Diseño de prototipo de casa autosostenible para la creación de nuevos sistemas ecológicos, en el Centro de Investigaciones de Ingeniería, USAC

Para la implementación de nuevos sistemas ecológicos para que una casa sea autosostenible se debe de tomar en cuenta la salud y la ecología del lugar ya que hay lugares que, por su ubicación geográfica podrían ser más soleados que otros, incluso lugares donde la mayoría del tiempo llueve. Según la ubicación, así se tendrán los recursos naturales que se podrían utilizar para la creación de sistemas ecológicos

Mucositis Prevention for Patients Receiving High Dose Chemotherapy and Stem Cell Transplantation : Preventive Strategies - There is Always More to do

The aim of this thesis was to investigate oral cryotherapy (OC) as prophy-laxis against oral mucositis (OM) in patients given high-dose chemotherapy for stem cell transplantation (SCT). A new mouth rinse device was tested for possible additive effect to OC. For study I-III, 78 patients were randomised to OC or standard oral care (SOC). Papers I and II showed that OC patients had significantly less severe mucositis, pain, opioid use, lower C-reactive protein and less parenteral nutrition treatment (TPN). There was no difference in relapse rate, and 5-year survival was unexpectedly significantly better in the OC group (Paper III). In paper IV, the local effect of OC on the mucosa of the mouth was investigated by the use of an infrared thermograph. Change in surface temperature in eight areas of the mouth cavity was measured after cooling of the mouth in healthy volunteers. A substantial lowering of the temperature (-12.9 °C, mean) was seen which could explain the efficacy of OC. To exclude that acute cooling in itself is traumatic, the proinflammatory cytokine IL-6 was measured in saliva and showed no increase after cooling. Paper V reported a study in 40 allogeneic SCT patients. 20 were given SOC including OC and 20 in addition received Caphosol®, a calcium phosphate mouth rinse, during chemotherapy and until day 21. Severity of mucositis, use of opioids and TPN, effects on nutrition and CRP levels were measured. No significant difference was found between the groups in any of these variables, but a non-significant trend for an advantage for the combination could be seen. IL-6 saliva levels were measured. There was a substantial increase (more than 10-fold), in mean IL-6 levels from baseline to beginning of mucositis and a weak correlation between increased IL-6 levels and severity of OM, suggesting that IL-6 in saliva may be a useful marker of the inflammatory mucosal process. This thesis demonstrates that OC is effective as prophylaxis against chemotherapy-induced OM. As a consequence of this work, OC has been introduced as the standard of care in all SCT patients in our institution

To be safe at home or at hospital after autologous stemcell transplantation : why readmission to hospital

Background: Chemotherapy in connecting with autologous stem cell transplantation (SCT) is an established treatment for patients diagnosed with myeloma and lymphoma. Chemotherapy has side effects nausea/vomiting, infection, diarrhoea, fatigue and oral mucositis. SCT often requires hospitalization for weeks. Today it is common to treat patients in an outpatient care in combination with visits at the clinic/ward. Despite experience about outpatient care in connection with SCT, it is still a small proportion of patients who are treated on an outpatient basis. Reasons to readmit unplanned from homecare to hospital are mainly incidence of infection. Purpose: To investigate in what extend patients undergoing autologous SCT, received an outpatient care or care at a University hospital in Sweden during transplant period and if the treatment at outpatient care was interrupted to study the reason for readmitting to hospital care, also to compare intra venous (iv) treatment with antibiotics or total parenteral nutrition and length of hospital stay. Methods: The study was a quantitative, retrospective, descriptive design. A review from medical and nursing records of 88 adult patients who underwent autologous SCT in 2013-2014 and treated at a University Hospital in Sweden. Results: Thirty-nine patients were cared for outside hospital at home/home-like environment and 28 of them were readmitted to hospital. Forty-nine was cared for at hospital ward. The results showed that the main reason of readmission to hospital was related to nausea/vomiting, oral mucositis, stomach problem or other reason. No patients treated outside the hospital in the home/home-like environment the entire post-transplant period (n=11) needed total parenteral nutrition in contrast to patients readmitted to hospital (n=28) where 7 patients needed total parenteral nutrition. Among patients cared for at hospital ward during the entire post- transplant period (n=49), 17 patients needed total parenteral nutrition. Conclusion: Staying at home during the transplant period leads to less total parenteral nutrition, iv antibiotics and fewer days in the hospital

To be safe at home or at hospital after autologous stemcell transplantation : why readmission to hospital

Background: Chemotherapy in connecting with autologous stem cell transplantation (SCT) is an established treatment for patients diagnosed with myeloma and lymphoma. Chemotherapy has side effects nausea/vomiting, infection, diarrhoea, fatigue and oral mucositis. SCT often requires hospitalization for weeks. Today it is common to treat patients in an outpatient care in combination with visits at the clinic/ward. Despite experience about outpatient care in connection with SCT, it is still a small proportion of patients who are treated on an outpatient basis. Reasons to readmit unplanned from homecare to hospital are mainly incidence of infection. Purpose: To investigate in what extend patients undergoing autologous SCT, received an outpatient care or care at a University hospital in Sweden during transplant period and if the treatment at outpatient care was interrupted to study the reason for readmitting to hospital care, also to compare intra venous (iv) treatment with antibiotics or total parenteral nutrition and length of hospital stay. Methods: The study was a quantitative, retrospective, descriptive design. A review from medical and nursing records of 88 adult patients who underwent autologous SCT in 2013-2014 and treated at a University Hospital in Sweden. Results: Thirty-nine patients were cared for outside hospital at home/home-like environment and 28 of them were readmitted to hospital. Forty-nine was cared for at hospital ward. The results showed that the main reason of readmission to hospital was related to nausea/vomiting, oral mucositis, stomach problem or other reason. No patients treated outside the hospital in the home/home-like environment the entire post-transplant period (n=11) needed total parenteral nutrition in contrast to patients readmitted to hospital (n=28) where 7 patients needed total parenteral nutrition. Among patients cared for at hospital ward during the entire post- transplant period (n=49), 17 patients needed total parenteral nutrition. Conclusion: Staying at home during the transplant period leads to less total parenteral nutrition, iv antibiotics and fewer days in the hospital

Patients’ Subjective Experiences of Outpatient- and InpatientCare during Autologous Hematopoietic Stem Cell Transplantation – A Quantitative Questionnaire Study

Background: As early as 1997 it was stated that the outpatient model when patients are cared for in their homes (outpatient care) in connectionwith hematopoietic stemcell transplantation (hSCT), gave positive results regarding safety and effectiveness. But in the year of 2022, in manycountries, it is still an offer and not a standard treatment. Despite long international and national experience of outpatient treatment at hSCT, manypatients are still fully cared for in hospitals. Purpose: To describe the patients’ subjective experiences of outpatient (OP)- and inpatient (IP) care during autologous hematopoietic stem celltransplantation and to ensure the quality of care outside hospital environment as a form of care in order to improve the patient's experience ofsafety and security at autologous hematopoietic stem cell transplantation at a University Hospital in Sweden. And, to evaluate physicians' andnurses’ assessment using a standardized assessment form of the patient's self-care ability when cared for outside the hospital. Methods: A quantitative questionnaire study with pre-selected response alternatives and open-ended questions. Results: Most patients, regardless of the form of care, OP or IP care, felt satisfied with the information given by the care provider. Nearly all ofthe patients who were cared for in hospital and who responded to the questionnaire, experienced anxiety during the care period compared withpatients who were cared for in a home environment responding to the questionnaire, where the vast majority did not experience any anxiety duringthe care period. Conclusion: Most patients indicate, as shown in other studies, that they felt satisfied with the care and information they received in connectionwith hematopoietic stem cell transplantation but patients in IP care felt more anxiety than patients in OP care. Regarding evaluating physicians'and nurses’ assessment using a standardized assessment form of the patient's self-care ability when cared for outside the hospital, there wereno notable differences in the assessment. Clinical relevance: A questionnaire provides the healthcare provider with a basis for developing and improving in clinical care for patientsreceiving hSCT. Regarding attention to the mental well-being equated with the physical well-being it is a clinical task for healthcare providers. Awell-developed basis for assessing the patient's level of care can ensure the best care

Protocol for a randomised controlled trial to study cryoprevention of chemotherapy-induced oral mucositis after autologous stem cell transplantation

INTRODUCTION: A majority of patients who receive myeloablative therapy prior to hematopoetic stem cell transplantation develop oral mucositis (OM). This adverse cytotoxic effect manifests as oral mucosal erythema and ulcerations and frequently necessitates high doses of morphine for pain alleviation. OM may also interfere with food intake and result in parenteral nutrition, weight loss and impaired quality of life. To date, there have been a few studies of evidence-based interventions for prevention of OM. Cooling the oral mucosa using ice chips in conjunction with chemotherapy is known to reduce the severity of OM although clinical application is still limited due to several disadvantages. The primary endpoint of this study is therefore to evaluate the efficacy of an innovative intraoral cooling device (Cooral) compared with ice cooling in reducing the degree of OM, in patients with myeloma or lymphoma. METHOD AND ANALYSIS: A total of 180 patients from four different university hospitals in Sweden will be randomised to ice or Cooral in a proportion of 1:1. The degree of OM will be assessed at eight intraoral locations, in accordance with the Oral Mucositis Assessment Scale and WHO scale. Patients will be registered beginning at admission and will continue until discharge or until day +28. The primary variable is analysed in a multiple linear regression model. The significance level used is 5%. ETHICS AND DISSEMINATION: The study protocol, questionnaire, diaries and letter of invitation to participants have been reviewed by the local ethical board in Göteborg. The trial results will be published in a peer-reviewed journal and disseminated to participants. TRIAL REGISTRATION NUMBER: NCT03203733; Pre-results. PROTOCOL VERSION: Version 4, 2017-06-05.CC BY-NC 4.0This article has a correction:Correction: Protocol for a randomised controlled trial to study cryoprevention of chemotherapy-induced oral mucositis after autologous stem cell transplantationhttp://dx.doi.org/10.1136/bmjopen-2018-021993corr1</p

Innovative intraoral cooling device better tolerated and equally effective as ice cooling.

PURPOSE: Most of the patients who receive myeloablative therapy prior to stem cell transplantation develop oral mucositis (OM). This adverse reaction manifests as oral mucosal erythema and ulcerations and may require high doses of morphine for pain alleviation. OM may also interfere with food intake and result in weight loss, a need for parenteral nutrition, and impaired quality of life. To date, there have been very few studies of evidence-based interventions for the prevention of OM. Cryotherapy, using ice chips, has been shown to reduce in an efficient manner the severity and extent of OM, although clinical applications are still limited due to several shortcomings, such as adverse tooth sensations, problems with infectious organisms in the water, nausea, and uneven cooling of the oral mucosa. The present proof-of-concept study was conducted to compare the tolerability, temperature reduction, and cooling distribution profiles of an intra-oral cooling device and ice chips in healthy volunteers who did not receive myeloablative treatment, and therefore, did not experience the symptoms of OM. METHODS: Twenty healthy volunteers used the cooling device and ice chips for a maximum of 60 min each, using a cross-over design. The baseline and final temperatures were measured at eight intra-oral locations using an infra-red thermographic camera. The thermographic images were analysed using two digital software packages. A questionnaire was used to assess the tolerability levels of the two interventions. RESULTS: The intra-oral cooling device was significantly better tolerated than the ice-chips (p = 0.0118). The two interventions were equally effective regarding temperature reduction and cooling distribution. CONCLUSIONS: The intra-oral cooling device shows superior tolerability in healthy volunteers. Furthermore, this study shows that temperature reduction and cooling distribution are achieved equally well using either method

Feeling safe or falling through the cracks-Patients' experiences of healthcare in cirrhosis illness: A qualitative study.

IntroductionPatients with cirrhosis have a long-lasting relationship with medical personnel. Hierarchy in the healthcare contacts and feeling stigmatised may affect the patient's interactions with these care providers. Despite healthcare professionals' awareness of patients' increased self-care needs, patients report getting insufficient information and support. The patients' expectations and experiences of interacting with healthcare professionals in cirrhosis care is hence a research area that needs further investigation.PurposeTo capture patients' descriptions of healthcare experiences in relation to cirrhosis illness.Material and methodsData comprise semi-structured interviews (N = 18) and open-ended questionnaire responses (N = 86) of patients with cirrhosis. Braun and Clarke's thematic analysis process was used, including both semantic and inductive elements. The study is reported following the COREQ guidelines.FindingsThe analysis resulted in two themes: 1) Struggle to be in a dialogue and 2) Being helped or harmed. Six sub-themes were identified concerning aspects of experiences within each theme during the analysis. These sub-themes included: 'getting information', 'being involved', 'being perceived as a person', 'enduring care', 'feeling lost in the healthcare organisation', and 'not being taken care of'.ConclusionsPatients with cirrhosis express concerns regarding where to turn in the continuum of cirrhosis care. They emphasise the importance of being involved in the dialogue with the healthcare professional, to be perceived as a person with a unique need to be informed. The healthcare organisation and continuity of care are either viewed as confusing or as helping to shape a safe and trustful contact, which was an important difference in feeling helped or harmed. Hence, patients wished for improved collaboration with healthcare professionals and to receive increased information about their disease. Person-centred communication in nurse-led clinics may increase patient satisfaction and prevent patients from falling through the cracks

Liver cirrhosis turns life into an unpredictable roller-coaster : A qualitative interview study

Aim: To explore how persons living with liver cirrhosis experience day-to-day life. Background: Liver cirrhosis is the sixth most common cause of death among adults in Western countries. Persons with advanced liver cirrhosis report poor quality of life, in comparison with other chronic diseases. However, knowledge regarding day-to-day life during earlier stages of the disease is lacking. In other chronic diseases, the suffering process is well explored, while in liver cirrhosis suffering is insufficiently investigated. Design: An exploratory study, with a qualitative inductive interview approach. Methods: A purposive maximum variation sample of 20 informants with liver cirrhosis aged 25-71, from two gastroenterology outpatient clinics in mid-Sweden, were interviewed from September 2016 to October 2017. Interview data were analysed inductively with qualitative content analysis. Reporting followed the COREQ guidelines. Results: The experiences of day-to-day life living with liver cirrhosis comprised four sub-themes. Living with liver cirrhosis implied varying levels of deterioration, the most apparent being exhaustion or tiredness. The informants had to find ways of adapting to a new life situation. The insecurity of future health evoked existential reflections such as feeling emotionally and existentially distressed. Shame and guilt were reasons for feeling stigmatised. These sub-themes emerged into one overarching theme of meaning: life turns into an unpredictable roller-coaster. This is based on experiences of liver cirrhosis as an unpredictable disease with fluctuating symptoms, worries and disease progression. Conclusion: Living with cirrhosis implies an unpredictable condition with a progressive, stigmatising disease. The fluctuating symptoms and deep concerns about future life pose an increased personal suffering. Relevance to clinical practice: Within healthcare, knowledge of the person's experience is vital to enable and fulfil the person's healthcare needs. Clinical registered nurses need a person-centred approach to strengthen their patients to cope with their new life situation