Defining the Denominator for Measuring Quality of End-of-Life Care in Children with Cancer: Results of a Nominal Group Technique.

OBJECTIVE: To determine which groups of children with cancer for whom to apply the newly developed quality measures (QMs) for end-of-life (EOL) care. STUDY DESIGN: In a series of nominal groups, panelists answered the question: "Which children, diagnoses, conditions, or prognoses should be included when examining the quality of EOL care for children with cancer?" In each group, individual panelists proposed answers to the question. After collating individual responses, each panelist ranked their 5 top answers and points were assigned (5 pts for the best answer, 4 pts the second best, etc.). A team of pediatric oncology and palliative care clinician-scientists developed and applied a coding structure for responses and associated themes and subthemes for responses. RESULTS: We conducted 5 nominal groups with a total of 44 participants. Most participants identified as female (88%) and non-Hispanic White (86%). Seventy-nine percent were clinicians, mainly in pediatric palliative care, pediatric oncology, or hospice; 40% were researchers and 12% were bereaved parents. Responses fell into 5 themes: (1) poor prognosis cancer; (2) specific treatment scenarios; (3) certain populations; (4) certain symptoms; and (5) specific utilization scenarios. Poor prognosis cancer and specific treatment scenarios received the most points (320 pts [49%] and 147 pts [23%], respectively). CONCLUSIONS: Participants developed a framework to identify which children should be included in EOL QMs for children with cancer. The deliberate identification of the denominator for pediatric QMs serves as a potent tool for enhancing quality, conducting research, and developing clinical programs.

Elaboración de modelos dentales didácticos en resina epóxica / Elaboration of didactic dental models in epoxy resin

Los modelos de estudio son un registro fundamental para el diagnóstico, el plan de tratamiento, la presentación de caso y la evaluación del progreso del tratamiento dental; son registros anatomofisiológicos de las arcadas dentarias que sirven para evaluar la dentición en los tres planos del espacio y la oclusión en la relación cúspide-fosa, en una dimensión estática y dinámica. Para obtener los modelos de estudio es imprescindible obtener impresiones totales con diversos materiales de impresión de los arcos dentarios, que reproduzcan fielmente todos los detalles anatómicos, para posteriormente obtener un modelo en yeso piedra. Los modelos obtenidos a partir de una impresión generalmente son a base de yeso odontológico, los cuales a pesar de sus mejoras aún conservan algunas características negativas como: baja resistencia a la fractura por impacto, baja resistencia al desgaste por abrasión, inestabilidad dimensional y radiopacidad que impide la simulación de procedimientos endodóncicos. Con la finalidad de mejorar la simulación en la práctica odontológica, se usa la resina epóxica que puede emplearse en la obtención de modelos, este material es más resistente y presenta una mayor resistencia a la abrasión; además es radiolúcido, por lo que es útil para la réplica de preparaciones y procedimientos de simulación endodóntica. Los detalles de la superficie obtenidos con resina epóxica son superiores a los obtenidos con yeso. El uso de simuladores es una herramienta educativa con la que se favorece la adquisición de ciertas habilidades, destrezas, técnicas y competencias necesarias para la formación de estudiantes o profesionales de odontología. En el presente trabajo se describe la técnica para la elaboración de modelos dentales didácticos en resina epóxica para utilizarlos en la enseñanza de la práctica odontológica (AU)

Study studies are a fundamental record for diagnosis, treatment plan, case presentation and evaluation of the progress of dental treatment. They are anatomo-physiological records of the dental arches to evaluate the dentition in the three planes of space and the occlusion in the cusp-fossa relationships, in a static and dynamic dimension. To obtain the study models, it is essential to obtain total impressions with various impression materials of the dental arches, which faithfully reproduce all the anatomical details, in order to later obtain a stone plaster model. Those obtained from an impression are generally based on dental plaster, which despite its improvements still retain some negative characteristics such as: low resistance to fracture by impact, low resistance to wear by abrasion, dimensional instability and radio opacity that prevents the simulation of endodontic procedures. In order to improve simulation in dental practice, the use of epoxy resin can be used to obtain models, this material is more resistant and has greater resistance to abrasion, it is radiolucent, which makes them Useful for replicating preparations and endodontic simulation procedures, the surface details obtained with epoxy resin are superior to those obtained with plaster. The use of simulators is an educational tool that favors the acquisition of certain abilities, skills, techniques and competencies necessary for the training of the student or professional in dentistry. In the present work, the technique for the elaboration of didactic dental models in epoxy resin to be used in the teaching of dental practice is described.(AU)

Chemosensory representation of first-time oral exposure to ethanol in the orbitofrontal cortex of mice.

Intermittent ethanol consumption changes the neuronal activity of the orbitofrontal cortex (OFC) in rodents, which has been attributed to important participation in the development of addiction, particularly alcoholism. The OFC participates in gustatory sensory integration. However, it is unknown whether this region can encode chemosensory elements of oral ethanol administration independently of the consumption movement (orofacial motor response) when administered for the first time (naïve mice). To answer this question, we used a sedated mouse model and a temporary analysis protocol to register extracellular neuronal responses during the oral administration of ethanol. Our results show an increase in neuronal frequency (in the first 500 ms) when low (0.6, 1, and 2.1 M) and high (3.2, 4.3, and 8.6 M) concentrations of ethanol are orally administered. The modulatory effect of ethanol was observed from low and high concentrations and differed from the tastants. There was consistent neuronal activity independent of the concentration of ethanol. Our results demonstrate a sensory representation of oral ethanol stimulation in the OFC neurons of naïve mice under sedation.

Changes in somatosensory perception induced by trigeminal injury after Maxillofacial Surgical Procedures / Cambios en la percepción somatosensorial inducidos por lesiones trigeminales causadas por procedimientos quirúrgicos maxilofaciales

Abstract Evidence has been reported that shows that somatosensory perception can be altered by a trigeminal injury resulting from maxillofacial surgical procedures. However, the surgical procedures that most frequently cause trigeminal lesions and the risk factors are unknown. In the same way, there is little information on what has been determined in preclinical models of trigeminal injury. This article integrates relevant information on trigeminal injury from both clinical findings and primary basic science studies. This review shows that the age and complexity of surgical procedures are essential to induce orofacial sensory alterations.

Resumen Se han reportado evidencias que demuestran que la percepción somatosensorial puede ser alterada por la lesión trigeminal producto de procedimientos quirúrgicos maxilofaciales. Sin embargo, se desconoce cuáles son los procedimientos quirúrgicos que más frecuentemente producen lesiones trigeminales, y los factores de riesgo. De la misma forma hay poca información sobre lo que se ha determinado en modelos preclínicos de lesión trigeminal. El objetivo de este artículo es integrar información relevante sobre la lesión trigeminal desde los hallazgos clínicos como los principales estudios de ciencia básica. Esta revisión demuestra que la edad y el tipo de procedimiento son fundamentales para inducir alteraciones sensoriales orofaciales, así como los procesos neurobiológicos que subyacen a estos padecimientos.

Strawberry Juice Powders: Effect of Spray-Drying Conditions on the Microencapsulation of Bioactive Components and Physicochemical Properties.

The drying of fruit juices has advantages such as easy handling of powders, reduction in volume, and preservation of the characteristics of the fruit. Thus, in this work, the effect of the spray drying conditions of strawberry juice (SJ) with maltodextrin (MX) as a carrying agent on the microencapsulation of bioactive compounds and physicochemical properties was studied. The content of phenolic compounds and antioxidant activity showed higher values at low concentrations of MX, while the effect of drying temperature was negligible. The thermal characterization showed that the low molecular weight sugars in the juice decreased the glass transition temperature (Tg). The morphological analysis by scanning electron microscopy (SEM) indicated that at low concentrations of MX, the particles agglomerated, while at intermediate and high concentrations, the particles were observed as well separated. Through microstructural analysis by X-ray diffraction (XRD), the presence of amorphous state was confirmed in all the samples, which is beneficial for preventing chemical and biochemical reactions, and promoting the conservation of the microencapsulated bioactive compounds.

Application of Differential Scanning Calorimetry (DSC) and Modulated Differential Scanning Calorimetry (MDSC) in Food and Drug Industries.

Phase transition issues in the field of foods and drugs have significantly influenced these industries and consequently attracted the attention of scientists and engineers. The study of thermodynamic parameters such as the glass transition temperature (Tg), melting temperature (Tm), crystallization temperature (Tc), enthalpy (H), and heat capacity (Cp) may provide important information that can be used in the development of new products and improvement of those already in the market. The techniques most commonly employed for characterizing phase transitions are thermogravimetric analysis (TGA), dynamic mechanical analysis (DMA), thermomechanical analysis (TMA), and differential scanning calorimetry (DSC). Among these techniques, DSC is preferred because it allows the detection of transitions in a wide range of temperatures (-90 to 550 °C) and ease in the quantitative and qualitative analysis of the transitions. However, the standard DSC still presents some limitations that may reduce the accuracy and precision of measurements. The modulated differential scanning calorimetry (MDSC) has overcome some of these issues by employing sinusoidally modulated heating rates, which are used to determine the heat capacity. Another variant of the MDSC is the supercooling MDSC (SMDSC). SMDSC allows the detection of more complex thermal events such as solid-solid (Ts-s) transitions, liquid-liquid (Tl-l) transitions, and vitrification and devitrification temperatures (Tv and Tdv, respectively), which are typically found at the supercooling temperatures (Tco). The main advantage of MDSC relies on the accurate detection of complex transitions and the possibility of distinguishing reversible events (dependent on the heat capacity) from non-reversible events (dependent on kinetics).

Relationship between alcoholism addiction and periodontitis. an in vivo study using drinking-in-darkness protocol in rats

Periodontal disease (PD) has been considered a probable risk factor for several systemic diseases. among them, PD is presumed to be one of the possible etiologies of chronic illness of the central nervous system. In this context, poor oral health and PD is associated with substance abuse in humans. however, if periodontal lesions can produce addiction is unknown. this paper aims to evaluate the possibility that chronic periodontal injury (CPL) can cause ethanol binge intake in drink-in-darkness (DID) protocol in rats. in CPL group (n=10) experimental damage was done to the periodontal tissue of the second maxillary molar, the control group (n=9) received sham injury. forty-three days after CPL the intake of ethanol was assessed using several concentrations in DID experiment. during the DID experiment, we observed significant differences between the binge-type consumption of ethanol at the lowest concentration of 10 percent (p=0.01). differences in consumption of 20 percent ethanol are observed during a few days (p=0.04), and there are no differences in consumption at 40 percent concentration of ethanol (p=0.2). it is concluded that chronic periodontal lesion leads to alcoholism in wistar rats.

Multidimensional study of orofacial chronic neuropathic pain: an experimental study in rats

Orofacial neuropathic chronic pain (NCP) is frequently attributed to lesions caused by orofacial surgeries and dental treatments. there are many experimental models available to study orofacial NCP, however, many are extremely painful for the animal due to the amplitude of the innervated region. a previously proposed mental nerve constriction model, mNC, was used in this project. forty wistar rats were randomly divided into two groups: one group included rats with mNC (n=20), and another rats with sham lesions (n=20). through the use of the fixed ratio program and the progressive program, a decrease of motivation for a sweet substance, caused by the lesion, was evaluated. the possibility of alterations in cognitive learning and adaptation abilities was also assessed using the go/no-go behavioral task. the mNC group showed low induced and spontaneously evoked pain responses, as well as a decrease in the motivation for sucrose, a sign of anhedonia. this decrease does not depend on taste processing. finally, although no alterations in the learning-memory process were observed, the mNC group did show alterations when adapting to a new rule.

Curcumina, una alternativa térapéutica para la clínica dental. Parte: antiinflamatorio y analgésico / Curcumin, a therapeutic alternative for the dental clinic (Part I):An anti-inflammatory and analgesic

La curcumina es una sustancia derivada de una planta llamada Curcuma longa. A esta sustancia se le han atribuido diversos efectos terapéuticos. En relación con la clínica dental, se ha observado que, además de ayudaren el control del dolor, ha sido efectiva contra la periodontitis, estomatitis y mucositis pediátrica. El control del dolor e inflamación son aspectos muy importantes para la mayoría de los tratamientos en odontología; la búsqueda de nuevas alternativas analgésicas y antiinflamatorias que, en comparación con las actuales, sean más eficientes, efectivas y tengan menos efectos colaterales es uno de los grandes retos de las ciencias biomédicas. La presente revisión muestra algunas evidencias científicas de los efectos de la curcumina como un antiinflamatorio y analgésico, con el propósito de sentar las bases para futuros estudios clínicos y de ciencia básica que aporten un mayor entendimiento de los procesos celulares, bioquímicos, moleculares, fisiológicos y farmacológicos de la curcumina como una sustancia potencialmente útilen el consultorio dental.

Curcumin is a substance derived from the plant Curcuma longa andone that has been attributed a range of therapeutic eff ects. In dentalpractice, curcumin has not only been found to help with pain control, buthas also been eff ective against periodontitis, stomatitis, and pediatricmucositis. Controlling pain and infl ammation are both very importantaspects of most dental treatments. The search for more effi cient andeff ective analgesic and anti-infl ammatory alternatives with fewerside eff ects compared to those currently used is one of the greatestchallenges for biomedical science. This review presents some of thescientifi c evidence of the eff ects of curcumin, both as an analgesic andan anti-infl ammatory agent, in order to establish the foundations forfurther clinical and basic science studies that will provide a greaterunderstanding of the cellular, biochemical, molecular, physiological,and pharmacological processes of curcumin as a potentially usefulsubstance in dental practice.

Clinical applications of molecular basis for craniosynostosis: a narrative review / Aplicaciones clínicas de las bases moleculares de la craneosinostosis: revisión narrativa

Abstract: cranial sutures are specialized structures composed of the sutural mesenchyme, the overlying scalp, the dura and osteogenic fronts. Each one of these structures express important proteins for osteogenic maturation, membranous ossification of skull bones, and homeostasis of cranial sutures in a differential, spatial and temporal manner. These proteins include fibroblast growth factor (FGF) and its receptors (FGFR), the transforming growth factor beta (TGF-beta), bone morphogenetic proteins (BMPs), as well as transcription factors TWIST and MSX2, among others. The alteration in the expression of one or more of these proteins causes multiple pathological conditions; one of them is the premature closure of one or more cranial sutures, known as craniosynostosis. This malformation is commonly treated with surgery. However, advances in the fields of molecular and cellular biology have allowed to conduct research on some proteins involved in the development of craniosynostosis. The results of these studies can lead to future preventive therapeutic strategies that may be used as a complement to the surgical treatment of craniosynostosis. Possible strategies include the use of specific drugs that can regulate the expression and activation of FGF signaling pathways, TGF-beta or BMPs, to prevent or avoid craniosynostosis or re-synostosis after a surgery.

Resumen: las suturas craneales son estructuras especializadas compuestas por el mesénquima sutural, el pericráneo suprayacente, la duramadre y los frentes osteogénicos. Cada una de estas estructuras expresan de forma diferencial, espacial y temporalmente, proteínas importantes para la maduración osteogénica, la osificación membranosa de los huesos calvarios y la homeostasis de las suturas craneales. Estas proteínas incluyen el factor de crecimiento fibroblástico (FGF) y sus receptores (FGFR), el factor de crecimiento transformante beta (TGF-beta), las proteínas morfogenéticas óseas (BMPs), así como factores de transcripción TWIST y MSX2, entre otros. La alteración en la expresión de una o varias de estas proteínas provoca múltiples condiciones patológicas, una de ellas es el cierre prematuro de una o varias suturas craneales, conocido como craneosinostosis. Esta malformación es comúnmente tratada con cirugía. Sin embargo, los avances en los campos de la biología molecular y celular han permitido investigar algunas proteínas que participan en el desarrollo de la craneosinostosis. Los resultados de estos estudios pueden generar futuras estrategias terapéuticas preventivas o que complementen los tratamientos quirúrgicos de la craneosinostosis. Algunas estrategias posibles son el uso de fármacos específicos que puedan regular la expresión y activación de las vías de señalización del FGF, el TGFbeta o de las BMPs, para prevenir la craneosinostosis o evitar la resinostosis tras una cirugía.

Conocimientos de los estudiantes de la carrera Medicina sobre educación ambiental / The students' of the medicine career knowledge have more than enough environmental education

Se realizó una investigación, con el objetivo de determinar los conocimientos de los estudiantes de la carrera medicina sobre educación ambiental. Se emplearon como métodos del nivel teórico, el análisis documental, la sistematización e histórico-lógico, como método del nivel empírico se aplicó la encuesta en su modalidad de cuestionario a los estudiantes de la carrera medicina. Se estructuró de forma que se reflejaron las dimensiones objeto de estudio a través de los indicadores propuestos en el instrumento. En los resultados de la aplicación de estos instrumentos se puede observar, de manera general que solamente los estudiantes del 5to. año de la carrera medicina, poseen un conocimiento satisfactorio sobre educación ambiental, aunque persisten debilidades en cuanto a los conocimientos, procedimientos, actitudes y desarrollo. Sin embargo, existen potencialidades y oportunidades que permiten transformar esta situación a partir de la organización didáctica de los contenidos.

The investigation, with the objective of determining the knowledge of the students of the career medicine has more than enough environmental education. They were used as methods of the theoretical level the documental analysis, the systematizing and historical-logical, as method of the empiric level the survey was applied in its questionnaire modality to the students of the career medicine. It was structured so that they were reflected the dimensions study object through the indicators proposed in the instrument. In the results of the application of these instruments one can observe, in a general way that only the students of the fifth year of the career medicine, possess a satisfactory knowledge on environmental education, although weaknesses persist as for the knowledge, procedures, attitudes and development. However, potentialities and opportunities that allow transforming this situation starting from the didactic organization of the contents exist.

Resultados de las pruebas de desempeño en la superación posgraduada para Enfermería en servicios clínico-quirúrgicos por competencias profesionales especializadas / Results of the performance tests of specialized professional competences in postgraduate education for nursing at the clinical-surgical services

Se realizó un estudio, donde se aplicó un pre-experimento desde las Ciencias Pedagógicas, que nos permitió comparar los resultados de dos pruebas de desempeño realizadas a una muestra de profesionales de la Enfermería, de los hospitales clínicos quirúrgicos y especializados del segundo y tercer nivel de atención de salud de La Habana. Este estudio tuvo como objetivo identificar la necesidad de una formación posgraduada para Enfermería en servicios clínico-quirúrgicos, para satisfacer las necesidades de aprendizaje de estos profesionales y elevar la calidad de la atención a los pacientes en hospitales. Se aplicó una prueba de desempeño antes de la intervención y otra después, en una muestra pareada no paramétrica. Estas pruebas se realizaron previa identificación de competencias profesionales especializadas para la Enfermería Clínico-Quirúrgica, las que dieron como resultados la necesidad de una formación posgraduada para estos profesionales y que con la intervención propuesta, se logró un mejoramiento en el desempeño profesional y la satisfacción de los pacientes con la atención de enfermería recibida.

A study was conducted where a pre-experiment was applied in pedagogic sciences which allowed us to compare the results of two performance tests carried out in a sample of nursing professionals and of clinical surgical hospital professionals and 2nd and 3rd degree specialists in La Habana province. This study was aimed to identify the need for postgraduate formation for clinical and surgical nursing in order to meet the learning requirements of these professionals and to increase the quality of care in hospitals. A performance test was made before and after the intervention using non-parametric paired sample. These tests were carried out after determining the specialized professional competencies for the clinical and surgical nursing and yielded as results the need for postgraduate formation. The suggested intervention managed to improve the professional performance and to make patients feel satisfied with the nursing care rendered.

Caracterización del rendimiento académico de los estudiantes del plan de estudios D de Enfermería / Characterization of the academic performance in students of nursing plan D

A partir de las indicaciones del Ministerio de Educación Superior de transitar hacia una nueva generación de planes de estudios, surge el Plan D para la carrera de Enfermería en la búsqueda de un perfeccionamiento curricular. El trabajo expone algunos resultados finales de una investigación aprobada como Proyecto Ramal por la Dirección de Ciencia y Tecnología del Ministerio de Salud Pública con el objetivo general de caracterizar el rendimiento académico de los estudiantes en la Facultad 10 de Octubre de la Universidad de Ciencias Médicas de La Habana a partir de la realización de un estudio cuantitativo, analítico, de cohortes, longitudinal y retroprospectivo con utilización de técnicas cualitativas en el período comprendido entre los cursos académicos 2006-2007 y 2012-2013. De forma global, el rendimiento académico de los estudiantes varió significativamente según su formación como técnicos: tecnológica o emergente. Las causas que incidieron en este comportamiento son de origen multifactorial, destacándose fundamentalmente los aspectos personológicos y de vocación a la profesión(AU)

Plan D for the Nursing career arises from the search of a curricular improvement from the instructions of the Ministry of Higher Education of moving toward a new generation of syllabi. This paper shows some final results from an investigation which was approved as a Branch Project by the Office of Science and Technology of the Public Health Ministry. The general objective of this paper was to characterize the students' academic performance at 10 de Octubre Medical School (Havana Medical University). It is a cohort study, which was also quantitative, analytical, longitudinal and retroprospective with the use of qualitative techniques from the academic year 2006-2007 to 2012-2013. As a whole the academic performance of the students changed significantly according to their vocational training as technicians either technological or emergent. The causes of these results depend on many factors and the main ones are personal and vocation to the profession(AU)

Diseño curricular del diplomado en Enfermería clínico-quirúrgica para el sistema de salud cubano / Curricular design of the clinical-surgical nursing diploma's course for the Cuban health system

Se realizó una investigación con el objetivo de proponer un diseño curricular de posgrado en Enfermería clínico-quirúrgica, como respuesta a las necesidades de aprendizaje de enfermería en estos servicios y a las exigencias de salud de los pacientes. Para la propuesta se parte de la necesidad de superación posgraduada en estos servicios y garantizar la calidad de la atención. Los principales métodos utilizados fueron: revisión documental, talleres nacionales, modelación y enfoque de sistema, los que permitieron realizar el diseño curricular para garantizar el mejoramiento profesional y humano de los recursos laborales de Enfermería. La propuesta pretende preparar y actualizar a estos profesionales para la atención especializada a los pacientes, en una de las áreas más complejas y abarcadoras. No existes antecedentes en Cuba hasta donde hemos indagado, de propuestas posgraduadas específicas para estos servicios, el que se realizó a partir de un sistema de competencias profesionales especializadas

A research study was made to submit a curricular design of a postgraduate course in clinical-surgical nursing, in response to the learning requirements of nursing in these services and to the health demands of patients. This proposal stems from the need of postgraduate upgrading in these services and of guaranteeing the quality of care. The main methods were documentary review, national workshops, modeling and system approach, all of which allowed making the curricular design for professional and human improvement of the nursing resources. The proposal intends to prepare these professionals and update their knowledge on specialized care to patients in one of the most comprehensive and complex areas of health care. As far as we have researched, there are no previous specific proposals in terms of postgraduate studies for these services. The current proposal of curricular design took as a basis a system of specialized professional competencies