[Design and validation of SAHERA questionnaire to assess patient satisfaction in a Rehabilitation Service]. / Diseño y validación del cuestionario SAREHA para evaluar la satisfacción de los pacientes en un Servicio de Rehabilitación.

The development of a questionnaire that measures user satisfaction in the area of Rehabilitation is essential in order to measure the success achieved and to be able to introduce actions to improve health care. OBJECTIVE: To design and validate a questionnaire to assess the satisfaction of the care received in a Rehabilitation Department. MATERIAL AND METHODS: A cross-sectional study was carried out in the Rehabilitation Department of the Complejo Asistencial Universitario de Salamanca (CAUSA). A questionnaire was designed and prepared by experts using the Delphi technique. For the face validity, a pilot study was used using focal groups (doctors, nursing staff, physiotherapists, occupational therapists, and patients). An evaluation was made of the reliability (intraclass correlation coefficient) and internal consistency (Cronbach alpha). In a second stage, it was completed by 207 patients. The questionnaire consisted of 24 items that evaluated 4 dimensions: care/relationship, information/treatment, infrastructure, and general evaluation. RESULTS: A Cronbach alpha and intraclass correlation of greater than 0.8 was obtained in the first stage using a pilot test on 40 patients with a mean age of 58 years (SD ±16). The scale showed a good internal consistency in its final version (Cronbach alpha of 0.82) and an adequate stability (intraclass correlation of 0.8). CONCLUSIONS: The data obtained in the study showed that the designed questionnaire had a reliability of validity. And for this reason, it would be a valid and reliable tool for measuring the satisfaction of the care received by patients in Rehabilitation Departments.

Evaluation of the formation and carbon dioxide capture by Li4SiO4 using in situ synchrotron powder X-ray diffraction studies.

Carbon capture and storage using regenerable sorbents are an effective approach to reduce CO2 emissions from stationary sources. In this work, lithium orthosilicate (Li4SiO4) was studied as a carbon dioxide sorbent. For a deeper understanding of the synthesis and carbonation mechanism of Li4SiO4, an in situ synchrotron radiation powder X-ray diffraction technique was used. The Li4SiO4 powders were synthesized by a combination of ball milling of a Li2CO3 and SiO2 mixture followed by a thermal treatment process at low temperature. In situ studies showed that formation of Li4SiO4 from the as-milled 2Li2CO3-SiO2 mixture involves decomposition of Li2CO3 by reaction with SiO2via Li2SiO3 as an intermediate compound. No evidence of Li2Si2O5 formation was obtained, in spite of thermodynamic predictions. The CO2 capture by Li4SiO4 was evaluated dynamically over a wide temperature range, reaching a maximum weight increase of 34 wt% and good cyclability after about 10 cycles. By thermogravimetric and microstructural analyses in combination with ex situ and in situ measurements, a two step carbonation mechanism and its influence on the final CO2 capture was clearly elucidated. Under dynamical conditions up to 700 °C, the lower number of Li2CO3 nuclei initially formed retards the double shell formation and the nucleation and growth of the Li2CO3 particles remains the controlling step up to higher CO2 capture capacity. Isothermal carbonation at 700 °C favours the formation of a higher number of Li2CO3 nuclei that creates a thin carbonate shell. The CO2 diffusion through this shell is the limiting step from the beginning and further carbonation is hindered as the reaction progresses.

Usefulness of echocardiography and doppler echocardiography in endomyocardial fibrosis.

OBJECTIVE: Our goal was to demonstrate the usefulness of echocardiography and cardiac Doppler echocardiography (echo-Doppler) in the diagnosis of endomyocardial fibrosis, an unusual restrictive cardiomyopathy in Argentina. METHODS: Between 1980 and 1998, we studied 10 women (aged 27 to 58 years) with endomyocardial fibrosis confirmed by surgery and/or endomyocardial biopsy. Of the 10 cases of endomyocardial fibrothrombosis, 8 were biventricular and 2 were left ventricular. Six patients had only an echocardiographic study, and the last 4 patients (after 1987) had an echo-Doppler study also; 3 had a transesophageal echocardiography examination as well. Seven patients had grade III-IV dyspnea, 2 had an edematous-ascitic syndrome, and 1 had right heart failure at the first examination. Four patients died of heart failure and 1 of overimposed sepsis. Surgery was successful in 2 patients with the biventricular form of the disease. In one of them, fibrotic decortication was performed in both ventricles together with tricuspid and mitral replacement. In the other, the right side was not surgically treated because of its mild engagement. One patient was lost to follow-up, and 3 patients are awaiting surgery at this writing. RESULTS: In all 10 patients, echocardiography was the first diagnostic tool used. In M-mode echocardiography, the typical image showed the "square root" sign in the septum and posterior wall in addition to the "merlon" sign, characterized by a hypercontractile basal ventricle opposing an obliterated apex. In 2-dimensional echocardiography, inversion of the normal sized heart with obliterated ventricles and dilated atria were seen in the whole group. In 1 patient, the fibrous thrombus was limited to the apex of the right ventricle (Shaper's type 1) in a biventricular form, whereas in the left side of this patient and in the other 9 patients, the fibrous thrombus that initially occupied the apex engaged the posterior papillary muscle, pulling the posterior valve downward (Shaper's type 2) and generating tricuspid and/or mitral regurgitation that was always mild or moderate. The fibrous thrombus never altered the movement of the underlying myocardium. There were hypoechoic and hyperdense echoes inside the fibrotic material (the latter compatible with calcium), and in all 10 patients, different grades of pericardial effusion were found. Echo-Doppler showed the same minimal percentage of change in mitral and tricuspid velocities as found in healthy patients, which clearly differentiates endomyocardial fibrosis from constrictive pericarditis. Furthermore, a restrictive pattern was observed on both atrioventricular valves when both sides were engaged with a markedly short tricuspid deceleration time. Pulmonary veins showed a markedly diastolic D wave and a broad reversal A wave (the latter presented a low velocity when the wall of the left atrium was diseased) caused by an increased end-diastolic left ventricular pressure to the same extent throughout the respiratory cycle. Hepatic veins showed a markedly deep diastolic forward wave throughout the respiratory cycle and a marked reversal with inspiration. CONCLUSIONS: We showed (1) echocardiographic studies of a significant number of patients with this unusual disease, (2) the characteristic diagnostic signs in M-mode and 2-dimensional echocardiography, and (3) the common echo-Doppler patterns shared by all subjects studied with this technique.