An Analysis of the Correlates of Aggression in a Social Learning Program for Severely and Persistently Mentally Ill Inpatients.

PURPOSE: This study aimed to examine the relationship between behavioral variables and aggression among severely and chronically mentally ill inpatients in a Social Learning Program (SLP) at a state psychiatric facility. METHODS: Using archival data over a 24-month period, a total of 23 severely and chronically mentally ill inpatients comprised the sample in this study. The predictor variables included length of current hospitalization; length of stay on SLP; basic activities of daily living (ADLs); instrumental ADLs; attendance in programming; participation in programming; and the number of minor, major, and intolerable infractions received. The criterion variable was number of aggressive episodes (e.g., hitting persons or objects). RESULTS: Results of a standard multiple regression analysis indicated an overall model of two predictors (intolerable infractions and instrumental ADLs) that significantly predicted number of aggressive episodes. Findings suggested that SLP patients who have a tendency to be aggressive are able to adequately and concurrently complete daily hygiene needs and participate in scheduled treatment groups and activities. DISCUSSION: Our findings provide valuable information regarding aggressive tendencies that can inform treatment planning. Specifically, our results suggested there are not necessarily obvious warning signs for aggression among severely and persistently mentally ill inpatients. Rather, other individualized patient factors may be at play in the expression of aggressive impulses, emphasizing the importance of adequate staff-to-patient ratios so that care planning and implementation can be appropriately individualized.

Movement strategies during obstacle crossing in people with Parkinson disease: A systematic review with meta-analysis.

OBJECTIVE: Navigating obstacles involves adjusting walking patterns, particularly when stepping over them. This task may be particularly challenging for people with Parkinson disease (PD) for several reasons. This review aims to compare the spatiotemporal gait parameters of people with and without PD while stepping over obstacles. LITERATURE SURVEY: A systematic literature search was conducted in six databases (PubMed, Scopus, Web of Science, EBSCO, Embase, and SciELO) from inception to September 2023. METHODOLOGY: Studies were selected that evaluated gait parameters of people with and without PD while walking over obstacles. Two independent researchers evaluated the eligibility and extracted gait parameters during obstacle crossing. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Heterogeneity was assessed using I2-tests. Random effects models were determined for effect sizes as standardized mean differences (SMD). SYNTHESIS: Twenty-five studies were included in the review and 17 in the meta-analysis. Most of the studies (58%) showed a low risk of bias. People with PD exhibit a shorter step when landing after crossing an obstacle (SMD = -0.50 [-0.69 to -0.31]). Compared to people without PD, people with PD also widen their support base (SMD = 0.27 [0.07-0.47]) and reduce gait velocity (SMD = -0.60 [-0.80 to -0.39]) when crossing the obstacle. CONCLUSIONS: People with PD adopt a more conservative motor behavior during obstacle crossing than those without PD, with a shorter step length when landing after crossing an obstacle, greater step width and lower crossing speed.

Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

Marketing your practice in a social world.

Social media use has moved beyond just being a way for family and friends to keep in touch. Now it is imperative that all businesses implement a social media strategy into their overall marketing plan. Medical practices are no exception. Using social media within your medical practice will allow you take your marketing to a new level of success. It also allows you to connect with patients on a more personal, less corporate level.

Measuring Pressure Redistribution Properties of 4 Hospital Bed Surfaces: A Quality Improvement Project.

BACKGROUND: Pressure ulcers/injuries are not only prevalent in the long-term care facilities but also in the acute care setting. Pressure ulcer development has many contributing factors, including prolonged high surface interface pressure between the skin and mattress surface. PURPOSE: The purpose of this quality improvement project was to measure the pressure redistribution properties of 4 hospital surfaces. METHODS: Pressure measurements were performed on 8 participants lying on 1) standard mattress; 2) standard mattress with a static, air-filled bed overlay placed on top of it; 3) mattress with pulsing technology; and 4) mattress with immersing technology. Participants were volunteers measured while lying in the supine position and, in one instance, in the prone position. Pressures were measured with a full-body interface pressure mapping system. RESULTS: Of the 4 surfaces evaluated, the surface that provided the most effective pressure redistribution properties was the combination of the standard viscoelastic mattress with the static, air-filled overlay. CONCLUSION: These results can help guide surface choice for providing the best pressure redistribution properties in order to help prevent pressure ulcers/injuries.

Human Activity in Antarctica: Effects on Metallic Trace Elements (MTEs) in Plants and Soils.

Colobanthus quitensis (Kunt) is one of the two vascular plant species present in Antarctica and develops under severe environmental conditions, being found in both pristine and human-threatened environments. We determined the Cd, Cr, Cu, Mn, Ni, Pb, and Zn levels in C. quitensis roots, leaves, and soils of origin using flame atomic absorption spectroscopy. In January 2017, we collected samples from four geographical zones on the longitudinal gradient along which C. quitensis is distributed, starting from Punta Arenas (PAR) at the extreme south of mainland Chile and moving southwards to the Antarctic territory from King George Island (KGI) to Hannah Point Peninsula (PHA) and finally Lagotellerie Island (LAT). We used certified reference material to validate the plant tissues and soil samples we collected. The highest concentrations of metals that we measured in the soils and in the C. quitensis roots and leaves were in samples we collected at the KGI station, the zone with the greatest human activity. The lowest concentrations we measured were at the LAT station, an island with little human intervention and scarce fauna. The mean concentrations of metals in the roots and leaves of C. quitensis followed a similar order at all sampling locations: Mn > Zn > Cu > Ni > Pb > Cr > Cd. In contrast, in soil, they followed the following order: Mn > Zn > Cu > Cr > Pb > Ni > Cd. The concentration levels obtained for the different metals in the soil and plants tissue samples in this region of Antarctica indicated that the area was non-polluted. However, the metallic trace element (MTE) concentrations may be at an early stage of contamination, as described in other areas of the Antarctic, being a new threat to this continent.

Guía de práctica clínica para el diagnóstico y tratamiento de la distrofia muscular de Duchenne. Sociedad Peruana de Neurología. Versión Corta / Clinical Practice Guidelines for diagnosis and treatment of Duchenne muscular dystrophy. Peruvian Neurology Society. Short Version

RESUMEN Objetivo : Elaborar una guía de práctica clínica peruana para el diagnóstico y tratamiento de la Distrofia Muscular de Duchenne y Becker (DMD). Materiales y métodos : Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas en neurología, neuropediatría, genética y metodología. El GEG formuló ocho preguntas para desarrollar las recomendaciones de la Guía de Práctica Clínica (GPC). Se realizó una búsqueda sistemática en Medline, Scopus y CCRT durante el periodo enero-abril 2021 para responder a las preguntas PICO. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados : Las preguntas PICO, se orientaron para explorar el tamizaje, diagnóstico y tratamiento de la DMD. Se formularon 15 recomendaciones (10 fuertes, 5 condicionales) y 11 puntos de buena práctica clínica Conclusión : Se presenta la guía para el diagnóstico y tratamiento de la DMD, elaborada bajo una metodología basada en las evidencias actuales.

ABSTRACT Objective : to provide evidence-based clinical recommendations for the diagnosis and treatment of Duchenne Muscular Dystrophy. Methods : a guideline development group (GEG) was formed that included specialized physicians in the fields of neurology, neuropediatrics, genetics, and methodology. The GEG asked eight clinical questions to be answered by recommendations in this clinical practice guidelines (CPG). We conducted a systematic search and - when deemed relevant - primary studies in Medline, Scopus, and the Cochrane Controlled Register of Trials during 2021 were reviewed. Evidence was selected to answer each of the clinical questions posed. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and a diagnosis and treatment flowchart. Results : this CPG addressed eight clinical questions, divided into three topics: screening, diagnosis, and treatment. Based on these questions, fifteen recommendations were formulated (10 strong, 5 conditional) and 11 points for good clinical practice. Conclusion : this paper summarizes the methodology and evidence- based conclusions of the CPG for the diagnosis and treatment of Duchenne muscular dystrophy.

Participación política de las estudiantes de Enfermería bajo la noción de servicio: opinión de las actoras / Política de estudantes de Enfermagem no México. Opinião dos atores / Poltical Participation of nursing students in Mexico. Actors opinion

Objetivo: Estudiar los factores que han influido en la participación política de los estudiantes de Enfermería en México en la segunda década del siglo XXI. Metodología: Es un estudio exploratorio, cualitativo e interpretativo, basado en la Sociología de las Profesiones y el enfoque estructural funcionalista; la población de estudio fueron ocho enfermeras, el análisis de contenido se realizó através de una categorización abierta, definiendo cuatro categorías: 1) Características de las estudiantes de enfermería, 2) Actitudes de las estudiantes de enfermería durante su formación, 3) Enseñanza de los Profesores y 4) Reflexiones sobre la escasa participación política de los estudiantes de Enfermería. Resultados: Los resultados se ven impregnados de las vivencias y experiencias de las participantes, sin embargo, ellas destacan que su participación y actitudes políticas tienen una base en la formación y la influencia de los profesores, el estudio refleja su preocupación para que las nuevas generaciones de enfermeras y enfermeros tengan la posibilidad de adquirir nuevas visiones. Conclusiones: Los resultados permiten reconocer que la política de las estudiantes de enfermería es una asignatura pendiente en México, hecho que permite reconsiderar la noción de servicio del personal de enfermería, reafirmando y difundiendo la importancia social que tiene la profesión.

Adaptación del modelo de Kristen Swanson para el cuidado de enfermería en adultas mayores / Adaptação do modelo de Kristen Swanson para cuidados de enfermagem em mulheres idosas / Adaptation of the model of Kristen Swanson for nursing care of elderly women

RESUMEN Objetivo: adaptar el modelo de Kristen M. Swanson para el cuidado de enfermería en adultas mayores, enfocado en sus necesidades de salud, tomando como referencia la valoración integral y la interpretación de su vivencia. Método: el estudio fue cualitativo con enfoque hermenéutico. Se entrevistaron diez adultas mayores, de 65 a 84 años de edad, que asistían la Casa de Día en Toluca, a quienes se les aplicaron entrevistas semiestructuradas a profundidad, las cuales se transcribieron, codificaron y agruparon en las dimensiones de análisis de los contenidos centrales de cada unidad temática. Se tomó como referencia el círculo hermenéutico de Heidegger para la comprensión e interpretación de los códigos sustantivos. El análisis fue de contenido mediante la técnica del discurso. Resultados: son seis las categorías de cuidado identificadas en las acciones terapéuticas que intervienen para el logro del bienestar. El acompañamiento familiar, la esperanza, el movimiento, la orientación en salud, el diálogo terapéutico y el amor son factores que propician el bienestar de las mujeres mayores. La disposición de las categorías se organizaron en campos semánticos de donde emergieron tres dimensiones: la de ser mujer, adulta mayor y estrategias de afrontamiento, y el cuidado de enfermería. A partir del análisis hermenéutico se construyó el Modelo de Kristen Swanson para el cuidado de enfermería en adultas mayores con sus cinco procesos de cuidado: Mantener las creencias; El conocer; El estar con; El hacer por; y El permitir o posibilitar. Conclusión: el modelo de cuidado dirigido a mujeres mayores se fundamenta en: el diálogo, esperanza, movimiento y orientación de salud centrado en el ejercicio de la autonomía.

RESUMO Objetivo: adaptar o modelo de Kristen M. Swanson para o cuidado de enfermagem em idosos, com foco em suas necessidades de saúde, tendo como referência a avaliação e interpretação abrangente de sua experiência. Método: estudo qualitativo com abordagem hermenêutica, onde foram entrevistadas dez idosas, com idade entre 65 e 84 anos, que frequentavam uma Casa de Dia em Toluca, a quem foram aplicadas entrevistas semi-estruturadas em profundidade, as quais foram transcritas, codificadas e agrupadas. nas dimensões da análise dos conteúdos centrais de cada unidade temática. O círculo hermenêutico de Heidegger foi tomado como referência para a compreensão e interpretação dos códigos substantivos. A análise foi de conteúdo através da técnica do discurso. Resultados: existem seis categorias de cuidados identificadas nas ações terapêuticas que interferem na obtenção do bem-estar. Acompanhamento familiar, esperança, movimento, orientação em saúde, diálogo terapêutico e amor são fatores que promovem o bem-estar das mulheres idosas. A disposição das categorias foi organizada em campos semânticos, dos quais emergiram três dimensões: ser mulher, mulher idosa e estratégias de enfrentamento e cuidado de enfermagem. A partir da análise hermenêutica, foi possível construir o Modelo de Kristen Swanson para o cuidado de enfermagem de idosas com seus cinco processos de cuidado: Mantendo crenças; Sabendo; Estar com; Fazendo por; e Permitir ou habilitar. Conclusão: O modelo assistencial voltado à mulher idosa é baseado em: diálogo, esperança, movimento e orientação em saúde voltada ao exercício da autonomia.

ABSTRACT Objective: to adapt the model of Kristen M. Swanson for nursing care of elderly women, focused on their health needs, taking as a reference the comprehensive assessment and interpretation of their experience. Method: the study was qualitative with hermeneutic approach, ten elderly women were interviewed, aging from 65 to 84 years old, who attended a Day House in Toluca, to whom semi-structured interviews were applied in depth, which were transcribed, codified and grouped in the dimensions of the central contents analysis of each thematic unit. Heidegger's hermeneutic circle was taken as a reference for the understanding and interpretation of the substantive codes. The analysis was of content through the discourse technique. Results: there are six categories of care identified in the therapeutic actions that intervene in the achievement of well-being. Family accompaniment, hope, movement, guidance in health, therapeutic dialogue and love are factors that promote the well-being of elderly women. The disposition of the categories was organized into semantic fields from which three dimensions emerged: that of being a woman, elderly woman and coping strategies, and nursing care. From the hermeneutic analysis, it was possible to buildup the Model of Kristen Swanson for nursing care of elderly women with their five healthcare processes: Maintaining beliefs; Knowing; Being with; Doing by; and Allowing or enabling. Conclusion: the care model aimed at elderly women is based on: dialogue, hope, movement and health guidance focused on the exercise of autonomy.

Evaluación de la exposición a benceno en trabajadores de diferentes áreas laborales / Assessment of benzene's exposure at different work areas

Resumen Objetivo: Evaluar niveles de ácido trans, transmucónico (AttM) y su relación con parámetros hematimétricos y hepáticos en trabajadores expuestos a benceno en Valencia (Venezuela). Sujetos y métodos: Se desarrolló una investigación descriptiva, correlational, con diseño no experimental, de campo y transversal. Se analizaron muestras de 2 grupos de trabajadores expuestos a benceno: 30 trabajadores de una planta de empaques (TPE), 18 trabajadores de estaciones de servicio (TES) y un grupo control (GC) de 22 individuos. La medición del AttM se realizó en muestras de orina recolectadas al final de la jornada laboral, y fueron analizadas por cromatografía líquida de alta resolución con detección ultravioleta (HPLC-UV).Se determinó la biometría hemática y transaminasas (TGO y TGP). Se utilizó estadística no paramétrica para analizar los resultados. Resultados: Al comparar los valores de AttM se observaron diferencias significativas entre los grupos (TPE: 2,47; TES: 0,94; GC: 0,34 mg.g -1 creat); el hábito tabáquico no representó un factor influyente para los resultados. Los parámetros hematológicos y transaminasas para todos los grupos se observaron dentro de los valores de referencia; el contaje de plaquetas mostró correlación significativa (p= 0,033) con el biomarcador en los grupos expuestos. Conclusión: el AttM permitió evaluar la exposición ocupacional al benceno en los grupos estudiados, y presentó correlación significativa con el contaje de plaquetas, sin que este parámetro hematológico se observe alterado en comparación con los valores de referencia.

Abstract Objective: to evaluate trans, trans - muconic acid levels (ttMA) and its relationship with hematimetric and liver parameters in workers exposed to benzene in Valencia (Venezuela). Subjects and methods: A descriptive and correlational research, no experimental design, field and cross, was developed. Samples of 2 groups of workers exposed to benzene were analyzed: 30 workers at a packaging plant (PPW) and 18 employees, gas stations attendants (GSA), besides, 22 individuals in a control group. ttMA measurement was performed on urines samples collected at the end of the workday and were analyzed by high performance liquid chromatography with ultraviolet detection (HPLC-UV). Hematological and hepatics parameters (GOTand GPT) were determined in blood samples blood. Non parametric statistics were used to analyze the results Results: When comparing ttMA values, significant differences between groups were observed (PPW: 2,47; GSA 0,94; CG: 0,34 mg.g -1 creat); Smoking status not represent influential factor for the results. Hematological parameters and transaminases for all groups were inside reference values; platelet count showed significant correlation (p= 0,033) with biomarker in exposed groups. Conclusion: ttMA allowed to evaluate occupational exposure to benzene in the groups studied. It was observed significant correlation with platelet count, without alteration in the hematological parameter when compared with the reference value.

When motion is not perceived: evidence from adaptation and dynamical stability.

Adaptation was used to probe the perceiver's activation state when either motion or nonmotion percepts are formed for bistable, single-element apparent motion stimuli. Although adaptation was not observed in every instance, when it was observed its effect was to increase the probability of both motion-to-nonmotion and nonmotion-to-motion switches, the time scale of adaptation corresponding to neurophysiological observations for directionally selective cortical cells (Giaschi et al. 1993). This susceptibility to de-stabilizing adaptation effects indicated that the nonmotion percept was not the result of inadequate stimulation producing subthreshold levels of motion detector activation; if that were the case, activation-dependent adaptation would have decreased the nonmotion-to-motion switching rate by reducing activation further below threshold. Above-threshold activation levels are therefore associated with both nonmotion and motion perceptual states, and the failure to perceive motion despite the presence of adequate motion detector stimulation can be attributed to inhibitory competition between detectors activated by motion-specifying stimulus information and detectors activated to similar levels by motion-independent stimulus information, consistent with the dynamical quality of single-element apparent motion.