Procedimiento de inserción del catéter central de inserción periférica (PICC) en adultos FEMORA. Procedimientos de enfermería: canalización y cuidados de vías vasculares

O programa FEMORA recompila procedementos estandarizados, con evidencia científica, para os profesionais do Sergas. A protocolización dos coidados confórmase como instrumento indispensable de soporte para a práctica clínica. Entre as súas numerosas vantaxes cabe destacar a redución na diversidade inapropiada da práctica clínica, o que propicia unha atención máis xusta e equitativa aos pacientes. Este procedemento unifica, así mesmo, criterios de actuación que serven de punto de partida para unha avaliación de calidade do proceso asistencial.El programa FEMORA recopila procedimientos estandarizados, con evidencia científica, para los profesionales del Sergas. La protocolización de los cuidados se conforma como instrumento indispensable de soporte para la práctica clínica. Entre sus numerosas ventajas cabe destacar la reducción en la diversidad inapropiada de la práctica clínica, lo que les propicia una atención más justa y equitativa a los pacientes. Este procedimiento unifica, asimismo, criterios de actuación que sirven de punto de partida para una evaluación de calidad del proceso asistencial

Surplus production, variability, and climate change in the great sardine and anchovy fisheries

We used fishery and survey data to calculate annual surplus production (ASP) and instantaneous surplus production rates (ISPR) for eight anchovy and nine sardine stocks. In addition, we calculated ASP per unit spawning area for six anchovy and six sardine stocks. Median ASP was highest for stocks with highest median biomass (mostly anchovies), and ASP was typically about 16% of stock biomass. ASP was often negative, more frequently for anchovies (36% of years) than for sardines (17% of years). ISPR was less variable for sardines and autocorrelated for longer-lived stocks (mostly sardines). Strong biomass increases tended to be preceded by short, abrupt increases in ISPR, and declines were pronounced when catches exceeded ASP for 5 years or more. The longest “runs” of positive and negative production were 21 and 4 years for sardine off Japan, 10 and 3 years for sardine off California, 8 and 2 years for anchovy off Peru, and 4 and 3 years for anchovy off California. ISPR is more sensitive to environmental changes than catch, biomass, or ASP and appear to be better for identifying environmentally induced regime shifts. Long time series show evidence of density-dependent effects on ASP in anchovies and sardines, but environmentally induced variation appears to dominate.Des statistiques de pêche et des données d’inventaire nous ont servi à calculer la production excédentaire annuelle (ASP) et les taux instantanés de production excédentaire (ISPR) chez huit stocks d’anchois et neuf stocks de sardines. De plus, nous avons calculé l’ASP par unité de surface de frayère chez six stocks d’anchois et six stocks de sardines. L’ASP moyen est maximal chez les stocks qui possèdent la plus grande biomasse médiane (surtout des anchois) et correspond normalement à environ 16% de la biomasse du stock. L’ASP est souvent négative, plus souvent chez les anchois (36% des années) que chez les sardines (17% des années). L’ISPR est moins variable chez les sardines et est autocorrelé chez les stocks à longévité plus grande (surtout des sardines). Les augmentations importantes de biomasse sont normalement précédées d’une croissance abrupte de l’ISPR; lorsque les prises dépassent l’ASP pour 5 ans ou plus, il y a un déclin prononcé. Les plus longues « séquences » de production positive et négative ont été respectivement de 21 et 4 années pour les sardines au large du Japon, de 10 et 3 années pour les sardines au large de la Californie, de 8 et 2 années pour les anchois au large du Pérou et de 4 et 3 années pour les anchois au large de la Californie. Les ISPR est plus sensible aux changements de l’environnement que ne le sont les captures, la biomasse ou l’ASP et semblent être plus appropriés pour détecter les changements de régime dus à l’environnement. Les longues séries temporelles laissent croire à l’existence d’effets de densité-dépendance sur l’ASP chez les anchois et les sardines, mais la variation attribuable à l’environnement semble dominer.Versión del editor2,213

100 años investigando el mar. El IEO en su centenario (1914-2014).

Se trata de un libro que pretende divulgar a la sociedad las principales investigaciones multidisciplinares llevadas a cabo por el Instituto Español de Oceanografía durante su primer siglo de vida, y dar a conocer la historia del organismo, de su Sede Central y de los nueve centros oceanográficos repartidos por los litorales mediterráneo y atlántico, en la península y archipiélagos.Kongsberg 200Postprin

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care