Dispositivos robóticos de mano en neurorrehabilitación: revisión sistemática sobre viabilidad y efectividad en la rehabilitación del ictus / Hand robotic devices in neurorehabilitation: A systematic review on the feasibility and effectiveness of stroke rehabilitation

La terapia asistida por robot es una intervención relativamente nueva, cada vez más empleada en el tratamiento rehabilitador del paciente con ictus. Permite incrementar el número de repeticiones en la realización de movimientos de tareas específicas. Para esta revisión se ha realizado una búsqueda entre agosto y octubre de 2021 en las bases de datos PubMed, Web of Science, Scopus, Cochrane, PEDro y OTseeker, seleccionando un total de seis ensayos controlados y aleatorizados donde se utilizara la terapia de mano asistida por robot en la rehabilitación del ictus. Los estudios coinciden en que la terapia de mano asistida por robot presenta beneficios en todas las fases de la rehabilitación del ictus que se traducen en mejoras motoras y funcionales del miembro superior y en mejoras en la negligencia hemiespacial.(AU)

Robot-assisted therapy is a relatively new intervention, increasingly used in the rehabilitation treatment of stroke patients. It allows to increase the number of repetitions in the performance of specific tasks movements. For this review, a search was carried out between August and October 2021 in the PubMed, Web of Science, Scopus, Cochrane, PEDro and OTseeker databases, selecting a total of six randomized controlled trials where robot-assisted hand therapy was used in stroke rehabilitation. Studies agree that robot-assisted hand therapy has benefits in all phases of stroke rehabilitation that translate into motor and functional improvements of the upper limb and improvements in hemispatial neglect.(AU)

[Hand robotic devices in neurorehabilitation: A systematic review on the feasibility and effectiveness of stroke rehabilitation]. / Dispositivos robóticos de mano en neurorrehabilitación: revisión sistemática sobre viabilidad y efectividad en la rehabilitación del ictus.

Robot-assisted therapy is a relatively new intervention, increasingly used in the rehabilitation treatment of stroke patients. It allows to increase the number of repetitions in the performance of specific tasks movements. For this review, a search was carried out between August and October 2021 in the PubMed, Web of Science, Scopus, Cochrane, PEDro and OTseeker databases, selecting a total of six randomized controlled trials where robot-assisted hand therapy was used in stroke rehabilitation. Studies agree that robot-assisted hand therapy has benefits in all phases of stroke rehabilitation that translate into motor and functional improvements of the upper limb and improvements in hemispatial neglect.

Epidemiología del ictus cardioembólico y su asociación con la penetración de los ACOD en España: primer estudio poblacional 2005-2018 / Epidemiology of atrial fibrillation-related ischemic stroke and its association with DOAC uptake in Spain: first national population-based study 2005 to 2018

Introducción y objetivos: La prevalencia y la incidencia de la fibrilación auricular (FA), un importante factor de riesgo de ictus cardioembólico, han aumentado sustancialmente en los últimos años. Sin embargo, varios estudios europeos han observado una disminución en la tasa de ictus cardioembólico asociada con un aumento de la penetración de los anticoagulantes orales de acción directa (ACOD). Este estudio ecológico evalúa la asociación entre la penetración de los ACOD y la tasa de incidencia de ictus cardioembólicos en España. Métodos: Los datos se obtuvieron del Registro de Actividad Sanitaria Especializada del Ministerio de Sanidad de España (RAE-CMBD). Los ictus cardioembólicos se identificaron mediante códigos ICD. Las tasas de incidencia se estandarizaron por edad y se ajustaron a la población estándar europea de 2013. Se utilizaron modelos de regresión de Poisson para estimar la asociación entre la penetración de los ACOD y la tasa de ictus cardioembólico en pacientes de 65 o más años. Resultados: La tasa de incidencia ajustada (TI) del ictus cardioembólico aumentó desde 2005 (2,20/100.000 personas/año) hasta 2012 (2,67). A partir de 2012, tras la introducción de los ACOD para la prevención del ictus cardioembólico en España, la TI se ha mantenido constante o ha disminuido ligeramente (en 2018, 2,66). Los resultados del modelo de regresión de Poisson indican que la penetración de los ACOD tiene una influencia estadísticamente significativa en la tasa de ictus cardioembólicos de los mayores de 65 años (RDI=0,995; IC95%, 0,995-0,996). Conclusiones: Los resultados de este estudio muestran una asociación entre la penetración de los ACOD y una menor incidencia de ictus cardioembólicos. A pesar de que esta asociación no implica causalidad, indica que una mayor penetración de los ACOD podría llevar a un mayor beneficio clínico para los pacientes con FA en España (AU)

Introduction and objectives: The incidence and prevalence of atrial fibrillation (AF), a major risk factor for stroke, has increased substantially in the past few years. However, several studies have reported a decline in AF-related stroke rates associated with higher uptake of direct oral anticoagulants (DOACs). This ecological study evaluated the association between DOAC uptake in Spain and the incidence rate (IR) of AF-related ischemic stroke. Methods: Data were obtained from the Registry of Activity of Specialized Healthcare of the Spanish Ministry of Health (RAE-MDS). AF-related ischemic strokes were identified using International Classification of Diseases codes. IR were age-standardized and adjusted to the 2013 European standard population. Poisson regression models were used to identify the association between DOAC uptake and AF-related ischemic stroke in patients aged ≥ 65 years. Results: Before the use of DOACs, the adjusted IR of AF-related ischemic stroke increased steadily from 2005 (IR=2.20 per 100 000 person/y) to 2012 (IR=2.67). Upon DOAC uptake in Spain from 2012 onwards for AF-related ischemic stroke prevention, the IR remained constant or decreased slightly (IR in 2018=2.66). Poisson regression showed that DOAC uptake was a significant predictor for the rate of AF-related ischemic stroke in patients older than 65 years (IRR=0.995; 95%CI, 0.995-0.996). Conclusions: This study shows an association between DOAC use and a reduced incidence of AF-related ischemic stroke. While this association is based on aggregate data and cannot demonstrate causality, these findings suggest that higher DOAC uptake could improve health outcomes in AF patients in Spain (AU)

Efectividad de la terapia de movimiento inducido por restricción del lado sano en la rehabilitación del miembro superior en pacientes con parálisis cerebral: revisión sistemática / Effectiveness of constraint-induced movement therapy in upper extremity rehabilitation in patients with cerebral palsy: A systematic review

Antecedentes y objetivo En la parálisis cerebral hemipléjica puede aparecer el «aprendizaje de no uso». La terapia de movimiento inducido por restricción del lado sano parece revertir este fenómeno. El objetivo del presente artículo es revisar la evidencia sobre su efectividad en la funcionalidad del miembro superior, la realización de las actividades de la vida diaria y la calidad de vida. Pacientes y métodos Se llevó a cabo una revisión sistemática entre enero y abril del 2019 en las bases de datos PubMed, Cochrane, PEDro y TripDataBase. Se han incluido 14 estudios clínicos donde se describen sus características. Resultados La mayor parte de los estudios encuentran mejorías significativas frente a grupos controles. Solo un artículo investiga sobre calidad de vida. Conclusiones La terapia de movimiento inducido por restricción parece tener efectos positivos en la rehabilitación motora de la extremidad superior de estos sujetos. Se necesitan más estudios que valoren los factores individuales más influyentes en la rehabilitación (AU)

Background and objective In hemiplegic cerebral palsy, learned non-use may appear. This phenomenon can be reversed by constraint-induced movement therapy in the healthy side. The aim of this article was to review the evidence of the effectiveness of this therapy on upper extremity functioning, the performance of activities of daily living and quality of life. Patients and methods We performed a systematic review between January and April 2019 in the PubMed, COCHRANE, PEDro and TRIPDATABASE databases. We included 14 clinical studies describing their characteristics. Results Most of the studies found significant improvements compared with control groups. Only one article investigated quality of life. Conclusions Constraint-induced movement therapy seems to have positive effects in the motor rehabilitation of the upper extremity in patients with hemiplegic cerebral palsy. Further studies are needed to assess the individual factors of greatest influence in rehabilitation (AU)

[Effectiveness of constraint-induced movement therapy in upper extremity rehabilitation in patients with cerebral palsy: A systematic review]. / Efectividad de la terapia de movimiento inducido por restricción del lado sano en la rehabilitación del miembro superior en pacientes con parálisis cerebral: revisión sistemática.

BACKGROUND AND OBJECTIVE: In hemiplegic cerebral palsy, learned non-use may appear. This phenomenon can be reversed by constraint-induced movement therapy in the healthy side. The aim of this article was to review the evidence of the effectiveness of this therapy on upper extremity functioning, the performance of activities of daily living and quality of life. PATIENTS AND METHODS: We performed a systematic review between January and April 2019 in the PubMed, COCHRANE, PEDro and TRIPDATABASE databases. We included 14 clinical studies describing their characteristics. RESULTS: Most of the studies found significant improvements compared with control groups. Only one article investigated quality of life. CONCLUSIONS: Constraint-induced movement therapy seems to have positive effects in the motor rehabilitation of the upper extremity in patients with hemiplegic cerebral palsy. Further studies are needed to assess the individual factors of greatest influence in rehabilitation.

[Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke]. / Imagineria motora: revision sistematica de su efectividad en la rehabilitacion de la extremidad superior tras un ictus.

INTRODUCTION: Motor imagery or mental practice of movement is a relatively new intervention that is being used on an increasingly more frequently basis in the treatment of stroke patients. It consists in the person evoking a movement or gesture in order to learn or improve its execution. Neuroimaging studies have shown that imagining movements activates neuronal patterns that are similar to those produced when they are actually performed. PATIENTS AND METHODS: A systematic review was conducted between January and June 2017 in the Web of Science, PubMed, CINHAL, PEDro and Scopus databases to select clinical trials carried out with stroke patients in whom this technique was used as rehabilitation. Thirteen randomised clinical trials were included. The characteristics of the studies and the measures of results were summarised and the evidence of their outcomes was described. RESULTS: Most of the studies found significant differences in terms of improved motor rehabilitation of the upper limb among the subjects in the experimental groups. Only one of the studies failed to show any evidence of its effectiveness in isolation. None of them made any reference to its effectiveness in improving sensory alterations. CONCLUSIONS: Motor imagery, combined with conventional therapy (physiotherapy or occupational therapy), seems to have positive effects on the motor rehabilitation of the upper limb following a stroke. Further research is needed to improve the heterogeneity of the interventions and to evaluate their effectiveness in the long term.

TITLE: Imagineria motora: revision sistematica de su efectividad en la rehabilitacion de la extremidad superior tras un ictus.Introduccion. La imagineria motora o practica mental del movimiento es una intervencion relativamente nueva, cada vez mas empleada en el tratamiento del paciente con ictus. Consiste en la evocacion, por parte de la persona, de un movimiento o gesto para aprender o mejorar su ejecucion. Estudios de neuroimagen han demostrado que la imaginacion de movimientos activa patrones neuronales similares a su ejecucion. Pacientes y metodos. Se ha realizado una revision sistematica entre enero y junio de 2017 en las bases de datos Web of Science, PubMed, CINHAL, PEDro y Scopus, seleccionando los ensayos clinicos llevados a cabo con pacientes con ictus en los que se empleara esta tecnica como intervencion rehabilitadora. Se incluyeron 13 estudios clinicos aleatorizados. Se resumieron las caracteristicas de los estudios y las medidas de resultados, y se describio la evidencia de sus resultados. Resultados. La mayor parte de los estudios encuentran diferencias de mejora significativas en la rehabilitacion motora de la extremidad superior entre los sujetos de los grupos experimentales. Solo uno de los estudios no mostro evidencia de su efectividad de forma aislada. En ninguno se hace referencia a su efectividad en la mejora de las alteraciones sensitivas. Conclusiones. La imagineria motora, combinada con terapia convencional (fisioterapia o terapia ocupacional), parece tener efectos positivos en la rehabilitacion motora de la extremidad superior tras un ictus. Se precisan mas estudios que mejoren la heterogeneidad de las intervenciones y que valoren su efectividad a largo plazo.

Infralittoral-sublittoral (submerged zone) macroinfauna community structure of high-impact, medium-impact and non-impact beaches on the Gulf of Cádiz coast (SW Spain). Evaluation of anthropogenic alterations: Nourishments, human impact and urbanization.

Beaches are dynamic transitional environments subject to numerous natural and anthropic alterations. In these ecosystems, the infralittoral-sublittoral macrofauna communities play a key role in the food web. The objective of this study was to compare macrofauna communities on six beaches on the Gulf of Cádiz coast, which were classified according to the anthropic alterations they support, and evaluate the influence of abiotic factors on the species distribution. Sampling was done in the infralittoral-sublittoral zone of each beach using a modified manual dredge. Five perpendicular transects of 25 m, each separated by 10 m, were performed per beach, with a total sample area of 43.75 m2 per beach. A total of 27 species were found, of which Donax trunculus, Diogenes pugilator, and Tritia grana were the most abundant. Anthropogenic effects are appreciable in the infralittoral-sublittoral although they are areas that are permanently submerged and less exposed than the intertidal. Beach nourishments carried out with large volumes of sand can alter the grain size, the most influential parameter on the distribution of the species, and consequently, affect the macrofauna community that inhabits these beaches.

Zinc(ii), cobalt(ii) and manganese(ii) networks with phosphoserine ligand: synthesis, crystal structures and magnetic and proton conductivity properties.

A series of zinc(ii), cobalt(ii) and manganese(ii) coordination networks with phosphoserine ligand (H3PSer) are synthesized and characterized. Whereas in compounds 1 and 2 with the general formula [M(HPser)]n [M = Zn (1) and Co (2)], the metal(ii) ion presents a tetrahedral geometry, in [Co(HPSer)(H2O)2]n (3) and [Mn(HPSer)(H2O)]n (4), the metal(ii) ions are in a distorted octahedral geometry. The 3D frameworks are formed by inorganic layers built up from MO4 or MO6 polyhedra and phosphate groups. These layers are linked by the carboxylate groups of the phosphoserine ligand. The presence of extended hydrogen bonding stabilizes the 3D network and favours the proton transfer leading to moderate proton conductors. The highest proton conductivity, 2.70 × 10-5 S cm-1 (at 80 °C and 95% RH), is obtained for compound 3. Temperature-dependent magnetic susceptibility measurements for 2-4 reveal predominant antiferromagnetic interactions between the paramagnetic metal(ii) ions.

The number of risk factors is the strongest predictor of prostate cancer mortality: multi-institutional outcomes of an extreme-risk prostate cancer cohort

Purpose: To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis. Materials and methods: Extreme-risk prostate cancer patients were defined as patients with at least one extremerisk factor: stage cT3b-cT4, Gleason score 9-10 or PSA[50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c-cT3a, Gleason 8 and PSA[20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical- free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients. Results: With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariateanalysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the "number of risk factors" variable, this model provided the best distinction between patients with C2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint. Conclusions: Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments (AU)

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The number of risk factors is the strongest predictor of prostate cancer mortality: multi-institutional outcomes of an extreme-risk prostate cancer cohort.

PURPOSE: To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis. MATERIALS AND METHODS: Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b-cT4, Gleason score 9-10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c-cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients. RESULTS: With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the "number of risk factors" variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint. CONCLUSIONS: Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.

Modeling of biomass fractionation in a lab-scale biorefinery: Solubilization of hemicellulose and cellulose from holm oak wood using subcritical water.

Lignocellulose fractionation is a key biorefinery process that need to be understood. In this work, a comprehensive study on hydrothermal-fractionation of holm oak in a semi-continuous system was conducted. The aim was to develop a physicochemical model in order to reproduce the role of temperature and water flow over the products composition. The experiments involved two sets: at constant flow (6mL/min) and two different ranges of temperature (140-180 and 240-280°C) and at a constant temperature range (180-260°C) and different flows: 11.0, 15.0 and 27.9mL/min. From the results, temperature has main influence and flow effect was observed only if soluble compounds were produced. The kinetic model was validated against experimental data, reproducing the total organic carbon profile (e.g. deviation of 33%) and the physicochemical phenomena observed in the process. In the model, it was also considered the variations of molecular weight of each biopolymer, successfully reproducing the biomass cleaving.

Solvation and surface effects on polymorph stabilities at the nanoscale.

We explore the effects of particle size and solvent environment on the thermodynamic stability of two pairs of polymorphs subjected to ball-mill neat grinding (NG) and liquid assisted grinding (LAG). Two systems were studied: (i) forms I and II of a 1 : 1 theophylline : benzamide cocrystal and (ii) forms A and B of an aromatic disulfide compound. For both systems, the most stable-bulk polymorph converted to the metastable-bulk polymorph upon NG. LAG experiments yielded different outcomes depending on the amount of solvent used. This was further investigated by performing carefully controlled LAG experiments with increasing µL amounts of solvents of different nature. With these experiments, we were able to monitor form A to B and form I to II conversions as a function of solvent concentration and derive polymorph equilibrium curves. The concentration required for a switch in polymorphic outcome was found to be dependent on solvent nature. We propose that these experiments demonstrate a switch in thermodynamic stability of the polymorphs in the milling jar. Form B, the stable-bulk polymorph, has less stable surfaces than form A, thus becoming metastable at the nanoscale when surface effects become important. Ex situ diffraction and electron microscopy data confirm crystal sizes in the order of tens of nanometers after the ball mill grinding experiments reach equilibrium. DFT-d computations of the polymorph particles stabilities support these findings and were used to calculate cross-over sizes of forms A and B as a function of solvent. Attachment energies and surface stabilities of the various crystalline faces exposed were found to be very sensitive to the solvent environment. Our findings suggest that surface effects are significant in polymorphism at the nanoscale and that the outcomes of equilibrium ball-mill NG and LAG experiments are in general controlled by thermodynamics.

Can the study of self-assembly in solution lead to a good model for the nucleation pathway? The case of tolfenamic acid.

To further our understanding of the role of solution chemistry in directing nucleation processes new experimental and computational data are presented on the solution and crystallisation chemistry of tolfenamic acid (TA), a benchmark polymorphic compound. With these, and previously published data, we were able to establish that TA is rapidly fluctuating between conformers in solution with either solvated monomers or dimers present depending on the solvent. Hence, despite the fact that conformational polymorphs can be obtained from crystallisations in ethanol, we found no links between solution chemistry and crystallisation outcomes. We discuss the implications of these conclusions for the nature of the nucleation pathway via dimers and clusters and raise experimental questions about how best to undertake relevant crystallisation studies.

Proton conductors based on alkaline-earth substituted La(28-x)W(4+x)O(54+3x/2).

Lanthanum tungstates, "La6WO12", are mixed ion proton-electronic conductors with very interesting properties for technological applications and better phase stability compared to alkaline earth perovskites. A new series of compounds La(27.04-x)M(x)W(4.96)O(55.44-x/2□8.56+x/2) (M = Ca(2+), Sr(2+) and Ba(2+)) are investigated with the aim of increasing the concentration of oxygen vacancies and studying their effects on the structure and transport properties. The materials have been studied by high-resolution laboratory X-ray powder diffraction and scanning electron microscopy combined with energy dispersive spectroscopy (EDS). High temperature X-ray powder diffraction and thermal analysis in wet and dry N2 gas did not show any evidence of phase transition up to 800 °C. The total conductivity was studied by impedance spectroscopy under dry and wet atmospheres and as a function of the oxygen partial pressure. The electronic contribution to the conductivity was determined by the Hebb-Wagner polarization method. The generation of extrinsic vacancies in the lattice with alkaline earth doping leads to a decrease of the ionic conductivity for high doping level, suggesting a proton trapping mechanism.

In-tube solid-phase microextraction coupled by in valve mode to capillary LC-DAD: Improving detectability to multiresidue organic pollutants analysis in several whole waters.

A simple and fast capillary chromatographic method has been developed to identify and quantify organic pollutants at sub-ppb levels in real water samples. The major groups of pesticides (organic halogens, organic phosphorous, and organic nitrogen compounds), some hydrocarbons (polycyclic aromatic hydrocarbons), phthalates and some phenols such as phenol and bisphenol A (endocrine disruptors) were included in this study. The procedure was based on coupling, in-tube solid-phase microextraction (IT-SPME) by using a conventional GC capillary column (95% methyl-5% phenyl substituted backbone, 80cmx0.32mm i.d., 3microm film thickness) in the injection valve to capillary liquid chromatography with diode array detection. A comparative study between the IT-SPME manifold and a column-switching device using a C(18) column (35mmx0.5mm i.d., 5microm particle size) has been performed. The IT-SPME procedure was optimal, it allows reaching limits of detection (LODs) between 0.008 and 0.2microg/L. No matrix effect was found and recoveries between 70 and 116% were obtained. The precision of the method was good, and the achieved intra- and inter-day variation coefficients were between 2 and 30%. This procedure has been applied to the screening analysis of 28 compounds in whole waters from several points of the Mediterranean coast (Valencia Community, Spain).

Gestión de la seguridad del paciente en una unidad de urgencias de atención primaria / Ensuring patient safety in an emergency primary health care service

Objetivo: La seguridad clínica o los riesgos a los que se someten los pacientes en función de su relación con el sistema sanitario han sido mencionados con mucha frecuencia en el desarrollo de las ciencias sanitarias. Ciertas unidades, como las de pacientes críticos, son más propicias a errores por la multitud de fármacos y procedimientos. El objetivo del estudio fue describir la experiencia en el análisis de los efectos adversos(EA) en urgencias de atención primaria y, aún más, propiciar la identificación y prevención de los EA antes de que estos ocurran. Método: Creación de un grupo de trabajo en noviembre de 2007 en la unidad clínica de urgencias del centro de salud para definir las situaciones de riesgo donde se pueden producir EA, prevenir su aparición, analizar los que aparezcan y corregirlos dentro de un contexto de mejora continua de calidad asistencial. Realizamos un análisis y estudio descriptivo retrospectivo sobre las notificaciones de EA durante el año 2008.Resultados: Se atendieron un total de 75.525 urgencias, y en total se detectaron 11EA (0,15‰), de los que 9 corresponden a errores de identificación en la apertura del episodio clínico (errores de filiación) y dos a EA con consecuencias clínicas leves. Conclusiones: El EA más frecuente es el error de identificación en la apertura del episodio clínico o historia clínica, lo que conlleva (de no corregirse a tiempo) a la generación de un episodio de asistencia urgente a una persona que no le corresponde (AU)

Objective: Clinical safety and the risks affecting patients in their relations with the health care system have long been discussed in the health sciences. Certain settings, such as critical care units, are highly susceptible to error because of the many drugs and procedures they manage. Our main objetive was to initiate analysis of adverse events in an emergency primary health care service, as well as to facilitate the identification and prevention of such events. Methods: A working group was formed in November 2007 in our emergency primary health care service and charged with defining situations in which there is risk of adverse events, preventing such events, and analyzing and correcting those that occurred with a view to making ongoing improvements in patient care. We undertook a retrospective study of adverse event reports in 2008.Results: We attended 75525 consultations, and found 11 incidents (0,15‰). Nine were caused by errors in identifying the onset of the episode (referral errors) and 2 were events with scarce clinical consequences. Conclusions: Mistakes in identifying the onset of a clinical episode or relevant medical history are the most common type of event. This error generates the need for an emergency department visit that could have been avoided if the error had been corrected in time (AU)

New micromethod combining miniaturized matrix solid-phase dispersion and in-tube in-valve solid-phase microextraction for estimating polycyclic aromatic hydrocarbons in bivalves.

Miniaturized matrix solid-phase dispersion (MSPD) was developed for the extraction of common polycyclic aromatic hydrocarbons (PAHs) from bivalve samples (100mg, dry weight). Additional clean-up and analyte enrichment was accomplished by in-tube solid-phase microextraction (SPME). For this purpose the extracts collected after MSPD were diluted with water and injected into a capillary column coated with the extractive phase. This capillary column was connected to the analytical column by means of a switching valve. Separation and quantification of the PAHs were carried out using a monolithic LC column and fluorescence detection. Since the in-tube SPME device allowed the processing of large volumes of the extracts (2.0 mL) excellent sensitivity was achieved, thus making solvent evaporation operations unnecessary. The overall recoveries ranged from 10% to 28% for the studied compounds. The relative standard deviation (RSD) ranged from 2% to 10% for intra-day variation (n=3), and the limits of detection (LODs) were < or =0.6 ng/g (dry weight). The proposed procedure was very simple and rapid (total analysis time was approximately 20 min), and the consumption of organic solvents and extractive phases was drastically reduced. The reliability of the proposed MSPD/in-tube SPME method was tested by analysing several bivalves (mussels and tellins) as well as a standard reference material (SRM).

Asociación de placenta íncreta, previa y membranácea / Association of placenta increta, previa and membranacea

Aunque la placenta membranácea y la placenta íncreta son entidades poco frecuentes, tienen una gran importancia pues habitualmente causan hemorragias abundantes y pueden conducir a una histerectomía. Suelen asociarse a placenta previa, antecedentes de cirugía uterina (cesárea, legrados) y gestaciones múltiples, entre otras. Se comenta la posibilidad del diagnóstico anteparto y diferentes modalidades de tratamiento (AU)

Alteraciones perceptivas y práxicas en pacientes con traumatismo craneoencefálico: relevancia en las actividades de la vida diaria / Perceptive and praxic impairments in traumatic brain injury patients: significance in activities of daily living

Objetivo. Describir la implicación de los déficit perceptivos y práxicos en la correcta ejecución de las actividades de la vida diaria (AVD), y revisar algunas de las pruebas de evaluación específicas y las técnicas de intervención empleadas para el entrenamiento en dichas alteraciones tras un traumatismo craneoencefálico (TCE). Desarrollo. Los procesos relacionados con la percepción visual básica de los objetos (color, forma, tamaño, etc.) y la percepción más compleja de los mismos (profundidad, localización, reconocimiento, etc.), así como otros procesos relacionados con la integración de la información sensorial (discriminación derecha-izquierda y trastornos del esquema corporal, entre otros), son determinantes para la adecuada ideación, planificación motora y ejecución de los movimientos propositivos (praxias). Si la realización de las AVD requiere del adecuado funcionamiento de las diferentes estructuras del sistema nervioso central, su valoración y tratamiento serán necesarios para conseguir el mayor nivel de independencia posible en aquellas personas que han sufrido un TCE, objetivo prioritario de la terapia ocupacional. Las AVD pueden clasificarse en dos grandes grupos: básicas (alimentación, aseo personal, vestido, etc.) e instrumentales (preparación de alimentos, manejo de dinero, realización de compras, utilización de transportes públicos, etc.). Conclusiones. Las alteraciones en ambos procesos, perceptivo y práxico, constituyen un amplio porcentaje de los déficit que presentan los pacientes con TCE y que se traducen, desde un punto de vista clínico, en la dificultad para llevar a cabo una vida independiente. Se destaca la necesidad de evaluar correctamente dichos procesos neuropsicológicos, por su implicación en las AVD (AU)

Objective. The main goal of the present study is to describe the implication of different perceptive and praxic deficits in activities of daily living (ADL). We also review some assessing scales and intervention techniques used in the training of these mentioned alterations after a traumatic brain injury (TBI). Development. There are three kinds of processes important for a correct ideation, motor planification and execution of a learned purposeful movement (praxis). Some of these processes are related to the visual basic perception of the objects (colour, form, size, etc). Others are related to the most complex perception functions (depth, location, recognition ,etc). The third group of functions are those integrating the sensory information (discrimination right-left side, corporal scheme disorders, etc). If ADL performance needs a suitable functioning of different structures of the nervous central system, then assessment and treatment will be necessary to obtain the best independence level of TBI patients. This is the main objective in occupational therapy. ADL may be separated in two different groups: basic abilities (feeding, grooming, dressing, etc) and instrumental abilities (meal preparation, managing money, shopping, using public transportation, etc). Conclusion. Impairments in both praxic and perceptive processes constitute one of the most prevalent deficits in TBI patients. From a clinical point of view, these deficits may lack the capacity to carry an independent life (AU)