Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. / Atención farmacéutica en enfermedades respiratorias: situación y oportunidades de la farmacia hospitalaria en España.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS: Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Continental-scale migration patterns and origin of Helicoverpa zea (Lepidoptera: Noctuidae) based on a biogeochemical marker.

Insect migrations have ecological and economic impacts, particularly in agriculture. However, there is limited knowledge about the migratory movements of pests at the continental scale, which is an important factor influencing the spread of resistance genes. Understanding the migratory patterns of economic pests, like Helicoverpa zea (Boddie), is essential for improving Integrated Pest Management (IPM) and Insect Resistance Management (IRM) strategies. In this study, we used stable hydrogen isotopic ratios in wing tissue as a biogeochemical marker to examine migratory patterns and estimate the native origins of H. zea individuals collected across a wide latitudinal gradient in North America. Samples collected at higher latitudes (Ontario, Canada and Minnesota, USA) exhibited a greater proportion (60%-96%) of nonlocal individuals, with an increased probability of origin from the southeastern United States. Populations from mid-latitudes (Florida, North Carolina, and South Carolina) showed a blend of local and nonlocal (40%-60%) individuals. Finally, 15% of the southernmost population individuals (Puerto Rico) were classified as migratory, with some having a probability of origin at higher latitudes (>30°). Overall, our results provide evidence of a northward spring/summer migration of H. zea in North America and underscore the significance of the southeastern United States as a hub for genetic flow. In addition, based on stable hydrogen isotopic ratios, there is strong evidence of reverse (southward) migration of H. zea from the continental United States to Puerto Rico. Our study highlights the implications for IPM and IRM programs and the need for management strategies that account for both northward and southward migration patterns.

A Palearctic view of a bat fungal disease.

The fungal infection causing white-nose disease in hibernating bats in North America has resulted in dramatic population declines of affected species, since the introduction of the causative agent Pseudogymnoascus destructans. The fungus is native to the Palearctic, where it also infects several bat species, yet rarely causes severe pathology or the death of the host. Pseudogymnoascus destructans infects bats during hibernation by invading and digesting the skin tissue, resulting in the disruption of torpor patterns and consequent emaciation. Relations among pathogen, host, and environment are complex, and individuals, populations, and species respond to the fungal pathogen in different ways. For example, the Nearctic Myotis lucifugus responds to infection by mounting a robust immune response, leading to immunopathology often contributing to mortality. In contrast, the Palearctic M. myotis shows no significant immunological response to infection. This lack of a strong response, resulting from the long coevolution between the hosts and the pathogen in the pathogen's native range, likely contributes to survival in tolerant species. After more than 15 years since the initial introduction of the fungus to North America, some of the affected populations are showing signs of recovery, suggesting that the fungus, hosts, or both are undergoing processes that may eventually lead to coexistence. The suggested or implemented management methods of the disease in North America have encompassed, for example, the use of probiotics and fungicides, vaccinations, and modifying the environmental conditions of the hibernation sites to limit the growth of the pathogen, intensity of infection, or the hosts' responses to it. Based on current knowledge from Eurasia, policy makers and conservation managers should refrain from disrupting the ongoing evolutionary processes and adopt a holistic approach to managing the epizootic.

Vista paleártica de una enfermedad fúngica de murciélagos Resumen La enfermedad fúngica que produce el síndrome de nariz blanca en murciélagos en hibernación en Norte América ha resultado en declinaciones poblacionales dramáticas en las especies afectadas desde la introducción del agente causante, Pseudogymnoascus destructans. El hongo es nativo del Paleártico, donde también infecta a varias especies de murciélagos; sin embargo, raramente causa patología severa o la muerte del hospedero. Pseudogymnoascus destructans infecta a los murciélagos durante la hibernación invadiendo y digiriendo el tejido de la piel, lo que resulta en la disrupción de los patrones de torpor y la consecuente emaciación. Las relaciones entre el patógeno, el huésped y el ambiente son complejas, y los individuos, las especies y poblaciones responden al patógeno fúngico de distintas maneras. Por ejemplo, Myotis lucifugus, especie del Neártico, responde a la infección montando una respuesta inmune robusta, produciendo una inmunopatología que a menudo contribuye a la mortalidad. En contraste, M. myotis del Paleártico no presenta respuesta inmunológica significativa a la infección. La falta de una fuerte respuesta, resultado de la larga coevolución entre hospederos y el patógeno en el rango nativo de distribución del patógeno, probablemente contribuye a la supervivencia en especies tolerantes. Después de más de 15 años desde la introducción del hongo en Norte América, algunas de las poblaciones afectadas están mostrando señales recuperación, lo que sugiere que el hongo, hospederos, o ambos, están pasando por procesos que eventualmente pueden conducir a la coexistencia. Los métodos de manejo de la enfermedad sugeridos o implementados en Norte América han abarcado, por ejemplo, el uso de probióticos y fungicidas, vacunaciones y modificación de las condiciones ambientales de los sitios de hibernación para limitar el crecimiento del patógeno, la intensidad de la infección o las respuestas de los hospederos. Con base en conocimiento actual de Eurasia, los formuladores de políticas y los manejadores de la conservación deberían abstenerse de alterar los procesos evolutivos en curso y adoptar un enfoque holístico para gestionar la epizootia.

[Translated article] Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. METHODS: An electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. RESULTS: A total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients' perspective on the management of the disease. CONCLUSION: Our study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

Falta de conhecimento sobre os fatores de risco não ocupacionais da dor lombar entre profissionais de saúde ocupacional brasileiros: um estudo observacional transversal / Lack of knowledge about non-occupational low back pain risk factors among brazilian occupational health professionals: a cross-sectional observational study

INTRODUÇÃO: A dor lombar possui alta prevalência, sendo uma das principais causas de incapacidade no Brasil e no mundo. A dor lombar apresenta etiologia multifatorial, sendo extremamente comum em trabalhadores. OBJETIVOS: Verificar o conhecimento sobre os fatores de risco para dor lombar, crenças e atitudes sobre o manejo da dor lombar entre profissionais de saúde (fisioterapeutas e ergonomistas) atuantes na área ocupacional. MATERIAIS E MÉTODOS: Foi realizado um estudo observacional transversal com 81 profissionais de saúde ocupacional brasileiros. Os participantes preencheram um questionário eletrônico composto por dados profissionais, sociodemográficos, itens sobre fatores de risco para dor lombar e a Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Conhecimentos, crenças e atitudes foram analisados por meio do teste do qui-quadrado para fatores de risco para dor lombar e um modelo de regressão linear para crenças e atitudes dos profissionais de saúde. RESULTADOS: Obesidade (7,4%), ficar sentado mais de 2 horas (8,6%), atividade física (9,9%), falta de apoio psicossocial no trabalho (11,1%) e consumo de álcool (37,0%), apresentaram os menores índices de conhecimento sobre fatores de risco da dor lombar pelos profissionais. Itens sobre saúde geral apresentaram o menor conhecimento. Uma orientação biomédica e psicossocial equilibrada de crenças e atitudes sobre o manejo da dor lombar foi observada. CONCLUSÃO: Profissionais de saúde ocupacional brasileiros carecem de conhecimento sobre os fatores de risco não ocupacionais da dor lombar, especialmente o estado geral de saúde. Esses profissionais também possuem conceitos biomédicos e psicossociais equilibrados no manejo da dor lombar.

INTRODUCTION: Low back pain (LBP) is highly prevalent and is one of the main causes of disability in Brazil and around the world. LBP presents a multifactorial etiology, being extremely common in workers. OBJECTIVE: This study aimed to verify the knowledge about the LBP risk factors, beliefs and attitudes about the management of LBP among health professionals (physiotherapists and ergonomists) working in the occupational area. MATERIALS AND METHODS: A cross-sectional observational study was conducted with 81 Brazilian occupational health professionals. Participants completed an electronic questionnaire comprising professional data, sociodemographics, items about LBP risk factors, and the Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Knowledge, beliefs and attitudes were analyzed using the chi-square test for LBP risk factors and the linear regression model for health professionals' beliefs and attitudes. RESULTS: Obesity (7.4%), sitting for more than 2 hours (8.6%), physical activity (9.9%), lack of psychosocial support at work (11.1%) and consuming alcohol (37.0%) presented the lowest rate of knowledge about LBP risk factors by professionals. Items about general health showed the lowest knowledge. A balanced biomedical and psychosocial orientation of beliefs and attitudes about managing LBP was observed. CONCLUSION: Brazilian occupational health professionals lack knowledge about non-occupational LBP risk factors, especially general health status. These professionals also have balanced biomedical and psychosocial concepts in managing LBP.

Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.

En las últimas dos décadas, el videolaringoscopio (VDL) se ha convertido en una herramienta valiosa y eficaz para el manejo de la vía aérea no solo en el ámbito de anestesiología, sino en otras especialidades médicas durante escenarios clínicos que requieren la intubación traqueal y las cuales, en países como Estados Unidos corresponden anualmente a más de 15 millones dentro de salas de cirugía y 650.000 fuera de ella. Aproximadamente, hay una incidencia global acumulada de 6,8 % de eventos de vía aérea difícil en la práctica rutinaria y 0,1 al 0,3 % de intubaciones fallidas, ambas asociadas a complicaciones como desaturación, daño en la vía aérea, inestabilidad hemodinámica y muerte. Pese a que el VDL ha demostrado ventajas como mejoría de la visualización de la glotis, aumento de tasa de éxito al primer intento y menor curva de aprendizaje, su uso en la mayoría de las veces se ve limitado como dispositivo de rescate o de manera secundaria. El propósito de este artículo es comentar acerca de las ventajas y limitaciones del VDL vs. el laringoscopio directo en un variado número de escenarios clínicos, como salas de cirugía, unidades de cuidado intensivo, emergenciología, pediatría, obstetricia y covid-19, con el fin de considerar si su uso debiera hacerse de manera rutinaria.

Influence of microclimate and forest management on bat species faced with global change.

Climate refugia, areas where climate is expected to remain relatively stable, can offer a near-term safe haven for species sensitive to warming temperatures and drought. Understanding the influence of temperature, moisture, and disturbance on sensitive species is critical during this time of rapid climate change. Coastal habitats can serve as important refugia. Many of these areas consist of working forestlands, and there is a growing recognition that conservation efforts worldwide must consider the habitat value of working lands, in addition to protected areas, to effectively manage large landscapes that support biodiversity. The sensitivity of forest bats to climate and habitat disturbance makes them a useful indicator taxon. We tested how microclimate and forest management influence habitat use for 13 species of insectivorous bats in a large climate refugium in a global biodiversity hotspot. We examined whether bat activity during the summer dry season is greater in forests where coastal fog provides moisture and more stable temperatures across both protected mature stands and those regularly logged. Acoustic monitoring was conducted at a landscape scale with 20 study sites, and generalized linear mixed models were used to examine the influence of habitat variables. Six species were positively associated with warmer nighttime temperature, and 5 species had a negative relationship with humidity or a positive relationship with climatic moisture deficit. Our results suggest that these mammals may have greater climate adaptive capacity than expected, and, for now, that habitat use may be more related to optimal foraging conditions than to avoidance of warming temperatures and drought. We also determined that 12 of the 13 regionally present bat species were regularly detected in commercial timberland stands. Because forest bats are highly mobile, forage over long distances, and frequently change roosts, the stewardship of working forests must be addressed to protect these species.

Influencia del microclima y el manejo forestal sobre especies de murciélagos ante el cambio global Resumen Los refugios climáticos, áreas en donde se espera que el clima permanezca relativamente estable, pueden ofrecer un santuario a corto plazo para las especies sensibles al aumento de temperaturas y la sequía. Es muy importante entender la influencia de la temperatura, la humedad y las perturbaciones sobre las especies sensibles durante estos tiempos de cambio climático repentino. Los hábitats costeros pueden funcionar como refugios importantes. Muchas de estas áreas consisten en bosques funcionales y cada vez hay más reconocimiento de que los esfuerzos mundiales de conservación deben considerar el valor del hábitat de los suelos funcionales, además de las áreas protegidas, para manejar de manera efectiva los extensos paisajes que mantienen a la biodiversidad. La sensibilidad de los murciélagos de los bosques ante las perturbaciones climáticas y de hábitat hace que sean un taxón indicador útil. Analizamos cómo los microclimas y el manejo forestal influyen sobre el uso de hábitat de 13 especies de murciélagos insectívoros en un refugio climático amplio dentro de un punto caliente de biodiversidad mundial. Examinamos si la actividad de los murciélagos durante la temporada seca de verano es mayor en los bosques en donde la niebla costera proporciona humedad y temperaturas más estables tanto en los árboles maduros como aquellos que son talados con regularidad. Realizamos el monitoreo acústico a escala de paisaje en 20 estudios de sitio y usamos modelos lineales mixtos generalizados para examinar la influencia de las variables del hábitat. Seis especies estuvieron asociadas positivamente con la temperatura nocturna más cálida y cinco especies tuvieron una relación negativa con la humedad o una relación positiva con el déficit climático de humedad. Nuestros resultados sugieren que estos mamíferos pueden tener una mayor capacidad de adaptación climática de lo que se pensaba y, por ahora, que el uso de hábitat puede estar más relacionado con las condiciones óptimas de forrajeo que con la evasión de las temperaturas elevadas y la sequía. También determinamos que 12 de las 13 especies con presencia regional fueron detectadas con regularidad en los puntos de tala comercial. Ya que los murciélagos del bosque tienden a moverse mucho, forrajear a lo largo de grandes distancias y con frecuencia cambiar de nido, debemos abordar la administración de los bosques funcionales para proteger a estas especies.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Understanding variation in impacts from private protected areas across regions and protection mechanisms to inform organizational practices.

Private land protection is an important and growing tool to address biodiversity loss and climate change. Thus, better empirical evidence on the effectiveness of private land protection and organizational practices, such as targeting of lands for protection and choice of protection mechanism (i.e., fee simple land acquisition and conservation easements), is needed. We addressed this gap by estimating the impacts of The Nature Conservancy's (TNC) (a large nongovernmental organization with relatively decentralized management) conservation land acquisitions and easements from 1988 to 2016 in three regions of the United States (Mid-Atlantic, New England and New York, and California). We estimated impact in terms of avoided conversion by comparing natural land cover on 3179 protected parcels with matched unprotected parcels. Nineteen of 21 ecoregional plans used threats of agriculture and development to identify priorities for protection. When regions and protection mechanisms were pooled, on average there was no evidence of avoided conversion from 1988 to 2016. Accounting for mechanisms, TNC land acquisitions avoided conversion and easements did not. TNC's easements on parcels acquired by conservation partners did avoid conversion. Limitations of these results include focus on a single measure of impact, inability to capture future avoided conversion, and low land cover change accuracy in California. Our results suggest that private land protection managers who seek to avoid land conversion in the near to medium term should increase focus on areas with higher threats. Special attention should be paid to strengthening accountability and the role of partners, improving or clarifying how easements are used, and facilitating the flow of resources to work with the greatest potential impact.

Comprensión de la variación en el impacto de las áreas protegidas privadas sobre las regiones y los mecanismos de protección para guiar las prácticas organizativas Resumen La protección de terreno privado es una herramienta importante, aunque su naturaleza voluntaria puede sesgar la protección hacia parcelas menos amenazadas­lo que resulta en que la conversión no se evite o se evite muy poco. Además, muchos programas de protección privada tienen una supervisión limitada y pocos reportes de sus resultados. Por lo tanto, se necesitan mejores evidencias empíricas de la efectividad de la protección en suelo privado y las prácticas organizativas, como el enfoque en tierras para protección y la selección de los mecanismos de protección (adquisición de terrenos a título oneroso y servidumbres de conservación). Abordamos esta brecha con la estimación de impactos de las adquisiciones de suelo de The Nature Conservancy (TNC, una gran organización no gubernamental con un manejo relativamente descentralizado) y las servidumbres implementadas entre 1988 y 2016 en tres regiones de los Estados Unidos: Atlántico Medio, Nueva Inglaterra y Nueva York, y California. Estimamos el impacto en términos de la conversión que se evitó al comparar la cobertura de suelo en 3,179 parcelas protegidas con parcelas desprotegidas equivalentes. Diecinueve de los 21 planes eco­regionales usaron las amenazas a la agricultura y al desarrollo para identificar las prioridades de protección. Cuando agrupamos las regiones y los mecanismos de protección, en promedio no hubo impacto alguno. Si se consideran los mecanismos, las adquisiciones de suelo de la TNC tuvieron un impacto mientras que las servidumbres no. Las servidumbres de la TNC en las parcelas adquiridas por socios de conservación sí tuvieron un impacto, aunque esta manera de proteger sólo se presentó en las regiones del Atlántico Medio y de Nueva Inglaterra y Nueva York. Nuestros resultados sugieren que la protección privada, especialmente mediante servidumbres, puede estar sesgada hacia suelos no amenazados. Los gestores que buscan evitar la conversión del suelo a mediano o corto plazo deberían enfocarse más en las áreas con más amenazas. Se debería prestar especial atención al fortalecimiento del papel y las responsabilidades de los socios, a la mejora o aclaración de cómo se usan las servidumbres y la facilitación del flujo de recursos para trabajar con el mayor impacto potencial.

[Effectiveness of the clinical assistant in the control of hypertensive and diabetic patients in primary care]. / Efectividad del asistente clínico en el control de pacientes hipertensos y diabéticos en atención primaria.

OBJECTIVE: To evaluate the effectiveness of the incorporation of the clinical assistant in improving the control of type 2 diabetes mellitus and hypertension in a primary care center. DESIGN: Quasi-experimental study (pre-post), with a control group, with a 1-year follow-up. SETTING: Primary care center. PARTICIPANTS: Patients between the ages of 18 and 85 with a diagnosis of diabetes type 2 and/or hypertension were selected. INTERVENTION: Incorporation of the figure of the clinical assistant, previously trained. The latter contacted the patient to explain their role and obtain informed consent, assessed compliance with the protocols, and when they were incomplete and/or detected warning signs, referred the patient directly to medicine and/or nursing. RESULTS: Three thousand and sixty-four patients participated, 30.74% assigned to the intervention group. Fifty percent were women. The mean age was 68.5 years (SD 11.07). 93.59% of diabetic patients in the intervention group had at least one determination of glycosylated hemoglobin compared to 86.83% in the control group (p=0.003). Fundus and diabetic foot screening was significantly higher in the intervention group (94.31% and 85.41% vs. 83.49% and 72.38%). 88.43% of the patients in the intervention group had registered blood pressure figures compared to 62.06% of the patients in the control group (p<0.05). There were not statistically significant differences in the control of blood pressure between the patients with recorded measures (p=0.478). CONCLUSIONS: Clinical assistants can facilitate the implementation and compliance with chronic diseases protocols, and in the long run improve the degree of control of these patients and the quality of care.

Estomas: complicaciones, manejo y prevención. Una revisión actual / Stomas: complications, management, and prevention. An updated review

Introducción. La resección segmentaria del intestino y su derivación temporal o definitiva es un procedimiento frecuente en la práctica quirúrgica, que implica la construcción de un estoma. La enfermedad que lleva a la cirugía, las condiciones clínicas del paciente y los aspectos técnicos en la construcción de la ostomía son puntos claves en la evolución posoperatoria. Métodos. Se realizó una revisión de la literatura identificando las complicaciones asociadas a la construcción de estomas, con el objetivo de ofrecer herramientas de tratamiento y toma de decisiones al personal médico involucrado en la atención de estos pacientes. Resultados. La cirugía de urgencia, la inmunosupresión, la obesidad y la técnica en la apertura del orificio en la pared abdominal, favorecen la aparición de complicaciones tempranas que requieren manejo médico o reintervención quirúrgica. Conclusiones. Todo paciente con estoma debe ser valorado minuciosamente por el cirujano y la terapista enterostomal en las primeras 72 horas luego de la cirugía.

Introduction. Segmental resection of the intestine and its temporary or permanent bypass is a frequent procedure in surgical practice, which involves the construction of a stoma. The disease that leads to surgery, the clinical conditions of the patient and the technical aspects in the construction of the ostomy are key points in the postoperative evolution. Methods. A review of the literature was performed, identifying the complications associated with the construction of stomas, with the aim of offering treatment and decision-making tools to the medical personnel involved in the care of these patients. Results. Emergency surgery, immunosuppression, obesity, and the technique used to open the orifice in the abdominal wall favor the appearance of early complications that require medical management or surgical reintervention. Conclusions. Every patient with a stoma must be carefully evaluated by the surgeon and the enterostomal therapist in the first 72 hours after surgery.

Pharmacologic treatment of kidney stones: Current medication and pH monitoring.

Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.

Executive summary of the consensus document on the shared care of patients with HIV infection between primary and hospital care.

The current reality of the diagnosis and treatment of HIV infection justifies a multidisciplinary and coordinated approach between Primary Care and Hospital Care, contemplating bidirectionality and communication between the two care settings. The consensus document, coordinated by the AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC-GeSIDA) and the Spanish Society of Family and Community Medicine (semFYC), was born out of this need. Here, the recommendations of the four sections that comprise it are summarized: the first deals with aspects of prevention and diagnosis of HIV infection; the second contemplates the clinical care of people living with HIV; the third deals with social factors, including legal and confidentiality issues, quality of life, and the role of NGOs; finally, the fourth block addresses bidirectional and shared training/teaching and research.

Use of a flexible tip bougie (FlexTip) in the management of the first-attempt failure intubation with the C-MAC D-Blade videolaryngoscope in the intensive care unit: A prospective, case series.

We describe a series of 11 cases in which we used the new flexible tip (FlexTip) bougie as a rescue device following first-attempt failure at intubation with the C-MAC D-Blade video laryngoscope in our UCI. We collected data from all intubations performed using the C-MAC D-Blade video laryngoscope over a 16-month period. Ninety six patients were included in the study: 79 (86.8%) were intubated at the first attempt; 11 (12.1%) required 2 attempts; and 1 patient required 3 attempts. The Frova Intubating Introducer was used in 1 of the 12 patients requiring more than 1 intubation attempt, and the FlexTip was used in the remaining 11. This study shows that the new FlexTip bougie is a good rescue device when the first attempt at video laryngoscope intubation fails.

Anesthetic considerations in the perioperative management of the patient with Jarcho-Levin Syndrome.

Jarcho-Levin syndrome is an eponym used to describe a spectrum of small thoracic skeletal dysplasias with variable involvement of vertebrae and ribs. Initially considered lethal, it is currently compatible with life in its mildest forms. Bone alterations that lead to a restrictive respiratory pattern, recurrent respiratory infections and particular phenotype, can make perioperative anesthetic management difficult. The proper assessment of the airway is of special interest because it presents predictors of a difficult airway, as well as the prevention, early diagnosis and adequate treatment of respiratory failure. We present the case of a patient with Jarcho-Levin Syndrome who underwent vertebral distraction surgery, with its most notable implications in anesthetic management.

Effective conservation of subterranean-roosting bats.

Bats frequently inhabit caves and other subterranean habitats and play a critical role in subterranean food webs. With escalating threats to subterranean ecosystems, identifying the most effective measures to protect subterranean-roosting bats is critical. We conducted a meta-analysis to evaluate the effectiveness of conservation and management interventions for subterranean-roosting bats. We used network analyses to determine to what extent interventions for bats overlap those used for other subterranean taxa. We conducted our analyses with data extracted from 345 papers recommending a total of 910 conservation interventions. Gating of roost entrances was applied to preserve bat populations in 21 studies, but its effectiveness was unclear. Habitat restoration and disturbance reduction positively affected bat populations and bat behavior, respectively, in ≤4 studies. Decontamination was assessed in 2 studies and positively affected bat populations, particularly in studies focused on reducing fungal spores associated with white-nose syndrome in North America. Monitoring of bat populations as an effective conservation strategy was unclear and infrequently tested. Only 4% of bat studies simultaneously considered other subterranean organisms. However, effective interventions for bat conservation had similarities with all other organisms. If other subterranean organisms are considered when applying interventions to conserve bats, they might also benefit.

Conservación eficiente de murciélagos subterráneos Resumen Es común que los murciélagos habiten en cuevas y otros hábitats subterráneos y contribuyan a las redes alimenticias bajo tierra. Ya que estos ecosistemas cada vez se enfrentan a más amenazas, es importante identificar las medidas más efectivas para proteger a los murciélagos subterráneos. Realizamos un metaanálisis para evaluar la eficiencia de la conservación y las intervenciones de manejo para estos mamíferos. Usamos un análisis de redes para determinar el grado al que las intervenciones en pro de los murciélagos se traslapan con aquellas usadas para otros taxones subterráneos. Realizamos nuestros análisis con datos extraídos de 345 artículos que recomendaban 910 intervenciones de conservación. Se aplicó la colocación de compuertas en la entrada de los dormideros para conservar la población de murciélagos en 21 estudios, pero no quedó clara su efectividad. La restauración del hábitat y la reducción de las perturbaciones afectaron, respectivamente, a las poblaciones y al comportamiento de los murciélagos en ≤ 4 cuatro estudios. Se evaluó a la desinfección en dos estudios y ésta tuvo un efecto positivo sobre las poblaciones, particularmente en los estudios enfocados en la reducción de esporas micóticas asociadas con el síndrome de nariz blanca en América del Norte. La eficiencia del monitoreo de las poblaciones de murciélagos como una estrategia de conservación no fue clara y casi nunca se evaluó. Sólo el 4% de los estudios sobre murciélagos consideró simultáneamente a otros organismos subterráneos. Sin embargo, las intervenciones eficientes para la conservación de murciélagos tuvieron similitudes con las de todos los demás organismos. Otros organismos pueden beneficiarse si se les considera cuando se aplican las intervenciones para conservar a los murciélagos.

Review of terrestrial temporarily conserved areas in Canada, the United States, and Mexico.

The establishment of protected areas is a cornerstone of conservation, but permanent protection could be inefficient or even impossible in some situations. We synthesized the literature on temporarily conserved areas (TCAs) across Canada, the United States, and Mexico. We used a comprehensive search string to retrieve peer-reviewed articles published from 2000 to 2021 from the Web of Science. We identified 27 relevant peer-reviewed articles that examined the potential benefits of TCAs in the study area, indicating TCA is a relatively understudied area of research in the peer-reviewed literature. The TCA studies were highly clustered; 77% of studies focused on protecting a single life stage of migratory species and 61% of studies related to temporary conservation of breeding or staging habitats for migratory birds. Ninety-three percent of studies focused on preventing human-driven threats, mainly on public lands of coastal areas, the Great Plains, and the Mississippi Valley in the central United States. Short-term and experimental studies were the dominant study types. TCAs have the potential to complement permanently protected areas and provide protection when permanent protection is difficult. Some included studies examined their conservation value, but the ecological, social, and economic outcomes of TCAs are unclear. More TCA research is needed to determine the role they could play in conservation worldwide. Embracing the concept of TCAs as conservation tool could lead to more comprehensive and consistent reporting of the outcomes of temporary area-based conservation measures. However, a global review and analysis of effectiveness of TCAs will be required if they are to play a formal role in meeting international targets for biodiversity conservation.

Revisión de áreas terrestres conservadas temporalmente en Canadá, Estados Unidos y México Resumen La creación de áreas protegidas es una piedra angular de la conservación, aunque en algunos casos la protección permanente podría ser ineficiente o incluso imposible. Condensamos la literatura sobre las áreas de conservación temporal (ACT) en Canadá, Estados Unidos y México. Usamos una cadena completa de búsqueda para obtener artículos revisados por pares publicados del 2000 al 2021 en Web of Science. Identificamos 27 artículos relevantes que analizaban el potencial de las ACT en el área de estudio, lo que indica que las ACT es un área poco estudiada en la literatura revisada por pares. Los estudios sobre ACT estaban muy agrupados: el 77% se enfocaban en la protección de un solo estadio de vida de las especies migratorias y el 61% se relacionaban con la conservación temporal de los hábitats de reproducción o de descanso de las aves migratorias. El 93% de los estudios se enfocó en la prevención de amenazas causadas por humanos, principalmente en los terrenos públicos de las áreas costeras, las Grandes Llanuras y el valle del Mississippi en el centro de los Estados Unidos. Los estudios experimentales y a corto plazo fueron el tipo de estudio dominante. Las áreas de conservación temporal tienen el potencial para complementar las áreas de protección permanente y proporcionar protección cuando es complicado proporcionarla permanentemente. Algunos de los estudios incluidos analizaron el valor para la conservación de las ACT, pero aún no están claros sus resultados ecológicos, sociales y económicos. Se necesita más investigación sobre las ACT para determinar el papel que podrían tener en la conservación mundial. Si se acepta el concepto de ACT como una herramienta de conservación, se podrían reportar los resultados de las medidas de conservación basadas en las ACT de forma más completa y consistente. Sin embargo, se requerirá una revisión y análisis global de la eficiencia de las ACT si se espera que tengan un papel formal en el cumplimiento de los objetivos internacionales de la conservación de la biodiversidad.

Desenvolvimento e validação de aplicativo para ensino de abordagem da dor em cuidados paliativos / Development and validation of mobile application for teaching the subject of pain management in palliative care

Resumo Introdução: Avaliação e manejo adequados da dor têm se tornado uma preocupação cada vez maior dos profissionais de saúde. Segundo a definição de cuidados paliativos da Organização Mundial da Saúde, são importantes a identificação precoce, a avaliação e o tratamento da dor. Objetivo: Este estudo teve como objetivos desenvolver e avaliar um aplicativo para dispositivos móveis voltado para o ensino de abordagem da dor em cuidados paliativos. Método: Foi desenvolvido um aplicativo móvel, seguido de sua utilização por médicos residentes e de avaliação qualiquantitativa prospectiva. Aplicou-se o teste de conhecimento. Obtiveram-se a usabilidade do aplicativo, por meio da System Usability Scale (SUS), e a satisfação, por meio do Net Promoter Score (NPS). Os dados foram tabulados no Microsoft Office Excel® e exportados para o software Statistical Package for the Social Sciences (SPSS) versão 20.0 (IBM): na realização das análises, adotou-se uma confiança de 95%. Para a análise qualitativa das avaliações, o conteúdo das respostas foi transcrito e organizado em nuvens de palavras para destacar as ideias centrais. O estudo foi aprovado pelo Comitê de Ética do Centro Universitário Christus. Resultado: Desenvolveu-se o PaliPain App, aplicativo constituído de casos clínicos de pacientes em cuidados paliativos com manifestações de dor, além de questões, vídeos e imagens, disponibilizado nas plataformas Android e iOS. Utilizaram o aplicativo 13 médicos residentes. A média de acertos de questões no pré-teste sobre dor em cuidados paliativos aumentou de 6,08 para 7,54 após manuseio do aplicativo. Na avaliação sobre a usabilidade do aplicativo, obtivemos na SUS uma média de 89,2, acima do nível considerado adequado de 70,0. Na avaliação de satisfação, 54% dos médicos responderam com pontuação 10 à pergunta: "Em uma escala de 0 a 10, quanto você recomendaria o aplicativo PaliPain a um amigo ou colega?". Conclusão: O PaliPain App, desenvolvido e disponibilizado nas plataformas Android e iOS, foi bem avaliado pelos médicos residentes, apresentando ótimos escores de usabilidade e de satisfação. Identificamos que houve ganho de conhecimento, com pontuação média na resolução de questões aumentando de 6,08 para 7,54 após livre uso da aplicação. O PaliPain App pode ser uma ferramenta útil para ensino de abordagem de dor para médicos residentes.

Abstract Introduction: Pain evaluation has become an increasingly relevant concern for healthcare workers. According to the World Health Organization's definition of Palliative Care, early identification, evaluation, and treatment of pain are important. Objective: Developing and rating an app for mobile devices that focuses on teaching the subject of pain management in Palliative Care. Research Methodology: The app was developed as a learning tool and tested by resident physicians while undergoing a qualitative and quantitative prospective evaluation. Mock tests were taken. The usability of the app was rated through the System Usability Scale (SUS), and satisfaction with the app was rated through the Net Promoter Score (NPS). The data was charted by using Microsoft Office Excel ® and was exported to the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM) software: an analysis was run with a 95% confidence interval. As for the qualitative analysis of the resident physicians' evaluations, all available content was transcribed and properly organized in word clouds in order to highlight the most important pieces of feedback that the physicians presented regarding the app. The study was approved by the Ethics Committee. Main Results: The PaliPain App was developed as a database filled with clinical cases of patients undergoing palliative care who were experiencing varying levels of pain, and also presents analysis of test questions, videos and images. It was made available for the Android and iOS platforms. The average correct answers in a mock test about pain management during palliative care rose from 6.08 to 7.54. Thirteen resident physicians made use of the app. In the evaluation of the app's usability, the average SUS score was 89.2. In the evaluation of user satisfaction, 54% of the resident physicians answered the question "from a scale of 0 to 10, what is the likelihood of you recommending the PaliPan app to a friend or colleague?" with a score of 10. Conclusion: The PaliPain App, developed and available on Android and iOS platforms, was well evaluated by resident physicians, presenting excellent scores for both usability and satisfaction. We identified that there was a gain in knowledge, with an average score in the resolution of questions increasing from 6.08 to 7.54 after free use of the application. The PaliPan app could be a useful tool to teach the subject of pain to resident physicians.

Copaiba oil and Neem extract can be a potential alternative for the behavioral control of Sitophilus zeamais

Abstract Insects' ethology is an important factor when it is desired to carry out pest management. This knowledge makes it possible to manipulate behavioral activities, repel, or attract insects according to needs and interests. The maize weevil Sitophilus zeamais (Mots., 1855) (Coleoptera: Curculionidae), one of the main stored grain pests, has been the target of studies of behavioral changes studies through natural substances due to its resistance to different insecticidal classes. Thus, this study aimed to evaluate the effect of sublethal concentrations of neem extract and copaiba oil on the locomotor behavior of S. zeamais. The behavioral characteristic considered were walking activity, the frequency of contact of insects with the treated grain mass, and the time spent for this behavior. The walking activity of the S. zeamais increased with exposure to Neem extract and Copaiba oil. In general, the Neem extract and Copaiba oil-induced more contact with grain mass than the control, suggesting an attractive effect on the insect, however more significant for the Neem oil. The insect's behavior was altered, presenting a specific path due to Copaiba oil and Neem extract stimuli. These results indicate that Copaiba oil and Neem extract can be a potential alternative for controlling S. zeamais on stored products since changes in this pests' behavior can reduce qualitative and quantitative grain damage. Thus, the development of products based on Copaiba oil and Neem extract may be helpful for storage pest management.

Resumo A etologia dos insetos é um fator importante quando se deseja relizar manejo de pragas. Através deste conhecimento, é possível manipular atividades comportamentais, repelir, ou atrair os insetos de acordo com as necessidades e interesses. O gorgulho do milho Sitophilus zeamais (Mots., 1855) (Coleoptera: Curculionidae), uma das principais pragas de grãos armazenados tem sido alvo de estudos de alterações comportamentais através de substâncias naturais devido à sua resistência a diferentes classes de insecticidas. Assim, este estudo teve como objetivo avaliar o efeito de concentrações subletais de extrato de neem e do óleo de copaíba sobre o comportamento de movimentação de S. zeamais. As características comportamentais consideradas foram: a atividade de caminhamento, a frequência do contato dos insetos com a massa de grãos tratada, e o tempo gasto para realização destes comportamentos. A atividade de caminhamento do S. zeamais aumentou quando os insetos foram expostos ao extrato de Neem e ao óleo de copaíba. Em geral, o extrato de Neem e o óleo de Copaíba induziram mais contato com a massa de grãos do que o controle, sugerindo um efeito atrativo sobre o inseto, contudo este efeito foi mais significativo para o óleo de Neem. O comportamento do inseto foi alterado, apresentando um caminhamento específico devido aos estímulos do óleo de copaíba e do extrato de Neem. Estes resultados indicam que o óleo de copaíba e o extrato de Neem podem ser alternativas potenciais para o controle do S. zeamais em produtos armazenados, uma vez que alterações no comportamento desta praga podem reduzir os danos qualitativos e quantitativos nos grãos. Assim, o desenvolvimento de produtos baseados no óleo de copaíba e no extrato de Neem pode ser útil para o manejo de pragas de armazenamento.