Donants d'òrgans a cor parat: recirculació normotèrmica i refredament corporal amb derivació cardiopulmonar com a mètode d'obtenció d'òrgans. Estudi clínic i experimental

[cat] Els donants a cor parat (OCP) són aquells que es troben en procés d'aturada cardiorespiratòria irrecuperable, amb un temps d'isquèmia calenta suficientment reduït que permeti l'extracció d'òrgans i teixits aptes per a trasplantament. Entenem per temps d'isquèmia calenta el temps transcorregut des del moment de l'aturada cardiocirculatòria fins a Ia perfusió de l'òrgan. El procediment d'obtenció d'òrgans OCP s'inicia un cop diagnosticada Ia mort per aturada cardiorespiratòria, moment en el qual es considera el cadàver com a donant potencial. Aleshores es valora el temps d 'isquèmia calenta i es du a terme Ia cateterització de l'artèria i vena femoral per poder iniciar Ia preservació dels òrgans. En el cas concret dels ronyons, originalment la perfusió s'assolia mitjançant la injecció de líquid fred a travès de l'artèria femoral (perfusió in situ), amb l'objectiu de disminuir-ne ràpidament Ia temperatura i limitar el metabolisme cel·lular i el dany provocat per Ia isquèmia calenta. Posteriorment s'han anat dissenyant tècniques per a Ia perfusió dels òrgans de DCP amb sistemes de derivació cardiopulmonar. S'ha assajat favorablement un procediment consistent en el refredament corporal amb circulació extracorpòria, que entre d'altres avantatges permet una hipotèrmia més suau i progressiva, amb una pressió de perfusió més elevada, cosa que és important per poder valorar la viabilitat de l'ús dels òrgans obtinguts per a trasplantaments. Per altra banda, el problema més important per Ia utilització dels òrgans de DCP és una major incidència de retard del funcionament i de fallada primària de l'empelt. En el cas del trasplantment renal, la disfunció inicial pot ser substituïda per Ia diàlisi fins que l'òrgan o bé recupera Ia funció o bé es practica un altre trasplantament. Per contra, el trasplantarnent hepàtic ha d'assegurar de manera immediata Ia funcionalitat de l'òrgan, perquè no es disposa de cap teràpia substitutiva. Es per això que els estudis que s'estan realitzant actualment van adreçats a valorar Ia viabilitat del fetge abans del trasplantament i a millorar-ne Ia funció mitjançant Ia modificació de les tècniques d'obtenció i preservació dels empelts fins al trasplantament

'Train the Trainers' Program to Improve Knowledge, Attitudes and Perceptions About Organ Donation in the European Union and Neighbouring Countries: Pre- and Post- Data Analysis of the EUDONORGAN Project

EUDONORGAN, a European Union-funded project to improve organ and tissue donation, included a blended-based 'Train the Trainers' program, which was implemented with the support of an international consortium from Croatia, Italy, Slovenia, and Spain. The web-based training included seven modules for which medical aspects, educational tips, and practical activities were scored using a 5-point Likert scale. The overall mean scores of satisfaction were higher than 4 for each module, without significant differences between HCPs and OKPs. In the face-to-face training survey similar scores above 4 were obtained for most items. Knowledge acquisition improved significantly in both HCPs and OKPs, as well as in transplant/donor coordinators, medical doctors, registered nurses, anesthesiologists/intensivists, and intensive care nurses. Improvements in attitudes and perceptions regarding organ donation were also observed, particularly among HCPs. In the accomplishment of the learning process, a successful pass mark of 95% was obtained. The 'Train the Trainers' program was associated with an improvement in learning and attitudes of healthcare and non-healthcare professionals for the benefit of organ and tissue donation

Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool

Objective: To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. Design: Pre-and postintervention study. Setting: Acute-care teaching hospital in Sabadell, Barcelona (Spain). Participants: Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. Results: Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. Conclusions: Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

BACKGROUND: Functional stereotactic surgery requires careful titration of sedation since patients with Parkinson disease need to be rapidly awakened for testing. This study reports a population pharmacodynamic model of propofol sedation and airway obstruction in the Parkinson disease population. METHODS: Twenty-one patients with advanced Parkinson disease undergoing functional stereotactic surgery were included in the study and received propofol target-controlled infusion to achieve an initial steady state concentration of 1 microg/ml. Sedation was measured using the Ramsay Sedation Scale. Airway obstruction was measured using a four-category score. Blood samples were drawn for propofol measurement. Individual pharmacokinetic profiles were constructed nonparametrically using linear interpolation. Time course of sedation and respiratory effects were described with population pharmacodynamic models using NONMEM. The probability (P) of a given level of sedation or airway obstruction was related to the estimated effect-site concentration of propofol (Ce) using a logistic regression model. RESULTS: The concentrations predicted by the target-controlled infusion system generally exceeded the measured concentrations. The estimates of C(50) for Ramsay scores 3, 4, and 5 were 0.1, 1.02, and 2.28 microg/ml, respectively. For airway obstruction scores 2 and 3, the estimates of C(50) were 0.32 and 2.98 microg/ml, respectively. Estimates of k(e0) were 0.24 and 0.5 1/min for the sedation and respiratory effects, respectively. CONCLUSIONS: The pharmacokinetic behavior of propofol in patients with Parkinson disease differs with respect to the population from which the model used by the target-controlled infusion device was developed. Based on the results from the final models, a typical steady state plasma propofol concentration of 0.35 microg/ml eliciting a sedation score of 3 with only minimal, if any, airway obstruction has been defined as the therapeutic target

Mobile application designed by and for older persons

[EN] This article describes how older persons can be integrated in the innovation activities within the development of a mobile application aimed at making the access to the information society and promoting the social interaction. IBV methodology named `Person Oriented Innovation¿ (IOP) has been used to include their experiences, values, hopes and preferences in the whole development process: problem definition; need analysis and specs preparation; and product validation.[ES] Este artículo explica cómo se puede integrar de manera activa a las personas mayores en las actividades de innovación relacionadas con el desarrollo de una aplicación para dispositivos móviles destinada a facilitar el acceso a las tecnologías de la información y a promover la interacción social. Para alcanzar este objetivo se ha utilizado la metodología desarrollada por el Instituto de Biomecánica (IBV), denominada ¿Innovación Orientada por las Personas¿ (IOP), como forma de incluir las experiencias, valores, expectativas y preferencias de las personas mayores en el proceso completo de desarrollo de la aplicación: definición del problema, análisis de necesidades y elaboración de especificaciones y validación del producto.El proyecto SI-Screen (AAL-2009-2-088) está financiado por la Comisión Europea y las organizaciones miembros del programa AAL (Ambient Assisted Living). En el caso de España por el Instituto de Salud Carlos III y el Ministerio de Industria y Comercio. El IBV ha desarrollado de forma conjunta este trabajo con las siguientes entidades: InnovationManufaktur, VIOS, Universität München der Bundeswehr, Brainware, Porsche Design Studio, Helios, FATEC, Tioman&Partners y ST-Servicios de TeleasistenciaBarbera Guillem, R.; Campos Soriano, N.; Bollain Pastor, C.; López Torres, M.; Soler Valero, A.; Tito Malone, M.; Poveda Puente, R.... (2013). Aplicaciones móviles pensadas por y para los mayores. Revista de biomecánica. 60:32-34. http://hdl.handle.net/10251/38638S32346

Considering and interpreting leisure: pastimes, entertainments, hobbies and addictions in the Barcelona of 1900

Coordinació: Teresa-M. SalaIn the throes of modernization, the Barcelona of 1900 was buzzing with energy and an unprecedented culture of leisure emerged. The city’s residents made full use of their free time, forging relationships with one another through a highly varied range of initiatives and activities, taking advantage of existing opportunities and creating new ones. In addition to the traditional celebration of civic festivals, popular meals and various types of processions, innovative new forms of cultural consumption sprang up to satisfy all tastes and budgets. Numerous cinemas opened, the first amusement parks threw open their gates and new theatres raised their curtains. Thanks to these developments, the vicinity around the avenue Paral·lel became the epicentre of Barcelona nightlife. This book offers a panoply of images of the diversions, entertainments and hobbies of that fascinating era of contrasts, the turn-of-the-century Barcelona of Modernisme

Leadership, management, quality, and innovation in organ donation: 2019 Kunming recommendations for One Belt & One Road countries

The findings and recommendations of the 2019 consensus conference in organ donation, held in Kunming, China, are here reported. The main objective of the conference was to gather relevant information from experts involved in the field. The data and opinions provided allowed to propose a series of recommendations for 'One Belt & One Road Countries' on how to achieve self-sufficiency in organ donation. Leadership in organ donation should be results-oriented and goal-driven based on the principles of excellence, empowerment, and engagement, providing the means, resources, and strategies necessary to reach the goal in earnest. Management includes good governance and transparency of a national registry of patients in the waiting list, donors, transplants, transplant teams, quality, and safety programs with continuous educational training of health care professionals. Mandatory monitoring, auditing and evaluation of quality must be incorporated into donation practices as relevant points in innovation, as well as the adoption of already established and novel processes and technologies. Achievement of self-sufficiency in organ donation is a crucial step to fight against transplant tourism and to prevent organ trafficking. Based on recommendations arising from the conference, each country could review and develop individualized action plans adjusted to its own circumstances and reality

STA, the Space Trajectory Analysis Project

This article describes the objectives of the Space Trajectory Analysis (STA) project. The article also details the birth of STA, and its present configuration. STA is a project to develop an open source astrodynamics software suite involving university science departments and space research institutions. It was initiated by ESA as internal activity in 2005 and now it involves 16 partners. The article explains the partnership into the STA Steering Board. The main purpose of the STA is to allow advanced simulation for the analysis of space trajectories in an open and free environment under the premises of innovation and reliability.Further, the article explains that the STA development is open source and is based on the state of the art astrodynamics routines that are grouped into modules. Finally, the article concludes about the benefits of the STA initiative: the STA project allows a strong link among applied mathematics, space engineering, and informatics disciplines by reinforcing the academic community with requirements and needs coming from real missions