with heart failure (EFICAR), additional to the recommended optimal treatment in primary care, to improve QoL, functional capacity and control of cardiovascular risk factors. Methods/Design: Multicenter clinical trial in which 600 patients with heart failure in NYHA class II-IV will be randomized to two parallel groups: EFICAR and control. After being recruited, through the reference cardiology services, in six health centres from the Spanish Primary Care Prevention and Health Promotion Research Network (redIAPP), patients are followed for 1 year after the beginning of the intervention. Both groups receive the optimized treatment according to the European Society of Cardiology guidelines. In addition, the EFICAR group performs a 3 month supervised progressive exercise program with an aerobic (high-intensity intervals) and a strength component; and the programme continues linked with community resources for 9 months. The main outcome measure is the change in health-related QoL measured by the SF-36 and the Minnesota Living with Heart Failure Questionnaires at baseline, 3, 6 and 12 months. Secondary outcomes considered are changes in functional capacity measured by the 6-Minute Walking Test, cardiac structure (B-type natriuretic peptides), muscle strength and body composition. Both groups will be compared on an intention to treat basis, using multi-level longitudinal mixed models. Sex, age, social class, co-morbidity and cardiovascular risk factors will be considered as potential confounding and predictor variables. Discussion: A key challenges of this study is to guarantee the safety of the patients; however, the current scientific evidence supports the notion of there being no increase in the risk of decompensation, cardiac events, hospitalizations and deaths associated with exercise, but rather the opposite. Safety assurance will be based on an optimized standardised pharmacological therapy and health education for all the participants

Lean road transportation – A systematic method for the improvement of road transport operations

Road transportation has become an important factor in international trade and the management of supply chains. However, this form of product logistics has generally been considered inefficient. Traditionally, practical inefficiencies of road transportation have been addressed through mathematical modelling, operations research-based methods, and simulation. This paper presents an alternative systematic approach to improve road transport operations based on lean thinking and the reduction of the seven transportation extended wastes (STEWs). To do this, the paper reviews the extant literature in the area of lean road transportation, providing a structured research definition of the application of lean thinking in road transport operations and hence guidance on the limited research conducted in this field. The systematic lean transportation method is then presented and empirically tested through a case study in a Mexican firm. The results obtained from the case study indicate that the proposed systematic lean method is an effective alternative for the improvement of road transport operations, with the number of distribution routes and distance travelled being reduced by 27% and 32% respectively. The proposed method can be used by organisations as a guide to help them improve their road transport operations. In addition, the paper’s aim is to contribute by stimulating scholars to further study the application of lean thinking and waste reduction in road transport operations

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Agenda para el futuro: Balance y perspectivas del desarrollo rural en América Latina y el Caribe una visión desde el IICA

396 páginas. Serie de desarrollo institucional N. 131.Libro escrito por el director general José Emilio Araujo. La obra intenta sistematizar algunos de Ios componentes de Ia doctrina institucional y ubicarlos en un contexto más amplio, junto con el conjunto de ideas, mandatos y decisiones que a lo largo de Ia ultima década, que han permitido que el IICA se transformara, ordenada y creativamente, en un organismo en gravitación interamericana y de utilidad innegable para el desarrollo agrícola y rural de sus Estados Miembros. Varias son Ias fuentes principales que componen este libro, entre ellas la nutrida documentación producida por el Instituto para Ios Estados Miembros, para foros regionales e internacionales y para capacitación interna. Esos documentos que se citan, en cada caso han sido utilizados generosamente

Agrarian reform in Latin America 1974 perspectives and possibilities

44 páginascontextualization of the situation of the agrarian reform in 1974 in Latin America is presented; its significant events and problems in its progress

El desarrollo rural humanista en América: Una perspectiva desde el IICA

572 páginas. Serie desarrollo institucional No. 5Este libro es el resultado de un trabajo de compilación de los mensajes, informes regulares, que en ejercicio de mis funciones, atribuciones y responsabilidades. Incorpora textos de los discursos de José Emilio G. Araujo ante reuniones anuales de la junta directiva y del Consejo Técnico Consultivo. Incorpora seis estudios de importancia sobre la situación agraria y rural de América Latina, sobre la educación, la investigación, las tendencias del sector agrícola en la región, y características del cambio estructural

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013