ter and of the recommendations included in it was based on discussion at several meetings of the GTMyN until a final consensus on the contents of each subject was reached. This system of preparation of recommen- dations (progressive feedback) was used for all chap- ters. Any discrepancies or points on which any member of the group expressed his/her disagreement were dis- cussed and agreed on by consensus, putting special emphasis on reviewing the levels of evidence and grades of recommendation established. The Editorial Committee then proceeded to make the final adjust- ment of each chapter, including the literature review, for its submission and final approval at the meeting of the GTMyN held in March 2011.
23. Mesejo A , Vaquerizo Alonso C , Acosta Escribano J , Ortiz Leyba C, Montejo González JC; et al; forthe Spanish Society of Intensive Care Medicine and Coronary Units andthe Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE). Guidelinesforspecializednutritionalandmetabolicsupportinthecritically-illpatient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units andthe Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Introductionandmethodology. Medicina Intensiva [España] 2011;35(Suppl 1):1-6.
It is known that sepsis is a condition associated with arginine deficit and arginine has been associated with benefits for sepsis, such as an increase in acute phase reactants, genesis of nitric oxide (NO) with antibacte - rial activity, action as bowel neurotransmitter and regu- lator of microcirculation, production of ornithine pro- moting cell growth and cell differentiation and activity in insulin stimulation, as well as modulation of cell sig- nals from its metabolite, agmatin. However the use of arginine in sepsis is currently questioned in various clinical guides, unlike in other group of critically-ill patients. This is due to the fact that the results expressed inthe above mentioned metaanalysis by Heyland et al. 12 on the use of pharmaconutrient formu-
As a precursor of nitric oxide, it plays a major role in regulating cardiovascular function, particularly in dia- betic patients. Intravenous doses of 3-5 g reduce blood pressure and platelet aggregation. Arginine prevents cardiovascular dysfunction, as it restores nitric oxide synthesis, reduces production of free radicals, and inhibits leukocyte adherence to the endothelium, though in mesenteric ischemic conditions bowel mucosa function may be worsened 29 (IV).
energy expenditure (REE) measured by indirect calorimetry with 8 predictive equations with different variations and 15 different combinations. Only the Penn-State equation was accurate both globally andinthe different subgroups, so it is therefore considered to be the advisable equation for use incritically-ill patients, whether obese or not. It was confirmed that neither the severity of the disease as measured by the SOFA, nor fever or traumatic, surgical or medical disease, changed the precision of the equations.
Wetland Centre and its furnishing was included inthe BIOREGIO project proposal and into the project of the Swiss Financial Mechanism. One new staff member of the SNC SR was employed as assistant of the CWI coordinator from July 2010 to supportthe implementation of the CWI work plan with funding from the CWI budget and was equipped with PC.
Barr, J., Fraser, G.L., Puntillo, K., Ely, E.W., Gelinas, C., Dasta, J.F., Davidson, J.E., Devlin, J.W., Kress, J.P., Joffe, A.M., Coursin, D.B., Herr, D.L., Tung, A., Robinson, B.R., Fontaine, D.K., Ramsay, M.A., Riker, R.R., Sessler, C.N., Pun, B., Skrobik, Y., Jaeschke, R. (2013). Clinical Practice Guidelinesforthe Management of Pain, Agitation, and Delirium in Adult Patients inthe Intensive Care Unit. Crit Care Med; 41: 278-280. Barrero Raya, M.C., Parras-García de León, N. (2001).Delirium en el anciano. Salud Rural; XVIII (12): 11-49.
This was a multicentric, descriptive, prospective study carried out in six high-complexity institutions inthe city of Medellín (Colom- bia) during a four-month period. The target population was cons- tituted by adult patients over 18 years of age who were admitted to general wards and received NS for at least 48 hours. Gestational women and patients remitted from other hospital units or from other institutions with nutritionalsupport established were not in- cluded inthe study. In each participating institution, once patients fulfilling the inclusion criteria were selected, the presence of the complications defined for each type of NS was registered; the com- plication was reported only once as a new event.
Identification of stakeholders and interested parties will help define the best mechanism to initiate and maintain a productive and comprehensive policy dialogue. In some countries, this group will consist mainly of policy-makers of relevant ministries, andthe establishment of an interministerial task force to engage inthe dialogue will be sufficient action to ensure a rapid evolution of the policy framework required. In countries with a high degree of decentralization, mechanisms will have to be established for an effective feedback loop as part of the dialogue that ensures a meaningful involvement of policy- and decision-makers at the provincial and local administrative levels. There may be countries where decentralization has evolved to a level where policy-making is initiated at the district level, for example through district development councils, and this will require that the policy dialogue on the safe use of wastewater, excreta and greywater for agriculture and aquaculture is similarly initiated at that level, in districts where such use is a reality or has future potential. The engagement of civil society in policy debate helps create a strong platform of supportfor new policies. It requires additional mechanisms, such as special forums, focus group discussions and community consultation, to ensure that these broader views are reflected inthe policy framework.
The use of the Internet for health purposes is growing steadily as people increasingly go online to access factual and experiential information and to share their own health and illness experiences [1-3]. While health-related Internet use has increased steadily, the use of asynchronous communication tools for health care purposes among European populations remains relatively undeveloped and unexplored. Asynchronous communication refers to interaction that is non-concurrent, such as email, as opposed to the synchronous, real-time communication offered by phone consultation, for example. Email is a commonly used method of communication globally. It has become a major element of day-to-day life for many people, both at work andin their personal lives. However, the uptake inthe health care sector has been much lower than for other sectors, and email is not routinely used as a way for patients to contact their health care organization or professional [4,5] despite a reportedly high interest in associated eHealth services among European citizens . Various national policies encourage email use by patients inthe health care setting [7-11], for example in Denmark, where patients are able to engage in electronic communication with their family doctor via the official Danish health website . Inthe United States, health maintenance organizations such as Kaiser Permanente have embraced email for communicating with their patients, offering patient portals where patients can log inand use Web messaging to send an email to their health care professional, make appointments, and receive test results [13,14]. At present, relatively little is known about how patients use email to interact with health care, but this information is likely to be valuable in determining the success of proposed policies and impact of email use. Key variables that may influence the uptake of email communication between patientand health professional include patient health status, the “digital divide”, andthe potential impact on the use of health care services.
is nearly complete agreement between humans and pigs in their dietary requirements for nutri- ents, although the quantitative requirements for each nutrient differ between the two species. For example, the total requirement of crude protein in terms of dry matter is higher for piglets than for adult infants due to a higher growth rate in piglets (National Research Council, Anonym b, 1998). Surgically prepared pigs provide a pow- erful tool for investigating the digestion and ab- sorption of nutrients (Yen, 2000). Several types of surgeries have been carried out using the por- cine model to test their applicability to human surgery, to try new equipment, or to develop the necessary skills in surgeons. More recently, en- doscopic and laparoscopic surgical models have been developed and used extensively in pigs. Therefore, the objective of this article is to show that the use of the pig as a model for studying nutrient digestion and absorption in human sta- tus post bariatric surgery is feasible due to their similar characteristics in terms of nutrient ab- sorption and digestive physiology. Additionally, nutritionalandmetabolic evaluations during the postoperative period of pigs submitted to bariatric surgery provide new insights through postoperative digestibility trials; in this way, di- gestion and absorption process assessments of nutrients are complementary to classical human evaluations.
We will include studies of adults (where the majority of partici- pants are aged 18 or over). Adult participants could include indi- viduals who are the subject of the AD, and/or their family mem- bers (or friend or guardian) who are their proxy or surrogate deci- sion maker. There will be no restrictions related to health status. Therefore, studies could include well people inthe community, or patients with a diagnosed health problem, or people who are the final stages of their life. Studies could also include only those peo- ple who are the proxy or surrogate decision maker (for example, in situations where thepatient is terminally ill, or has dementia, and no longer able to make decisions on their own behalf). We will include studies where the intervention is directed to health professionals only, as long as data on one of the outcomes for this review is collected.
Figure 1. Coagulation abnormalities according to cirrhosis progression, reflected by Child-Pugh Score. As cirrhosis progress, levels of tissue factor pathway inhibitor, protein C, antithrombin, factors II,V, VII, IX, X, plasminogen activator inhibitor, plate- let count and TAFI decreases, while tissue factor, thrombomodulin, von Willebrabd Factor, homocysteine an platelet activation increases, leading to stable thrombin generation and a fragile balance between thrombosis and bleeding. Aggregated factors, such as portal hypertension or hyperbilirrubinemia, may trigger bleeding or thrombotic events. TAFI: thrombin-activatable fibrino- lysis inhibitor.
This study has the characteristics of a descriptive and action research belonging to the qualitative approach because, through the evaluation of the contents of the tourist handbook andthe level of the natives inthe community Rio Limón, which was developed inthe exactly place where the problem occurred, it was possible to describe and analyze it and at the end propose some possible solutions. It was used the ethnographic method to describe what was happening in this context. Moreover, the techniques and instruments used for gathering the data were specialized software “ATOS” for measuring the complexity of vocabulary used inthe handbook and diagnostic tests developed based on tourist information to identify the current level the Shuars have in English. All of these applied to the study population.
it is widely recognized that agitation is a common phenomenon, both in medical and psychiatric emergency and inpatient settings. Acute episodes of psychomotor agitation account for 900,000 annual visits to psychiatric emergency services (4) and represent a total of 1.7 million emergency department visits per year inthe USA (5). Furthermore, it is estimated that up to 10% of psychiat- ric emergencies attended at emergency services involve an acute agitation episode (6–8). Agitation is frequently associated with an underlying psychiatric disorder, particularly schizophrenia, bipolar disorder, personality disorders, Alzheimer’s disease, or other types of dementia, among others (6, 9, 10). In cases of dementia, there are multiple factors that can precipitate or worsen psychomotor agitation, such as medical problems, drug adverse events, sleep abnormalities, delirium, depression, or environmen- tal and social factors, but it is mostly linked to the severity of the neurocognitive disorder (11). Treatment of the agitated patient is complex, due to the status of thepatient, the involvement of multiple healthcare professionals (HCPs), andthe ethical/legal concerns on the different management procedures.
As strengths of this study, we should mention the idea that glycemic control can be modified using specific enteral nutrients inthecriticallyillpatient; also the external validity of themethodology (prospective, blind-randomized, multicenter) andthe generalizability of results. Its main limitations are that it was an open- label study, so some of its results (especially effects on infectious complications) need to be considered with caution. The use of capillary samples for blood glucose instead of arterial samples and use of the point-of-care glucose meter could be considered a further limitation. Consensus recommendations published in 2013  highlight the need to obtain arterial rather than capil- lary blood samples. This was selected as the standard- ized method by the researchers at the nine hospitals given it was logistically nonviable to collect arterial blood samples at the frequency necessary at two of the centers. However, regardless of the greater or lesser reliability of absolute glycemia values, the use of capil- lary samples should not affect the comparisons made between the three groups of patients. As a final limita- tion, the sample size precluded reaching conclusions on outcome measures (such as mortality) other than those related to glycemic or infection control.
Introduction: Forcritically patients, enteral immu- nonutrition results in notable reductions in infections andin length of stay in hospital, but not on mortality, raising the question as to whether this relate to the he- terogeneous nature of criticallyill patients or to the ab- sence of the altered absorption of specific nutrients within the immunonutrient mix (e.g. iron). Immune-as- sociated functional iron deficiency (FID) is not only one of the many causes or anaemia inthecriticallyill, but also a cause of inappropriate immune response, leading to a longer duration of episodes of systemic inflamma- tory response syndrome and poor outcome.
Data were reported by the attending physician after reviewing medical charts and radiological and laboratory records. Two periods were analyzed based on data on all patients within the cohort consecutively diagnosed with An/H1N1 influenza: the 2009 pandemic (H1N1)v infection period between epidemiological weeks 23 and 52 of 2009, andthe post-pandemic Influenza (H1N1)v infection period between epidemiological weeks 50 and 52 of 2010 and weeks 1 to 9 of 2011. Children under 15 years old were not enrolled inthe registry. The An/ H1N1 infection was confirmed by means of real-time reverse-transcription-polymerase chain reaction (RT- PCR) on either nasopharyngeal swab samples or tracheal secretions ordered by the attending physicians at inten- sive care unit (ICU) admission. An/H1N1 testing was performed in each institution or centralized in a refer- ence laboratory when local resources were not available. RT-PCR methods and further details are described else- where . A confirmed case was defined as an acute respiratory illness with laboratory-confirmed An/H1N1. Only confirmed cases were included inthe current report.
5. With these thoughts in mind, the 8th Meeting of the Conference of the Contracting Parties to the Convention on Wetlands, held in Spain on 18-26 November 2002, adopted a Strategic Plan forthe application of the Convention during the period 2003-2008. That Strategic Plan recognized the adoption by the Convention of a broader approach to wetland conservation and sustainable use in achieving full application of the wise use principle and safeguarding wetland resources. Developing and simplifying this plan, the Conference of the Parties meeting in Kampala, Uganda, November 2005, has agreed this Strategic Framework to be used in conjunction with the Strategic Plan during the second triennium. COP9 agreed five Goals, each to be achieved through a series of strategies with key result areas and indicators to measure effectiveness.