Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review.

Objective: Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method: An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result: A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion: The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

Binaural Beat Effects on Attention: A Study Based on the Oddball Paradigm.

The impact of binaural beats (BBs) on human cognition and behavior remains and various methods have been used to measure their effect, including neurophysiological, psychometric, and human performance evaluations. The few approaches where the level of neural synchronicity and connectivity were measured by neuroimaging techniques have only been undertaken in spontaneous mode. The present research proposes an approach based on the oddball paradigm to study BB effect by estimating the level of attention induced by BBs. Evoked activity of 25 young adults between 19 and 24 years old with no hearing impairments nor clinical neurological history were analyzed. The experiment was conducted in two different sessions of 24.5 min. The first part consisted of 20-min BB stimulation in either theta (BBθ) or beta (BBß). After the BB stimulation, an oddball paradigm was applied in each BB condition to assess the attentional effect induced by BBs. Attention enhancement is expected for BBß with respect to BBθ. Target event related potentials (ERPs) were mainly analyzed in the time and time-frequency domains. The frequency analysis was based on continuous wavelet transform (CWT), event-related spectral perturbation (ERSP), and inter-trial phase coherence (ITPC). The study revealed that the P300 component was not significantly different between conditions (BBθ vs. BBß). However, the target grand average ERP in BBθ condition was mainly composed of 8 Hz-frequency components, appearing before 400 ms post-stimulus, and mainly on the centro-parietal regions. In contrast, the target grand average ERP in BBß condition was mainly composed of frequency components below 6 Hz, mainly appearing at 400 ms post-stimulus on the parieto-occipital regions. Furthermore, ERPs in the BBθ condition were more phase locked than the BBß condition.

Enhancing Diversity in the Ophthalmology Workforce.

Health care teams are most effective at addressing complex problems and improving health outcomes for underserved populations when team members bring diverse life experiences and perspectives to the effort. With rates of visual impairment expected to increase in the United States by 2050, especially among minority populations, diversification of the ophthalmology workforce will be critical in reducing disparities in access to and quality of vision health care. Currently, ophthalmology is less diverse with respect to race, ethnicity, and gender than graduating medical classes and other medical specialties, as well as the general US population. In addition, data on diversity in sexual orientation and gender identity, socioeconomic status, and disability are lacking in ophthalmology. The Minority Ophthalmology Mentoring and Rabb-Venable Excellence in Ophthalmology Programs are examples of initiatives to increase racial and ethnic diversity in the workforce and can serve as models for increasing other aspects of inclusiveness. Other strategies for improving vision health care for all Americans include continuing to support existing diversity programs and creating new ones; addressing unconscious and implicit bias in medical school, residency, and faculty selections; conducting holistic reviews of medical school and residency applications; diversifying selection committees and leadership; and encouraging faculty development of underrepresented groups.

Esclerodermia cutánea localizada (Morfea): reporte de caso

RESUMEN La esclerodermia cutánea localizada es una enfermedad crónica del tejido conectivo, etiología desconocida, caracterizada por áreas de piel induradas. Existen varias formas. La Morfea es una enfermedad rara con incidencia de 0,3-3 casos por 100.000 habitantes / año. Más común en mujeres, proporción 4:1 mujer/hombre. Mujer, 21 años acude al Servicio de Dermatología del Hospital de Clínicas por cuadro de 3 años de evolución de mancha roja en cadera de lado derecho que luego se vuelve marrón, aparece luego otra lesión similar en muslo y rodilla derechos con misma evolución, sin desencadenante aparente ni síntomas acompañantes. Al examen físico se observa varias placas hipocrómicas algunas con bordes eritematosos, entre 2-3 cm, límites netos y bordes irregulares distribuidos en muslo derecho. Placas hipercrómicas induradas entre 1-6 cm de diámetro, límites netos, bordes regulares en cadera y muslo derechos, y brazo izquierdo. Piel difícil de plegar. Biopsia de piel compatible con Morfea. Recibe tratamiento con hidroxicloroquina, metotrexate, corticoides tópicos, vitamina A, C, E con respuesta y evolución favorable. Esclerodermia localizada aparece en adultos entre 40- 50 años, en comparación con paciente que afectó segunda década de vida. Tronco como localización más frecuente, característica de la paciente, además en miembros superiores e inferiores. Artralgias se presentan en 44% de casos, coincidentes con la paciente. Aumento del factor reumatoideo, eosinofilia, VSG guían hacia diagnóstico de Morfea en fase activa, no apreciables en el caso. Tratamiento con metotrexate como inmunosupresor es la terapéutica con evolución favorable, así como indican estudios, complementados con hidroxicloroquina y vitaminas A y E.

ABSTRACT Localized scleroderma is a chronic connective tissue disease, unknown etiology, characterized by areas of indurated skin. There are several types. It is a rare disease with an incidence of 0.3-3 cases per 100,000 inhabitants / year. More common in Caucasian women, with a 2-4:1 female/male ratio. Woman, 21 years of age goes to the Dermatology Department of the Hospital de Clínicas for the 3-year history of the red woman on the right who later turns brown, a similar lesion appears on the right leg, apparently not trigger or symptoms companions. On physical examination, several hypochromic plaques were observed, some with erythematous borders, between 2-3 cm, net boundaries and irregular borders distributed in the right thigh. Indurated hyperchromic plates between 1 and 6 cm in diameter, net boundaries, regular edges in red and right thighs, and left side. Skin difficult to fold. Skin biopsy compatible with Morphea. Treated with hydroxychloroquine, methotrexate, topical corticosteroids, vitamin A, C, E with response and favorable evolution. Localized scleroderma appears in adults between 40-50 years, in comparison with the patient who affected the second decade of life. The trunk as the most frequent location, found in the patient, also in the upper and lower limbs. Join pains are presented in 44% of cases. Increase of the rheumatoid factor, eosinophilia, VSG guide to the diagnosis of Morphea in active phase, not appreciable in the case. Treatment with methotrexate as an immunosuppressant is the appropriate therapy, as indicated by studies, supplemented with hydroxychloroquine and vitamins A and E.

Greener synthesis of chemical compounds and materials.

Modern trends in the greener synthesis and fabrication of inorganic, organic and coordination compounds, materials, nanomaterials, hybrids and nanocomposites are discussed. Green chemistry deals with synthesis procedures according to its classic 12 principles, contributing to the sustainability of chemical processes, energy savings, lesser toxicity of reagents and final products, lesser damage to the environment and human health, decreasing the risk of global overheating, and more rational use of natural resources and agricultural wastes. Greener techniques have been applied to synthesize both well-known chemical compounds by more sustainable routes and completely new materials. A range of nanosized materials and composites can be produced by greener routes, including nanoparticles of metals, non-metals, their oxides and salts, aerogels or quantum dots. At the same time, such classic materials as cement, ceramics, adsorbents, polymers, bioplastics and biocomposites can be improved or obtained by cleaner processes. Several non-contaminating physical methods, such as microwave heating, ultrasound-assisted and hydrothermal processes or ball milling, frequently in combination with the use of natural precursors, are of major importance in the greener synthesis, as well as solventless and biosynthesis techniques. Non-hazardous solvents including ionic liquids, use of plant extracts, fungi, yeasts, bacteria and viruses are also discussed in relation with materials fabrication. Availability, necessity and profitability of scaling up green processes are discussed.

Genetic parenthood and causation: An objection to Douglas and Devolder's modified direct proportionate genetic descent account.

In a recent publication Tom Douglas and Katrien Devolder have proposed a new account of genetic parenthood, building on the work of Heidi Mertes. Douglas and Devolder's account aims to solve, among other things, the question of who are the genetic parents of an individual created through somatic cell nuclear transfer (i.e. cloning): (a) the nuclear DNA provider or (b) the progenitors of the nuclear DNA provider. Such a question cannot be answered by simply appealing to the folk account of genetic parenthood, according to which the genetic parents of an individual are those individuals who produced the egg and sperm, respectively, which fused to create the embryo. It cannot be so as in cloning there is no fertilization as such. In this article I critically examine Douglas and Devolder's new account of genetic parenthood and demonstrate that it is vulnerable to counterexamples that exploit the lack of a condition specifying that genetic parents should cause a child's coming into existence.

Priorities and Future Actions for an Effective Use of Phytotherapy in Livestock-Outputs from an Expert Workshop.

This study reflects on the recognised need for more joined-up, high-quality research on phytotherapy that addresses the current societal challenges in finding alternatives to the use of antibiotics. The study applied a multidisciplinary participatory approach in an expert workshop exercise within the FP7 EU IMPRO project. Prior to this study, a literature review was elaborated on research in the field of phytotherapy as applied to farm animals, cooperation between research bodies and initiatives to reduce the use of antibiotics by using phytotherapeutic remedies. The review was delivered to the participants of the workshop so as to receive feedback on it and enrich the discussion. Different expertise, background in research or veterinary practice, and varying positions regarding phytotherapy were the criteria in targeting participants. A structured workshop was subsequently organised, with questions to experts addressing scientific validation of phytotherapy, effective treatment under farm conditions and necessary developments for the future. Challenges identified by the experts were as follows: poor study designs, lack of reproducibility of studies, poor standardisation of products, cost-benefit concerns, lack of veterinarian training and poor data availability. To overcome obstacles, the need for improved study designs for clinical trials was given priority in order to prove the efficacy of remedies and to implement a monitoring system which enables the assessment of the effectiveness of treatments in farm practice. Reflections in this report are intended to be a resource for scientists, policy makers and end users for an effective use of phytotherapy at farm level.

Psoralea glandulosa as a potential source of anticancer agents for melanoma treatment.

With the aim of identifying novel agents with antigrowth and pro-apoptotic activity on melanoma cancer, the present study was undertaken to investigate the biological activity of the resinous exudate of aerial parts from Psoralea glandulosa, and its active components (bakuchiol (1), 3-hydroxy-bakuchiol (2) and 12-hydroxy-iso-bakuchiol (3)) against melanoma cells (A2058). In addition, the effect in cancer cells of bakuchiol acetate (4), a semi-synthetic derivative of bakuchiol, was examined. The results obtained show that the resinous exudate inhibited the growth of cancer cells with IC50 value of 10.5 µg/mL after 48 h of treatment, while, for pure compounds, the most active was the semi-synthetic compound 4. Our data also demonstrate that resin is able to induce apoptotic cell death, which could be related to an overall action of the meroterpenes present. In addition, our data seem to indicate that the apoptosis correlated to the tested products appears, at least in part, to be associated with an increase of reactive oxygen species (ROS) production. In summary, our study provides the first evidence that P. glandulosa may be considered a source of useful molecules in the development of analogues with more potent efficacy against melanoma cells.

Impedance spectroscopy assisted by magnetic nanoparticles as a potential biosensor principle for breast cancer cells in suspension.

Breast cancer (BC) is the leading cause of cancer death in women worldwide, with a higher mortality reported in undeveloped countries. Ideal adjuvant therapeutic strategies require the continuous monitoring of patients by regular blood tests to detect circulating cancer cells, in order to determine whether additional treatment is necessary to prevent cancer dissemination. This circumstance requires a non-complex design of tumor cell biosensor in whole blood with feasibility for use in poor regions. In this work we have evaluated an inexpensive and simple technique of relative bioimpedance measurement, assisted by magnetic nanoparticles, as a potential biosensor of BC cells in suspension. Measurements represent the relative impedance changes caused by the magnetic holding of an interphase of tumor cells versus a homogenous condition in the frequency range of 10-100 kHz. The results indicate that use of a magnet to separate tumor cells in suspension, coupled to magnetic nanoparticles, is a feasible technique to fix an interphase of tumor cells in close proximity to gold electrodes. Relative impedance changes were shown to have potential value as a biosensor method for BC cells in whole blood, at frequencies around 20 kHz. Additional studies are warranted with respect to electrode design and sensitivity at micro-scale levels, according to the proposed technique.

Antifungal study of the resinous exudate and of meroterpenoids isolated from Psoralea glandulosa (Fabaceae).

ETHNOPHARMACOLOGICAL RELEVANCE: Psoralea glandulosa L. (Fabaceae) is a medicinal resinous shrub used in Chilean folk medicine as antiseptic in treatment of infections and skin diseases caused by bacteria and fungus. AIM OF THE STUDY: To evaluate the in vitro antifungal activity of the resin and the active components from P. glandulosa against clinical yeast isolates. MATERIALS AND METHODS: Active compounds were obtained of the resinous exudate from aerial parts of P. glandulosa. Eight species of yeast were exposed to the resin and two major compounds. Minimum inhibitory concentration (MIC(80)) was determined according to the standard broth microdilution method. RESULTS: Bakuchiol and 3-hydroxy-bakuchiol demonstrated potent activity with the MIC(80) ranging from 4 to >16 and 0.125 to 16 µg/mL, respectively. The resin had some degree of antifungal activity. CONCLUSIONS: The overall results provided important information for the potential application of the 3-hydroxy-bakuchiol from P. glandulosa in the therapy of serious infection and skin diseases caused by clinical yeast.

Two novel ternary albendazole-cyclodextrin-polymer systems: dissolution, bioavailability and efficacy against Taenia crassiceps cysts.

The effect of two water-soluble polymers: pectin and polyvinylpyrrolidone in combination with beta-cyclodextrin, on the dissolution, bioavailability and cysticidal efficacy of albendazole was evaluated using a commercial suspension as reference product. The dissolution of the albendazole-beta-cyclodextrin-pectin formulation was slow and incomplete (44.7%). No statistical differences in C(max) and AUC were found between this formulation and the reference. Also its cysticidal efficacy (33%) was similar to the reference (38%). The albendazole-beta-cyclodextrin-polyvinylpyrrolidone formulation exhibited the highest dissolution rate (78.5%) and its bioavailability was also significantly increased (2.3-fold). In addition, the cysticidal activity of this formulation (83%) was greater than a commercial suspension. Our results suggest that the ternary system of albendazole-beta-cyclodextrin-polyvinylpyrrolidone could be a potential alternative for the treatment of systemic helmintic diseases and it is worth to continue its preclinical evaluation.

Caracterización epidemiológica de la psoriasis en el Hospital Militar Central / Epidemiological characterization of psoriasis in the Central Military Hospital

Introducción: La psoriasis (Psa) es una enfermedad inflamatoria crónica recidivante mediada por el linfocito T, caracterizada por una hiperproliferación epidérmica. Se encuentra poca información disponible de la caracterización epidemiológica de esta enfermedad en la población colombiana; por esta razón, es imperativo establecer modelos de observación y seguimiento que puedan dar claridad del origen, los factores relacionados, el curso clínico y el pronóstico de la enfermedad en nuestro medio, de tal forma que existan elementos que permitan comparar su comportamiento frente a otros grupos poblacionales. Objetivo: Describir las características epidemiológicas y clínicas en los pacientes con psoriasis atendidos en el Servicio de Dermatología del Hospital Militar Central (HOMIC). Materiales y métodos: Es un estudio de corte transversal de una cohorte prospectiva de pacientes con psoriasis, en el cual se incluyó a 86 pacientes con diagnóstico clínico e histológico de psoriasis valorados entre julio de 2007 y julio de 2008 en el servicio de dermatología del HOMIC, a quienes se les diligenció un formato de historia clínica que incluía características epidemiológicas, clínicas, cuantificación del Indice de Severidad Area de Psoriasis (PASI) e Índice de Calidad de Vida Dermatológica (DLQI). Las variables fueron analizadas en el programa estadístico SPSS versión 11.5 para Windows. Resultados: Se incluyó a 86 pacientes (61.6% hombres y 38.4% mujeres) con edad promedio de 54 años; el 63.3% eran casados y el 14%, solteros. La raza mestiza fue predominante. Según su estado socioeconómico el 50% pertenecía al estrato tres. La mayoría de pacientes iniciaron su enfermedad después de los 50 años en promedio y al examen físico presentaban una psoriasis vulgar (89%), seguida de la gutata (7%); el compromiso ungueal fue de 26.7% y se observó principalmente los pits y la onicolisis. La media del PASI fue de 7.8, valor que clasifica la severidad de la enfermedad en tipo leve. En cuanto a tratamiento el 100% habían recibido tratamiento tópico mientras el 54% habían utilizado algún tipo de tratamiento sistémico; con respecto a esto los corticoides tópicos y la fototerapia eran los más utilizados. Conclusiones: La caracterización clínica y epidemiológica de la psoriasis en el Hospital Militar Central fundamenta el soporte para consolidar una cohorte en la población colombiana que sirva de base estadística para dirigir proyectos multidisciplinarios en instituciones de salud encaminados al estudio y manejo efectivo de la enfermedad.

Estudio preliminar en pacientes con fibrosis quística / Preliminary study in patients with cystic fibrosis

La Fibrosis Quística (FQ), enfermedad congénita y hereditaria cuyas manifestaciones clínicas a nivel del sistema respiratorio y digestivo llevan al paciente a una desnutrición progresiva yrepetidos eventos de manifestaciones de estos dos sistemas con el consecuente ingreso prolongado. Se realizó un estudioexperimental preclínico con el fin de evaluar los resultados del tratamiento homeopático en pacientes portadores de FQ de la provincia de Camagüey atendidos en el Hospital PediátricoProvincial en el período de enero del 2004 a diciembre del 2006. Se constató como resultado global una mejor calidad de vida con disminución de síntomas, aumento de peso, ganancia en calidad de la actividad física y una recuperación psicosocial.

Estudio preliminar en pacientes con fibrosis quística / Preliminary study in patients with cystic fibrosis

La Fibrosis Quística (FQ), enfermedad congénita y hereditaria cuyas manifestaciones clínicas a nivel del sistema respiratorio y digestivo llevan al paciente a una desnutrición progresiva yrepetidos eventos de manifestaciones de estos dos sistemas con el consecuente ingreso prolongado. Se realizó un estudioexperimental preclínico con el fin de evaluar los resultados del tratamiento homeopático en pacientes portadores de FQ de la provincia de Camagüey atendidos en el Hospital PediátricoProvincial en el período de enero del 2004 a diciembre del 2006. Se constató como resultado global una mejor calidad de vida con disminución de síntomas, aumento de peso, ganancia en calidad de la actividad física y una recuperación psicosocial.(AU)

Eficacia de la terapia floral en el tratamiento de la diversidad / Effectiveness of flower therapy in the treatment of diversity

Con el propósito de evaluar la eficacia de la terapia floral en estudiantes con necesidades educativas especiales de medicina, enfermería y estomatología se realizó en ensayo clínico fase II temprana, abierto, no secuencial y unicéntrico desde el 2001 hasta el 2002. Los trastornos de atención detectados fueron eliminados en un gran número de estudiantes, se mantuvieron en una minoría que presentó, además, coeficiente de inteligencia inferior al término medio o deficiente. Existió una mejoría significativa en el rendimiento docente como resultado de la aplicación de las esencias florales. No se constataron reacciones adversas

Eficacia de la terapia floral en el tratamiento de la diversidad / Effectiveness of flower therapy in the treatment of diversity

Con el propósito de evaluar la eficacia de la terapia floral en estudiantes con necesidades educativas especiales de medicina, enfermería y estomatología se realizó en ensayo clínico fase II temprana, abierto, no secuencial y unicéntrico desde el 2001 hasta el 2002. Los trastornos de atención detectados fueron eliminados en un gran número de estudiantes, se mantuvieron en una minoría que presentó, además, coeficiente de inteligencia inferior al término medio o deficiente. Existió una mejoría significativa en el rendimiento docente como resultado de la aplicación de las esencias florales. No se constataron reacciones adversas(AU)

Homeopatia en la remodelacion osea / Homeopathy in osseous remodeling

Se presenta el caso de un paciente de 8 anos de edad con fractura desplazada del 1/3 superior de humero izquierdo. Se inicia tratamiento homeopatico con Calcarea carbonica 30c. A los 15 dias se formo un buen callo oseo y en los siguientes 20 dias el humero remodela totalmente.

Homeopatia en la remodelacion osea / Homeopathy in osseous remodeling

Se presenta el caso de un paciente de 8 anos de edad con fractura desplazada del 1/3 superior de humero izquierdo. Se inicia tratamiento homeopatico con Calcarea carbonica 30c. A los 15 dias se formo un buen callo oseo y en los siguientes 20 dias el humero remodela totalmente.(AU)