Discriminative Dissolution Method Using the Open-Loop Configuration of the USP IV Apparatus to Compare Dissolution Profiles of Metoprolol Tartrate Immediate-Release Tablets: Use of Kinetic Parameters.

The use of the USP IV apparatus (flow-through cell) has gained acceptance in recent years due to its versatility and ability to discriminate due to its hydrodynamic conditions. Therefore, the objective of the present study was to develop a discriminative dissolution method in the USP IV apparatus using the open-loop configuration, as well as to propose a method to compare non-cumulative dissolution profiles obtained in the open-loop configuration considering kinetic parameters and validate its predictive power through its comparison with independent and dependent methods using five commercial immediate-release tablet drugs (one reference drug and four generic drugs) of metoprolol tartrate as a model drug. The comparison of the non-accumulated dissolution profiles consisted of determining the geometric ratio of Cmax, AUC0∞, AUC0Cmax, and Tmax (kinetic parameters) of the generic/reference drugs, whereby generic drugs "C" and "D" presented the highest probability of similarity since their 90% confidence intervals were included, or they were very close to the acceptance interval (80.00-125.00%). These results were consistent with the f2, bootstrap f2, and dissolution efficiency approaches (independent models). In conclusion, the proposed comparison method can be an important tool to establish similarity in dissolution profiles and to facilitate the development/selection of new formulations and positively ensure bioequivalence in clinical studies.

Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial.

OBJECTIVE: To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper. DESIGN: Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor. PARTICIPANTS AND SETTING: Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System. INTERVENTIONS: The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy. PRIMARY OUTCOME: Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity. RESULTS: The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group. CONCLUSIONS: In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand, Wrist, and Fingers.

OBJECTIVE: To assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DESIGN: A multicenter assessor-blinded, parallel, 2-group controlled trial. SETTING: Trauma and rehabilitation services of 4 hospitals. PARTICIPANTS: Six hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). INTERVENTIONS: The experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. MAIN OUTCOME MEASURES: The primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). RESULTS: The experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=-1.64; 95% confidence interval, -2.64 to -0.65) and physiotherapy sessions (mean difference=-8.52, 95% confidence interval, -16.92 to -0.65) compared to the control group. CONCLUSIONS: In patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients' functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.

The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial.

BACKGROUND: Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new delivery systems are needed to solve lack of adherence. AIM: To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN: A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING: Community health centers in rural southern Spain. POPULATION: Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS: Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the CareHand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS: The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS: A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT: mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcomes.

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial.

BACKGROUND: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. OBJECTIVE: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. METHODS: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. RESULTS: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; η2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05). CONCLUSIONS: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04713-4.

Rare Proteus mirabilis Aortic Valve Infective Endocarditis without a Urinary Tract Infection.

Proteus mirabilis infective endocarditis is a rare disease with only 17 reported cases. It is typically associated with urinary tract infections (UTIs), staghorn calculi, and/or asymptomatic bacteriuria. We present a case of a 73-year-old male who presented with positive blood cultures for Proteus mirabilis but with a negative urinalysis and urine culture. He presented with acute renal failure and required hemodialysis. TTE was remarkable for a 30% ejection fraction, and no vegetations were visualized. TEE demonstrated a small vegetation on the left aortic valve. The initial urine culture remained negative throughout his hospitalization. He was treated with IV antibiotics and discharged without hemodialysis.

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial.

QUESTION: In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. INTERVENTION: Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. OUTCOME MEASURES: The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. RESULTS: Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength. CONCLUSION: In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. TRIAL REGISTRATION: ACTRN12619000344190.

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol.

BACKGROUND: Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)-related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA. METHODS: The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up. DISCUSSION: This study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient's status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04263974 . Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.

Comparación de los criterios NINDS-AIREN y VASCOG para el diagnóstico de deterioro cognitivo vascular mayor en una clínica / Comparison of the NINDS-AIREN and VASCOG criteria for the diagnosis of major vascular cognitive impairment in a memory clinic

Introducción. El deterioro cognitivo vascular mayor tiene una alta prevalencia en la población mayor de 60 años. El diagnóstico es complejo y existen múltiples criterios con alto grado de heterogeneidad entre ellos. Se requieren estudios de validación de los criterios VASCOG y la comparación con los otros grupos de criterios disponibles para el diagnóstico de deterioro cognitivo vascular mayor. Objetivo. Comparar los criterios NINDS-AIREN y VASCOG para el diagnóstico de deterioro cognitivo vascular mayor en una clínica de memoria. Pacientes y métodos. Se realizó un estudio descriptivo observacional de corte transversal analítico en adultos mayores que asistieron a una clínica de memoria universitaria durante un año. Se recopiló la historia clínica de los pacientes, se verificaron los criterios de inclusión y exclusión y se aplicaron los criterios NINDS-AIREN y VASCOG. Posteriormente se evaluaron los resultados de la resonancia magnética cerebral y se aplicaron nuevamente los criterios definidos. Resultados. La frecuencia de diagnóstico de deterioro cognitivo vascular mayor fue mayor utilizando los criterios VASCOG. La concordancia entre los criterios NINDS-AIREN y VASCOG fue muy alta (100%), con un nivel de consistencia sustancial (kappa = 0,698) para un diagnóstico definitivo. Antes de realizar la resonancia, el nivel de concordancia se redujo (55,6%), con un nivel de consistencia sustancial (kappa = 0,620). Conclusiones. Los criterios NINDS-AIREN y VASCOG tienen un alto nivel de consistencia para el diagnóstico de deterioro cognitivo vascular mayor, con un nivel moderado de concordancia en los criterios clínicos. Dependiendo de los criterios utilizados, la prevalencia de diagnóstico cambia y es mayor para los criterios VASCOG

Introduction. Major vascular cognitive impairment has a high prevalence in elder population over 60 years old. Its diagnosis is complex, and there are multiple criteria with a high degree of heterogeneity between them. Validation studies of the VASCOG criteria are required, and comparison with the other groups of criteria available for the diagnosis of major vascular cognitive impairment. Aim. To compare NINDS-AIREN and VASCOG criteria to diagnose major vascular cognitive impairment in a memory clinic. Patients and methods. An analytical transversal observational study was performed in elder adults who attended to university memory clinic for one year. Clinical records of patients were collected, verifying inclusion and exclusion criteria by applying NINDS-AIREN and VASCOG criteria. Subsequently cerebral magnetic resonance imaging results were assessed and yet again defined criteria were applied. Results. Major vascular cognitive impairment diagnosis rate was greater by applying VASCOG criteria. Concordance between NINDS-AIREN and VASCOG criteria was very high (100%), with a substantial consistence level (kappa = 0.698) for a final diagnosis. Before performing a magnetic resonance imaging, concordance level was reduced (55.6%) with a substantial consistence level (kappa = 0.620). Conclusions. NINDS-AIREN and VASCOG criteria have a high consistence level for major vascular cognitive impairment diagnosis, with a moderate concordance level in clinical criteria, to different assessed domains. Depending on criteria used, diagnosis prevalence changes, being higher with VASCOG criteria

Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial.

QUESTION: In people who have undergone surgical carpal tunnel release, do sensorimotor-based exercises performed on the touchscreen of a tablet device improve outcomes more than a conventional home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Fifty participants within 10 days of surgical carpal tunnel release. INTERVENTION: Each participant was prescribed a 4-week home exercise program. Participants in the experimental group received the ReHand tablet application, which administered and monitored exercises via the touchscreen. The control group was prescribed a home exercise program on paper, as is usual practice in the public hospital system. OUTCOME MEASURES: The primary outcome was functional ability of the hand, reported using the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were grip strength, pain intensity measured on a 10-cm visual analogue scale, and dexterity measured with the Nine-Hole Peg Test. Outcomes were measured by a blinded assessor at baseline and at the end of the 4-week intervention period. RESULTS: At Week 4, functional ability improved significantly more in the experimental group than the control group (MD -21, 95% CI -33 to -9) on the QuickDASH score (0 to 100). Although the mean estimates of effect on the secondary outcome also all favoured the experimental group, none reached statistical significance: grip strength (MD 5.6 kg, 95% CI -0.5 to 11.7), pain (MD -1.4 cm, 95% CI -2.9 to 0.1), and dexterity (MD -1.3 seconds, 95% CI -3.7 to 1.1). CONCLUSION: Use of the ReHand tablet application for early rehabilitation after carpal tunnel release is more effective in the recovery of functional ability than a conventional home exercise program. It remains unclear whether there are any benefits in grip strength, pain or dexterity. TRIAL REGISTRATION: ACTRN12618001887268.

Successful Aging in Colombia: The Role of Disease.

Objective: This study aimed to determine the prevalence of successful aging (SA) and identify its predictive factors in a cohort of older people in the Colombian Andes Mountain. Method: Data were drawn from a prospective longitudinal study of community-dwelling elderly people in Manizales. SA encompassed indicators in four domains: physical, cognitive, emotional, and social functioning. Results: The prevalence of SA was 24.4%. The independent predictors were good and very good self-rated health, middle-high/high-income level, absence of chronic conditions, married status, high educational level, and very high spirituality. Discussion: The prevalence of SA was low: One of 10 people older than 65 years showed SA when presence of diseases was included in the criteria, compared with one of four when such an item was excluded. The identification of predictive factors allows distinguishing this population in primary care services and promoting strategies that ensure high functionality levels for as long as possible.

KvN mechanics approach to the time-dependent frequency harmonic oscillator.

Using the Ermakov-Lewis invariants appearing in KvN mechanics, the time-dependent frequency harmonic oscillator is studied. The analysis builds upon the operational dynamical model, from which it is possible to infer quantum or classical dynamics; thus, the mathematical structure governing the evolution will be the same in both cases. The Liouville operator associated with the time-dependent frequency harmonic oscillator can be transformed using an Ermakov-Lewis invariant, which is also time dependent and commutes with itself at any time. Finally, because the solution of the Ermakov equation is involved in the evolution of the classical state vector, we explore some analytical and numerical solutions.

Estudio EDECO Estudio poblacional de deterioro cognitivo en población colombiana / EDECO Study Population study of cognitive impairment in a colombian community

Objetivo: se presenta un estudio poblacional de deterioro cognitivo de un grupo de ancianos valorados en la comunidad en los cuales se determinó la prevalencia de deterioro cognitivo a través de la prueba del reloj. Material y métodos: se valoraron 803 ancianos que habitaban en comunidad, durante los meses de noviembre de 2011 a agosto de 2012, de distintas regiones del país. Se aplicaron formatos de registro y se procesaron en forma descriptiva. Resultados: los relojes evaluados por medio de los criterios de Cacho para detección de deterioro cognitivo, permitieron identificar que 40% de la población de ancianos incluidos en el estudio, presentaban un resultado sugestivo de deterioro cognitivo. El rango de edad más afectado por deterioro cognitivo, en el grupo de relojes calificados, se observó entre los 70 y 79 años (46.1%), seguido por los individuos entre los 80 y los 89 años (31.8%). El rango de edad entre 60 y 69 años mostró una prevalencia de deterioro cognitivo en 19.6%. El 57.6% de los ancianos con resultados sugestivos de deterioro cognitivo presentaban antecedente de hipertensión arterial. El 14.3% de los ancianos evaluados refirieron haber sido diagnosticado con diabetes mellitus, de los cuales 48.7% presentaron hallazgos subjetivos de deterioro cognitivo (17.4% del total de población con deterioro cognitivo). El antecedente de accidente cerebrovascular se observó en el 4.9% de la población, de los cuales 56% obtuvieron puntajes sugestivos de deterioro cognitivo. Conclusiones: con respecto a nuestro estudio, 40% de la población presentaba hallazgos sugestivos de deterioro cognitivo, además se logró evidenciar una importante prevalencia de deterioro cognitivo en factores de riesgo reportados en la literatura. También se observó que en todos los grupos evaluados los errores en la localización de las manecillas predominaron como el principal error en la realización de la prueba, seguido de las alteraciones en la presencia y secuencia de los números, mientras que la realización de la esfera fue la variable menos afectada en todos los grupos poblacionales. Se observó en el estudio que los resultados sugestivos de deterioro cognitivo presentaron una relación directa con el analfabetismo, el nivel educativo y la edad. Finalmente podemos sugerir que la prueba del reloj, en el contexto del anciano colombiano que habita en comunidad, constituye una herramienta útil para el tamizaje de la demencia en atención primaria y geriatría clínica.

Objective: a population-based study of cognitive impairment in a group of elders evaluated in the community in which the prevalence of cognitive impairment was determined through the clock test, is presented. Materials and methods: 803 elderly people living in community during the months of November 2011 to August 2012 from different regions of the country were evaluated. Registration forms were applied and processed in a descriptive way. Results: clocks evaluated by Cacho criteria for detection of cognitive impairment helped to identify that 40% of the elderly population included in the study had a suggestive result of cognitive impairment. The age range most affected by cognitive decline in the group of qualified clocks was observed between 70 and 79 years (46.1%), followed by individuals between 80 and 89 years (31.8%). The age range between 60 and 69 years showed a prevalence of cognitive impairment in 19.6%. 57.6% of the elderly with results suggestive of cognitive impairment had a history of hypertension. 14.3% of the elderly evaluated reported having been diagnosed with diabetes mellitus, and of these, 48.7% had subjective findings of cognitive impairment (17.4% of total population with cognitive impairment). A history of stroke was observed in 4.9% of the population, of which 56% obtained scores suggestive of cognitive impairment. Conclusions: regarding our study, 40% of the population was suggestive of cognitive impairment and additionally a significant prevalence of cognitive impairment in risk factors reported in the literature was evidenced. It was also observed that in all groups evaluated, the errors in locating the hands predominated as the main error in performing the test, followed by alterations in the presence and sequence of numbers while making the circle was the less affected variable in all the population groups. It was observed in the study that the results suggestive of cognitive impairment had a direct relationship with illiteracy, educational level and age. Finally, we can suggest that the clock test in the context of the Colombian elderly living in community is a useful tool for the screening of dementia in primary care and clinical geriatrics.

[Surgical/medical competences, self-perception among a group of students recently graduated]. / Competencias médico-quirúrgicas. Autopercepción en médicos recién egresados de la licenciatura.

BACKGROUND: Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. We undertook this study to identify the surgical/medical competencies (SMC) acquired by a group of students after graduating from the Faculty of Medicine, National Autonomous University of Mexico. METHODS: This was a cross-sectional, comparative, observational, and prospective study. Students from the class (1999-2003) who accepted to participate were included in the study. Thirty SMC were evaluated as well as demographic and academic background data from the graduates. Data were analyzed using Mann-Whitney, Kruskal-Wallis andX2tests. RESULTS: Of 341 interviewees, 310 subjects participated in the study; 61% of all participants were females. Mean age at graduation was 25 years; 66% of all participants concluded their medical training in 6 years; 30% of the interviewees had a < or = 8.0-point grade average score; 62% concluded their 6th school year in a Mexican Institute of Social Security (IMSS) and/or in a Ministry of Health (SSa) facility. Subjects reported having little or no command over 21/30 listed SMCs. Female participants rated themselves as less proficient than their male counterparts (p < or = 0.05). The presence of three other concomitant factors among several participants negatively influenced their self-perception of whether or not they possessed certain skills. CONCLUSIONS: A group of recently graduated physicians subjectively perceived themselves as possessing partial or no command over the SMCs included in the Surgery Department syllabus. These results must be completed through an objective assessment.

El clima organizacional y el compromiso personal hacia la organización, la intención de permanencia y el esfuerzo: Evidencias provenientes de Perú / The organizational climate and personal commitment to the organization, intention to stay and effort: Evidences from Peru

Cada vez los nexos afectivos y morales de las personas hacia las organizaciones en las cuales trabajan constituyen uno de los activos más importantes de las mismas, al unísono con otros elementos tales como las competencias. Sin embargo, en Latinoamérica las investigaciones a este respecto son muy escasas. El conocimiento relativo al comportamiento humano resulta muy raquítico si se compara con otras latitudes. El marco teórico parte del supuesto que el Clima Organizacional es el antecedente del Compromiso, según lo conceptúan Meyer y Allen (1991). Estos autores dividen al compromiso en tres grandes componentes: afectivo, de continuación y normativo. En el primero, la persona establece lazos emocionales intensos con su organización y disfruta de su estancia en ella. En el segundo, la persona siente que ha invertido mucho tiempo y esfuerzo en la organización; dejarla implica costos. En el último, existe un sentido del deber moral de continuar perteneciendo a la organización. En este estudio exploratorio se tomaron dos muestras: 100 personas en la primera y 89 en la segunda. Se aplicaron dos cuestionarios: uno para medir el compromiso hacia la organización y el otro para el clima organizacional, incluyendo el apoyo percibido de la organización; además la intención de permanecer en la organización y la búsqueda de otro empleo (en una de las muestras). Se esperaban encontrar correlaciones intensas entre el compromiso afectivo y la intención de continuar laborando en la organización, lo cual sucedió. Igualmente, de acuerdo con el marco teórico, se establecieron hipótesis respecto a los tres tipos de compromiso y su relación con los componentes del clima organizacional, las cuales se vieron confirmadas. Los resultados corroboran, en gran medida, los encontrados en otras investigaciones efectuadas en México. En el artículo se mencionan conclusiones importantes para las organizaciones a fin de lograr...

Every time the affective and moral nexuses of the people towards the organizations in which they work constitute one of the important assets in conjunction with other aspects such as the competences. Nevertheless, in Latin America the investigations, in this respect, are very scarce. The knowledge relative to the human behavior is very rickety if it is compared with other latitudes. The Theoretical frame part of if the Organizational Climate is the antecedent of the Commitment, according with the description of Meyer y Allen (1991). These authors divide the commitment in three great components: affective, of continuation and normative. In first, the person settles down intense emotional bows with his organization and enjoys his stay. In the second, the person feels that she has invested to long time and effort in the organization; to leave implies it costs. In the last, exist a sense of having moral to continue belonging to the organization. In this exploratory study two samples were taken: 100 people in the first and 89 in second. Two questionnaires were applied: one to measure the commitment towards organization and the other for the organizational climate, including the support perceived of the organization; moreover the intention to remain in the organization and the search of another use (in one of the samples). They were hoped to find intense correlations between the effective commitment and intention to continue toiling in organization, which happened. In agreement with the theoretical frame, hypothesis with respect to he three types of commitment and his settled down relation with the components of the organizational climate, which were confirmed. The results corroborate, to a great extent, the found ones in other investigations conducted in Mexico. In the article conclusions important for the organizations are mentioned in arder to obtain the commitment of their members as suggestions for future investigations consider.