A proposed set of metrics for standardized outcome reporting in the management of low back pain

Background and purpose - Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set. Patients and methods - An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions. Results - Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on preexisting tools. Interpretation - The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver

Efeito de auxinas sintéticas no enraizamento in vitro da macieira Effects of synthetic auxins on the in vitro rooting of apple tree

Brotações de macieira (Malus domestica, Borkh), cv. Fred Hough, oriundas do processo de multiplicação in vitro, foram inoculadas em meio MS e MS/2, testando-se os reguladores de crescimento: ácido indol-3-acético (AIA); ácido indolbutírico (AIB) e ácido naftaleno acético (ANA), nas concentrações de 0, 1, 3 e 5 miM com o objetivo de observar o efeito dessas auxinas sobre o enraizamento da cultivar. Foram acrescentadas aos meios as vitaminas MS mio-inositol (100 mg/L) e sacarose (30 g/L) em meio de ágar (6 g/L). O pH do meio foi ajustado para 5,8 e a cultura foi incubada a 25 ± 2º C e 16 horas de fotoperíodo a 2.000 lux, permanecendo por 30 dias. Os tratamentos foram repetidos cinco vezes e cada repetição constou de cinco explantes inoculados em frasco de 250 mL contendo 40 mL do meio. O meio MS/2 em todas as concentrações testadas foi melhor que o MS. O ANA e o AIB, ambos na concentração de 3 miM, em meio MS/2, tiveram comportamento semelhante na porcentagem de enraizamento e no número de raízes produzidas; no entanto, o ANA provocou efeitos indesejáveis na qualidade destas, havendo formação de calo na base das brotações e raízes grossas. O AIA obteve melhor resposta nas altas concentrações, mas não foi melhor que o AIB e ANA.<br>Apple shoots (Malus domestica, Borkh), cv. Fred Hough derived from in vitro multiplication process were inoculated in MS and MS/2 basal media added by growth substances indol acetic acid (IAA); indol butiric acid (IBA) and naphtalene acetic acid (NAA) at 0, 1, 3 and 5 µM. The media also included: MS vitamins, myo-inositol (100.0 mg/L); sucrose (30.0 g/L); agar (6.0 g/L). The pH was adjusted to 5.8 before autoclaving. The treatments were incubated in a growth room at 25±2ºC, 16 hours photoperiod under light intensity of 2,000 lux during 30 days. The treatments were replicated five times. Each replicate was composed by a 250 mL flask containing 40 mL medium with five explants. The medium MS/2 in all the tested concentrations was better than MS. The NAA and IBA, both at 3.0 µM on MS/2 showed similar effects as percentage of rooting and number of roots are concerned. However, NAA treated explants presented a higher callus incidence at the base of shoots along with thicker roots. IAA had a better response when used in higher concentrations but it did not achieve the performance of IBA ou NAA

Propagación del banano: técnicas tradicionales, nuevas tecnologías e innovaciones.

Se pasa revista a los diferentes tipos de propagación del banano tradicional (fundamentalmente hijos y rizomas o partes del mismo), aún utilizada en plantaciones de tipo familiar y en plantaciones establecidas en gran número de países tropicales dedicadas al consumo local, y a través de cultivo in vitro (cultivo de tejidos), utilizada en las modernas explotaciones de bananos dedicados a la exportación. El trabajo se inicia con una descripción de las características morfológicas y desarrollo de la planta, una breve descripción de las estructuras de propagación a la que siguen luego dos grandes apartados: Propagación tradicional y microprogación. En este último apartado se aborda la propagación por organogénesis, mediante la micropropagación tradicional en medios de cultivos semisólidos y más actual por bioreactores y la propagación por embriogénesis somática. Se discute en profundidad los medios de cultivo e iluminación requeridos durante las diferentes fases de propagación por cultivo in vitro y se finaliza abordando los aspectos de endurecimiento, aclimatación y trasplante al campo de las plantas propagadas por cultivo de tejidos.Made available in DSpace on 2018-10-25T00:59:34Z (GMT). No. of bitstreams: 1 Propagaciondebanano.pdf: 996976 bytes, checksum: 5d01cd86550772486af13dca5b786dcb (MD5) Previous issue date: 2018-10-24bitstream/item/185018/1/Propagacion-de-banano.pd