¿Cómo diseñar, aplicar y evaluar un programa de Mentoring en enfermedad renal crónica? evaluación narrativa del impacto en 6 centros asistenciales

Antecedentes y objetivo La enfermedad renal crónica (ERC) requiere de un proceso de adaptación en el paciente, que se puede facilitar con el apoyo de los profesionales sanitarios, así como por iguales capacitados. El objetivo de este estudio es presentar la puesta en marcha de un programa piloto de paciente mentor para promover la adaptación de los pacientes con ERC. Materiales y método Diseño mixto (cuantitativo y cualitativo) pre-post. El estudio se llevó a cabo en 6 hospitales de España. Los instrumentos utilizados para medir el impacto fueron escalas elaboradas ad-hoc (formato de respuesta escala de Likert de 10 puntos) de satisfacción y adquisición de competencias, así como la creación de grupos focales con 8 pacientes mentores y 10 profesionales sanitarios. Se dividió el programa en 4 fases: 1) Diseño y validación de contenidos del programa manualizado y selección de pacientes mentores; 2) Formación a mentores, satisfacción con la formación y competencias adquiridas por los mentores; 3) Implementación de los grupos de apoyo mutuo y perfil de los asistentes a los grupos de apoyo mutuo, y 4) Evaluación y resultados del programa de Mentoring. Resultados Se han formado a un total de 39 mentores en habilidades para conducción de grupos, así como para facilitar apoyo emocional. Se han conducido 22 grupos de apoyo con 121 participantes (22% cuidadores). El 65% de los pacientes estaban en consulta de ERC. Un 65% de los pacientes participantes consideraron hacer algún cambio en su estilo de vida tras la asistencia al programa. Todos los ítems que evalúan satisfacción y utilidad han mostrado una puntuación muy elevada, por encima del valor 8, 5 sobre 10. Conclusiones Este es el primer programa manualizado de Mentoring en ERC llevado a cabo de manera simultánea en 6 hospitales españoles. La naturaleza del programa, manualizado y altamente estructurado, permite su replicabilidad minimizando el riesgo de error. Background and objective Chronic kidney disease (CKD) requires patients to participate in an adaptation process, which may be facilitated with the support of healthcare professionals and trained peers. The objective of this study is to present the implementation of a pilot patient mentoring programme to promote adaptation in patients with CKD. Materials and method Pre-test-post-test design (quantitative and qualitative). The study was carried out in six hospitals in Spain. The instruments used to measure impact were ad-hoc scales (10-point Likert scale response format) on satisfaction and skill acquisition, as well as the creation of focus groups with eight patient mentors and 10 healthcare professionals. The programme was split into four phases: 1. Design and validation of the manualised programme''s content, and selection of patient mentors; 2. Mentor training, satisfaction with training and skills acquired by the mentors; 3. Implementation of mutual support groups and profile of those attending these mutual support groups; 4. Assessment and results of the Mentoring programme. Results In total, 39 mentors were trained on group management skills, as well as how to provide emotional support. 22 support groups were held, with 121 participants (22% carers). The 65% of the patients were attending the CKD clinic. 65% of the participating patients considered making some form of lifestyle change after taking part in the programme. All the items assessing satisfaction and usefulness scored very highly, achieving 8.5 out of 10 or above. Conclusions This is the first manualised mentoring programme in CKD to be undertaken simultaneously in six Spanish hospitals. The manualised and highly structured nature of the programme make it easy to replicate, minimising the risk of error

Modeling the Subsurface Structure of Sunspots

While sunspots are easily observed at the solar surface, determining their subsurface structure is not trivial. There are two main hypotheses for the subsurface structure of sunspots: the monolithic model and the cluster model. Local helioseismology is the only means by which we can investigate subphotospheric structure. However, as current linear inversion techniques do not yet allow helioseismology to probe the internal structure with sufficient confidence to distinguish between the monolith and cluster models, the development of physically realistic sunspot models are a priority for helioseismologists. This is because they are not only important indicators of the variety of physical effects that may influence helioseismic inferences in active regions, but they also enable detailed assessments of the validity of helioseismic interpretations through numerical forward modeling. In this paper, we provide a critical review of the existing sunspot models and an overview of numerical methods employed to model wave propagation through model sunspots. We then carry out an helioseismic analysis of the sunspot in Active Region 9787 and address the serious inconsistencies uncovered by \citeauthor{gizonetal2009}~(\citeyear{gizonetal2009,gizonetal2009a}). We find that this sunspot is most probably associated with a shallow, positive wave-speed perturbation (unlike the traditional two-layer model) and that travel-time measurements are consistent with a horizontal outflow in the surrounding moat.Comment: 73 pages, 19 figures, accepted by Solar Physic

Determinants and Differences in Satisfaction with the Inhaler Among Patients with Asthma or COPD

Satisfaction with the inhaler is an important determinant of treatment adherence in patients with asthma and chronic obstructive pulmonary disease (COPD). However, few studies have compared these 2 groups to identify the factors associated with satisfaction with the inhaler. To assess and compare satisfaction with the inhaler in patients with asthma or COPD and to determine the variables associated with high inhaler satisfaction. A multicenter, cross-sectional study of 816 patients (406 with asthma and 410 with COPD) was conducted. Satisfaction was assessed with the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. All participants completed the Test of Adherence to Inhalers and either the Asthma Control Test (ACT) or the COPD Assessment Test (CAT). Overall, the asthma group was significantly more satisfied with the inhaler (mean [standard deviation] FSI-10 scores: 44.1 [6.5] vs 42.0 [7.7]; P <.001) and more satisfied on most (7 of 10; 70%) items. Patients with asthma were significantly more satisfied with the inhaler regardless of the adherence level or the type of nonadherence pattern. Younger age, good disease control (ACT ≥20 or CAT ≤10), previous inhaler training, and absence of unwitting nonadherence were all independently and significantly associated with high inhaler satisfaction. Age, disease control, and training in inhalation technique all play a more significant role than the specific diagnosis in explaining satisfaction with the device in patients with asthma and COPD. These findings underscore the need to provide better training and more active monitoring of the inhalation technique to improve patient satisfaction, treatment adherence, and clinical outcomes

7th Drug hypersensitivity meeting: part two

No abstract availabl

Commentaria in octo libros Aristotelis de physica auscultatione

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Accelerated aging of absorber coatings for CSP receivers under real high solar flux: Evolution of their optical properties

The use of durable high solar absorptance receivers is a key element in a CSP plant project. In this article, different receiver materials are studied: four alloy substrates (T91, T22, VM12, Inconel 617) combined with four new absorber coatings, operable in solar towers with molten salts or steam as heat transfer fluids, and a classic Pyromark® paint considered as a reference. In order to test the durability of the coatings, 200 solar accelerated aging cycles were applied on the samples, using a concentrated solar facility (named SAAF). The cycles were defined so as to apply realistic high solar flux and temperature on the front side of the samples, and with high cooling and heating rates reproducing the fast variation of solar irradiation due to cloudy weather and subsequent thermal shocks. The optical characteristics of the coatings were measured at the beginning and at regular intervals during the aging procedure. Different behaviors of the coatings were observed depending on the substrate, before any aging cycle. After this first aging campaign, some evolutions were observed on the solar absorptance or thermal emittance, depending on the substrate and the coating. Nevertheless, the degradations noticed are not significant enough to conclude about the durability of the coatings

Creative cities: the cultural industries and the creative class

The aim of this article is to critically examine the notion that the creative class may or may not play as a causal mechanism of urban regeneration. I begin with a review of Florida's argument focusing on the conceptual and theoretical underpinnings. The second section develops a critique of the relationship between the creative class and growth. This is followed by an attempt to clarify the relationship between the concepts of creativity, culture and the creative industries. Finally, I suggest that policy-makers may achieve more successful regeneration outcomes if they attend to the cultural industries as an object that links production and consumption, manufacturing and service. Such a notion is more useful in interpreting and understanding the significant role of cultural production in contemporary cities, and what relation it has to growth