Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain.

INTRODUCTION: Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. METHODS: This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. RESULTS: We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients' perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). DISCUSSION: The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.

[Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic.] / La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19.

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. METODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud.

La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19 / Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. MÉTODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes

Main and accessory olfactory bulbs and their projections in the brain anticipate feeding in food-entrained rats.

The olfactory bulb (OB) has a circadian clock independent of the suprachiasmatic nucleus, but very little is known about the functional significance of its oscillations. The OB plays a major role in food intake as it contributes to the evaluation of the hedonic properties of food, it is necessary for a normal pattern of locomotor behavior and their ablation disrupts feeding patterns. Previously we demonstrated that OB of rabbit pups can be entrained by periodic nursing but it was not clear whether food was the entraining signal. Here we hypothesized that OB can be entrained by a food pulse during the day in adult rats under a restricted feeding schedule. Then we expect that OB will have a high activation before food presentation when animals show food anticipatory activity (FAA). To this aim we determined by immunohistochemistry the expression of FOS protein, as an indicator of neural activation, in the mitral and granular cell layers of the main and accessory OB. Additionally we also explored two of the OB brain targets, the piriform cortex (PC) and bed nuclei of the accessory olfactory tract (BAOT), in three groups: ad libitum (ALF), restricted feeding (RF), and fasted rats after restricted feeding (RF-F). In ALF group FOS levels in both main and accessory OB were low during the day and high during the night at the normal onset of the increase of activity, in agreement with previous reports. On the contrary in RF and RF-F groups FOS was high at the time of FAA, just before food presentation, when animals are in a state of high arousal and during food consumption but was low during the night. In their brain targets, we observed a similar pattern as OB in all groups with the only difference being that FOS levels remained high during the night in RF-F group. We conclude that the OB is entrained by food restriction by showing high activation at the time of food presentation, which persists during fasting and impose a similar FOS pattern to the two brain targets explored only in fed animals.

The median preoptic nucleus exhibits circadian regulation and is involved in food anticipatory activity in rabbit pups.

Rabbit pups are a natural model to study food anticipatory activity (FAA). Recently, we reported that three areas in the forebrain - the organum vasculosum of lamina terminalis, median preoptic nucleus (MnPO) and medial preoptic area - exhibit activation during FAA. Here, we examined the PER1 protein profile of these three forebrain regions in both nursed and fasted subjects. We found robust PER1 oscillations in the MnPO in nursed subjects, with high PER1 levels during FAA that persisted in fasted subjects. In conclusion, our data indicate that periodic nursing is a strong signal for PER1 oscillations in MnPO and future experiments are warranted to explore the specific role of this area in FAA.

Activation of organum vasculosum of lamina terminalis, median preoptic nucleus, and medial preoptic area in anticipation of nursing in rabbit pups.

Rhythmic feeding in rabbit pups is a natural model to study food entrainment because, similar to rodents under a schedule of food restriction, these animals show food-anticipatory activity (FAA) prior to daily nursing. In rodents, several brain systems, including the orexinergic system, shift their activity to the restricted feeding schedule, and remain active when subjects are hungry. As the lamina terminalis and regions of the preoptic area participate in the control of behavioral arousal, it was hypothesized that these brain regions are also activated during FAA. Thus, the effects of daily milk ingestion on FOS protein expression in the organum vasculosum of lamina terminalis (OVLT), median preoptic nucleus (MnPO), and medial preoptic area (MPOA) were examined using immunohistochemistry before and after scheduled time of nursing in nursed and fasted subjects. Additionally, FOS expression was explored in orexin (ORX) cells in the lateral hypothalamic area and in the supraoptic nucleus (SON) because of their involvement in arousal and fluid ingestion, respectively. Pups were entrained by daily nursing, as indicated by a significant increase in locomotor behavior before scheduled time of nursing in both nursed and fasted subjects. FOS was significantly higher in the OVLT, MnPO, and MPOA at the time of nursing, and decreased 8 h later in nursed pups. In fasted subjects, this effect persisted in the OVLT, whereas in the MnPO and MPOA, values did not drop at 8 h later, but remained at the same level or higher than those at the time of scheduled nursing. In addition, FOS was significantly higher in ORX cells during FAA in nursed pups in comparison with 8 h later, but in fasted subjects it remained high during most fasting time points. Additionally, OVLT, SON, and ORX cells were activated 1.5 h after nursing. We conclude that the OVLT, MnPO, and MPOA, but not SON, may participate in FAA, as they show activation before suckling of periodic milk ingestion, and that sustained activation of the OVLT, MnPO, and MPOA by fasting may contribute to the high arousal state associated with food deprivation. In agreement with this, ORX cells also remain active after expected nursing, which is consistent with reports in other species.

Pautas metodológicas para reducir los estereotipos de género en orientación profesional / Diretrizes metodológicas para reduzir os estereótipos de gênero na orientaçâo profissional / Approaches underpinning the reducing of gender stereotypes in career guidance

Es sabido que existe una extensa literatura teórica en materia de orientación profesional referida a la importancia de evitar estereotipos de género e intervenciones discriminatorias. No obstante, se ha trabajado menos en la identificación de sugerencias metodológicas y didácticas dirigidas a implementar programas preventivos de la discriminación de género. En este ensayo, que se basa en el modelo británico DOTS, se proponen estrategias específicas que ayuden a los especialistas a planificar programas de orientación y consejo desde la perspectiva de género. Se proponen enfoques desde el aprendizaje experiencial, aprendizaje social, desarrollo de competencias y aprendizaje basado en el trabajo, acompañados de ejemplos concretos de actividades útiles para la intervención en educación y en orientación profesional.(AU)

Sabe-se que em temas de orientação da carreira há uma extensa literatura teórica sobre a importância de evitar os estereótipos de gênero e intervenções discriminatórias. Menos comum é, contudo, identifi car sugestões metodológicas e didáticas para implementar programas de prevenção da discriminação de gênero. Neste ensaio, seguindo o modelo britânico DOTS, são propostas estratégias específi cas para ajudar os especialistas a planejar programas de orientação de aconselhamento a partir da perspectiva de gênero. São propostas abordagens, como: aprendizagem experiencial, aprendizagem social, desenvolvimento de competências e aprendizagem baseada no trabalho e exemplos explícitos de atividades, úteis para a intervenção em educação e orientação para a carreira.(AU)

There is a lot of theoretical literature about the importance of avoiding gender stereotypes and discriminatory strategies in career guidance interventions. Less common, however, is the existence of methodological and pedagogical suggestions to implement programs for preventing gender discrimination in education. In this article, following the British model of DOTS, specific strategies are proposed to help specialists to implement guidance counseling programs to avoid sexism in education at different levels. A variety of approaches are proposed on which the counselor can base their intervention: experiential learning, social learning, development of competencies, work-based learning and some instances of actual activities that are usefull in interventions in education and career guidance.(AU)

Pautas metodológicas para reducir los estereotipos de género en orientación profesional / Diretrizes metodológicas para reduzir os estereótipos de gênero na orientaçâo profissional / Approaches underpinning the reducing of gender stereotypes in career guidance

Es sabido que existe una extensa literatura teórica en materia de orientación profesional referida a la importancia de evitar estereotipos de género e intervenciones discriminatorias. No obstante, se ha trabajado menos en la identificación de sugerencias metodológicas y didácticas dirigidas a implementar programas preventivos de la discriminación de género. En este ensayo, que se basa en el modelo británico DOTS, se proponen estrategias específicas que ayuden a los especialistas a planificar programas de orientación y consejo desde la perspectiva de género. Se proponen enfoques desde el aprendizaje experiencial, aprendizaje social, desarrollo de competencias y aprendizaje basado en el trabajo, acompañados de ejemplos concretos de actividades útiles para la intervención en educación y en orientación profesional.

Sabe-se que em temas de orientação da carreira há uma extensa literatura teórica sobre a importância de evitar os estereótipos de gênero e intervenções discriminatórias. Menos comum é, contudo, identifi car sugestões metodológicas e didáticas para implementar programas de prevenção da discriminação de gênero. Neste ensaio, seguindo o modelo britânico DOTS, são propostas estratégias específi cas para ajudar os especialistas a planejar programas de orientação de aconselhamento a partir da perspectiva de gênero. São propostas abordagens, como: aprendizagem experiencial, aprendizagem social, desenvolvimento de competências e aprendizagem baseada no trabalho e exemplos explícitos de atividades, úteis para a intervenção em educação e orientação para a carreira.

There is a lot of theoretical literature about the importance of avoiding gender stereotypes and discriminatory strategies in career guidance interventions. Less common, however, is the existence of methodological and pedagogical suggestions to implement programs for preventing gender discrimination in education. In this article, following the British model of DOTS, specific strategies are proposed to help specialists to implement guidance counseling programs to avoid sexism in education at different levels. A variety of approaches are proposed on which the counselor can base their intervention: experiential learning, social learning, development of competencies, work-based learning and some instances of actual activities that are usefull in interventions in education and career guidance.

De la evaluación a la formación de competencias genéricas: aproximación a un modelo / Da avaliação à formação de competências genéricas: aproximação de um modelo / An evaluation model to guide a general competence model

Este artículo teórico, de ensayo psicopedagógico, trata de explicar que se puede trasladar un modelo de evaluación de competencias a otro modelo, paralelo de formación de las mismas. La autora inicia su discurso con una introducción que justifica el interés internacional por el desarrollo de la competencia laboral en el mundo del trabajo, presenta algunas definiciones del término “competencia”, introduce un modelo clasificatorio entre varios de los que existen, pasa a relatar los métodos para evaluar competencias y, finalmente, expone un modelo de formación de las siete competencias genéricas más significativas y demandadas en el mundo del trabajo.

Este artigo teórico, de ensaio psicopedagógico, objetiva demonstrar que se pode transpor um modelo de avaliação de competências a outro modelo, paralelo, de formação das mesmas. A autora inicia seu discurso com uma introdução que justifica o interesse internacional pelo desenvolvimento da competência laboral no mundo do trabalho, apresenta algumas definições do termo competência, introduz um modelo classificatório entre os vários que existem, relata os métodos para avaliar competências e, finalmente, expõe um modelo de formação de sete competências genéricas mais significativas e demandadas no mundo do trabalho.

This psychopedagogical theoretical essay aims at showing that it is possible to apply a model of competence evaluation to propose a model to develop those competences. The author justifies her proposal as based on the international demand for development of job competences. She presents some definitions of competence, proposes a classification model, describes some competence evaluation methods and proposes a model to develop the seven more demanded general competences in the job market.

Da avaliação à formação de competências genéricas: aproximação de um modelo / An evaluation modelo to guide a general competence model

Este artigo teórico, de ensaio psicopedagógico, objetiva demonstrar que se pode transpor um modelo de avaliação de competências a outro modelo, paralelo, de formação das mesmas. A autora inicia seu discurso com uma introdução que justifica o interesse internacional pelo desenvolvimento da competência laboral no mundo do trabalho, apresenta algumas definições do termo competência, introduz um modelo classificatório entre os vários que existem, relata os métodos para avaliar competências e, finalmente, expõe um modelo de formação de sete competências genéricas mais significativas e demandadas no mundo do trabalho.(AU)

[Effect of selective digestive decontamination on the nosocomial infection and multiresistant microorganisms incidence in critically ill patients]. / Descontaminación selectiva del tubo digestivo: efecto sobre la incidencia de la infección nosocomial y de los microorganismos multirresistentes en enfermos ingresados en unidades de cuidados intensivos.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication in mechanically ventilated patients. Other infections related to the use of invasive devices, such urinary tract infections (UTI) and central venous catheter-related bloodstream infections are found in patients admitted in intensive care units (ICU). Selective digestive decontamination (SDD) is a set of manoeuvres (hygiene, topic digestive antimicrobials and short course of systemic antibiotics) aimed at decreasing the incidence of nosocomial infections, mainly VAP, in ICU. The objective of this study was to describe the impact of SDD in the rates of nosocomial infections in an 18-bed medical-surgical ICU. PATIENTS AND METHOD: All patients admitted in the ICU from October 1998 to September 1999 with expected mechanical ventilation for at least 72 h or with an illness where SDD has proven to be efficacious. The infection rates during this period were compared with the infection rates of the period without SDD (October 1997 to September 1998). RESULTS: VAP rates decreased from 12.38 to 3.64 per 1000 days of mechanical ventilation (RR 0.3; CI 95%: 0.16 to 0.53). Urinary tract infection rates decreased form 7.70 to 4.51 per 1000 bladder-catheter days (RR 0.6. CI 95%: 0.37 to 0.93). Central venous catheter related bloodstream infections decreased from 5.92 to 2.73 per 1000 catheter days (RR: 0.5. CI 95%: 0.24 to 0.90). There was no emergence of resistant microorganims when SDD was used. CONCLUSIONS: SDD reduces infection rates in ICU without any significant adverse events.

Descontaminación selectiva del tubo digestivo: efecto sobre la incidencia de la infección nosocomial y de los microorganismos multirresistentes en enfermos ingresados en unidades de cuidados intensivos / Effect of selective digestive decontamination on the nosocomial infection and multiresistant microorganisms incidence in critically ill patients

FUNDAMENTO: La neumonía asociada a ventilación mecánica (NAVM) es una complicación frecuente en pacientes en ventilación mecánica. Asimismo, los pacientes ingresados en la unidad de cuidados intensivos (UCI) pueden presentar otras infecciones relacionadas con el uso de dispositivos invasivos: infecciones del tracto urinario (ITU) y bacteriemias asociadas a catéteres venosos centrales (BACVC). La descontaminación digestiva selectiva (DDS) es un conjunto de maniobras (higiene, administración de antimicrobianos no absorbibles y un tratamiento corto de antibióticos sistémicos) cuyo objetivo es reducir la incidencia de infecciones nosocomiales, principalmente la NAVM. El objetivo del estudio es describir el impacto de la DDS en las tasas de infecciones nosocomiales en una unidad medicoquirúrgica de 18 camas. PACIENTES Y MÉTODO: Todos los pacientes ingresados en la UCI desde octubre de 1998 a septiembre de 1999, con un tiempo de ventilación mecánica de al menos 72 h o con enfermedad en que ha sido demostrada su eficacia, fueron tratados con DDS. Las tasas de infección durante este período fueron comparadas con las del período sin DDS (octubre de 1997 a septiembre de 1998). RESULTADOS: Las tasas de NAVM disminuyeron de 12,38 a 3,64 por 1.000 días de ventilación mecánica (riesgo relativo [RR] = 0,3; intervalo de confianza [IC] del 95 por ciento, 0,16-0,53); las tasas de ITU disminuyeron de 7,70 a 4,51 por 1.000 días de sondaje urinario (RR = 0,6; IC del 95 por ciento, 0,37-0,93), las BACVC de 5,92 a 2,73 episodios por 1.000 días de CVC (RR = 0,5; IC del 95 por ciento, 0,24-0,90). No hubo aparición de microorganismos resistentes a los antimicrobianos asociados a la DDS. CONCLUSIONES: La DDS reduce las tasas de infección en la UCI sin efectos secundarios significativos. (AU)