PDF superior Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Septic patient

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Septic patient

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Septic patient

There is insufficient evidence to recommend the use of glutamine in septic patients receiving parenteral nutri- tion. However, given the good results and absence of glu - tamine-related adverse effects in the various studies per- formed in the general population of critically-ill patients , these patients could benefit from the use of this substance. Routine use of omega-3 fatty acids cannot be recom- mended until further evidence has been gathered, although the use of lipid emulsions with a high omega-6 fatty acid content should be avoided. Septic patients should receive an adequate supply of essential trace ele- ments and vitamins. Further studies are required before the use of high-dose selenium can be recommended.
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Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Obese patient

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Obese patient

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 and in the different subgroups, so it is therefore considered to be the advisable equation for use in critically-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.
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Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: introduction and methodology.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: introduction and methodology.

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.
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Guía práctica clínica sobre el soporte nutricional en paciente crítico pediátrico

Guía práctica clínica sobre el soporte nutricional en paciente crítico pediátrico

67 Fernandez J., Herrero J., Martínez P., (2011)., Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Consensus SEMICYUC-SENPE: Indications, tim[r]

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Referencias 
          bibliográficas

Referencias bibliográficas

23. Mesejo A , Vaquerizo Alonso C , Acosta Escribano J , Ortiz Leyba C, Montejo González JC; et al; for the Spanish Society of Intensive Care Medicine and Coronary Units and the Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE). Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units and the Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Introduction and methodology. Medicina Intensiva [España] 2011;35(Suppl 1):1-6.
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Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Cardiac patient

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Cardiac patient

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).

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Components of dental clinic patient loyalty as perceived by the dentist

Components of dental clinic patient loyalty as perceived by the dentist

Dentists also claim that there are different patient profiles and thus different behaviors. They suggest that the figure the loyal patient exists as somebody who follows the dentist’s medical advice and who gives priority to dental health over price, showing a favourable willingness to treatment. On the opposite side, there exists the non-loyal patient, he /she that only considers cost(Benito, 2012; Prados, 2012). At the same time, its shown by studies that financial problems constituted the most common reasons for non-retention. Older age, having insurance, and living within a sixty-mile radius were significant drivers of patient retention (Makarem C et al., 2014).
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TítuloA meta analysis of genome wide association studies identifies novel variants associated with osteoarthritis of the hip

TítuloA meta analysis of genome wide association studies identifies novel variants associated with osteoarthritis of the hip

informed consent, complete the self-administered questionnaire (SAQ), attend the clinic visit, and complete at least the anthropometric, DEXA, and vertebral X-ray procedures. The MrOS cohort recruited only men. Study of Osteoporotic Fractures (SOF): The Study of Osteoporotic Fractures (SOF) is a prospective multicenter study of risk factors for vertebral and non vertebral fractures[16]. The cohort is comprised of 9704 community – dwelling women 65 years old or older recruited from populations-based listings in four U.S. areas: Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania. Women enrolled in the study were 99% Caucasian with African American women initially excluded from the study due to their low incidence of hip fractures. A cohort of AA women was recruited at the 6 th Visit. The SOF participants were followed up every four months by postcard or telephone to ascertain the occurrence of falls, fractures and changes in address. To date, follow-up rates have exceeded 95% for vital status and fractures. All fractures are validated by x-ray reports or, in the case of most hip fractures, a review of pre-operative radiographs. The inclusion criteria were: 1) 65 years or older, (2) ability to walk without the assistance of another, (3) absence of bilateral hip replacements, (4) ability to provide self-reported data, (5) residence near a clinical site for the duration of the study, (6) absence of a medical condition that (in the judgment of the investigator) would result in imminent death, and (7) ability to understand and sign an informed consent. To qualify as an enrollee, the participant had to provide written informed consent, complete the self-administered questionnaire (SAQ), attend the clinic visit, and complete at least the anthropometric measures. The SOF study recruited only women
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1st International Experts' Meeting on Agitation: conclusions regarding the current and ideal management paradigm of agitation / José Martínez Raga     et al

1st International Experts' Meeting on Agitation: conclusions regarding the current and ideal management paradigm of agitation / José Martínez Raga et al

In daily clinical practice, the three aspects that were discussed by the expert group, namely early identification, adequate management, and pharmacological treatment of agitation, are tightly intertwined. Thus, improvement of one of these areas may have a positive impact on the other ones. The potential for agitation to escalate into aggressive behavior, putting patients, staff, and others at risk, highlights the importance to address the behavior early, rapidly, and efficiently relying on the most ade- quate and effective pharmacological and non-pharmacological interventions for each patient to ensure the safety of everyone involved (6, 31). At the meeting, some solutions were identified by the expert participants to reduce the current barriers and, consequently, optimize the procedures and interventions for managing the agitated patient. However, such potential solu- tions did not target directly these three aspects of agitation but rather proposed more practical solutions that could be imple- mented in the day-to-day practice. An action plan is presented here (Figure 4) based on the discussion of the solutions at the meeting.
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Percepción de los enfermeros sobre seguridad del paciente en el servicio de emergencia: un estudio cualitativo

Percepción de los enfermeros sobre seguridad del paciente en el servicio de emergencia: un estudio cualitativo

The process began by the reading of the transcripts as many times as necessary, and flowed to the identification of thematic catego- ries and names for the categories in an induc- tive manner. Different from other approaches, conventional content analysis is not based on preconceived categories, but the raw data is processed by open coding (Hsieh & Shannon, 2005). Once the categories were identified, the authors discussed them and code categories with similar themes or concepts were col- lapsed. Finally, the authors coded the content of each statement within each category until consensus was reached.
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Comparative study of adolescents with and without ADHD

Comparative study of adolescents with and without ADHD

The cluster analysis and Biplot analysis applied to the sample detected two groups of personality sub-profiles in the adolescent patients with ADHD. Approximately 25% of the sample, for both men and women subjects, belongs to cluster 1 (women n = 8, 25.8% - men n = 8, 26.7%). Cluster 1 was characterized by higher scores on most scales in the MACI questionnaire, i.e., adolescents belonging to this cluster have a sub-profile pattern of a more maladaptive personality than the ones belonging in cluster 2. Based on these results, one could postulate that 25% of adolescents, both male and fe- male presenting ADHD (belonging to cluster 1) may be at an increased risk of developing a personality with maladaptive traits, hindering the subject’s lifestyle. Also, the presence of these traits could be predisposing factors for the devel- opment of future psychopathology requiring further assess- ment to evaluate the need for more specialized interventions. Belonging to cluster 1 or 2 is not associated with the type of clinical presentation of ADHD, use of medication, adverse childhood experiences (ACEs), grade retention, or
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TítuloRadium 223 dichloride: a new paradigm in the treatment of prostate cancer

TítuloRadium 223 dichloride: a new paradigm in the treatment of prostate cancer

The idea of using systemic radionuclide therapy targeting bone metastases results in an effective strategy able to deliver high doses of radiation to metastatic bone lesions, limiting the toxicity on healthy tissues [9–11]. During the last years, bone-targeting radiopharmaceuticals were represented by radioactive isotopes emitting b-particles, and lately by conversion electron emitters [12,13]. At present, only three compounds, 89 Sr (approved in Europe for prostate cancer), 153 Sm-lexidronam (153Sm- EDTMP; approved in Europe for osteoblastic metastases) and 186Re-etidronate (186Re- HEDP; approved in some European countries) have been available for pain relief secondary to skeletal metastases [14,15]. Unfortunately, the exposure of surrounding tissues to β and γ-emissions is associated with toxicities due to the relatively long range of the radiation. On the other hand, preliminary studies reported that radionuclides emitting α- particles could represent a new approach in this setting [14]. α-Emitters are characterized by shorter range (<0.1 mm) and higher energy radiation than β-particles and γ-rays, according to low linear energy transfer (LET) radiation. In addition, tissue penetration with α-emitters accounts for a diameter of 2–10 cells, minimizing the damage to healthy hematopoietic tissue. Besides, due to the high LET radiation, α- particles are evaluated as more lethal, inducing nonrepairable double-strand DNA breaks in adjacent tumor cells [16].
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15 Lee mas

Empathic Accuracy in Chronic Pain: Exploring Patient and Informal Caregiver Differences and Their Personality Correlates

Empathic Accuracy in Chronic Pain: Exploring Patient and Informal Caregiver Differences and Their Personality Correlates

In addition to the study of personality and health correlates of empathic accuracy, important contributions of the present investigation included the study of sex differences in precision and the inclusion of partners and other main caregivers altogether. In relation to sex differences, it has been argued that women are more precise in estimating the physical and emotional states of their counterparts, arguably due to differences in motivation and socialization but not in ability [26,69]. Consistent with this idea, male spouses of chronic pain patients have been found to underestimate the patient’s physical disability, while female spouses have been shown to accurately estimate such disability [36]. Contrary to this idea, another investigation indicated that male and female spouses were comparably good at inferring the care recipient’s pain severity [31] and a recent experimental study revealed that male-to-female differences in accuracy are more likely to be due to stereotypes than to real differences [70]. In our investigation, men and women were very similar at estimating the interference of pain on the other (both when the recipient of empathic accuracy was the patient and the caregiver), which would be in line with research indicating no sex differences in empathic accuracy [31]. If, indeed, motivational reasons are key predictors explaining sex differences in empathy, one possible explanation for male-to-female similarities in judgment is that, in situations where empathy is perceived as important (i.e., in the presence of illness), men and women might become similarly motivated to estimate the status of their counterparts, thus leading to comparable empathic accuracy estimates. Surprisingly, though, our study revealed that female caregivers were more likely to overestimate the severity of a patient’s pain compared to male caregivers. Research has shown that spouse catastrophizing, which is a tendency to worry and focus on the worst possible pain-related scenarios [71], is associated with increased perceptions of patient pain severity [72]. This tendency to ruminate and magnify the threat value of pain is more marked in women [73], which might provide with a tentative explanation for the higher tendency to present increased pain severity estimates of female caregivers in the sample. Again, because of the novelty of these findings and the differences in sample composition, sample size, and together with other methodological differences between the current and past similar research (i.e., measures and constructs evaluated), replication studies will be crucial to obtaining a reliable body of research into the social components into pain research.
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18 Lee mas

Content validity & initial reliability of the rating instrument for therapy contract setting revised at UC (RITCS UC)

Content validity & initial reliability of the rating instrument for therapy contract setting revised at UC (RITCS UC)

In training, raters were informed that in contracting therapists had to explain to the patient about the universal patient responsibilities, therapist responsibilities and individualized patient responsibilities. First, in training, raters learned that therapists had to explain to the patient about universal patient responsibilities regarding attendance, fees, and the patient’s role. In the sub-section universal patient responsibilities on attendance, raters learned that therapists would have to explain to the patient that, in therapy, patients should attend each session (indicating how often), arrive on time (explaining the consequences of late arrivals), stay for the duration of the session, and notify the absences in advance. In universal patient responsibilities regarding fees, raters learned that therapists should set a fee, explain the financial consequences for missed sessions, and establish procedures for payments due and payment methods to the patient. In universal patient responsibilities about the patient’s role, raters learned that therapists had to explain the tasks for treatment according to their own therapeutic model. As videotaped sessions therapeutic model was TFP, the workshop taught that in TFP one of the patient’s roles is to keep honesty about thoughts, feelings, and behavior. Another patient's role addressed and taught in training was that TFP patients should avoid life events that negatively impact the treatment.
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Person to Person Household and Nosocomial Transmission of Andes Hantavirus, Southern Chile, 2011

Person to Person Household and Nosocomial Transmission of Andes Hantavirus, Southern Chile, 2011

To characterize and compare the outbreak viral se- quences, we used as reference material a selection of se- quences from strains obtained 2 or 3 years earlier in the same ecogeographic region near Corral. All 5 medium fragments obtained from case-patient isolates in this cluster were highly similar to each other but were more distantly related to the reference sequences. The strong relatedness of the viruses in the Corral cluster is supported by high bootstrap and posterior probability values in the phylo- genetic analyses. Furthermore, the small segment showed 100% identity between the 5 sequences in this cluster. The dates of exposure to high-risk environments or to persons with ANDV infection, known incubation periods, and 100% sequence identify all support a conclusion of person- to-person transmission (7). Our data showed 99%–100% identity for a fragment of 913 bp of the medium segment, supporting identity using different sequences. However, we did not include noncoding region fragments, which might provide additional confirmation of identity.
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Vol. 90, Núm. 4 (2019)

Vol. 90, Núm. 4 (2019)

From birth, the patient presented polyuria and hypokalemic metabolic alkalosis making a diagnosis of Neonatal Bartter Syndrome in the first week of life.. Laboratory tests confirmed uri[r]

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Coagulation abnormalities in the cirrhotic patient

Coagulation abnormalities in the cirrhotic patient

Randomized clinical trials provide little support, however, using plasma before invasive procedures, except for bleeding diathesis is clearly indicated. Al- though plasma is commonly used in patients who have cirrhosis with prolonged INR, injudicious use should be regarded as a risk and liability in light of the limitations of the INR and the risks associated with plasma use. Moreover, the amount of fresh fro- zen plasma requested is typically inadequate to reach the desired INR in the great majority of cirr- hotic patients. Morover, transfusion-related compli- cations rate has been reported to be 15% at 48 h after transfusion. Described transfusion-related complication in cirrhotic patients include transfu- sion related acute lung injury and acute kidnay in- jury related to tubular necrosis. 4,54,55
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Being in front of the patient. Nurse-patient interaction and use of technology in emergency services

Being in front of the patient. Nurse-patient interaction and use of technology in emergency services

The previous example can be extrapolated to other emergency situations like: constant monitoring of vital signs and the infusion pumps, among others. Without technology, some cases could not be detected and classiied as urgent: … yes, sure, very important, because if you do not have monitors, if you do not have instruments to measure many vital parameters in the patient you could not do it in emergency (Talu: E16P7PAR14-17). Likewise, the lack of technology can delay processes, given that it facilitates decision making and expedites processes. Currently, technological equipment is part of the daily work in nursing, its use is seen as a matter of custom and it is estimated that many tasks cannot be undertaken without technology: with the vital sign monitor the problem is that you get used… that is the biggest problem, you get used to it as chief, so, what can I do if don’t have it? (Laura: E9P4PAR32-34). The problem arises when custom limits action and resources are not sought, the situation is complicated and service becomes chaos. Also, and although nurses are accustomed to technology, some resist change, every change generates an impact (13OCN1), every change has an adaptation period (13OCN1); examples of the dificulties in the adaptation process are expressions in terms that before there were objections to its use, now because of custom professionals conceive it as necessary in their work, …when technology really fails, and above all if you are accustomed to that technology, sometimes your life does turn to chaos (Liliana: E8P3PAR19-21); …everything new generates resistance, but today we have the advantages of that and there they were taken advantage, which is important, it is very cumbersome to go back and adapt to manual work (Talu: E16P4PAR1-3,5).
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Recin nacidos pretrmino con sepsis nosocomial: comparacin de dos consensos y una escala clnica, utilizados en la identificacin de sepsis mediante un estudio de evaluacin de pruebas diagnsticas

Recin nacidos pretrmino con sepsis nosocomial: comparacin de dos consensos y una escala clnica, utilizados en la identificacin de sepsis mediante un estudio de evaluacin de pruebas diagnsticas

Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis; ACPP, criterios del International Pediatric Sepsis Consensus Conference: Definitio[r]

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Smoking Cessation Treatments: Current Psychological and Pharmacological Options

Smoking Cessation Treatments: Current Psychological and Pharmacological Options

Background: Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world. Objective: To provide an overview of smoking-cessation treat- ments, including pharmacological and psychological options, and to gather current scientific evidence available on them. Methods: Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-be- havioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi- randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries. Results: After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention. Conclusions: It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment. (REV INVEST CLIN. 2019;71:7-16)
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