National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context?

BACKGROUND: Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce. METHODS: A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research. RESULTS: We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers. CONCLUSIONS: In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.

The amygdala modulates prepulse inhibition of the auditory startle reflex through excitatory inputs to the caudal pontine reticular nucleus.

BACKGROUND: Sensorimotor gating is a fundamental pre-attentive process that is defined as the inhibition of a motor response by a sensory event. Sensorimotor gating, commonly measured using the prepulse inhibition (PPI) of the auditory startle reflex task, is impaired in patients suffering from various neurological and psychiatric disorders. PPI deficits are a hallmark of schizophrenia, and they are often associated with attention and other cognitive impairments. Although the reversal of PPI deficits in animal models is widely used in pre-clinical research for antipsychotic drug screening, the neurotransmitter systems and synaptic mechanisms underlying PPI are still not resolved, even under physiological conditions. Recent evidence ruled out the longstanding hypothesis that PPI is mediated by midbrain cholinergic inputs to the caudal pontine reticular nucleus (PnC). Instead, glutamatergic, glycinergic, and GABAergic inhibitory mechanisms are now suggested to be crucial for PPI, at the PnC level. Since amygdalar dysfunctions alter PPI and are common to pathologies displaying sensorimotor gating deficits, the present study was designed to test that direct projections to the PnC originating from the amygdala contribute to PPI. RESULTS: Using wild type and transgenic mice expressing eGFP under the control of the glycine transporter type 2 promoter (GlyT2-eGFP mice), we first employed tract-tracing, morphological reconstructions, and immunohistochemical analyses to demonstrate that the central nucleus of the amygdala (CeA) sends glutamatergic inputs lateroventrally to PnC neurons, including GlyT2+ cells. Then, we showed the contribution of the CeA-PnC excitatory synapses to PPI in vivo by demonstrating that optogenetic inhibition of this connection decreases PPI, and optogenetic activation induces partial PPI. Finally, in GlyT2-Cre mice, whole-cell recordings of GlyT2+ PnC neurons in vitro paired with optogenetic stimulation of CeA fibers, as well as photo-inhibition of GlyT2+ PnC neurons in vivo, allowed us to implicate GlyT2+ neurons in the PPI pathway. CONCLUSIONS: Our results uncover a feedforward inhibitory mechanism within the brainstem startle circuit by which amygdalar glutamatergic inputs and GlyT2+ PnC neurons contribute to PPI. We are providing new insights to the clinically relevant theoretical construct of PPI, which is disrupted in various neuropsychiatric and neurological diseases.

Salud percibida por las personas mayores en España en función del tipo de demanda de actividad física / Saúde percebida pelas pessoas mais velhas na Espanha de acordo com o tipo de demanda para a atividade física / Health perceived by older people in Spain regarding the type of physical activity demand

Actualmente asistimos a un lento e inevitable proceso de envejecimiento de la población. Este hecho convierte a las personas mayores en un grupo poblacional de excepcional interés para las investigaciones científicas. Uno de los objetivos mas presentes en la literatura es el de mejorar su salud y su calidad de vida, logrando un envejecimiento activo. Por ello, el objetivo principal de la presente investigación es conocer cómo perciben las personas mayores su salud en función del grupo de demanda de actividad física en el que se encuentran, estableciéndose, además, relaciones con las variables sociodemográficas. La metodología ha consistido en una encuesta seccional aplicada a una muestra estadísticamente representativa de personas mayores de 64 años en España. Los resultados muestran que las personas físicamente activas perciben mejor su estado de salud y que las diferencias sociodemográficas se reducen o invierten en este grupo.

We witness a slow and inevitable process of demographic aging of the population, which makes the elderly a population group of particular interest in our field of research. Literature focuses on improving their health and quality of life through active aging. For that reason, the main goal of this research was to learn how the elderly perceive their health regarding the different types of demand for physical activity, relating them to socio-demographic variables. The methodology consisted in a sectional survey applied to a statistically representative sample of over-64 seniors in Spain. The results suggest that physically active people have better perception of their health. Furthermore, socio-demographic differences were reduced or reverted in that group.

Assistimos atualmente a um processo lento e inevitável do envelhecimento da população no mundo. Esse fato converte as pessoas mais velhas em um grupo populacional de excepcional interesse para as investigações científicas. Um dos objetivos mais discutidos na literatura científica é procurar melhorar a saúde e a qualidade de vida, para assim obter um envelhecimento ativo. Então, o objetivo principal desta pesquisa é conhecer como as pessoas mais velhas percebem sua saúde de acordo com a demanda do grupo da atividade física que elas participam, além de estabelecer relações com as variáveis sócio-demográficas. A metodologia constituiu-se em um estudo seccional aplicado a uma amostra estatisticamente representativa de pessoas com mais de 64 anos na Espanha. Os resultados mostraram que as pessoas fisicamente ativas percebem melhor seu estado de saúde e as diferenças sócio-demográficas são reduzidas ou revertidas neste grupo.