Modeling the cortical response elicited by wrist manipulation via a nonlinear delay differential embedding.

Regarding motor processes, modeling healthy people's brains is essential to understand the brain activity in people with motor impairments. However, little research has been undertaken when external forces disturb limbs, having limited information on physiological pathways. Therefore, in this paper, a nonlinear delay differential embedding model is used to estimate the brain response elicited by externally controlled wrist movement in healthy individuals. The aim is to improve the understanding of the relationship between a controlled wrist movement and the generated cortical activity of healthy people, helping to disclose the underlying mechanisms and physiological relationships involved in the motor event. To evaluate the model, a public database from the Delft University of Technology is used, which contains electroencephalographic recordings of ten healthy subjects while wrist movement was externally provoked by a robotic system. In this work, the cortical response related to movement is identified via Independent Component Analysis and estimated based on a nonlinear delay differential embedding model. After a cross-validation analysis, the model performance reaches 90.21% ± 4.46% Variance Accounted For, and Correlation 95.14% ± 2.31%. The proposed methodology allows to select the model degree, to estimate a general predominant operation mode of the cortical response elicited by wrist movement. The obtained results revealed two facts that had not previously been reported: the movement's acceleration affects the cortical response, and a common delayed activity is shared among subjects. Going forward, identifying biomarkers related to motor tasks could aid in the evaluation of rehabilitation treatments for patients with upper limbs motor impairments.

Criterios de justificación de discrepancias en el Servicio de Conciliación de la medicación al alta hospitalaria: Guía para farmacéuticos comunitarios / Criteria for Justifying Discrepancies in the Hospital Discharge Medication Reconciliation Service: Guidance for Community Pharmacists

JUSTIFICACIÓN: más del 90 % de los pacientes conciliados al alta hospitalaria presentan algún tipo de discrepancia en su medicación, aunque solo entre 5-15% son errores de conciliación. Para la prestación del Servicio de Conciliación, es necesario conocer la justificación clínica de la mayoría de las discrepancias.OBJETIVOS: seleccionar criterios que faciliten al farmacéutico comunitario la justificación de las discrepancias identificadas al alta hospitalaria, elaborar una guía y evaluar la satisfacción de los farmacéuticos con su uso en el estudio Concilia Medicamentos.MATERIAL Y MÉTODOS: un grupo constituido por un farmacéutico comunitario, un farmacéutico hospitalario, un profesor de farmacología y dos de atención farmacéutica seleccionaron los grupos terapéuticos que presentan discrepancias más habitualmente. Los criterios se seleccionaron de acuerdo con la evidencia científica disponible en las guías clínicas y fichas técnicas. Utilizaron la guía 188 farmacéuticos comunitarios de 8 provincias españolas para la justificación de las discrepancias detectadas en el estudio Concilia Medicamentos 2. La satisfacción de los farmacéuticos se analizó mediante un cuestionario online al finalizar el estudio.RESULTADOS/DISCUSIÓN: la guía de evaluación de discrepancias desarrollada recoge 20 grupos terapéuticos de tratamientos crónicos habituales, estructurados en 13 tablas: Inhibidores de la bomba de protones, antidiabéticos, antiagregantes plaquetarios, anticoagulantes orales, diuréticos, betabloqueantes, calcioantagonistas, IECA, ARA-II, estatinas, AINE, opioides, benzodiazepinas y análogos. (AU)

Perfil de población con baja visión que asiste a la unidad de baja visión y rehabilitación visual en un hospital clínico de Chile / Low vision population assisting a unit of low vision and visual rehabilitation in a clinical hospital from Chile

El objetivo de este trabajo fue caracterizar epidemiológica y sociodemográficamente a las personas atendidas en la Unidad de Baja Visión y Rehabilitación Visual del Hospital Clínico de la Universidad de Chile. El método utilizado fue un estudio descriptivo, transversal y retrospectivo de los registros clínicos de las personas atendidas en la Unidad, entre marzo de 2015 a octubre de 2016. Para el análisis se utilizó el software MS Excel, calculando las frecuencias relativas y medidas de posición central y dispersión. En los resultados se observaron un mayor número de pacientes de sexo femenino (55,5%), y adultos mayores de 60 años o más (53,3%). El 73,3% de los pacientes pertenecieron al sistema de salud público y un 35,6% poseían menos de 8 años de estudio. El 80 % de las personas atendidas se encuentra en edad laboral, de éstos un 63,9% se encontraban laboralmente inactivos. Las enfermedades oftalmológicas con mayor frecuencia correspondieron a las enfermedades genéticas del ojo (22,2%) y la degeneración macular relacionada con la edad (17,8%). Un 57,8% de los pacientes presentó alguna patología sistémica asociada a baja visión. Sólo un 6,0% recibió rehabilitación visual anteriormente. Se concluyó que la mayor prevalencia de enfermedades oculares asociadas al envejecimiento como la degeneración macular relacionada con la edad y enfermedades genéticas del ojo, sumado a las características sociodemográficas y en particular a que un 94% de los pacientes no habían tenido acceso a rehabilitación visual, constituyen un perfil que desafía al desarrollo de medidas de salud pública que resguarden la prevención, acceso y rehabilitación, siendo la formación de equipos multidisciplinarios especialistas una necesidad imperiosa.

This work aimed to do a characterization, epidemiological and socio demographical, to the people attended in a Low Vision and Rehabilitation Unit from a Clinical Hospital of the Universidad de Chile. A descriptive, transversal and retrospective method was used for the clinical registers of the people attended in the Unit, between March 2015 to October 2016. For the analysis, a MS Excel software was used, calculating the relative and measured frequencies of central position and dispersion. In the results, a greater number of feminine patients (55. 5%) were observed, and seniors of 60 years or more (53.3%). 73.3% of the patients belonging to the Public Health Care System and 35.6% had less than 8 years of studies. The 80% of attended patients were in working age, from this 63,9% were unemployed. The ophthalmological diseases with more frequency belonged to eye genetic diseases (22.2%) and macular degeneration related to age (17.8%). 57.8% of the patients presented a systematic pathology associated with low vision. Just 6.0% received previous visual rehabilitation. We concluded that the greater prevalence of ocular diseases associated to aging such as macular degeneration related to age and eye genetic diseases added to the sociodemographic features and particularly a 94% of the patients did not have access to visual rehabilitation, represent a profile that challenges the development public health care measures that safeguard the prevention, access, and rehabilitation, being an imperative need the making of specialist multidisciplinary teams.

Facing High EEG Signals Variability during Classification Using Fractal Dimension and Different Cutoff Frequencies.

In the development of a brain-computer interface (BCI), some issues should be regarded in order to improve its reliability and performance. Perhaps, one of the most challenging issues is related to the high variability of the brain signals, which directly impacts the accuracy of the classification. In this sense, novel feature extraction techniques should be explored in order to select those able to face this variability. Furthermore, to improve the performance of the selected feature extraction technique, the parameters of the filter applied in the preprocessing stage need to be properly selected. Then, this work presents an analysis of the robustness of the fractal dimension as feature extraction technique under high variability of the EEG signals, particularly when the training data are recorded one day and the testing data are obtained on a different day. The results are compared with those obtained by an autoregressive model, which is a technique commonly used in BCI applications. Also, the effect of properly selecting the cutoff frequencies of the filter in the preprocessing stage is evaluated. This research is supported by several experiments carried out using a public data set from the BCI international competition, specifically data set 2a from BCIIC IV, related to motor tasks. By a statistical test, it is demonstrated that the performance achieved using the fractal dimension is significantly better than that reached by the AR model. Also, it is demonstrated that the selection of the appropriate cutoff frequencies improves significantly the performance in the classification. The increase rate is approximately of 17%.

Analyzing EEG signals to detect unexpected obstacles during walking.

BACKGROUND: When an unexpected perturbation in the environment occurs, the subsequent alertness state may cause a brain activation responding to that perturbation which can be detected and employed by a Brain-Computer Interface (BCI). In this work, the possibility of detecting a sudden obstacle appearance analyzing electroencephalographic (EEG) signals is assessed. For this purpose, different features of EEG signals are evaluated during the appearance of sudden obstacles while a subject is walking on a treadmill. The future goal is to use this procedure to detect any obstacle appearance during walking when the user is wearing a lower limb exoskeleton in order to generate an emergency stop command for the exoskeleton. This would enhance the user-exoskeleton interaction, improving the safety mechanisms of current exoskeletons. METHODS: In order to detect the change in the brain activity when an obstacle suddenly appears, different features of EEG signals are evaluated using the recordings of five healthy subjects. Since the change in the brain activity occurs in the time domain, the features evaluated are: common spatial patterns, average power, slope, and the coefficients of a polynomial fit. A Linear Discriminant Analysis-based classifier is used to differentiate between two conditions: the appearance or not of an obstacle. The evaluation of the performance to detect the obstacles is made in terms of accuracy, true positive (TP) and false positive (FP) rates. RESULTS: From the offline analysis, the best performance is achieved when the slope or the polynomial coefficients are used as features, with average detection accuracy rates of 74.0 and 79.5 %, respectively. These results are consistent with the pseudo-online results, where a complete EEG recording is segmented into windows of 500 ms and overlapped 400 ms, and a decision about the obstacle appearance is made for each window. The results of the best subject were 11 out of 14 obstacles detected with a rate of 9.09 FPs/min, and 10 out of 14 obstacles detected with a rate of 6.34 FPs/min using slope and polynomial coefficients features, respectively. CONCLUSIONS: An EEG-based BCI can be developed to detect the appearance of unexpected obstacles. The average accuracy achieved is 79.5 % of success rate with a low number of false detections. Thus, the online performance of the BCI would be suitable for commanding in a safely way a lower limb exoskeleton during walking.

Comparative phylogeography of co-distributed Phrygilus species (Aves, Thraupidae) from the Central Andes.

The Neotropical ecoregion has been an important place of avian diversification where dispersal and allopatric events coupled with periods of active orogeny and climate change (Late Pliocene-Pleistocene) have shaped the biogeography of the region. In the Neotropics, avian population structure has been sculpted not only by geographical barriers, but also by non-allopatric factors such as natural selection and local adaptation. We analyzed the genetic variation of six co-distributed Phrygilus species from the Central Andes, based on mitochondrial and nuclear markers in conjunction with morphological differentiation. We examined if Phrygilus species share patterns of population structure and historical demography, and reviewed the intraspecific taxonomy in part of their geographic range. Our results showed different phylogeographic patterns between species, even among those belonging to the same phylogenetic clade. P. alaudinus, P. atriceps, and P. unicolor showed genetic differentiation mediated by allopatric mechanisms in response to specific geographic barriers; P. gayi showed sympatric lineages in northern Chile, while P. plebejus and P. fruticeti showed a single genetic group. We found no relationship between geographic range size and genetic structure. Additionally, a signature of expansion was found in three species related to the expansion of paleolakes in the Altiplano region and the drying phase of the Atacama Desert. Morphological analysis showed congruence with molecular data and intraspecific taxonomy in most species. While we detected genetic and phenotypic patterns that could be related to natural selection and local adaptation, our results indicate that allopatric events acted as a major factor in the population differentiation of Phrygilus species.

Percepción de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria / Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy

Objetivo: Explorar la percepción de Formadores Colegiales con experiencia previa sobre su formación y sus funciones futuras en la implantación y sostenibilidad del servicio de Seguimiento Farmacoterapéutico en el ámbito de la farmacia comunitaria española. Método: Estudio cualitativo mediante la técnica del grupo focal. El coordinador de la reunión focal utilizó un guión temático previamente elaborado que permitía explorar la opinión de los Formadores Colegiales sobre sus experiencias y percepciones acerca del futuro de esta nueva figura profesional. El contenido de la conversación fue registrado en una grabadora, transcrito en su totalidad y posteriormente analizado mediante análisis de contenido. Resultados: La reunión grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmacéuticos, en Madrid, tuvo una duración de 95 minutos. Participaron seis Formadores Colegiales. En función de los temas tratados se identificaron dos dimensiones; una primera que abarca las funciones que debe desempeñar un Formador Colegial (resaltando la función de motivador, facilitador de la comunicación y formador metodológico y clínico) y una segunda en las que se describen las características que ese profesional debe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio de Farmacéuticos correspondiente, con lugar físico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otras características). Conclusiones: El presente artículo aporta información relevante sobre la figura innovadora del Formador Colegial, describiendo las características intrínsecas necesarias para desarrollar su labor y las funciones a desempeñar. Dicha información debería ser utilizada por aquellos Colegios Oficiales de Farmacéuticos provinciales que deseen implantar Servicios Profesionales Farmacéuticos, tales como el servicio de Seguimiento Farmacoterapéutico

Objective: To explore opinions and perceptions of Practice Change Facilitator of their training and experiences in assisting in the implementation of Medication Reviews with follow- up in Spanish community pharmacy. Methods: A focus group of six Practice Change Facilitators was conducted at the headquarters of the Spanish General Council of Pharmacists’ Associations. A semi-structured interview guide was used. Results: Two domains emerged underpinned by a number of themes. One domain was related to the interaction between the pharmacy and the Practice Change Facilitator. This included their role as a motivator, a facilitator of internal and external communication, and teacher of the clinical aspects and methodological issues of the process of medication reviews with a follow-up. The second domain was composed of themes including personal traits and characteristics, and by work-related conditions such as flexibility of the individual and contractual obligations. Conclusions: This paper provides qualitative evidence which can be used by employers to further define the role, functions and optimal personal traits of Practice Change Facilitators

Factores que inciden en la participación social de los adultos mayores en actividades físico-recreativas / Factors affecting social participation of older adults in recreational physical activity

Esta investigación se enmarcó en la temática de ocupación y adulto mayor activo, con el propósito de dar respuesta a la pregunta de investigación ¿Qué factores inciden en la participación social del adulto mayor en actividades físico-recreativas?, orientándose a aquellos factores facilitadores u obstaculizadores de dicha participación. Para este objetivo realizamos entrevistas en profundidad a cuatro personas que cumplieron los criterios muestrales establecidos para el estudio, que corresponden a: adultos mayores que se reconozcan a sí mismos como activos, que participen hace al menos un año en actividades físico-recreativas, como mínimo una vez por semana en el último año. Para el análisis de datos de esta investigación cualitativa utilizamos la técnica de análisis de contenido desde el relato de los participantes, obteniendo como principales factores facilitadores de esta participación el intercambio de recursos no tangibles, la motivación, el cuerpo vivido, la trayectoria de vida, la habituación y la accesibilidad, como factores que influyen en la participación de adultos mayores. Además de los mencionados existe una variedad de factores que interactúan entre sí, determinando atrayentes relaciones inter e intra factoriales, donde identificamos aspectos transversales a las distintas temáticas abordadas en esta investigación que posibilitan la apertura de nuevas líneas de investigación para la ciencia de la ocupación y terapia ocupacional.

This research was part of the issue of occupation and active older adult, setting a goal to answer the research question: what factors influence the social participation of the elderly, specifically in recreational physical activity?, aiming specifically those factors that emerge as facilitators or impede participation. To achieve this objective, in-depth interviews were conducted to four people who met the criteria established for the study sample, corresponding to: older adult who recognize themselves as active, involved at least a year in recreational physical activity, and as at least once a week in the last year. This exploratory qualitative used the technique of content analysis from the account of participants, having as main findings of this participation facilitating factors, where the most significant relate to: exchange of intangible resources, motivation, lived body, path of life, habituation and accessibility, which relate primarily to factors relating to that person, being a powerful accessibility elderly external prism that influences their involvement in such activities. In addition there was a variety of factors that interact with each other attractive determining relationships within and between categories, which identified issues which cut across the different themes addressed in this research. Finally, note that the nature of this study enables the opening of new lines of research that may contribute to the occupation science and occupational therapy.

Uso de ácido tranexámico en el postoperatorio de cirugía cardiaca / Use of tranexamic acid in postoperative cardiac surgery

El objetivo de este estudio prospectivo, doble ciego y aleatorizado fue evaluar el impacto de la administración de ácido tranexámico (AT) después de cirugía cardiaca con circulación extracorpórea en el sangrado postoperatorio. Material y Método: Durante la inducción de la anestesia los pacientes recibieron un bolo de 10 mg•kg-1 de AT, más 50 mg en el cebado de la máquina de circulación extracorpórea, seguido de una infusión continua de 1 mg•kg-1•h-1 hasta el término de la cirugía. En ese momento los pacientes fueron aleatoriamente distribuidos en 2 grupos: el grupo control recibió 10 ml•h-1 de suero fisiológico, y el grupo de estudio una dosis de 1 mg•kg-1•h-1 de AT, en ambos casos durante el trascurso de 10 horas. El objetivo primario fue observar alguna diferencia en el sangrado durante el primer día de postoperatorio. El objetivo secundario fue observar alguna diferencia en la transfusión de sangre (glóbulos rojos, plaquetas) durante el primer día del postoperatorio y en la incidencia de reoperaciones. Tanto el anestesista como el cirujano fueron ciegos a la distribución de los pacientes en cada grupo. Se utilizó el t-test para el análisis de diferencias en las medias de las variables continuas y el z-test para las proporciones. Se consideró estadísticamente significativo un valor de p < 0,05. Se efectuó análisis de regresión múltiple para encontrar variables capaces de predecir sangrado durante el primer día postoperatorio...

The objective of this prospective, double blind, randomized trial is to evaluate the impact of tranexamic acid (TA) administration after cardiac surgery with cardiopulmonary bypass in postoperative bleeding. Materials and Methods: During induction of general anesthesia, patients received a bolus of TA of 10 mg•kg-1 plus 50 mg in the CPB priming followed by a continuous infusion of 1 mg•kg-1•h-1 until the end of the surgery. Then, patients were randomly allocated into one of two groups: the isotonic saline (IS) group received 10 ml•h-1 of isotonic saline and the TA group received an infusion of 1 mg•kg-1•h-1 of TA. Both groups received their infusions for 10 hours. Primary outcome was bleeding during first postoperative day (POD1). Secondary outcomes were blood transfusion (PRBC, platelets) during POD1 and surgical re-exploration. Anesthesiologists and surgeons were blind to patient allocation. A t-test was used to analyze differences in means of continuous variables and z-test for proportions. A p value < 0.05was considered statistically significant. Multiple regression analysis was performed to find variables able to predict bleeding in the POD1. Results: 273 patients were included, there were 15 lost per group. 125 patients in the TA group and 118 patients in the IS group were analyzed. Both groups were compared in their demographics characteristics, comorbidity and lab tests and no significant differences were found. No statistically significant differences between groups in the primary and secondary outcomes were found. Multiple regression analysis establishes the variable minutes in cardiopulmonary bypass was able to predict bleeding in the POD1. Conclusions: Postoperative infusion of TA does not decrease bleeding, transfusions and re-explorations during the POD1 of cardiac surgery with cardiopulmonary bypass...

Reversión de la anticoagulación en pacientes con dosis altas de heparina: protamina en dosis standard versus dosis reducidas / Reversal anticoagulation in patients with high doses heparin: protamine in standard doses versus small doses

Evaluar y comparar, en pacientes sometidos a circulación extracorpórea (CEC), la reversión de la anticoagulación con dos dosis distintas de protamina: una dada en forma proporcional a la heparina usada versus una dosis calculada según peso del paciente, independiente de la heparina administrada. Material y Método: Se incorporaron los pacientes que para la CEC requirieron una dosis de heparina superior a 300 U•kg-1. Los criterios de exclusión fueron: alteraciones de las pruebas de coagulación preoperatorias y paro circulatorio hipotérmico. La técnica anestésica, el uso de fármacos y el uso de hemoderivados fue de decisión del anestesista. Para la reversión con protamina los pacientes fueron aleatorizados en dos grupos: Grupo A o dosis estándar: Reversión con 0,8 mg protamina por cada 100 U de heparina usada. Grupo B o dosis reducida: Reversión con 2,4 mg protamina•kg-1, independiente de la dosis de heparina usada. La protamina fue preparada por una persona ajena al pabellón y el equipo tratante era ciego al grupo del paciente. El seguimiento de los pacientes las primeras 24 h en UTI fue realizado por una persona ciega al grupo del paciente. Resultados: Hubo solamente una diferencia demográfica: más mujeres en el grupo B (p = 0,029). En el preoperatorio no hubo diferencias en hematocrito, recuento de plaquetas, tratamiento anticoagulante oral (TACO) y heparina preoperatoria, tipo de cirugía y uso de aspirina. En el intraoperatoriono hubo diferencias en el tiempo de coagulación activada (TCA) basal, hematocritos en CEC, TCA en CEC y duración de CEC. La dosis de heparina por kg de peso fue mayor en el grupo B (p = 0,0433). La relación protamina/heparina total fue 0,81 para el Grupo A y 0,44 para el Grupo B, las que fueron diferentes (por el diseño del estudio)...

Objective: To evaluate and compare reversal of anticoagulation with different dose regimens of protamine in patients undergoing to CPB (cardiopulmonary bypass), one given according to the heparin dose administered and another calculated according to patient’s weight. Patients y Methods: Patients subjected to CPB and receiving a heparin dose greater than 300 IU/kg were enrolled. Exclusion criterias were: preoperative coagulopathy and hypothermic circulatory arrest. The anesthetic technic, drugs given and blood products transfusion were decided by the attending anesthesiologist. Patients were randomized to: Group A or standard dose: Reversal with 0.8 mg of protamine for each 100 IU of heparin given. Group B or reduced dose: Reversal with 2.4 mg of protamine per kilogram of patient’s weight, independent of heparin dose used. The protamine was prepared for a person blinded to group allocation, same as the team taking care of the patient. The patient’s follow up in the ICU during the first 24 hours was also done by someone blinded to group allocation. Results: There was only one demographic difference at baseline: more women in Group B (p = 0.029). There were no differences among the preoperative: hematocrit, platelets count, oral anticoagulant treatment, heparin administration, aspirin consumption and surgical plan. In the intraoperative course there were no differences in the baseline ACT, hematocrit during CBP, ACT in CBP and CBP duration. The average heparin dose (adjusted per kilogram) was greater in Group B (p = 0.0433).The protamine/heparin ratios were different among groups (Group A 0.81; Group B 0.44), as expected in this study design. The activated coagulation time (ACT)...

Uso de bloqueo paravertebral torácico bilateral en cirugía cardiaca para extubación postoperatoria inmediata: serie de casos clínicos / Use of paravertebral block thoracic bilateral in cardiac surgery to extubation Immediate postoperative: clinical case series

El desarrollo de protocolos de extubación precoz en cirugía cardiaca se basa en el uso de técnicas anestésicas que persiguen el objetivo de tener un paciente con un estado de vigilia adecuado y una vía aérea segura durante el período de emergencia de la anestesia. Se diseñó un estudio prospectivo y descriptivo con el objetivo de evaluar si el uso de bloqueo paravertebral torácico bilateral (BPVTB) previo a una cirugía cardiaca en adultos disminuye los requerimientos intraoperatorios (IO) de opioides, y aumentando con ello la posibilidad de extubación segura en el pabellón y, además, evaluar la calidad analgésica postoperatoria (PO). Material y Método: Los pacientes deben ser adultos sometidos a una cirugía cardiaca por esternotomía. Los criterios de exclusión fueron: cirugía larga y compleja, paro circulatorio, hipotermia profunda, insuficiencia cardiaca, hipertensión pulmonar severa, obesidad > grado II, enfermedad pulmonar severa y coagulopatía. Los pacientes seleccionados fueron sometidos a un BPVTB, y luego se indujo anestesia general no estandarizada. Tras realizar la cirugía prevista, al inicio del cierre de la piel se suspende el agente anestésico inhalatorio, se realiza prueba de ventilación espontánea y se extuba en pabellón si cumple criterios establecidos. Posteriormente se evaluó PaO2 y PaCO2(ingreso UCI), se aplicó escala visual análoga (EVA) para medir intensidad del dolor (6 h del PO) y al finalizar el primer día de PO se consignó el consumo de opioides, la incidencia de náuseas y vómitos y la necesidad de usar ventilación mecánica invasiva (VMI) o no invasiva (VMNI)...

The development of early extubation protocols in cardiac surgery are based on anesthesic techniques able to have the appropriate anesthesia depth and a secured airway during the emergence of anesthesia. A prospective study was design in adults subjected to cardiac surgery in order to evaluate the effectiveness of preoperative bilateral paravertebral thoracic block (BPVTB) in decreasing intraoperative opiods doses and allow a safe extubation in the operating room (OR) and, even more, give a good quality postoperative (PO) analgesia. Material and Methods: Patients subjected to a cardiac surgery with sternotomy. Exclusion criteria were: long and complex surgery, circulatory arrest, deep hypothermia, cardiac failure, severe pulmonary hypertension, obesity grade II or greater, severe lung disease and coagulophaty. A cohort of patients were subjected to a BPVTB, then general anesthesia was induced (no standarized technique). After cardiac surgery, at the beginning of skin suture, inhaled anesthetics were discontinued and after successful spontaneous breathing test, the patient was extubated in the operating room. PaO2 y PaCO2 was evaluated at the arrival to the ICU. Visual analogue scale (VAS) was applied every 6 hours to measure pain level. At the end of the first day opiod dose, PONV and ventilation support (invasive and noinvasive) was registered...(AU)

Exploración de las percepciones de los farmacéuticos comunitarios en la práctica del seguimiento farmacoterapéutico dentro del contexto del programa conSIGUE / Pharmacist experience of delivering medication reviews with follow up within the project conSIGUE

Introducción: Para la realización del estudio principal del programa conSIGUE se han desarrollado dos fases prepiloto (Murcia y Granada) y una fase piloto (Cádiz), en las que han participado sesenta farmacias. Objetivos: Explorar la percepción de los farmacéuticos participantes en estas fases sobre su experiencia como proveedores de seguimiento farmacoterapéutico, sobre las difi cultades encontradas y las áreas de mejora identificadas, en el conteto del programa conSIGUE. Método: Para la obtención de información se eligió el grupo focal. Todos los grupos focales tuvieron lugar en las sedes de los tres colegios de farmacéuticos, y en todos los casos participaron el mismo coordinador y la misma observadora. Las reuniones se grabaron y se transcribieron íntegramente. Se realizó un análisis de contenido utilizando el software NVivo®. Resultados: Se realizaron un total de ocho grupos focales. Las mayores difi cultades para la realización del servicio son la falta de tiempo, de personal y la falta de formación y experiencia clínica para realizar las diferentes intervenciones. El seguimiento permite mejorar la organización interna de la farmacia, la relación entre los miembros del equipo, conocer mejor Bot Plus, superar el miedo a relacionarse con los médicos y modificar el tipo de relación con los pacientes. Además, produce una importante satisfacción personal. Los formadores colegiales son valorados muy positivamente. Conclusiones: La figura del formador colegial es de gran interés tanto en los momentos iniciales de implantación del servicio como en su sostenibilidad en el tiempo, ya que permite solucionar los problemas que surgen en la práctica del seguimiento(AU)

Introduction: Prior to undertaking a main study, “conSIGUE” 60 pharmacies participated in two pre-pilot phases (Murcia y Granada) and one pilot (Cádiz). Objectives: To explore the experiences and perception of participating pharmacists when undertaking medication review with follow-up. Methods: Focus groups were used as the qualitative technique. All the meetings took place at the three Professional Association headquarters and were conducted by the same researchers. The groups were tape-recorded with a content analysis was performed NVivo®. Results: Eight focus groups were completed. Lack of time, f human resources and the lack of clinical education and skills to do pharmaceutical interventions were identified as the major barriers. Medication review with follow-up was seen to improve the internal organization of the pharmacy, the relationship among members of the staff, the knowledge and use of Bot-plus (a drug information program). The service helped to overcome the fear of physicians and modifi ed the relationship with patients. It also produced a great level of personal satisfaction for the pharmacists. The mentoring programme was assessed very positively. Conclusions: The use of a mentoring element, through the professional college facilitator, to the program appeared to be very important in the initiation and sustainability of the service as it assists to practically solve individualised problems faced by specific pharmacists(AU)

EEG signal classification using time-varying autoregressive models and common spatial patterns.

The performance of EEG signal classification methods based on Common Spatial Patterns (CSP) depends on the operational frequency bands of the events to be discriminated. This problem has been recently addressed by using a sub-band decomposition of the EEG signals through filter banks. Even though this approach has proven effective, the performance still depends on the number of filters that are stacked and the criteria used to determine their cutoff frequencies. Therefore, we propose an alternative approach based on an eigenstructure decomposition of the signals' time-varying autoregressive (TVAR) models. The eigen-based decomposition of the TVAR representation allows for subject-specific estimation of the principal time-varying frequencies, then such principal eigencomponents can be used in the traditional CSP-based classification. A series of simulations show that the proposed classification scheme can achieve high classification rates under realistic conditions, such as low signal-to-noise ratio (SNR), a reduced number of training experiments, and a reduced number of sensors used in the measurements.

Sustained hypoxia enhances TASK-like current inhibition by acute hypoxia in rat carotid body type-I cells.

Carotid body type-I cells respond to acute hypoxia with membrane depolarization and calcium-dependent neurotransmitter release. The inhibition of a TASK-like background potassium channels plays a key role in initiating this response. Chronic hypoxia enhances the carotid body chemosensory responses evoked by acute hypoxia, however the accurate mechanism by which chronic hypoxia increases carotid body reactivity is not clear. Therefore, we investigated the effects of chronic hypoxia upon TASK-like currents in isolated type-I cells. Carotid bodies were excised from anaesthetized newborn Sprague-Dawley rats and dissociated by collagenase-trypsin digestion. Isolated cells were maintained under 5% CO(2) in normoxic (21% O(2)) or hypoxic (1-2% O(2)) environment for 24 and 48 hours. Channel activity (NPo) was recorded using the cell-attached configuration of the patch-clamp technique. In normoxic and 24 hours hypoxic cultured cells, acute hypoxic stimuli decreases NPo approximately 70% with no effects on current amplitude. On the other hand, in cultured cells subjected to 48 hours of hypoxia, NPo decreases near to 90% in response to acute hypoxia. We concluded that continuous hypoxic exposure enhances the TASK-like channel activity inhibition in response to acute hypoxia. Our results provide a potential mechanism by which chronic hypoxia increases carotid body reactivity.

Lectura crítica como método docente en el postgrado de psiquiatría / Critical reading as a postgraduate teaching strategy in psychiatry

Introduction: Supervised critical reading of classic psychiatric texts and modern papers is a valida ted educational practice in postgraduate studies in psychiatry dating back to two centuries. There are experiences reported in international literature, in different psychiatry teaching centres. Material and Methods: Our department of psychiatry has included critical reading in its educational schedule. The reading time is sixty minutes, and our analysis includes 70 hours of reading. Results: Open discussion and teaching in small groups has been conducted, relating Spanish texts, and German texts translated to Spanish, with the analysis of patients attending our department. Conclusions: Critical reading allows discussion with the tutor, questioning, and the study of difficult cases, with psychopathological interest. Reading classic texts allows critical reading of modern literature.

Introducción: La lectura crítica de textos clásicos y modernos a cargo de un tutor docente es una práctica docente validada en la formación de postgrado de psiquiatría. Su inicio data desde hace dos siglos. Existen experiencias registradas en docencia en distintos centros formadores de psiquiatría en la literatura internacional. Método Docente: El departamento de psiquiatría ha establecido un horario en el curriculum de postgrado para lecturas críticas de textos. El grupo de 6 a 8 becados está a cargo de un profesor de psiquiatría. La duración es de 60 minutos aproximado. Se analizan 2 años de estudio restrospectivo con más de 70 horas. Resultados: Discusiones abiertas y docencia en grupos pequeños. Lectura de textos de psiquiatría clásica en español y traducción de textos alemanes. Dos presentaciones de pacientes con tema afín. Conclusiones: La lectura crítica permite un intercambio de opiniones, preguntas abiertas al tutor, estudio de casos clínicos de diagnóstico difícil y de interés psicopatológico. El conocimiento de los textos clásicos permite un análisis crítico de los textos modernos.

Uso del DIU con levenorgestrel como alternativa a la histerectomía en pacientes con alto riesgo quirúrgico / Levonorgestrel-releasing intrauterine device (LNG-IUD) as an alternative to hysterectomy in high-risk-surgical patients

Presentamos nuestra experiencia de 6 pacientes con metrorragia a repetición, portadoras de patologías médicas que representaban un riesgo desde el punto de vista anestésico y quirúrgico, en las cuales se insertó DIU-LNG como alternativa a la histerectomía. Todas evolucionan satisfactoriamente y sin complicaciones, con disminución significativa de las pérdidas hemáticas desde el tercer mes de uso, objetivadas por pictogramas. Se concluye que el DIU-LNG es un excelente método para el control de metrorragias en pacientes con patologías médicas relevantes.

We present our experience with 6 patients with menorrhagia and medical conditions considered high risk patients for anaesthesia and surgical procedures. We inserted LNG-IUD as alternative to hysterectomy. Three months later, all of them reduced menstrual blood loss as it was shown by pictorial charts, without complications. LNG-IUD is an excellent alternative to hysterectomy in this group of patients.

Acetylcholine sensitivity in sensory neurons dissociated from the cat petrosal ganglion.

The petrosal ganglia contain the somata of the sensory fibers of the glossopharyngeal nerves, innervating structures of the tongue, pharynx, carotid sinus and carotid body. Petrosal ganglia were excised from adult cats and their neurons were dissociated and kept in tissue culture for 7-12 days. Intracellular recordings were obtained through conventional microelectrodes. In response to depolarizing pulses, most cells (41/60) presented a 'hump' in the falling phase of their action potentials (H-type), while the remaining neurons lack such hump (F-type). The two types of cells had no differences in resting membrane potential or action potential amplitude. Acetylcholine (ACh) applied locally elicited responses in nearly two thirds of both H-type and F-type neurons tested. Most H-type neurons (17/19) responded with a slow long lasting depolarization, while the remaining (2) did so by generating spikes. In contrast, half of F-type neurons (6/12) responded with one or more spikes and the other half only with a slow depolarization. These results indicate that ACh receptors are present in the soma of many petrosal ganglion neurons subjected to tissue culture, thus supporting the idea that - under normal conditions - their peripheral sensory processes may be excited by ACh.

Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns.

The wound healing and antimicrobial properties of maggots are well known. Maggot debridement therapy has been used for the treatment of various conditions. For maggot debridement therapy, the larvae of the blowfly are applied over necrotic or nonhealing wounds. We used maggot debridement therapy with the larvae of Phaenicia sericata for limb salvage after bilateral lower extremity fourth-degree burns.