Home-based educational interventions for family caregivers of older adults after stroke: a scoping review.

OBJECTIVE: To map home-based educational interventions for family caregivers of older adults after stroke. METHOD: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used. RESULTS: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers. CONCLUSION: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.

Home-based educational interventions for family caregivers of older adults after stroke: a scoping review / Intervenções educativas domiciliares para cuidadores familiares de idosos pós-AVC: revisão de escopo / Intervenciones educativas domiciliarias para cuidadores familiaresde adultos mayores después de un accidente cerebrovascular:revisión de alcance

ABSTRACT Objective: To map home-based educational interventions for family caregivers of older adults after stroke. Method: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used. Results: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers. Conclusion: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.

RESUMO Objetivo: Mapear intervenções educativas domiciliares para cuidadores familiares de idosos pós-AVC. Método: Revisão de escopo baseada na metodologia JBI, realizada em 23 de maio de 2023. Foram utilizados o aplicativo Rayyan e Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Resultados: Dos 1.705 estudos, foram incluídos nove publicados de 2006 a 2020: 44% das intervenções foram educativas teórico-práticas; 77,7% eram ensaios clínicos randomizados; e a intervenção "presencial" (56%) foi a mais comum, realizada por enfermeiros em 88,9% dos casos. Foram realizadas de três a 15 sessões de 42 minutos. Os conteúdos educativos foram organizados em dez categorias, divididas em educação voltada ao cuidado do idoso e autocuidado ao cuidador. Conclusão: As intervenções educativas identificadas fortalecem os conhecimentos e habilidades dos participantes em áreas como educação, cuidado, comunicação, autogestão, reabilitação e nutrição, bem como autocuidado para auxiliar com segurança os idosos em suas atividades diárias.

RESUMEN Objetivo: Mapear las intervenciones educativas domiciliarias para cuidadores familiares de adultos mayores después de un accidente cerebrovascular. Método: Revisión de alcance basada en la metodología del JBI realizada el 23 de mayo de 2023. Se utilizó el aplicativo Rayyan y Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Resultados: De 1.705 estudios, se incluyeron nueve publicados del 2006 al 2020: el 44% de las intervenciones fueron educativas teórico-prácticas; el 77,7% fueron ensayos clínicos aleatorizados; y la intervención "cara a cara" (56%) fue el más común, entregadas por enfermeras en 88,9% de casos. Se realizaron de tres a 15 sesiones de 42 minutos. Los contenidos educativos se organizaron en diez categorías divididas en educación dirigida al cuidado del adulto mayor y al autocuidado del cuidador. Conclusión: Las intervenciones educativas identificadas fortalecen los conocimientos y habilidades de los participantes en áreas como la educación, cuidado, comunicación, autogestión, rehabilitación y nutrición, así como al autocuidado para asistir de forma segura al adulto mayor en sus actividades cotidianas.

Aplicaciones móviles para el autoaprendizaje en el cuidador del adulto mayor con accidente cerebrovascular: Revisión integradora / Mobile applications for self-learning in the caregiver of the elderly with stroke: integrative review

Resumen Objetivo: Analizar la evidencia disponible en la literatura sobre intervenciones con aplicaciones móviles para favorecer el autoaprendizaje de atención y asistencia en el cuidador primario del adulto mayor, con secuelas físicas de accidente cerebrovascular. Material y Métodos: Revisión integradora de la literatura publicada entre Enero de 2018 y Junio 2022 en las bases de datos CINAHL, EMBASE, LILACS, PubMed, Scopus y EBSCOhost. Los datos obtenidos se analizaron en cuatro etapas: identificación del tema, muestreo, selección y categorización de estudios y análisis, evaluación e interpretación de resultados bajo el método CASPe. Resultados: 2 fueron cualitativos y 1 cuantitativo; las intervenciones digitales fueron: mHealth, Movies4Stroke y MoCaB utilizadas para el autoaprendizaje y asistencia en el cuidador primario en las dimensiones control de la presión arterial, glucosa, colesterol y adherencia farmacológica. Las intervenciones educativas digitales aumentan el autoaprendizaje y facilita la atención en el cuidador del adulto mayor con secuelas físicas por accidente cerebrovascular. Conclusiones: Las intervenciones educativas digitales para el autoaprendizaje y asistencia en el cuidador primario desde la evidencia científica son mínimas. Es necesario diseñar intervenciones digitales accesibles, dinámicas y de fácil interacción para el autoaprendizaje en la generación de habilidades de cuidados en el encargado primario del adulto mayor con secuelas físicas post accidente cerebrovascular.

Abstract Objective: To analyze the evidence available in the literature on interventions with mobile applications to promote self-learning of care and assistance in the primary caregiver of the elderly with physical sequelae of stroke. Material and Methods: Integrative review of the literature published between January 2018 and June 2022 in the CINAHL, EMBASE, LILACS, PubMed, Scopus and EBSCOhost databases. The data obtained was analyzed in four stages: theme identification, sampling, selection and categorization of studies and analysis, evaluation and interpretation of results under the CASPe method. Results: 2 were qualitative and 1 quantitative; the digital interventions were: mHealth, Movies4Stroke and MoCaB used for self-learning and assistance in the primary caregiver in the dimensions of blood pressure control, glucose, cholesterol and pharmacological adherence. Digital educational interventions increase self-learning and facilitate care in the caregiver of the elderly with physical sequelae due to stroke. Conclusions: Digital educational interventions for self-learning and assistance in the primary caregiver from the scientific evidence are minimal. It is necessary to design accessible, dynamic and easy-to-interact digital interventions for self-learning in the generation of care skills in the primary caregiver of the elderly with post-stroke physical sequelae.

[Procalcitonin as sepsis predictor in cardiovascular surgery with cardiopulmonary bypass]. / Procalcitonina como predictor de sepsis en cirugía cardiovascular con circulación extracorpórea.

Background: Cardiopulmonary bypass generates an exacerbated response that may lead to sepsis. Objective: To describe the association between procalcitonin levels and sepsis diagnosis in cardiovascular surgery subjects with cardiopulmonary bypass. Methods: A case-series study was conducted in 142 patients. Serum procalcitonin levels were measured at 24 hours and at 72 hours after surgery using a point of care testing based on quantitative immunochromatographic method. To assess association between procalcitonin levels and sepsis status, we calculated area under the curve (AUC) and sensitivity, specificity, and predictive values for the best cut-off point. Results: From 142 patients studied, 7 developed sepsis after surgery (4.9%). For 24-hours procalcitonin levels AUC was 0.921 and best cut-off point was 3.8 ng/mL (sensitivity 0.857 and specificity 0.904). In the case of 72-hours procalcitonin levels, we observed a value of 0.868 for AUC and best cut-off point was 8.4 ng/mL (sensitivity 0.86 and specificity 0.97). Conclusions: Procalcitonin levels at 24 and 72 hours after cardiovascular surgery with cardiopulmonary bypass are associated with sepsis presence at cut-off points of 3.8 and 8.4 ng/mL respectively.

Introducción: la circulación extracorpórea durante la cirugía cardiovascular genera una respuesta exacerbada que puede asociarse con sepsis. Objetivo: describir la asociación entre los niveles de procalcitonina y el diagnóstico de sepsis en sujetos de cirugía cardiovascular con circulación extracorpórea. Material y métodos: se realizó un estudio de serie de casos en 142 pacientes. Los niveles de procalcitonina fueron medidos a las 24 horas y a las 72 horas después de la cirugía. Para evaluar la asociación entre los niveles de procalcitonina y la identificación de sepsis, se calculó el área bajo la curva (AUC) y la sensibilidad y especificidad identificando el mejor punto de corte. Resultados: de un total de 142 pacientes estudiados, 7 desarrollaron sepsis (4.9%). En los niveles de procalcitonina en las 24 horas, el AUC fue de 0.921 y el mejor punto de corte fue 3.8 ng/mL (sensibilidad de 0.857 y especificidad de 0.904). En el caso de los niveles de procalcitonina a las 72 horas, observamos un AUC de 0.868 y el mejor punto de corte fue 8.4 ng/mL (sensibilidad de 0.86 y especificidad de 0.97). Conclusiones: los niveles de procalcitonina a las 24 y 72 horas de la cirugía cardiovascular con circulación extracorpórea se asociaron con la presencia de sepsis con los puntos de corte de 3.8 ng/mL y 8.4 ng/mL respectivamente.

Magnetogenetic cell activation using endogenous ferritin.

The ability to precisely control the activity of defined cell populations enables studies of their physiological roles and may provide therapeutic applications. While prior studies have shown that magnetic activation of ferritin-tagged ion channels allows cell-specific modulation of cellular activity, the large size of the constructs made the use of adeno-associated virus, AAV, the vector of choice for gene therapy, impractical. In addition, simple means for generating magnetic fields of sufficient strength have been lacking. Toward these ends, we first generated a novel anti-ferritin nanobody that when fused to transient receptor potential cation channel subfamily V member 1, TRPV1, enables direct binding of the channel to endogenous ferritin in mouse and human cells. This smaller construct can be delivered in a single AAV and we validated that it robustly enables magnetically induced cell activation in vitro . In parallel, we developed a simple benchtop electromagnet capable of gating the nanobody-tagged channel in vivo . Finally, we showed that delivering these new constructs by AAV to pancreatic beta cells in combination with the benchtop magnetic field delivery stimulates glucose-stimulated insulin release to improve glucose tolerance in mice in vivo . Together, the novel anti-ferritin nanobody, nanobody-TRPV1 construct and new hardware advance the utility of magnetogenetics in animals and potentially humans.

Transition to the Role of Family Caregiver of Older Adults After a Stroke: A Specific Theory / Transición del rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular (ACV): teoría específica / Transição ao papel de cuidador familiar no idoso após acidente vascular cerebral (AVC): teoria específica

Introduction: Nursing professionals develop situation-specific theories to describe, explain, and provide comprehensive care during a family member's transition to the caregiver role. Objective: To develop a situation-specific theory about the transition to the role of family caregiver of older adults after a stroke. Methodology: The integrating approach by Meleis and Im was applied, which consists of five stages: 1) Description of the context and target population, 2) Verification of assumptions regarding the philosophical stance, 3) Exploration of multiple sources, 4) Theorization of concepts, and 5) Proposal of empirical indicators for validation and verification. Results: The prescriptive theory was developed in the light of Afaf Meleis' Theory of Transitions and was supported by an exhaustive literature review, with four underlying concepts: Situational transition to the family caregiver role, Care-related knowledge and skills, Self-confidence and coping in adopting the caregiver role, and Nursing therapeutic education. The following assumption emerges from these concepts: a healthy transition to the family caregiver role is directly dependent on the care-related knowledge and skills provided by Nursing therapeutic education to develop self-confidence and coping in adopting the caregiver role. Conclusions: The proposal provides a conceptual framework that identifies the transition challenges and needs faced by family caregivers to adopt the role of caregivers of older adults after a stroke.

Introducción: los profesionales de enfermería desarrollan teorías de situación específica para describir, explicar y proporcionar cuidados integrales durante la transición del familiar al rol cuidador. Objetivo: desarrollar una propuesta de teoría de situación específica sobre la transición al rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular. Metodología: se aplicó el enfoque integrador de Meleis e Im, que consta de cinco etapas: 1) descripción del contexto y población blanco; 2) comprobación de suposiciones en relación con la postura filosófica; 3) exploración de múltiples fuentes; 4) teorización de conceptos; y 5) propuesta de indicadores empíricos para la validación y comprobación. Resultados: la teoría prescriptiva fue desarrollada a la luz de la teoría de las transiciones de Afaf Meleis y se apoyó en una revisión exhaustiva de literatura, con cuatro conceptos subyacentes: transición situacional del rol cuidador familiar, conocimiento y habilidad del cuidado, confianza y afrontamiento en la adopción del rol cuidador, y educación terapéutica de enfermería. A partir de estos, surge la siguiente proposición: la transición saludable al rol cuidador familiar depende directamente de los conocimientos y habilidades de cuidado que brinda la terapéutica de enfermería para el desarrollo de confianza y afrontamiento en la adopción del rol cuidador. Conclusiones: la propuesta proporciona un marco conceptual que identifica los desafíos y necesidades de transición de los cuidadores familiares para la adopción del rol cuidador de la persona adulta mayor post accidente cerebrovascular.

Introdução: os profissionais de enfermagem desenvolvem teorias específicas para descrever, explicar e prestar cuidados holísticos durante a transição do familiar para o papel de cuidador. Objetivo: desenvolver uma proposta de teoria específica sobre a transição para o papel de cuidador familiar do idoso pós-AVC. Metodologia: foi aplicada a abordagem integrativa de Meleis e Im, composta por cinco etapas: 1) descrição do contexto e da população-alvo; 2) teste de hipóteses em relação à postura filosófica; 3) exploração de múltiplas fontes; 4) teorização de conceitos; e 5) proposta de indicadores empíricos para validação e teste. Resultados: a teoria prescritiva foi desenvolvida à luz da teoria das transições de Afaf Meleis e com o suporte de uma revisão exaustiva da literatura, com quatro conceitos subjacentes: transição situacional do papel de cuidador familiar, conhecimentos e competências de cuidado, confiança e enfrentamento na adoção do papel de cuidador e educação terapêutica em enfermagem. Destes conceitos emerge a seguinte proposição: a transição saudável para o papel de cuidador familiar depende diretamente do conhecimento e das competências de cuidado proporcionadas pela enfermagem terapêutica para o desenvolvimento de confiança e capacidade de enfrentamento na adoção do papel de cuidador. Conclusões: A proposta fornece um quadro conceitual que identifica os desafios e as necessidades de transição dos cuidadores familiares na adoção do papel de cuidador do idoso após acidente vascular cerebral (AVC).

Microorganisms isolated in patients with post-cardiac surgery mediastinitis at a cardiology hospital of Mexico City.

INTRODUCTION: Mediastinitis after cardiovascular surgery gives rise to prolonged hospital stay and increased medical care costs, and is associated with high in-hospital mortality. OBJECTIVE: To describe the clinical characteristics of patients with post-surgical mediastinitis, including the isolated microorganisms, resistance profile, and in-hospital survival. METHODS: Cross-sectional study of patients with bacteriologically-confirmed post-surgical mediastinitis cared for at a cardiology hospital in Mexico City between January 2017 and March 2019. RESULTS: Fifty-eight cases of mediastinitis were included. Median age was 67 years. Most subjects were males who underwent myocardial revascularization. During in-hospital follow-up, all-cause and mediastinitis-related mortality were 27.6% and 20.7%, respectively. Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli were the most commonly isolated microorganisms. High resistance to methicillin was found in coagulase-negative staphylococci, as well as high expression of extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae strains. CONCLUSIONS: High mortality and significant antimicrobial resistance were found in patients with post-cardiac surgery mediastinitis.

INTRODUCCIÓN: La mediastinitis posterior a cirugía cardiovascular deriva en estancia hospitalaria prolongada e incremento de los costos de la atención médica, y se asocia a elevada letalidad hospitalaria. OBJETIVO: Describir las características clínicas de los pacientes con mediastinitis posquirúrgica, incluyendo los microorganismos aislados, perfil de resistencia y supervivencia hospitalaria. MÉTODOS: Estudio transversal de pacientes con mediastinitis posquirúrgica bacteriológicamente confirmada, atendidos en un hospital de cardiología de la Ciudad de México entre enero de 2017 y marzo de 2019. RESULTADOS: Se incluyeron 58 casos de mediastinitis. La mediana de edad fue de 67 años. La mayoría de los sujetos fueron varones sometidos a revascularización miocárdica. Durante el seguimiento hospitalario, la letalidad por todas las causas y la secundaria a la mediastinitis fueron de 27.6 y 20.7 %, respectivamente. Los microorganismos más frecuentemente aislados fueron Staphylococcus aureus, Staphylococcus epidermidis y Escherichia coli. Se encontró alta resistencia a meticilina en los estafilococos coagulasa negativos y alta expresión de betalactamasas de espectro extendido en cepas de Escherichia coli y Klebsiella pneumoniae. CONCLUSIONES: En los pacientes con mediastinitis posquirúrgica analizados se observó alta letalidad e importante resistencia antimicrobiana.

Microorganismos aislados en pacientes con mediastinitis poscirugía cardiaca en un hospital de cardiología de la Ciudad de México / Microorganisms isolated in patients with post-cardiac surgery mediastinitis at a cardiology hospital of Mexico City

Resumen Introducción: La mediastinitis posterior a cirugía cardiovascular deriva en estancia hospitalaria prolongada e incremento de los costos de la atención médica, y se asocia a elevada letalidad hospitalaria. Objetivo: Describir las características clínicas de los pacientes con mediastinitis posquirúrgica, incluyendo los microorganismos aislados, perfil de resistencia y supervivencia hospitalaria. Métodos: Estudio transversal de pacientes con mediastinitis posquirúrgica bacteriológicamente confirmada, atendidos en un hospital de cardiología de la Ciudad de México entre enero de 2017 y marzo de 2019. Resultados: Se incluyeron 58 casos de mediastinitis. La mediana de edad fue de 67 años. La mayoría de los sujetos fueron varones sometidos a revascularización miocárdica. Durante el seguimiento hospitalario, la letalidad por todas las causas y la secundaria a la mediastinitis fueron de 27.6 y 20.7 %, respectivamente. Los microorganismos más frecuentemente aislados fueron Staphylococcus aureus, Staphylococcus epidermidis y Escherichia coli. Se encontró alta resistencia a meticilina en los estafilococos coagulasa negativos y alta expresión de betalactamasas de espectro extendido en cepas de Escherichia coli y Klebsiella pneumoniae. Conclusiones: En los pacientes con mediastinitis posquirúrgica analizados se observó alta letalidad e importante resistencia antimicrobiana.

Abstract Introduction: Mediastinitis after cardiovascular surgery gives rise to prolonged hospital stay and increased medical care costs, and is associated with high in-hospital mortality. Objective: To describe the clinical characteristics of patients with post-surgical mediastinitis, including the isolated microorganisms, resistance profile, and in-hospital survival. Methods: Cross-sectional study of patients with bacteriologically-confirmed post-surgical mediastinitis cared for at a cardiology hospital in Mexico City between January 2017 and March 2019. Results: Fifty-eight cases of mediastinitis were included. Median age was 67 years. Most subjects were males who underwent myocardial revascularization. During in-hospital follow-up, all-cause and mediastinitis-related mortality were 27.6% and 20.7%, respectively. Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli were the most commonly isolated microorganisms. High resistance to methicillin was found in coagulase-negative staphylococci, as well as high expression of extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae strains. Conclusions: High mortality and significant antimicrobial resistance were found in patients with post-cardiac surgery mediastinitis.

Sociodemography and epidemiology of the population attended in a psychological care center in Mexico / Sociodemografía y epidemiología de la población atendida en un centro de atención psicológica en México

Abstract: Objective: It was to analyze the sociodemographic and diagnostic characteristics of the population attending psychotherapy. Materials and Method: Design was quantitative, descriptive, retrospective and longitudinal of 322 files. Results: It was found that the majority is male (60%), young (33%), Catholic (81%) and with basic school (26%). Females present more anxiety disorders (56%), related to trauma and stressors (71.4%), personality (75%), primary support group (65%), child neglect (80%), abuse (71.4%) and others related to social environment (62.5%). Males had neurodevelopmental (100%), impulse control/behavioral (70%) and family upbringing (54.4%) problems. Most frequent problems are the parent-child relationship (14.6%), conflicts with the partner (8.9%) and life phase (6.1%). Conclusions: Instead of individual problems, most of population (especially women) attended derive from difficulties in their environment (insecurity, poverty) or from the lack of social skills to manage their interpersonal relationships in an assertive manner (parenting styles, resolution of couple problems). Aggressive masculinity is present in many situations, even when patients did not realize it when attending the service.

Resumen: Objetivo: Fue analizar las características sociodemográficas y diagnósticas de la población en psicoterapia. Materiales y Método: Diseño cuantitativo, descriptivo, retrospectivo y longitudinal de 322 expedientes. Resultados: La mayoría es masculina (60%), joven (33%), católica (81%) y con secundaria (26%). Las mujeres presentan más trastornos de ansiedad (56%), relacionados con traumas y estresores (71,4%), personalidad (75%), grupo de apoyo primario (65%), abandono infantil (80%), abuso (71,4%) y otros relacionados con el entorno social (62,5%). Los varones tenían problemas de neurodesarrollo (100%), control de impulsos/conducta (70%) y educación familiar (54,4%). Los problemas más frecuentes son la relación padre-hijo (14,6%), los conflictos con la pareja (8,9%) y la fase vital (6,1%). Conclusiones: En lugar de tratarse de problemáticas individuales, la mayoría de los problemas (especialmente para las mujeres) se derivan de las dificultades de su entorno (inseguridad, pobreza) o de la falta de habilidades sociales para manejar sus relaciones interpersonales de manera asertiva (estilos de crianza, resolución de problemas de pareja). La masculinidad agresiva se encuentra presente en muchas de las situaciones atendidas, aún cuando los pacientes no habían tomado conciencia de ello al llegar al servicio.

Intervención educativa sobre cuidado espiritual para estudiantes de licenciatura en enfermería y obstetricia / Spiritual care educational intervention for undergraduate nursing and midwifery students

Para los estudiantes de enfermería es indispensable la formación en el cuidado espiritual para identificar y satisfacer las propias necesidades espirituales y las de las personas que cuidarán, la dimensión espiritual es inherente al ser humano, para abordarla se requieren conocimientos que lleven a la reflexión e interés en la atención desde una perspectiva integral.

For nursing students, training in spiritual care is essential to identify and satisfy their own spiritual needs and those of the people they will care for; the spiritual dimension is inherent to the human being, and to address it requires knowledge that leads to reflection and interest in care from an integral perspective.

Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019.

Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients. Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis. Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p < 0.001). Log2-aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log2-EASIX (p < 0.001). For log2 aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4-6.5%], high (6-7) of 17.2% (95% CI = 14.7-19.6%), and very high (>7) of 47.6% (95% CI = 44.2-50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%. Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.

La salud y su cuidado como relación cultural intersubjetiva: reflexión fenomenológica en Schütz / Health and care as an intersubjective cultural relationship: phenomenological reflection in Schütz

Resumen El objetivo del presente ensayo fue reflexionar en torno a la salud y cuidado como relación cultural intersubjetiva, retomando algunos conceptos de Alfred Schütz como intersubjetividad, cultura y mundo de la vida. La salud comprende un significado objetivo y a la vez uno subjetivo, su cuidado dependerá de la conciencia de las personas y su intencionalidad; además se determina también por una conciencia colectiva. Se destaca el papel de la cultura como una forma de comunicación relacional entre seres humanos y entre varios conocimientos que dependen de las formas de vida que se mantienen por generaciones y que siguen teniendo diversas formas de vivencia de la salud. Se concluye que la salud debe ser un valor en un sentido ampliamente estricto, donde se considere la perspectiva social y la recreación de significados en torno a la vivencia; es decir, la convivencia social otorga significados que son visibles en la vida cotidiana. Es imperante para los profesionales de enfermería y de la salud integrar la cultura como una forma de acercamiento al cuidado de la salud.

Abstract The objective of this essay was to reflect on health and care as an intersubjective cultural relationship, taking up some of Alfred Schütz's concepts such as intersubjectivity, culture and the world of life. Health comprises an objective meaning and at the same time a subjective one, its care will depend on the conscience of the people and their intention; furthermore it is also determined by a collective conscience. It highlights the role of culture as a form of relational communication between human beings and between various knowledge that depend on the life forms that are maintained for generations and that continue to have various forms of health experience. It is concluded that health must be a value in a broadly strict sense, where the social perspective and the recreation of meanings around the experience are considered; In other words, social coexistence grants meanings that are visible in everyday life. It is imperative for nursing and health professionals to integrate culture as a way of approaching health care.

Resumo O objetivo deste ensaio foi refletir sobre saúde e cuidados como uma relação cultural intersubjetiva, retomando alguns dos conceitos de Alfred Schütz, como intersubjetividade, cultura e mundo da vida. A saúde compreende um significado objetivo e, ao mesmo tempo, subjetivo, seu cuidado dependerá da consciência das pessoas e sua intencionalidade; além disso, é também determinado por uma consciência coletiva. Destaca-se o papel da cultura como forma de comunicação relacional entre seres humanos e entre vários conhecimentos que dependem dos modos de vida mantidos por gerações e que continuam a ter diferentes formas de vivenciar a saúde. Conclui-se que a saúde deve ser um valor em sentido amplo, onde são consideradas a perspectiva social e a recriação de significados em torno da experiência; Em outras palavras, a coexistência social concede significados visíveis no dia a dia. É imperativo que os profissionais de enfermagem e saúde integrem a cultura como forma de abordar os cuidados de saúde.

Trascendencia espiritual, oportunidad de cuidadores informales de personas mayores: revisión integrativa desde la filosofía de Watson / Transcendência espiritual, oportunidade de portadores informais de idosos: revisão integrativa da filosofia de Watson / Spiritual transcendence, opportunity of informal careers of the elderly: integrative review from the Watson philosophy

Resumen: Introducción: Integrar la espiritualidad en el cuidado es un reto para enfermería que aún no se ha logrado superar por completo. El envejecimiento poblacional y el aumento de las multimorbilidades han incrementado la dependencia de las personas mayores y, por ende, la demanda de cuidadores informales. Países europeos han enfrentado estas transiciones desde hace años por lo que cuentan con estrategias innovadoras para el cuidado de ambos sujetos; sin embargo, en Latinoamérica este panorama aún se encuentra en vías de desarrollo. La filosofía de Jean Watson propone ideas vanguardistas para lograr la humanización del cuidado enfermero dentro de las que se destaca la capacidad de trascendencia del espíritu dependiendo de la fortaleza de la misma. Objetivo: Identificar las zonas de oportunidad que pueden propiciar la trascendencia espiritual de los cuidadores informales hacia las personas mayores a su cuidado tomando en cuenta las premisas básicas de la filosofía de Jean Watson y considerando solo bibliografía con población Iberoamericana. Métodos: Revisión integrativa de la literatura; se seleccionaron artículos que abordan la espiritualidad de cuidadores informales de personas mayores, aunque no sea el tema central, desarrollados en población de habla hispana y portuguesa entre los años 2010 y 2019 en idioma inglés, español y portugués de las bases de datos PubMed, Biblioteca Virtual en Salud (BVS), Cochrane, Lilacs, Scielo, CUIDEN y EBSCO host. Resultados: Se seleccionaron 6 artículos de investigación procedentes de las bases de datos PubMed y Biblioteca Virtual en Salud. En todos los casos se observa un fuerte apego espiritual por parte de los cuidadores informales; una de las prácticas religiosas más recurrentes de los cuidadores informales es la oración como una forma de comunicación y de sentirse cerca de un poder superior seguido de la participación frecuente en cultos y eventos propios de la religión. Discusión: De acuerdo con la filosofía de Jean Watson las relaciones humanas intensas producen un enlazamiento del espíritu de los participantes, enlace a través del cual es posible el reflejo del espíritu propio en el de la otra persona. Conclusión: Existe oportunidad para la trascendencia del espíritu dado el trabajo espiritual de los cuidadores informales.

Resumo: Introdução: Integrar a espiritualidade no cuidado é um desafio para a enfermagem que ainda não foi completamente superado. O envelhecimento da população e o aumento das multimorbidades aumentaram a dependência do idoso e, portanto, a demanda por cuidadores informais. Os países europeus enfrentam essas transições há anos, portanto têm estratégias inovadoras para o atendimento de ambos os assuntos; no entanto, na América Latina esse panorama ainda está em desenvolvimento. A filosofia de Jean Watson propõe idéias de vanguarda para alcançar a humanização da assistência de enfermagem, dentre as quais se destaca a capacidade de transcendência do espírito, dependendo de sua força. Objetivo: Identificar as áreas de oportunidade que possam propiciar a importância espiritual dos cuidadores informais para os idosos em seus cuidados, levando em consideração as premissas básicas da filosofia de Jean Watson e considerando apenas a bibliografia com a população ibero-americana. Métodos: Revisão integrativa da literatura; foram selecionados artigos que abordavam a espiritualidade de cuidadores informais de idosos, mesmo que não seja o tema central, desenvolvido na população de língua espanhola e portuguesa entre 2010 e 2019 em inglês, espanhol e português nas bases de dados PubMed, Biblioteca Virtual em Saúde (BVS), Cochrane, Lilacs, Scielo, CUIDEN e EBSCO host. Resultados: Seis artigos de pesquisa foram selecionados nas bases de dados PubMed e Virtual Health Library. Em todos os casos, um forte apego espiritual é observado pelos cuidadores informais; uma das práticas religiosas mais recorrentes dos cuidadores informais é a oração como forma de comunicação e a sensação de poder próximo ao poder superior, seguido pela participação frequente em serviços e eventos religiosos. Discussão: Segundo a filosofia de Jean Watson, relações humanas intensas produzem um elo entre o espírito dos participantes, um elo através do qual a reflexão do próprio espírito é possível na da outra pessoa. Conclusão: Há uma oportunidade para a transcendência do espírito, dada a obra espiritual dos cuidadores informais.

Abstract: Introduction: Integrating spirituality into care is a challenge for nursing that has not yet been completely overcome. Population aging and the increase in multimorbidities have increased the dependence of the elderly and, therefore, the demand for informal caregivers. European countries have faced these transitions for years so they have innovative strategies for the care of both subjects; However, in Latin America this panorama is still in development. The philosophy of Jean Watson proposes avant-garde ideas to achieve the humanization of nursing care, among which the capacity of transcendence of the spirit is highlighted, depending on its strength. Objective: To identify the areas of opportunity that can propitiate the spiritual importance of informal caregivers towards the elderly in their care, taking into account the basic premises of Jean Watson's philosophy and considering only bibliography with Ibero-American population. Methods: Integrative review of the literature; Articles were selected that addressed the spirituality of informal caregivers of the elderly, even if it is not the central theme, developed in the Spanish and Portuguese-speaking population between 2010 and 2019 in English, Spanish and Portuguese in the PubMed, BVS, Cochrane, Lilacs, Scielo, CUIDEN and EBSCO host databases. Results: Six research articles were selected from the PubMed and BVS databases. In all cases a strong spiritual attachment is observed by informal caregivers; one of the most recurrent religious practices of them is prayer as a form of communication and feeling close to higher power followed by frequent participation in religious services and events. Discussion: According to Jean Watson's philosophy, intense human relationships produce a link between the spirit of the participants, a link through which the reflection of one's own spirit is possible in that of the other person. Conclusion: There is an opportunity for the transcendence of the spirit given the spiritual work of informal caregivers.

Necesidades psicoemocionales del anciano hospitalizado en el sector público / Psychoemotional needs of hospitalized elderly in the public sector

Resumen Las necesidades psicoemocionales en los ancianos es un tema que ha cobrado interés recientemente; estudios relacionados hacen referencia al vínculo entre los problemas psicoemocionales y la calidad de vida de estos pacientes. El objetivo fue determinar las necesidades psicoemocionales más frecuentes en ancianos hospitalizados (AH) en el sector público. Estudio cuantitativo descriptivo, no experimental y transversal con 49 ancianos. Los resultados indicaron niveles bajos de ansiedad (68%) y depresión (98%), altos niveles de soporte social (89%) y calidad de vida (98%), y nivel medio de autoestima (92%). Se observó correlación positiva entre ansiedad y depresión (r = 0.547 p = 0.000), así como negativa entre depresión, autoestima y calidad de vida (r = 0.579 p = 0.000 y r = 0.399 p = 0.005). La depresión fluctuó en 33.5% (r2 ) de los casos ante la variación en la autoestima. Se concluye que la necesidad psicoemocional más frecuente es fortalecer la autoestima y disminuir la ansiedad, sobre todo en mujeres (52.38% con niveles moderado o grave). Se propone acompañamiento psicológico de primer nivel y uso de una batería para tamizaje de aplicación rápida por parte del personal de salud.

Abstract The psycho-emotional needs of the elderly are a topic that has gained recent interest; related studies refer to the link between psychoemotional problems and the quality of life of the elderly. The objective was to determine the most frequent psychoemotional needs of elderly people in hospital (EPIH) in the public sector. A quantitative, descriptive, non-experimental, cross-sectional study of 49 elderly people. The results indicated low levels of anxiety (68%) and depression (98%), high levels of social support (89%) and quality of life (98%), and average self-esteem (92%). Positive correlation was observed between anxiety and depression (r = 0.547 p = 0.000), as well as negative correlation between depression, self-esteem and quality of life (r = 0.579 p = 0.000 and r = 0.399 p = 0.005). Depression varied in 33.5% (r2) of cases due to variation in self-esteem. We conclude that the most frequent psychoemotional need is to strengthen self-esteem and reduce anxiety, especially in women (52.38% with moderate or severe levels). First-level psychological support and the use of a battery for rapid screening by health personnel is proposed.

A longitudinal MRI study on lymph nodes histiocytosis of a xenograft cancer model.

BACKGROUND: Efforts are continuously made to detect and investigate the pivotal processes and interplay between the response of sentinel lymph node and malignant cells from a primary tumor. Conversely, some frequently used tumor animal models, such as human cancer xenografts, rarely feature metastasis. Therefore, lymph node alterations are seldom assessed. We consider that studying lymph node response could contribute to the understanding of host reaction to cancer. In the present study, we explored the presence of regional lymph node alterations in parallel with tumor growth using a pancreatic tumor xenograft model which does not develop metastasis. METHODS AND FINDINGS: We established an animal cancer model by the subcutaneous inoculation of PANC-1 (a metastatic human pancreatic cancer cell line) in the left upper flank of athymic nude mice. Tumor animals, along with controls (n = 7 / group) were subjected to Magnetic Resonance Imaging (MRI) in order to follow tumor growth and brachial and axillary lymph nodes alterations over several weeks. Further histological analyses were performed at the end of the study. The individual average of the different lymph nodes sizes was 15-40% larger in the tumor animals compared to control animals at week 8 to week 20. The tumor size and lymph node size were not correlated. Histological analysis of the lymph nodes showed paracortical histiocytosis. No metastasis to lymph nodes could be detected by histology. In tumor bearing animals, histiocytosis was associated with isolated apoptotic bodies and migration of human tumoral cells was confirmed by specific immunostaining of human origin markers. CONCLUSIONS: The lack of metastasis as well as the pathological manifestation of the lymph node alteration in this pre-clinical model established here parallels findings in patients with sinus histiocytosis that is correlated with improved survival.

Fast T1 and T2 mapping methods: the zoomed U-FLARE sequence compared with EPI and snapshot-FLASH for abdominal imaging at 11.7 Tesla.

OBJECTIVE: A newly adapted zoomed ultrafast low-angle RARE (U-FLARE) sequence is described for abdominal imaging applications at 11.7 Tesla and compared with the standard echo-plannar imaging (EPI) and snapshot fast low angle shot (FLASH) methods. MATERIALS AND METHODS: Ultrafast EPI and snapshot-FLASH protocols were evaluated to determine relaxation times in phantoms and in the mouse kidney in vivo. Owing to their apparent shortcomings, imaging artefacts, signal-to-noise ratio (SNR), and variability in the determination of relaxation times, these methods are compared with the newly implemented zoomed U-FLARE sequence. RESULTS: Snapshot-FLASH has a lower SNR when compared with the zoomed U-FLARE sequence and EPI. The variability in the measurement of relaxation times is higher in the Look-Locker sequences than in inversion recovery experiments. Respectively, the average T1 and T2 values at 11.7 Tesla are as follows: kidney cortex, 1810 and 29 ms; kidney medulla, 2100 and 25 ms; subcutaneous tumour, 2365 and 28 ms. CONCLUSION: This study demonstrates that the zoomed U-FLARE sequence yields single-shot single-slice images with good anatomical resolution and high SNR at 11.7 Tesla. Thus, it offers a viable alternative to standard protocols for mapping very fast parameters, such as T1 and T2, or dynamic processes in vivo at high field.

Functional Single-Chain Polymer Nanoparticles: Targeting and Imaging Pancreatic Tumors in Vivo.

The development of tools for the early diagnosis of pancreatic adenocarcinoma is an urgent need in order to increase treatment success rate and reduce patient mortality. Here, we present a modular nanosystem platform integrating soft nanoparticles with a targeting peptide and an active imaging agent for diagnostics. Biocompatible single-chain polymer nanoparticles (SCPNs) based on poly(methacrylic acid) were prepared and functionalized with the somatostatin analogue PTR86 as the targeting moiety, since somatostatin receptors are overexpressed in pancreatic cancer. The gamma emitter 67Ga was incorporated by chelation and allowed in vivo investigation of the pharmacokinetic properties of the nanoparticles using single photon emission computerized tomography (SPECT). The resulting engineered nanosystem was tested in a xenograph mouse model of human pancreatic adenocarcinoma. Imaging results demonstrate that accumulation of targeted SCPNs in the tumor is higher than that observed for nontargeted nanoparticles due to improved retention in this tissue.

Reversal of hyperglycemia by insulin-secreting rat bone marrow- and blastocyst-derived hypoblast stem cell-like cells.

ß-cell replacement may efficiently cure type 1 diabetic (T1D) patients whose insulin-secreting ß-cells have been selectively destroyed by autoantigen-reactive T cells. To generate insulin-secreting cells we used two cell sources: rat multipotent adult progenitor cells (rMAPC) and the highly similar rat extra-embryonic endoderm precursor (rXEN-P) cells isolated under rMAPC conditions from blastocysts (rHypoSC). rMAPC/rHypoSC were sequentially committed to definitive endoderm, pancreatic endoderm, and ß-cell like cells. On day 21, 20% of rMAPC/rHypoSC progeny expressed Pdx1 and C-peptide. rMAPCr/HypoSC progeny secreted C-peptide under the stimulus of insulin agonist carbachol, and was inhibited by the L-type voltage-dependent calcium channel blocker nifedipine. When rMAPC or rHypoSC differentiated d21 progeny were grafted under the kidney capsule of streptozotocin-induced diabetic nude mice, hyperglycemia reversed after 4 weeks in 6/10 rMAPC- and 5/10 rHypoSC-transplanted mice. Hyperglycemia recurred within 24 hours of graft removal and the histological analysis of the retrieved grafts revealed presence of Pdx1-, Nkx6.1- and C-peptide-positive cells. The ability of both rMAPC and HypoSC to differentiate to functional ß-cell like cells may serve to gain insight into signals that govern ß-cell differentiation and aid in developing culture systems to commit other (pluripotent) stem cells to clinically useful ß-cells for cell therapy of T1D.

Factores que generan angustia en el servicio de urgencias del Hospital San Jose / Factors that produce anguish in the Hospital San Jose emergency service

El presente trabajo tiene por objetivo determinar las diferentes causas de angustia en el paciente, familia, personal medico y de enfermeria en el servicio de urgencias del Hospital San Jose de Bogota. El personal asignado al servicio de urgencias esta distribuido en tres turnos: manana, tarde y noche. Ademas del personal fijo de urgencias se cuenta con la colaboracion de los especialistas fijos de turno. El paciente que ingresa al servicio de urgencias del Hospital de San Jose, se siente angustiado principalmente por estar lejos de sus familiares, por el costo de hospitalizacion y por los cambios que debe realizar en sus actividades; ademas siente temor a dolor y la muerte. Desde el ingreso al servicio el paciente y la familia experimentan angustia, y aun antes; lo que nos hace ver la necesidad de tener una persona destinada a orientar y a informar al paciente y familia. Es necesario que el personal reconozca la necesidad del paciente y de la familia de tener informacion sobre su situacion para sentirse mas seguro e incluso colaborar mas en su recuperacion. Los pacientes consideran que el trato de los medicos es mas cordial que el dado por el personal de enfermeria. Cualquier procedimiento que se le realice al paciente le causa angustia, y mas si no sabe en que consiste el procedimiento y si este les va producir dolor. El personal medico y de enfermeria debe tener siempre presente que el paciente le teme a todo aquello que le es desconocido, por lo tanto les debe dar una explicacion de los procedimientos a realizar. Uno de los factores ambientales que mas..