Predicting adverse outcomes in older medical emergency department patients

Elderly people (≥ 65 years old) who visit the emergency room (ER) are at high risk of adverse outcomes such as admission to intensive care, readmission, loss of function and/or death. Early recognition of high-risk patients is of great importance in order to improve the care, outcome and/or quality of life of patients. This dissertation describes how you can map the risk of death within 30 days. Various drugs are compared that reflect disease severity on their ability to predict adverse outcomes: (a) the clinical gaze of the patient, nurse and doctor, b) the concerns of the patients and their caregivers and c) some factors in the blood specific to certain conditions (biomarkers). The main result of this research is the development of a new model that estimates the risk of mortality of acutely-ill elderly people within 30 days of ER visit (the RISE UP score) very well. The accuracy of this score is unique in the world of the ER. The RISE UP score was also successfully tested in COVID-19 patients of all ages

“De opgang” Stefan Hertmans

BOEK: De publicatie van de Franse vertaling van de roman De opgang (De Bezige Bij, 2020, vertaald als Une Ascencion) bij Uitgeverij Gallimard in januari 2022 laat ons toe om dieper in te gaan op het speurwerk dat Stefan Hermans verrichtte in meerdere van zijn naar het Frans vertaalde werken. De Belgische, Nederlandstalige auteur verwierf al bekendheid met zijn Franse vertalingen van Oorlog en terpentijn in 2015 (De Bezige Bij, 2013, vertaald als Guerre et térébenthine) en De bekeerlinge in 2018 (De Bezige Bij, 2016, vertaald als Le cœur converti), die eveneens bij Uitgeverij Gallimard werden uitgegeven.LIVRES : La publication aux éditions Gallimard en janvier 2022 de la traduction française du roman De opgang (De Bezige Bij, 2020) donne l’occasion de revenir sur les enquêtes menées par Stefan Hertmans dans plusieurs de ses œuvres traduites en français. L’auteur belge de langue néerlandaise est déjà connu pour des traductions françaises également publiées par les éditions Gallimard, Guerre et térébenthine en 2015 (Oorlog en terpentijn, De Bezige Bij, 2013) et Le cœur converti en 2018 (De bekeerlinge, De Bezige Bij, 2016)

François Azouvi. “Français, on ne vous a rien caché la Resistance, Vichy, notre mémoire”

LIVRES : L’historien est devenu un acteur parmi d’autres de la vague mémorielle qui a saisi l’espace public, mais aussi la sphère académique et scientifique. Il se situe donc de plus en plus dans les enjeux et les tensions portant sur la mémoire et son instrumentalisation politique. François Azouvi a fait de la mémoire un objet d’histoire et un champ d’investigation à part entière, suivant en cela un courant qui a envahi, à partir des années 1980, tous les domaines de la vie sociale, de l’activité scientifique et de la conscience personnelle et collective

Jérôme Cordelier. “L’espérance est un risque à courir”

Jérôme Cordelier. “L’espérance est un risque à courir” Dans l’ouvrage L’espérance est un risque à courir, – citation empruntée à Georges Bernanos dans une conférence aux étudiants brésiliens à Rio de Janeiro le 22 décembre 1944, – dont le sous-titre précise plus clairement qu’il veut aller Sur les traces des résistants chrétiens, 1939-1945, Jérôme Cordelier, journaliste, rédacteur en chef du service France au magazine Le Point et essayiste, dresse un panorama de résistants chrétiens et de le..

“Une ascension” Stefan Hertmans

LIVRES : La publication aux éditions Gallimard en janvier 2022 de la traduction française du roman De opgang (De Bezige Bij, 2020) donne l’occasion de revenir sur les enquêtes menées par Stefan Hertmans dans plusieurs de ses œuvres traduites en français. L’auteur belge de langue néerlandaise est déjà connu pour des traductions françaises également publiées par les éditions Gallimard, Guerre et térébenthine en 2015 (Oorlog en terpentijn, De Bezige Bij, 2013) et Le cœur converti en 2018 (De bekeerlinge, De Bezige Bij, 2016).BOEK: De publicatie van de Franse vertaling van de roman De opgang (De Bezige Bij, 2020, vertaald als Une Ascencion) bij Uitgeverij Gallimard in januari 2022 laat ons toe om dieper in te gaan op het speurwerk dat Stefan Hermans verrichtte in meerdere van zijn naar het Frans vertaalde werken. De Belgische, Nederlandstalige auteur verwierf al bekendheid met zijn Franse vertalingen van Oorlog en terpentijn in 2015 (De Bezige Bij, 2013, vertaald als Guerre et térébenthine) en De bekeerlinge in 2018 (De Bezige Bij, 2016, vertaald als Le cœur converti), die eveneens bij Uitgeverij Gallimard werden uitgegeven

La importancia de la fantasía y el juego de personificación para la conexión con la realidad. (Lo que nos enseña un sujeto diagnosticado con Asperger)

El  trabajo  aborda  a  partir  de  un  caso  clínico,  la  función  de  la  fantasía  en  niños  con perturbaciones  graves  del  desarrollo.  En particular  se  trabajó  un  diagnóstico  de  Asperger, articulando algunas ideas de Melanie Klein sobre la fantasía y el juego de personificación, con la línea de lectura lacaniana, a fin de sacar algunas conclusiones sobre la dirección de la cura en estos casos y sobre el valor de la función de la fantasía en general

Prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome:a systematic review and meta-analysis

OBJECTIVE: To review, inventory and compare available diagnostic tools and investigate which tool has the best performance for prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Systematic review and meta-analysis. Medline and Embase were searched up till 1 April 2021. Prospective studies with patients, suspected of NSTE-ACS, presenting in the primary care setting or by emergency medical services (EMS) were included. The most important exclusion criteria were studies including only patients with ST-elevation myocardial infarction and studies before 1995, the pretroponin era. The primary end point was the final hospital discharge diagnosis of NSTE-ACS or major adverse cardiac events (MACE) within 6 weeks. Risk of bias was evaluated by the Quality Assessment of Diagnostic Accuracy Studies Criteria. MAIN OUTCOME AND MEASURES: Sensitivity, specificity and likelihood ratio of findings for risk stratification in patients suspected of NSTE-ACS. RESULTS: In total, 15 prospective studies were included; these studies reflected in total 26 083 patients. No specific variables related to symptoms, physical examination or risk factors were useful in risk stratification for NSTE-ACS diagnosis. The most useful electrocardiographic finding was ST-segment depression (LR+3.85 (95% CI 2.58 to 5.76)). Point-of-care troponin was found to be a strong predictor for NSTE-ACS in primary care (LR+14.16 (95% CI 4.28 to 46.90) and EMS setting (LR+6.16 (95% CI 5.02 to 7.57)). Combined risk scores were the best for risk assessment in an NSTE-ACS. From the combined risk scores that can be used immediately in a prehospital setting, the PreHEART score, a validated combined risk score for prehospital use, derived from the HEART score (History, ECG, Age, Risk factors, Troponin), was most useful for risk stratification in patients with NSTE-ACS (LR+8.19 (95% CI 5.47 to 12.26)) and for identifying patients without ACS (LR-0.05 (95% CI 0.02 to 0.15)). DISCUSSION: Important study limitations were verification bias and heterogeneity between studies. In the prehospital setting, several diagnostic tools have been reported which could improve risk stratification, triage and early treatment in patients suspected for NSTE-ACS. On-site assessment of troponin and combined risk scores derived from the HEART score are strong predictors. These results support further studies to investigate the impact of these new tools on logistics and clinical outcome. FUNDING: This study is funded by ZonMw, the Dutch Organisation for Health Research and Development. TRIAL REGISTRATION NUMBER: This meta-analysis was published for registration in PROSPERO prior to starting (CRD York, CRD42021254122).</p

Wearable devices can predict the outcome of standardized 6-minute walk tests in heart disease

Wrist-worn devices with heart rate monitoring have become increasingly popular. Although current guidelines advise to consider clinical symptoms and exercise tolerance during decision-making in heart disease, it remains unknown to which extent wearables can help to determine such functional capacity measures. In clinical settings, the 6-minute walk test has become a standardized diagnostic and prognostic marker. We aimed to explore, whether 6-minute walk distances can be predicted by wrist-worn devices in patients with different stages of mitral and aortic valve disease. A total of n = 107 sensor datasets with 1,019,748 min of recordings were analysed. Based on heart rate recordings and literature information, activity levels were determined and compared to results from a 6-minute walk test. The percentage of time spent in moderate activity was a predictor for the achievement of gender, age and body mass index-specific 6-minute walk distances (p < 0.001; R2 = 0.48). The uncertainty of these predictions is demonstrated

Ascorbic Acid Encapsulation in Hydrophobic Silica Xerogel

Self-assembled hybrid organo-silica sol-gel materials are rapidly expanding for new and novel applications. The microporous solid silica matrix was used as a carrier for the controlled release of ascorbic acid (AA), selected as cargo molecule. One-step synthesis procedure was optimized for the preparation of silica–molecule composites by using tetraethoxysilane and methyltrimethoxysilane as precursors. The hydrophobic silica xerogel matrices were characterized by Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction. Specific surface area and porosity parameters were determined by Brunauer- -Emmett-Teller (BET) technique and the matrix surface morphology by scanning electron microscopy (SEM). The observed release pattern could be interesting for the development of AA-fortified food and for use in food packaging

Evaluación con un enfoque integrativo, de los constructos vulnerabilidad/resiliencia

Dentro de las enseñanzas pioneras que nos aportó S. Freud (1916-1917) contamos con el de las “Series Complementarias”, donde estableció el reconocimiento de una base necesariamente compleja en el estudio y tratamiento de los procesos mentales. A menudo en evaluación diagnóstica, enfrentamos la problemática de diferenciar mediante dispositivos o técnicas cortas, procesos en los que intervienen numerosas dimensiones de igual importancia, sin caer en enfoques reductivos. Las intervenciones evaluativos aspiran dar acabada cuenta al reconocimiento de los procesos disruptivos de eficacia traumática, entendiendo que los mismos obtienen o mitigan su iatrogenia según las cualidades somatomentales de los sujetos y de sus sistemas vinculares. La situaciones traumáticas, pueden derivar en consecuencias devastadoras en terrenos de personalidad vulnerable o podrán despertar resiliencia, en tanto “la capacidad humana de enfrentar, sobreponerse y ser fortalecido o transformado por experiencias de adversidad” (Grotberg, 2001). Los constructos Vulnerabilidad y Resiliencia, que han adquirido gran difusión en la última década, requieren su lectura dentro de un modelo biopsicosocial (Lutgendorf y Constanzo, 2003) La vulnerabilidad, particularmente ha de leerse integrativa y holísticamente en la trama íntima que la sostiene. Así podemos hablar de un sistema psicológico, uno neurológico, uno endocrino y uno inmunológico, en constante interacción con su medio y en el cual la mente juega a su vez, recursivamente, un activo rol. (Lunazzi, 2006). En nuestro país se han desarrollado instrumentos de evaluación (Zukerfeld y Zukerfeld, 1999), que apuntan a captar la interacción entre funcionamiento psíquico, capacidad de afrontamiento, red vincular, estrés y vulnerabilidad-resiliencia.Eje temático: Técnicas y Procesos de Evaluación PsicológicaFacultad de Psicologí