Terahertz electric-field-driven dynamical multiferroicity in SrTiO3.

The emergence of collective order in matter is among the most fundamental and intriguing phenomena in physics. In recent years, the dynamical control and creation of novel ordered states of matter not accessible in thermodynamic equilibrium is receiving much attention1-6. The theoretical concept of dynamical multiferroicity has been introduced to describe the emergence of magnetization due to time-dependent electric polarization in non-ferromagnetic materials7,8. In simple terms, the coherent rotating motion of the ions in a crystal induces a magnetic moment along the axis of rotation. Here we provide experimental evidence of room-temperature magnetization in the archetypal paraelectric perovskite SrTiO3 due to this mechanism. We resonantly drive the infrared-active soft phonon mode with an intense circularly polarized terahertz electric field and detect the time-resolved magneto-optical Kerr effect. A simple model, which includes two coupled nonlinear oscillators whose forces and couplings are derived with ab initio calculations using self-consistent phonon theory at a finite temperature9, reproduces qualitatively our experimental observations. A quantitatively correct magnitude was obtained for the effect by also considering the phonon analogue of the reciprocal of the Einstein-de Haas effect, which is also called the Barnett effect, in which the total angular momentum from the phonon order is transferred to the electronic one. Our findings show a new path for the control of magnetism, for example, for ultrafast magnetic switches, by coherently controlling the lattice vibrations with light.

The diary in the intensive care unit: Concept analysis.

INTRODUCTION: Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AIM: This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. METHOD: A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant. RESULTS: The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. CONCLUSIONS: The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

Monitoring storm evolution using a high-density seismic network.

Data acquired by a dense seismic network deployed in the Cerdanya basin (Eastern Pyrenees) is used to track the temporal and spatial evolution of meteorological events such as rainfall episodes or thunderstorms. Comparing seismic and meteorological data, we show that for frequencies above 40 Hz, the dominant source of seismic noise is rainfall and hence the amplitude of the seismic data can be used as a proxy of rainfall. The interstation distance of 1.5 km provides an unprecedented spatial resolution of the evolution of rainfall episodes along the basin. Two specific episodes, one dominated by stratiform rain and the second one dominated by convective rain, are analyzed in detail, using high resolution disdrometer data from a meteorological site near one of the seismic instruments. Seismic amplitude variations follow a similar evolution to radar reflectivity values, but in some stratiform precipitation cases, it differs from the radar-derived precipitation estimates in this region of abrupt topography, where radar may suffer antenna beam blockage. Hence, we demonstrate the added value of seismic data to complement other sources of information such as rain-gauge or weather radar observations to describe the evolution of ground-level rainfall fields at high spatial and temporal resolution. The seismic power and the rainfall intensity have an exponential relationship and the periods with larger seismic power are coincident. The time intervals with rain drops diameters exceeding 3.5 mm do not result in increased seismic amplitudes, suggesting that there is a threshold value from which seismic data are no longer proportional to the size of the drops. Thunderstorms can be identified by the recording of the sonic waves generated by thunders, with. Single thunders detected to distances of a few tens of kilometers. As the propagation of these acoustic waves is expected to be strongly affected by parameters as air humidity, temperature variations or wind, the seismic data could provide an excellent tool to investigate atmospheric properties variations during thunderstorms.

Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018 / Results Centre of Social and Health Care Network in Catalonia. Evolution 2013–2018

Objetivo : La Central de Resultados (CdR) nace con la misión de medir, evaluar y difundir los resultados alcanzados por los diferentes agentes del sistema sanitario, en base a medidas relevantes. El objetivo de este trabajo es describir la evolución de los indicadores utilizados en la CdR del ámbito sociosanitario (CdR-SS), incluyendo algunos indicadores sensibles a la práctica enfermera.Método: Estudio observacional, descriptivo y transversal de los 6 informes de CdR-SS (2013-2018). Se analizan indicadores que incluyen actividad realizada, días de estancia, consecución de objetivos rehabilitadores, altas a domicilio, mortalidad y úlceras por presión.Resultados: Hubo un aumento de la actividad en las diferentes líneas y una disminución en los días de estancia. Los resultados mostraron heterogeneidad entre centros. La mejora funcional y las altas a domicilio mostraron una tendencia creciente, mientras que la mortalidad tendió a disminuir. Se mantuvo estabilidad en la prevalencia de úlceras por presión de grados iii-iv.Conclusiones: La CdR-SS ha incluido diferentes indicadores en los diversos informes para mejorar la capacidad de evaluación y benchmarking sociosanitario. Los informes de CdR-SS aportan transparencia y rendimiento de cuentas del ámbito e invitan a profundizar en la mejora de este sector, mostrando que evoluciona hacia la atención intermedia con la entrada de subagudos y la mayor eficiencia de convalecencia. La incorporación de indicadores sensibles a la práctica enfermera contribuye a visibilizar los cuidados y al colectivo enfermero. (AU)

Objective: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice.Method: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013–2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed.Results: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III–IV pressure ulcers was maintained.Conclusions: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible. (AU)

[Results Centre of Social and Health Care Network in Catalonia. Evolution 2013-2018]. / Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018.

OBJECTIVE: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice. METHOD: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013-2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed. RESULTS: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III-IV pressure ulcers was maintained. CONCLUSIONS: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible.

Actividad y resultados del Grupo de Investigación Enfermera (GRIN), Instituto de Investigación Biomédica de Bellvitge (IDIBELL) / Activity and outcomes of the Nursing Research Group (GRIN), Bellvitge Institute for Biomedical Research (IDIBELL)

Este artículo presenta la composición, líneas de investigación y evolución del grupo de investigación enfermera (GRIN) vinculado al Instituto de Investigación Biomédica de Bellvitge (IDIBELL). Las líneas principales de investigación van dirigidas a la prestación de cuidados enfermeros y su impacto en los resultados de salud de los pacientes y familias, orientándose principalmente en la investigación en cuidados a poblaciones vulnerables, enfermos críticos, pacientes crónicos complejos y personas en extremos de edad, en las siguientes áreas de interés: i) promoción de la salud; ii) innovaciones tecnológicas, sistemas de información e inteligencia artificial para la salud; iii) desarrollo metodológico, ético y social de los cuidados; iv) gestión de cuidados y resultados sensibles a la práctica enfermera; v) cribado, detección precoz y prevención de complicaciones y discapacidades. Actualmente el grupo está formado por 33 enfermeras/os, que pertenecen a cuatro hospitales y la Universidad de Barcelona, siendo el 48% doctores y el 36% doctorandos. El grupo ha producido más de 150 publicaciones científicas en siete años, de las cuales, durante el último año, el 50% fue en Q1 y el 20% en Q2, además destacando que el 60% de los proyectos obtuvo algún tipo de financiación durante el último año. El grupo de investigación está acreditado como grupo preconsolidado por la Agencia de Gestión de Ayudas Universitarias y de Investigación (AGAUR) de la Generalitat de Cataluña

This article presents the composition, lines of research and evolution of the nursing research group (GRIN) linked to the Bellvitge Institute for Biomedical Research (IDIBELL). The main lines of research are targeted to the provision of nursing care and its impact on health outcomes for patients and relatives; it is particularly oriented towards research in care for vulnerable populations, critical patients, complex chronic patients, and people with extreme ages, within the following areas of interest: i) health promotion; ii) technological innovations, information systems and artificial intelligence for health; iii) methodological, ethical and social development of care; iv) management of care and nursing-sensitive outcomes; v) screening, early detection and prevention of complications and disabilities. Currently, the group is formed by 33 nurses from four hospitals and the University of Barcelona; 48% of its members are doctors and 36% are doctoral candidates. The group has published over 150 scientific articles in seven years; during the last year, 50% of these were in Q1 and 20% in Q2. It should also be highlighted that 60% of projects obtained some type of funding during the past year. The research group is accredited as a preconsolidated group by the Agency for Management of University and Research Grants (AGAUR) of the Generalitat of Catalonia

La terminología ATIC como herramienta de soporte a la gestión / EATIC terminology as a management support tool

El presente artículo pretende dar continuidad al publicado en el número anterior ("La terminología ATIC: consideraciones de uso en la prestación de cuidados"). Partiendo del mismo marco teórico-conceptual y en el contexto de la atención sanitaria, el primero iba orientado a situar ATIC desde la perspectiva de la prestación de cuidados, y este segundo artículo tiene como objetivo plantear las consideraciones y revisar las evidencias del uso de la terminología ATIC como herramienta de soporte a la gestión asistencial y directiva de la prestación de cuidados. Para ello se ha realizado una adaptación del método mixto, narrativo, contiguo, en el que los resultados de la revisión de los estudios se presentan secuencialmente junto a sus consideraciones esenciales.ATIC ofrece un soporte adecuado para la construcción de modelos de datos y estándares de prestación y gestión de cuidados. También garantiza la interoperabilidad semántica mediante el establecimiento de mapeos con los de otros vocabularios controlados. Ofrece una adecuada cobertura conceptual y minimiza el efecto infrauso, con un notable nivel de satisfacción de sus usuarios. A su vez, propone nuevos modelos de datos y orienta fórmulas emergentes para la medida de la intensidad y la complejidad de cuidados. Las evidencias que sustentan y demuestran el uso de ATIC como herramienta de soporte a la gestión de cuidados parecen apoyar el escenario de que ATIC ofrece un abanico de nuevos instrumentos, aunque el método empleado en este artículo deja las conclusiones a consideración de cada lector

This article is intended to continue the one published in the previous journal issue ("ATIC Terminology: Considerations of use in patient care"). Based on the same theoretical-conceptual framework, and in the healthcare setting, the first article was targeted to placing ATIC from the perspective of patient care, and the objective of this second article is to state the considerations and review the evidence for the use of the ATIC terminology as a support tool for the healthcare and administrative management of patient care. To this aim, there has been an adaptation of the mixed, narrative, adjacent method, where the outcomes of study review are presented sequentially, together with their essential considerations. ATIC offers an adequate support for building data models and standards for patient care provision and management. It also guarantees semantic interoperability, by implementing mapping with those of other controlled vocabularies. It offers an adequate conceptual coverage, and minimizes the underuse effect, with a noticeable level of satisfaction by users. At the same time, it suggests new data models, and orientates emerging formulas for measuring the intensity and complexity of patient care. The evidence supporting and demonstrating the use of ATIC as support tool for patient care management seems to support the scenario that ATIC offers a range of new tools, even though the method used in this article leaves conclusions to be drawn by each reader

Glucocorticoid Receptors, Brain-Derived Neurotrophic Factor, Serotonin and Dopamine Neurotransmission are Associated with Interferon-Induced Depression.

BACKGROUND: The role of inflammation in mood disorders has received increased attention. There is substantial evidence that cytokine therapies, such as interferon alpha (IFN-alpha), can induce depressive symptoms. Indeed, proinflammatory cytokines change brain function in several ways, such as altering neurotransmitters, the glucocorticoid axis, and apoptotic mechanisms. This study aimed to evaluate the impact on mood of initiating IFN-alpha and ribavirin treatment in a cohort of patients with chronic hepatitis C. We investigated clinical, personality, and functional genetic variants associated with cytokine-induced depression. METHODS: We recruited 344 Caucasian outpatients with chronic hepatitis C, initiating IFN-alpha and ribavirin therapy. All patients were euthymic at baseline according to DSM-IV-R criteria. Patients were assessed at baseline and 4, 12, 24, and 48 weeks after treatment initiation using the Patient Health Questionnaire (PHQ), the Hospital Anxiety and Depression Scale (HADS), and the Temperament and Character Inventory (TCI). We genotyped several functional polymorphisms of interleukin-28 (IL28B), indoleamine 2,3-dioxygenase (IDO-1), serotonin receptor-1A (HTR1A), catechol-O-methyl transferase (COMT), glucocorticoid receptors (GCR1 and GCR2), brain-derived neurotrophic factor (BDNF), and FK506 binding protein 5 (FKBP5) genes. A survival analysis was performed, and the Cox proportional hazards model was used for the multivariate analysis. RESULTS: The cumulative incidence of depression was 0.35 at week 24 and 0.46 at week 48. The genotypic distributions were in Hardy-Weinberg equilibrium. Older age (p = 0.018, hazard ratio [HR] per 5 years = 1.21), presence of depression history (p = 0.0001, HR = 2.38), and subthreshold depressive symptoms at baseline (p = 0.005, HR = 1.13) increased the risk of IFN-induced depression. So too did TCI personality traits, with high scores on fatigability (p = 0.0037, HR = 1.17), impulsiveness (p = 0.0200 HR = 1.14), disorderliness (p = 0.0339, HR = 1.11), and low scores on extravagance (p = 0.0040, HR = 0.85). An interaction between HTR1A and COMT genes was found. Patients carrying the G allele of HTR1A plus the Met substitution of the COMT polymorphism had a greater risk for depression during antiviral treatment (HR = 3.83) than patients with the CC (HTR1A) and Met allele (COMT) genotypes. Patients carrying the HTR1A CC genotype and the COMT Val/Val genotype (HR = 3.25) had a higher risk of depression than patients with the G allele (HTR1A) and the Val/Val genotype. Moreover, functional variants of the GCR1 (GG genotype: p = 0.0436, HR = 1.88) and BDNF genes (Val/Val genotype: p = 0.0453, HR = 0.55) were associated with depression. CONCLUSIONS: The results of the study support the theory that IFN-induced depression is associated with a complex pathophysiological background, including serotonergic and dopaminergic neurotransmission as well as glucocorticoid and neurotrophic factors. These findings may help to improve the management of patients on antiviral treatment and broaden our understanding of the pathogenesis of mood disorders.

New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors.

PURPOSE: To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions. METHOD: One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR). RESULTS: Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005). CONCLUSIONS: Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

Val66Met polymorphism and serum brain-derived neurotrophic factor in bipolar disorder: an open-label trial.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) is consistently associated with acute mood episodes in bipolar disorder, but there is a lack of longitudinal data to support this hypothesis. In this 16-week open-label clinical trial, we tested the predictive role of BDNF Val66Met polymorphism on serum BDNF levels and the relationship of serum BDNF and clinical response in people with bipolar disorder during an acute illness episode. METHOD: Sixty-four people with bipolar disorder who were medication-free at baseline and in an acute mood episode were recruited. They were matched with 64 healthy controls. Clinical evaluation, serum BDNF, and BDNF Val66Met polymorphism were determined at baseline, and change in serum BDNF was assessed in patients at weeks 2, 4, 8 and 16. RESULTS: There were no differences between patients and controls in serum BDNF or in frequencies of the BDNF Val66Met polymorphism genotype at baseline. The multivariable model showed that Met carriers had a significantly different change in BDNF levels compared with Val homozygotes. Not achieving a complete remission was also associated with lower prospectively assessed BDNF levels. CONCLUSION: This study provides the first longitudinal evidence that both the BDNF Val66Met polymorphism and remission status predict change in circulating BDNF levels.

Depressive and anxiety disorders in chronic hepatitis C patients: reliability and validity of the Patient Health Questionnaire.

UNLABELLED: Depression and anxiety in patients with hepatitis C virus (HCV) infection influence their health-related quality of life and their adherence to antiviral treatment. OBJECTIVE: To study the psychometric properties of the Patient Health Questionnaire (PHQ) as a screening instrument for depression and anxiety in HCV patients. METHODS: Criterion validity, using the structured clinical interview for DSM-IV-Axis I (SCID-I) to diagnose depression and anxiety disorders as diagnostic standard, was evaluated for both summed and algorithm-based PHQ in 500 HCV patients. Correlations with quality of life (Short-Form-36 Health Survey; SF-36) and severity of illness (Hospital Anxiety and Depression Scale; HADS) were calculated to assess construct validity. Test-retest reliability and patients' reaction to the PHQ were assessed in 120 HCV patients. RESULTS: Twenty-three percent of patients (N=114) had a psychiatric disorder (any depressive disorder=18.2%; major depressive disorder=6.4%; generalized anxiety disorder=7.0% and panic disorder=5.8%). The questionnaire demonstrated good test-retest reliability for any depressive disorder (k=.847), major depressive disorder (k=.784), generalized anxiety disorder (k=.787), panic disorder (k=.848), and for any psychiatric disorder (k=.847). There was good agreement between PHQ and SCID-I diagnoses (for any PHQ disorder, k=.821; overall accuracy=90.43%, sensitivity=83.84%; specificity=97.01%). Patients with any PHQ disorder had higher impairment on the SF-36 (p<.001). HADS depression and anxiety scores showed high correlations with PHQ depression (p<.001) and anxiety (p<.001) scores respectively. PHQ administration was well accepted by 97% of patients. CONCLUSIONS: The Spanish version of the PHQ is a reliable, valid, and useful screening instrument to detect depression, generalized anxiety and panic disorders in HCV patients.

Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic methods.

The extent of cryptic leishmaniasis in blood donors from a Spanish endemic area, (Eivissa Island) was studied using various immunological and parasitological methods. Sera from 656 blood donors were analysed: 16 (2.4%) were positive by ELISA and 50 (7.6%) by Western blot. Peripheral blood mononuclear cells (PBMC) and buffy coat (BC) samples, were analyzed by culture and nested-PCR. DNA of L. infantum was amplified in 27 (22.1%) of 122 PBMC. Parasites were isolated in 3 (4.5%) of 67 BC cultures and the strains were identified as L. infantum zymodeme MON-28. No parasites were isolated in PBMC culture. After 12 months, a second blood sample was obtained from 18 blood donors who were positive by nested-PCR in the first extraction; nine of them remained positive. Delayed type hypersensitivity (DTH) tests on 15/67 donors (22.3%) were positive. Comparison of results obtained by ELISA, WB and DTH; ELISA, WB and nested-PCR and nested-PCR and BC culture showed a significant association (Pearson test, P < 0.05). L. infantum zyodeme MON-28 was identified in three strains isolated from asymptomatic donors, which suggests a low virulence capacity of these strains. The detection of Leishmania DNA in a high number of asymptomatic subjects supports the need to monitor it in blood donors endemic areas.

Incidencia, contaminación ambiental y factores de riesgo de otitis media aguda en el primer año de vida: estudio prospectivo / Incidence, air pollution and risk factors of acute otitis media in the first year of life. A prospective study

Antecedentes: Los estudios epidemiológicos sobre la otitis media aguda (OMA) son muy escasos y en España no existe ninguno de tipo prospectivo. Objetivos: Describir la incidencia de la OMA durante el primer año de vida y sus factores de riesgo, con especial atención a la contaminación ambiental. Métodos: Estudio de una cohorte prospectiva de 229 recién nacidos durante el primer año de vida estratificados por zonas de contaminación, seguidos por sus pediatras en el centro de salud. La OMA de definió clínicamente. Se aplicó un cuestionario con los factores de riesgo/protectores, incluyendo sexo, hermanos mayores, hábito de fumar, lactancia materna, nivel socioeconómico, nivel de estudios y situación laboral de la madre. Resultados: La incidencia de episodios de OMA durante el primer año fue del 45 por ciento y la proporción de niños con al menos un episodio fue del 32 por ciento. Los factores de riesgo independientes fueron el sexo varón (odds ratio ajustada [ORa], 2,03; intervalo de confianza del 95 por ciento [IC 95 por ciento], 1,09-3,7) y vivir en una zona contaminada (ORa, 2,01; IC 95 por ciento, 1,05-3,84).Fueron factores protectores independientes nacer en primavera (ORa, 0,41; IC 95 por ciento, 0,19-0,88) y que la madre tuviera al menos estudios primarios (ORa, 0,53; IC 95 por ciento, 0,24-1,15). Los marcadores socioeconómicos indicaron un menor nivel medio entre las familias cuyos niños tuvieron al menos un episodio de OMA. Conclusiones: La contaminación ambiental y el bajo nivel socioeconómico son factores de riesgo de OMA mayores que tener hermanos o que los padres fumen. Un nivel cultural mínimo reduce el riesgo de OMA. Es posible disminuir en parte la incidencia de OMA actuando sobre algunos factores ambientales (AU)

[The hospital nursing discharge form. Establishing and validation of a standard formate]. / Alta de enfermería hospitalaria. Implantación y validación de un formato estándar.

The purpose of this article is to describe the design, application and validation process for a new hospital nursing medical discharge form. This process has three phases: FIRST PHASE: Redesigning the Document. In 1996, as a response to growing demands as well as the need to adapt to the requirements of data processing, all nursing documents in all hospital nursing files were updated following the recommendations of the Technical Commission. SECOND PHASE: Initial Application and Validation. The medical discharge form prepared in phase one was applied during the first trimester of 1997. The parties involved agreed to test this form until the end of the year in order to come to a consensus regarding its structure and content while at the same time determining its degree of comprehension and usefulness. THIRD PHASE: Editing and Final Format. The results of these analyses, together with revisions of criteria included in the NMDS and from the Conference on Hospital Discharge Abstract System, made it possible to draw up the final draft of this form which include nursing discharge criteria in the evaluation section. A pilot test was carried out in five hospital units to determine the validity of this form according to the same criteria of comprehension and usefulness. The results indicate a recommendation to eliminate the sections of medical diagnosis and medication upon discharge while to maintain the identification of the patient, the summary of his/her stay in the center, the description of the patient's case upon discharge and the treatment plan.

[Clinico-radiological dissociation in cerebral hemorrhage caused by afibrinogenemia]. / Disociación clinicorradiológica en la hemorragia cerebral por afibrinogenemia.

INTRODUCTION: Congenital afibrinogenemia is a very rare hereditary anomaly of coagulation. Only 150 cases have been published. Clinical manifestation in the form of some type of bleeding is similar to that of other congenital coagulopathies, although the pattern of presentation is different. Spontaneous bleeding is rare, but slight injury, which may be unnoticed, may trigger it off. In spite of being a congenital condition, it may be of late onset, as in our patient, with bleeding episodes occurring in the second decade of life. CLINICAL CASE: We describe a woman who had several episodes of bleeding, two of which were intracerebral. The principal feature of this was dissociation between the clinical findings and their detection by neuro-imaging. Substitutive therapy led to the disappearance of symptoms. CONCLUSION: Cerebral haemorrhage in the presence of afibrinogenemia may fail to be detected early on CT. On clinical suspicion of bleeding, early substitutive treatment should be started.

Visceral leishmaniasis: another HIV-associated opportunistic infection? Report of eight cases and review of the literature.

Visceral leishmaniasis (VL) is considered an opportunistic infection in immunocompromised patients. We review the clinical, laboratory, and therapeutic data in 63 patients (eight new cases and 55 cases reported in the literature) with Mediterranean VL (kala azar) and HIV-1 infection to determine whether VL should be considered an opportunistic infection in HIV-infected adults. We conclude that: (1) in areas where both leishmaniasis and HIV-1 infection are endemic, VL may be more frequent among HIV-infected adults; (2) in HIV-infected patients, the clinical picture did not differ significantly from classical kala azar, although it often ran a recurrent course, with resistance to antimonial therapy. We propose the inclusion of VL in the IVC-2 subgroup of the Centers for Disease Control (CDC) clinical classification of HIV-1 infection while prospective and larger studies further define whether there are clinical presentations that could justify adding VL to the list of opportunistic infections indicative of AIDS.