Evaluación de la satisfacción y conocimientos en la rehabilitación del ictus tras la aplicación de medidas sistematicas de información, formación y soporte para pacientes y cuidadores

El ictus afecta abruptamente muchos aspectos de la vida del paciente superviviente y de sus familiares más cercanos. Su incidencia y el coste económico relacionado con la discapacidad secundaria van en aumento en la mayoría de países occidentales y en todo el mundo. El desarrollo de iniciativas que proporcionen de forma adecuada información sobre el ictus y su prevención, así como la formación necesaria para la adquisición de habilidades de auto-cuidado o manejo de estos pacientes, es clave para que una organización con recursos sanitarios limitados de respuesta a una sociedad que cada vez precisa con mayor nitidez una red socio-sanitaria integrada. La información precisa convierte a los pacientes y cuidadores en agentes activos con una mayor implicación en su proceso terapéutico, al mismo tiempo que reduce la incertidumbre y el miedo característicos después de un ictus. La formación del paciente y su cuidador en técnicas de auto-cuidado garantiza la máxima autonomía posible del paciente en su vida diaria, objetivo primordial del programa rehabilitador. A su vez, el soporte que desde las unidades de rehabilitación se proporcione al paciente con ictus y su familia es clave para reducir la soledad y aumentar los niveles de confianza y participación en la vida familiar o social de ambos. La satisfacción del paciente y cuidador con según qué aspectos del programa rehabilitador nos da información sobre si estamos respondiendo adecuadamente a sus necesidades más inmediatas después del ictus, y puede orientar al proveedor del servicio en cuanto a la organización del mismo. El aumento del nivel de conocimiento sobre el ictus del paciente y el cuidador, por otra parte, indica también que la medida educacional implantada está siendo eficaz. En este trabajo se evalúa la eficacia de una medida específica dirigida a proporcionar información, formación y soporte al paciente y su cuidador después del ictus. El aumento de la satisfacción de ambos, así como su nivel de conocimientos sobre esta afección demuestra que estas medidas son factibles y pueden ayudar en la adaptación de los pacientes y sus cuidadores en la nueva situación. Por otra parte, constatamos la necesidad de desarrollar en nuestro medio herramientas válidas que nos permitan evaluar los resultados de las intervenciones, ya sea en términos de satisfacción, conocimientos u otras variables de resultado. Por ello, se ha validado la versión en castellano de la Escala de Satisfacción de Pound, una herramienta específica, y con una gran aceptación internacional, para medir el grado de satisfacción del paciente con el programa rehabilitador seguido después del ictus. En base a nuestros resultados concluimos que la implantación sistemática de medidas dirigidas a la educación, formación y soporte de pacientes y cuidadores en el programa de rehabilitación seguido tras el ictus es factible y efectiva, y que la Escala de Satisfacción de Pound es una herramienta válida también en nuestro medio para medir la satisfacción con el programa rehabilitador seguido tras el ictus.Stroke abruptly affects many aspects of life of the surviving patients and their closest relatives. Incidence and the economic cost associated with secondary disability are increasing in most western countries and around the world. The development of initiatives that adequately provide information on stroke and its prevention, as well as the necessary training to acquire skills for self-care or management of these patients, is a key aspect for a care organization with limited health resources to respond to a society that increasingly needs, with greater clarity, an integrated socio-health network. Accurate information makes patients and caregivers in active agents with a greater involvement in their therapeutic process, while reduces uncertainty and fear, both characteristics after stroke. Patient education and caregiver training in self-care techniques ensures the maximum possible patient autonomy in their life, which is a primary objective in the rehabilitation program. Also support provided from stroke rehabilitation units for patients and their families is key to reduce their feelings of loneliness and increase levels of confidence and participation in family and social life. Patient and caregiver satisfaction with some aspect of the rehabilitation program gives us information about whether we are properly responding to their immediate needs after stroke, and can guide the service provider in terms of organization. The improvement in patients and caregivers' knowledge about stroke also may indicate that the educational measure is being implemented effectively. In this work we evaluate the efficacy of a specific measure to provide education, training and support for patients and caregivers after stroke. Increased levels of satisfaction, as well as the improvement of their knowledge about this condition shows this kind of measures are feasible and can help patients and caregivers adapt to the new situation. On the other hand, we note the need to develop valid tools that allow us to evaluate the results of new interventions, in terms of satisfaction, knowledge or other outcome variables. Therefore, we validate the spanish version of The Satisfaction Pound Scale, a specific tool and with a great international acceptance, to measure patient's satisfaction with the rehabilitation program after stroke. With this work we conclude that implementation of systematic measures for education, training and support for patients and caregivers in the rehabilitation program after stroke is feasible and effective, and that de Satisfaction Pound Scale is a valid tool also in our environment to evaluate patient satisfaction with the rehabilitation program after stroke

Control Techniques and the Modeling of Electrical Power Flow across Transmission Networks

The ever greater share of renewable energy sources (RES) in the European energy market stresses the transmission grid to its limits with rising frequency. Therefore, there is a pressing need for a spatially and temporally detailed model of the European power system to serve as a basis for investigating the efficient integration of RES. Here we outline a far-reaching description of transmission grid operation and present a review of approaches developed for modeling the physical power flows and the respective congestion management techniques that control them. By this, we hope to equip the interdisciplinary energy research community with a better understanding of power systems and corresponding modeling tools, thus enhancing their respective efforts. Additionally, a literature review and classification of existing studies on these topics is included in the paper as well. The analysis shows that the fundamental modeling components determining power flows across power systems include the electricity market, the inter-zonal power trading and the intra-zonal congestion management models, where a complete incorporation of all of them requires an iterative or multi-level approach. However, due to the high complexity of such an approach, most common and computationally efficient strategies apply integrated approaches using linearized descriptions for the physical flows

Flexible Demand for Higher Integration of Renewables into the European Power System

The need for more flexibility options in the European power system will keep increasing with higher shares of intermittent power sources. Besides grid reinforcement and storage options, one of the promising candidates that can mitigate power curtailments would be a more flexible electricity demand, which could better follow the increasing variability of generation. Flexible demand technologies cannot only alleviate the expensive peak situations, but can also contribute into higher consumption of renewables by shifting demand to match the corresponding generation. In this paper we attempt to analyse the effects of different penetration levels of demand response technologies onto the integration of variable renewable energy sources by analysing the corresponding curtailments as well as the cost benefits for the system. At first, a pan-European power flow model primarily based on open source and data is introduced, followed by a verification process of the approach and data for the year 2015 which is performed within the context of the desired analyses in order to increase the validity of results. The model incorporates a variety of power generation technologies, modelling of hydropower as well as the transmission network layout. The generated model is then applied for different scenarios and weather years and assesses the integration of variable renewable energy sources for present and future power system configurations. Assuming different levels of flexibility for the electricity demand shows that grid congestion can be partly relieved and more renewable generation to be consumed, thus also decreasing the operational costs for the system. However, the limited amount of deferrable demand as well as the limitations of the available shifting time frames confines the ability of such technologies to lead to full renewables integration, especially for systems with high renewable shares