Un año de registro de traumatismos graves en Cataluña. Análisis de los primeros resultados

Objetivo: Evaluar los resultados del primer año de implantación de un registro poblacional hospitalario de traumatismos graves en Cataluña (TraumCat). Método: Un total de 15 hospitales han recogido de forma prospectiva información sobre pacientes traumáticos graves, adultos y pediátricos (menores de 16 años), durante un periodo de un año (del 1 julio 2012 al 1 julio 2013) y la han introducido en un registro informatizado accesible en red. Resultados: Se han registrado 1.106 casos de pacientes con traumatismos de alta energía (12,2% en menores de 16 años). Un 84% de los traumatismos fueron no intencionales en adultos jóvenes. El 54,4% de los traumatismos se originaron en accidentes de circulación y el 26,9% en precipitaciones. Un 5,4% correspondían a agresiones. Un 46% de pacientes presentaban un ISS mayor a 15, mientras que el NISS era mayor a 15 en un 51%. La tasa media de mortalidad fue del 10%. Sin embargo, en mayores de 60 años la tasa alcanzó el 25,2%. Conclusiones: TraumCat permite conocer la dimensión y evaluar el proceso asistencial en torno al traumatismo grave en Cataluña. Es preciso avanzar en la consolidación y mejora de esta herramienta como estrategia de monitorización del proceso asistencial y análisis de resultados

Evaluation of Safety and Efficacy of ReHub in Patients Who Underwent Primary Total Knee Arthroplasty: Study Protocol for a Randomized Controlled Trial

Background: Total Knee Arthroplasty (TKA) is an intervention that can significantly improve the quality of life of patients with advanced knee osteoarthritis. Early start of rehabilitation and its continuation at home once the patient is discharged are key factors for the success of the process.This study aims to assess the effectiveness of a home-based telerehabilitation solution (ReHub) on improving functional capacity and clinical outcomes for patients who underwent TKA. Methods/design: The study is a randomized, open-label with blinded outcome assessor, parallel assignment clinical trial with a sample size of 52 patients that is conducted according to the SPIRIT recommendations. After the TKA intervention, the patients are randomly allocated to the control group or the experimental group with a 1:1 ratio. Both groups follow a Fast Track recovery protocol which includes discharge after 2-3 days from surgery, a daily plan of 5 exercises for autonomous rehabilitation and domiciliary visits by a physiotherapist starting approximately 2 weeks after surgery. The experimental group uses the sensor-based telerehabilitation system ReHub to perform the exercises. The primary outcome measure is the range of motion of the knee. Secondary outcomes include physical performance, quality of life, pain intensity, muscle strength, treatment adherence and satisfaction with the ReHub system. The outcomes assessment is performed at hospital discharge (baseline), at stitch removal (2 weeks after baseline) and 2 weeks after stitch removal (4 weeks after baseline).The study conforms to the guidelines of the Declaration of Helsinki and was approved by the hospital's ethics committee. Discussion: The study will address an important gap in the evidence base by reporting the effectiveness of an affordable and low-cost home-based telerehabilitation solution in patients who underwent TKA. Ethics and dissemination: The study was approved by the hospital's ethics committee ("Comité Ético de Investigación Clínica del HCB", reg. HCB/2019/0571). The trial was registred at ClinicalTrials.gov (NCT04155957). The results of this study will be published in peer-reviewed journals as well as national and international conferences. Trial registration: NCT04155957 (ClinicalTrials.gov). Highlights: Assessing a home-based telerehabilitation solution effectiveness in knee surgery.In situations such as the CoVid-19 pandemic, it is a resolutive intervention method.Telerehabilitation is an alternative to conventional face-to-face physical therapy.This system is far less demanding in terms of human resources.Range of motion assessment is the primary outcome measure

Clinical results before and after implementation of a Fast - Track protocol for 507 patients who underwent total knee arthroplasty surgery: A retrospective, observational study.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. !is study aimed to assess the e'ects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: !is is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. !e variables studied were active knee #exion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. !e mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active #exion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. !e mean active extension was: -5.37º (SD = 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more signi$cant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in #exion and extension). However, the exact role of the Flexet device is still to be determined. Keywords: Total Knee Arthroplasty, Fast-Track, Rapid-Recovery, ROM, early mobilization, active physiotherapy

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. This study aimed to assess the effects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: This is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. The variables studied were active knee flexion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. The mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active flexion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. The mean active extension was: -5.37º (SD= 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more significant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in flexion and extension). However, the exact role of the Flexet device is still to be determined

The New Seafloor Observatory (OBSEA) for Remote and Long-Term Coastal Ecosystem Monitoring

A suitable sampling technology to identify species and to estimate population dynamics based on individual counts at different temporal levels in relation to habitat variations is increasingly important for fishery management and biodiversity studies. In the past two decades, as interest in exploring the oceans for valuable resources and in protecting these resources from overexploitation have grown, the number of cabled (permanent) submarine multiparametric platforms with video stations has increased. Prior to the development of seafloor observatories, the majority of autonomous stations were battery powered and stored data locally. The recently installed low-cost, multiparametric, expandable, cabled coastal Seafloor Observatory (OBSEA), located 4 km off of Vilanova i la Gertrú, Barcelona, at a depth of 20 m, is directly connected to a ground station by a telecommunication cable; thus, it is not affected by the limitations associated with previous observation technologies. OBSEA is part of the European Multidisciplinary Seafloor Observatory (EMSO) infrastructure, and its activities are included among the Network of Excellence of the European Seas Observatory NETwork (ESONET). OBSEA enables remote, long-term, and continuous surveys of the local ecosystem by acquiring synchronous multiparametric habitat data and bio-data with the following sensors: Conductivity-Temperature-Depth (CTD) sensors for salinity, temperature, and pressure; Acoustic Doppler Current Profilers (ADCP) for current speed and direction, including a turbidity meter and a fluorometer (for the determination of chlorophyll concentration); a hydrophone; a seismometer; and finally, a video camera for automated image analysis in relation to species classification and tracking. Images can be monitored in real time, and all data can be stored for future studies. In this article, the various components of OBSEA are described, including its hardware (the sensors and the network of marine and land nodes), software (data acquisition, transmission, processing, and storage), and multiparametric measurement (habitat and bio-data time series) capabilities. A one-month multiparametric survey of habitat parameters was conducted during 2009 and 2010 to demonstrate these functions. An automated video image analysis protocol was also developed for fish counting in the water column, a method that can be used with cabled coastal observatories working with still images. Finally, bio-data time series were coupled with data from other oceanographic sensors to demonstrate the utility of OBSEA in studies of ecosystem dynamics

State recognition for ‘contested languages’: a comparative study of Sardinian and Asturian, 1992–2010

While the idea of a named language as a separate and discrete identity is a political and social construct, in the cases of Sardinian and Asturian doubts over their respective ‘languageness’ have real material consequences, particularly in relation to language policy decisions at the state level. The Asturian example highlights how its lack of official status means that it is either ignored or subjected to repeated challenges to its status as a language variety deserving of recognition and support, reflecting how ‘official language’ in the Spanish context is often understood in practice as synonymous with the theoretically broader category of ‘language’. In contrast, the recent state recognition of Sardinian speakers as a linguistic minority in Italy (Law 482/1999) illustrates how legal recognition served to overcome existing obstacles to the implementation of regional language policy measures. At the same time, the limited subsequent effects of this Law, particularly in the sphere of education, are a reminder of the shortcomings of top-down policies which fail to engage with the local language practices and attitudes of the communities of speakers recognized. The contrastive focus of this article thus acknowledges the continued material consequences of top-down language classification, while highlighting its inadequacies as a language policy mechanism which reinforces artificial distinctions between speech varieties and speakers deserving of recognition

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p&lt;0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p&lt;0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations