Can Implementing New Services Organization Models to Better Meet the Needs of Young People Bring About Practice Changes? Analysis of an Experiment in Québec.

The research question addressed in this article is: Can implementing new services organization models to better meet the needs of young people bring about practice changes? More precisely, we examine the effects of a new model called Aire Ouverte (AO) which is implemented gradually across Quebec since 2019. This new model involves public sector and community organizations. To grasp practices' change, we use cultural historical activity theory (CHAT) and employ a qualitative approach. Beyond a precise description of work activities, we gained an inside view of how the actors involved represented their practice and context. Our results show that practice changes seen by actors are in line with the object of the intervention, that is, responding rapidly to the expressed needs of young people. The development of new tools, flexible functioning, strengthening of interprofessional and intersectoral collaboration, involvement of young people in decision-making, all should contribute to improving response to their needs. This being said, a critical look at practice changes reveals a challenge in aligning the design and objective of AO with the needs of some young people. We noted also a poor alignment of effective collaborative practices between levels of care and the practices sought from intersectoral collaboration.

Brain injuries from fisting. Front impact model / Traumas cerebrales por golpe de puño. Modelo de impacto en la frente

Boxing and other combat sports are associated with repetitive head trauma related to damage to the central nervous system. This work aimed to model the effect of a punch to the forehead given by a heavyweight boxer. Methodology: the Finite Element Method (FEM) was used. The research was based on simulating the effects of a dynamic impact and thus predicting, locating, and quantifying changes in the brain due to the blow. This simulation was validated by comparing medical research on brain injuries caused by impacts to the head. Results: The mathematical predictions showed significant brain effects: figures that exceed 100% risk. The MEF appears to be a practical, universal, inexpensive, and quick calculation tool, with important applications to detect evidence of brain trauma. (AU)

El boxeo y otros deportes de combate están asociados a traumas repetitivos en la cabeza, que pueden relacionarse con daños en el sistema nervioso central. El objetivo de este trabajo fue modelar el efecto de un golpe de puño en la frente, dado por un boxeador de peso pesado. Metodología: se utilizó el Método de Elementos Finitos (MEF). La investigación se basó en simular los efectos de un impacto dinámico y de esta forma predecir, localizar y cuantificar cambios en el cerebro debido al golpe. Para validar esta simulación, se comparó con investigaciones médicas sobre lesiones cerebrales, causadas por impactos en la cabeza. Resultados: Las predicciones matemáticas demostraron grandes efectos cerebrales: cifras que superan el 100% de riesgo. El MEF aparece pudiera ser una herramienta de cálculo práctica, universal, económica y rápida, con importantes aplicaciones para detectar evidencia de traumas cerebrales. (AU)

Relación terapéutica e influencia de la formación en la calidad de la misma en fisioterapeutas españoles: estudio observacional / 10.1016/j.ft.2022.11.005

Objetivo La relación terapéutica (RT) es determinante para el desarrollo y los resultados terapéuticos en fisioterapia. Se precisa formación del personal sanitario en métodos para llevarla a cabo. No se han encontrado publicaciones sobre la repercusión de este tipo de formación en la RT entre fisioterapeutas y pacientes. El objetivo fue evaluar las competencias de los fisioterapeutas españoles para el establecimiento de la RT y determinar si la realización de formación específica en RT influye en dicha relación. Métodos Estudio descriptivo transversal mediante encuesta electrónica a fisioterapeutas colegiados en España. Se incluyeron datos sociodemográficos, el cuestionario Working Alliance Inventory-Short (WAI-S) compuesto por 3 subescalas: establecimiento del vínculo y acuerdo en objetivos y tareas entre fisioterapeuta y paciente, y una pregunta dicotómica sobre la formación específica en RT de más de 5horas de duración. Resultados Participaron 264 fisioterapeutas. La puntuación más alta se obtuvo en la subescala vínculo y la más baja en metas. Las mujeres obtuvieron mayores puntuaciones en la subescala vínculo. Los fisioterapeutas con formación puntuaron más en todas las subescalas, y significativamente en la subescala metas. Una proporción mayor de mujeres realizó formación específica. Existe asociación directa entre la experiencia y las subescalas vínculo y tareas. No se encontraron diferencias significativas en los resultados del WAI-S en función de ninguna de las variables laborales analizadas. Conclusiones Los fisioterapeutas españoles tienen dificultades para establecer objetivos conjuntos. La formación específica en RT mejora todos los componentes del WAI-S, sobre todo la instauración conjunta de objetivos. Mayor experiencia profesional y ser mujer influye positivamente en una mejor RT (AU)

Objective The therapeutic relationship (RT) is determinant for the development and therapeutic results in physiotherapy. Training of health personnel in methods to carry it out is required. No publications have been found on the impact of this type of training on the RT between physiotherapists and patients. To evaluate the competencies of Spanish physiotherapists in establishing RT and to determine whether specific training in RT influences this relationship. Methods Cross-sectional descriptive study by means of an electronic survey of registered physiotherapists in Spain. We included sociodemographic data, the Working Alliance Inventory-Short (WAI-S) questionnaire composed of three subscales: establishment of the BOND and agreement on OBJETIVES and TASKS between physiotherapist and patient, and a dichotomous question on specific training in RT of more than 5h duration. Results A total of 264 physical therapists participated. The highest score was obtained in the subscale BOND, the lowest in GOAL. Women obtained higher scores on the BOND subscale. Physiotherapists with training scored higher on all subscales, and significantly higher on the GOAL subscale. A higher proportion of women undertook specific training. There was a direct association between experience and the subscales BOND and TASK. No significant differences were found in WAI-S scores as a function of any of the work variables analyzed. Conclusions Spanish physiotherapists have difficulties in establishing joint objectives. Specific training in RT improves all the components of the WAI-S, especially the joint establishment of objectives. More professional experience and being a woman have a positive influence on a better RT (AU)

Malformación venosa cavernosa en musculatura extrínseca ocular. Radioterapia estereotáctica fraccionada como alternativa terapéutica / Intramuscular cavernous venous malformation of extraocular muscles. Fractionated stereotactic radiotherapy as a therapeutic alternative

Las malformaciones venosas cavernosas que afectan a la musculatura extraocular son extremadamente poco frecuentes. Debido a esta localización su resección quirúrgica completa puede resultar difícil. Por este motivo se presenta un caso clínico de compromiso del músculo recto inferior, generando dolor retroocular y diplopía, que fue tratado con radioterapia estereotáctica fraccionada tras su recurrencia posquirúrgica. La radioterapia fraccionada estereotáctica supone un tratamiento alternativo eficaz en lesiones radiosensibles, sobre todo en aquellos casos con pronóstico funcional deficiente tras tratamiento quirúrgico

Intramuscular cavernous venous malformations affecting extraocular muscles are extremely uncommon. Due to their location, complete resection could be difficult. A clinical case is presented of an inferior rectus muscle orbital cavernous malformation treated with fractionated stereotactic radiotherapy after post-surgical excision recurrence. The malformation responded to radiotherapy with a reduction in size and symptoms. Fractionated stereotactic radiotherapy is an alternative and effective treatment for cavernous venous malformations that are surgically challenging due to their radiotherapy sensitivity

Intramuscular cavernous venous malformation of extraocular muscles. Fractionated stereotactic radiotherapy as a therapeutic alternative. / Malformación venosa cavernosa en musculatura extrínseca ocular. Radioterapia estereotáctica fraccionada como alternativa terapéutica.

Intramuscular cavernous venous malformations affecting extraocular muscles are extremely uncommon. Due to their location, complete resection could be difficult. A clinical case is presented of an inferior rectus muscle orbital cavernous malformation treated with fractionated stereotactic radiotherapy after post-surgical excision recurrence. The malformation responded to radiotherapy with a reduction in size and symptoms. Fractionated stereotactic radiotherapy is an alternative and effective treatment for cavernous venous malformations that are surgically challenging due to their radiotherapy sensitivity.

Inyección accidental de Ozurdex(R) intracristaliniano / Accidental intralenticular injection of Ozurdex(R)

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Empédocles y el sistema visual / Empedocles and the visual system

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