BACKGROUND/OBJECTIVES: The home enteral nutrition (HEN) provides nutritional support to children with chronic diseases who are nutritionally compromised and allows them to be discharged more quickly from hospitals. In 2003, a web-based registry (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition -NEPAD-) was created with the objective of gathering information about pediatric HEN practices in Spain. AIM: The aim of this study was to report the implementation of the NEPAD (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition) registry of pediatric HEN in Spain and to analyze data evolution trends from 2003 to 2010. SUBJECTS/METHODS: The data from the Spanish NEPAD registry were analyzed according to the following variables: demographic data, diagnosis, indication for HEN, nutritional support regime and administration route. RESULTS: Over the study period, 952 patients (1048 episodes) from 20 Spanish hospitals were included in the NEPAD registry. The most frequent indication for HEN was decreased oral intake (64%), and neurological disease was the most prevalent illness. HEN was delivered via a nasogastric tube in 573 episodes (54.7%), by gastrostomy in 375 episodes (35.8%), oral feeding in 77 episodes (7.3%) and by jejunal access in 23 episodes (2.2%). Significant differences in the mode of administration were observed based on the pathology of the child (χ(2), P<0.0001). The cyclic feeding was the most widely used technique for the administration of HEN. Most of the patients used a pump and a polymeric formula. Transition to oral feeding was the primary reason for discontinuation of this type of support. CONCLUSIONS: Since the NEPAD registry was established in Spain, the number of documented patients has increased more than 25-fold. Many children with chronic illness benefit from HEN, mainly those suffering from neurological diseases.
Enteral Nutrition/statistics & numerical data , Registries , White People , Child , Child Nutritional Physiological Phenomena , Child, Preschool , Enteral Nutrition/trends , Female , Gastrostomy , Hospitals , Humans , Infant , Internet , Intubation, Gastrointestinal , Male , Nervous System Diseases/diet therapy , Parenteral Nutrition, Home , Patient Discharge , Prospective Studies , Spain
Objetivo. Evaluar el impacto de un curso on-line sobre el nivel de conocimiento del programa OMI-AP (Oficina Médica Informatizada en Atención Primaria) en el personal médico. Material y métodos. Ciclo de Mejora para optimizar el conocimiento y uso de OMI-AP por los médicos de Familia del Servicio Murciano de Salud. Participaron 55 médicos de familia que realizaron el curso on-line sobre OMI-AP. Se realizó un curso on-line de 2 meses de duración en el que a través de 9 módulos se dio una formación de nivel avanzado sobre OMI-AP. Las mediciones efectuadas se realizaron en 2 fases: 1) una semana antes de comenzar el curso se aplicó a los alumnos inscritos un cuestionario sobre el nivel de conocimientos sobre OMI-AP (10 preguntas). 2) Una semana después de finalizar el curso se aplicó el mismo cuestionario. Resultados. Se analizó la nota media del cuestionario que fue de 5,31 puntos previamente a la realización del curso y de 7,70 puntos tras la finalización del curso (p<0,05). En 9 de las 10 preguntas analizadas el porcentaje de respuestas correctas mejoró significativamente tras la realización de curso. Conclusiones. La impartición del curso on-line de OMI-AP para médicos supuso una mejora significativa en el nivel de conocimiento de dicho programa, básico para la consulta diaria de los médicos de familia de nuestro servicio de salud. La formación on-line facilitó enormemente la formación de los profesionales al posibilitar una gestión del tiempo acorde a las necesidades del alumno (AU)
Objective. To evaluate the impact of an online course on the level of knowledge of the OMI-AP (Computerised Medical Office in Primary Care) program in medical personnel. Methods. Improvement cycle to optimize the knowledge and use of OMI-AP by family physicians in the Murcia Health Service. A total of 55 family physicians who completed an on-line course on OMI-AP were included. Advanced level training on the OMI-AP was given over a 2 month period via 9 modules. The measurements made were performed in two phases: 1st) A questionnaire on the level of knowledge of OMI-AP (10 questions) was completed one week before the students enrolled in the course. 2nd) The same questionnaire was used one week after completing the course. Results. The average score of the questionnaire was 5.31 points before the completion of the course and 7.70 points after the completion of the course (P<05). In 9 of the 10 questions analysed the percentage of correct answers significantly improved after the completion of the course. Conclusions. The delivery of the on-line OMI-AP course for doctors has led to a significant improvement in the level of knowledge of the program, essential for the daily practice of family physicians in our health service. On-line training greatly facilitates the training of professionals by enabling time management according to student needs (AU)
Humans , Male , Female , Internet , Webcasts as Topic , Primary Health Care/methods , Primary Health Care/trends , Family Practice/education , Family Practice/organization & administration , Physicians, Family/education , Physicians, Family , Medical Informatics/education , Surveys and Questionnaires , Medical Informatics/methods , Medical Informatics/trends
OBJECTIVE: To evaluate the impact of an online course on the level of knowledge of the OMI-AP (Computerised Medical Office in Primary Care) program in medical personnel. MATERIAL AND METHODS: Improvement cycle to optimize the knowledge and use of OMI-AP by family physicians in the Murcia Health Service. A total of 55 family physicians who completed an on-line course on OMI-AP were included. Advanced level training on the OMI-AP was given over a 2 month period via 9 modules. The measurements made were performed in two phases: 1st) A questionnaire on the level of knowledge of OMI-AP (10 questions) was completed one week before the students enrolled in the course. 2nd) The same questionnaire was used one week after completing the course. RESULTS: The average score of the questionnaire was 5.31 points before the completion of the course and 7.70 points after the completion of the course (P < 05). In 9 of the 10 questions analysed the percentage of correct answers significantly improved after the completion of the course. CONCLUSIONS: The delivery of the on-line OMI-AP course for doctors has led to a significant improvement in the level of knowledge of the program, essential for the daily practice of family physicians in our health service. On-line training greatly facilitates the training of professionals by enabling time management according to student needs.
Computer-Assisted Instruction , Health Knowledge, Attitudes, Practice , Physicians, Family/education , Primary Health Care , Education, Medical, Continuing/methods , Educational Measurement , Humans , Internet , Surveys and Questionnaires
OBJECTIVE: To determine the efficacy of premedication with intraoperative clonidine in association with low-dose ketamine to reduce the need for postoperative opiate analgesia in outpatient laparoscopic cholecystectomy. PATIENTS AND METHODS: We performed a prospective study of patients undergoing outpatient laparoscopic cholecystectomy between November 2005 and November 2006. The patients were distributed randomly in 2 groups: patients in the clonidine-ketamine group received clonidine (0.15 mg orally 60 minutes before surgery) and ketamine (20-mg intravenous bolus followed by intraoperative perfusion of 20 mg h(-1)); patients in the control group did not receive this medication. Pain assessed on a verbal numerical scale, number of times rescue analgesia was required to achieve a value below 3, and adverse effects of the medication were recorded in the postoperative period. RESULTS: Thirty-one patients (16 in the clonidine-ketamine group and 15 in the control group) were enrolled. Rescue analgesia was required on 2 occasions by 25% of patients in the clonidine-ketamine group and on 2 or 3 occasions by 533% of patients in the control group. Adverse effects were reported by 87.5% of patients in the clonidine-ketamine group (mainly visual disturbances, sedation, and nausea) and by 46.7% in the control group. This difference was significant during the patients' stay in the postanesthesia recovery unit. CONCLUSIONS: Patients receiving clonidine and ketamine required less additional opiate analgesia to achieve mild pain values (<3 on the numerical verbal scale) but suffered more adverse effects during their stay in the postanesthesia recovery unit. Discharge was not delayed, however.
Analgesics/administration & dosage , Cholecystectomy, Laparoscopic/adverse effects , Clonidine/administration & dosage , Ketamine/administration & dosage , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Preanesthetic Medication , Ambulatory Surgical Procedures , Analgesics, Opioid/administration & dosage , Female , Humans , Intraoperative Care , Male , Middle Aged , Prospective Studies
UNLABELLED: The handling of the nasal base includes, changes of inferior lateral cartilages and the skin of the nasal base, which vary according to the gendre and race of the patient. OBJECTIVE: To propose a technique for the handling of wide nasal base in patients with a wide columnella, where reducing its volume allows carrying out the alar plasty in a satisfactory way. MATERIAL AND METHODS: 50 cases of patients with Rhinoseptoplasty, with documented wide base and a wide columnella clinically and photographically; reduction of columnella was made by resection of two strips of skin at its base. Reducing the thickness of columnella and posterior alar plasty. RESULTS: In 100% of the cases that we were managed to diminish the nasal base the results were satisfactory. CONCLUSION: The resection of strips of skin in the base of the columnella is an effective and fast technique to reduce its volume and secondarily reducing the width of the nasal base.
Dermatologic Surgical Procedures , Nasal Septum/surgery , Nose/surgery , Rhinoplasty/methods , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prospective Studies
We report 6 cases diagnosed with accidental dural puncture after epidural injection of corticosteroids for low back pain. All the patients reported postdural puncture headache during their stay in the postanesthetic recovery unit. For 3 patients, pain resolved with treatment given in the recovery unit. Two other patients also required mild analgesics for 1 week. In the last patient, a blood patch was used to treat incapacitating headache 22 days after the epidural procedure and mild analgesics were needed for 4 more weeks. It is important to establish a protocol for treating postdural puncture headache in pain clinics to facilitate decision making. Good physician-patient communication is necessary to avoid refusals for permission for other epidural techniques and to facilitate management of symptoms.
Dura Mater/injuries , Injections, Epidural/adverse effects , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Clinical Protocols , Female , Humans , Low Back Pain/drug therapy , Male , Middle Aged
OBJECTIVE: To assess the efficacy of postoperative autologous transfusion to reduce homologous blood transfusion needs in primary knee replacement surgery. PATIENTS AND METHODS: A prospective study was carried out in 33 consecutive patients with diagnoses of arthrosis scheduled for primary knee replacement surgery with postoperative autotransfusion using a CBCII Constavac-Stryker (Stryker Instruments, Michigan, USA) recovery system from June through October 2002. We analyzed patient age, sex, preoperative and postoperative (24 hours) hemoglobin and hematocrit values, autologous blood reinfused and homologous blood transfusion incidence rate (if hematocrit was below 25%). RESULTS: Of the 33 patients receiving postoperative autotransfusion, one also needed homologous blood transfusion (3%). The mean volume of filtered whole blood reinfused was 538.63+/-261.23 mL, 1100 mL being the largest volume reinfused. We observed no complications related to use of autotransfusion devices during the perioperative period. CONCLUSIONS: Postoperative autotransfusion as the only blood salvage technique in primary knee prosthesis surgery nearly eliminates homologous transfusion needs. In addition, it is a safe, simple procedure and has replaced our hospital's preoperative autologous transfusion procedure.
Arthroplasty, Replacement, Knee/adverse effects , Blood Transfusion, Autologous , Postoperative Hemorrhage/therapy , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Care , Postoperative Hemorrhage/etiology , Prospective Studies
OBJECTIVE: To find the view of trainers (tutors and teaching assistants) of third-year family and community medicine (FCM) residents concerning their own teaching activity in areas such as training, the skills and qualities required to be a teacher and the inter-professional relationships that are current and that are needed in a primary care teaching team. DESIGN: Qualitative study developed between June 2000 and May 2002. Sample design with a volunteer population. SETTING: FCM teaching unit under the Primary Care Administration of Murcia. PARTICIPANTS AND/OR CONTEXTS: Tutors and teaching assistants in the FCM residents' programme. METHOD: Semi-structured interview for information gathering. Contents analysis to construct results on the basis of the semiological analysis of the textual discourse. Systematic return of the results. RESULTS: Belonging to the teaching team is the highest motivation for taking part in teaching. It gives the tutors more benefits (affective, care load) than difficulties (organisational adaptation). The tutor profile is sustained by his/her scientific-technical and personal qualities; that of the nurse, by his/her community qualities. Collaboration between nurse and tutor is informal and the teaching strategies most employed by tutors are guidance, guide-lines and encouragement of residents' autonomy. Nurses collaborate with teaching by transmitting a model of professional development and facilitating teamwork. CONCLUSIONS: The complexity of the training process stands out. Postgraduate FCM training is cross-professional, not exclusively circumscribed by the tutor-resident teaching relationship. The qualitative paradigm is shown to be useful for obtaining a vision of the teaching process from the perspective of different actors.
Attitude of Health Personnel , Family Practice/education , Internship and Residency , Interprofessional Relations , Female , Humans , Interviews as Topic , Male , Models, Educational , Spain
No disponible
Humans , Hernia/surgery , Digestive System Surgical Procedures/methods , Suture Techniques , Laparoscopy/methods
La endometriosis ureteral es una patología poco frecuente (1 por ciento de la endometriosis). Su forma de presentación es a menudo silente, de manera que el diagnóstico puede resultar complicado: Las técnicas de imagen y la laparoscopia exploradora pueden resultar de utilidad para el diagnóstico. El tratamiento está basado en terapia hormonal y en la resolución de la obstrucción ureteral (AU)
Adult , Female , Humans , Endometriosis , Endometriosis/surgery , Ureteral Diseases , Ureteral Diseases/surgery
We present two contour-based techniques, for computerized object recognition that avoid the difficulties due to translations, rotations and scaling. Our techniques do not require any shape representation. The first technique uses the scale-space filtered coordinate functions of contours and their "largest diameters". The second, uses the Hotelling transform of the vector representations of the points of contours. We applied both techniques to recognize human corneal endothelial cells, embedded in a sample of tissue. The results obtained using the Hotelling transform represent a considerable improvement when compared to those previously obtained using the coordinate functions, the curvature function and Fourier descriptors as representations of shape.
Artificial Intelligence , Image Enhancement/methods , Models, Biological , Pattern Recognition, Automated , Computer Simulation , Cornea/blood supply , Endothelium, Vascular/cytology , Fourier Analysis , Humans
Digital temporal and spatial filtering of fluoroscopic image sequences can be used to improve the quality of images acquired at low X-ray exposure. In this study, we characterized a nonlinear edge preserving, spatio-temporal noise reduction filter, the bidirectional multistage (BMS) median filter of Arce (1991). To assess image quality, signal detection and discrimination experiments were performed on stationary targets using a four-alternative forced-choice paradigm. A measure of detectability, d', was obtained for filtered and unfiltered noisy image sequences at different signal amplitudes. Filtering gave statistically significant, average d' improvements of 20% (detection) and 31% (discrimination). A nonprewhitening detection model modified to include the human spatio-temporal visual system contrast-sensitivity underestimated enhancement, predicting an improvement of 6%. Pixel noise standard deviation, a commonly applied image quality measure, greatly overestimated effectiveness giving 67% improvement in d'. We conclude that human testing is required to evaluate the filter effectiveness and that human perception models must be improved to account for the spatio-temporal filtering of image sequences.
Focal nodular hyperplasia is a benign liver tumor, that is rare during childhood. We report a new case, exceptional by the short age of the patient, and by the way of this we review the epidemiology, the actual diagnosis criterion and the treatment options.
Focal Nodular Hyperplasia/pathology , Humans , Infant , Male
La hiperplasia nodular focal es una tumoración hepática benigna, de rara presentación en la infancia. Presentamos un nuevo caso, excepcional por la corta edad del paciente, y a propósito de él realizamos una revisión de la epidemiología, de los criterios diagnósticos actuales y de las opciones de tratamiento (AU)
Male , Infant , Humans , Focal Nodular Hyperplasia
In this work it is described how to use the curvature function, the Fourier descriptors, and the coordinate functions of a contour to achieve automatic recognition of biological shapes. Those representations of shape and the coordinate functions were applied to recognize human corneal endothelial cells embedded in a sample of tissue. We assume that when the coordinates of the points of contours are analyzed directly, no representation of shape is being used. We applied scale-space filtering to the coordinate functions, to compensate the effects of scaling and to minimize the error due to quantization. A technique for compensating the effects of rotation, with or without the use of a representation of shape, is proposed. Our results show that, for a wide range of biological shapes, no representation of shape is required to solve or avoid the problems caused by translation, scaling, and rotation. We conclude that for certain applications the use of a representation of shape can provide some advantages. However, the coordinate functions of contours, evolved in scale-space, can be efficiently used, yielding even better results in applications of robotics and computer vision related to the recognition of biological shapes.
Cell Biology , Fourier Analysis , Endothelium, Corneal/cytology , Humans
A fully automatic computerized method for segmenting contours of corneal endothelial cells is proposed. As part of the method, scale-space filtering (i.e. Gaussian filtering) is used to achieve tasks different from noise removal. This type of filtering is applied making use of the separability property of Gaussian kernels, avoiding the erosion of images. A variant of unsharp masking is used to considerably increase the visibility of dark areas of images. It is shown how the overflow that occurs when two images are subtracted can be handled to produce better results than normal unsharp masking. The method is exemplified with a low quality specular micrograph. To test the performance of the method, its output is used to automatically calculate the average cell size of images of different samples of tissue and different visual quality. The obtained results are successfully compared to those obtained with a manual semi-automatic method. A method for reading the segmented contours is suggested as well as two shape representations to achieve morphometric analysis of individual cells.
Cell Size/physiology , Endothelium, Corneal/cytology , Image Enhancement/methods , Algorithms , Chi-Square Distribution , Humans , Image Interpretation, Computer-Assisted , Microscopy, Video/methods , Models, Biological , Normal Distribution , Regression Analysis
