Designing an app for home-based enriched Music-supported Therapy in the rehabilitation of patients with chronic stroke: a pilot feasibility study.

OBJECTIVE: After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app. METHOD: This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance. RESULTS: Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention. CONCLUSION: The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial.

Assessment of Pathology Learning Modules With Virtual Microscopy in a Preclinical Medical School Curriculum.

OBJECTIVES: To evaluate the ability of pathology modules to promote learning of pathology-related course content in a preclinical medical education curriculum. METHODS: Pathology modules were created for the "Hematology/Oncology" and "Women's Health" (WH) courses. Students were recruited over 2 consecutive academic years; cohorts 1 and 2 refer to 2 separate groups of students in years 1 and 2, respectively, of the study. Course performance data were collected. RESULTS: Use of pathology modules resulted in a statistically significant higher correlation between performance on the final examination and pathology-related questions in the Hematology/Oncology course and written examination and pathology-related questions in cohort 1 in the WH course. There was statistically significant improvement (P = .026) on pathology-related laboratory practical examination questions in the WH course for cohort 1, and no other statistically significant improvement for the other cohorts and examinations. The percentage of students completing all or part of the modules was highest in the WH course for cohort 1 (60%) compared with WH course cohort 2 (33%) and Hematology/Oncology cohort 1 (30%) and cohort 2 (39%). CONCLUSIONS: Pathology modules may improve acquisition and retention of pathology-related course content when used appropriately.

Dementia in Latin America: Paving the way toward a regional action plan.

Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF.

Cumplimiento estimado de los estándares de calidad propuestos en Cuidados Paliativos dentro de Unidades de Hospitalización de Oncología / Estimated compliance of Oncology Inpatient Units with the quality standards proposed in Palliative Care

Introducción: En 2006 se publicó la propuesta de la SECPAL y el Ministerio de Sanidad y Consumo de indicadores de calidad en Cuidados Paliativos con la proporción de cumplimiento de cada uno que se plantea como referencia. Objetivo: Realizar una estimación del cumplimiento de estos estándares en la atención de enfermos oncológicos avanzados en Unidades de Oncología Médica. Material y métodos: Doce profesionales (oncólogos y enfermeras) de cuatro Unidades de Hospitalización que atienden enfermos de Oncología Médica realizaron una estimación del porcentaje de cumplimiento en su unidad de los 35 indicadores de calidad de la SECPAL. Para cada estándar se calcula la media de las estimaciones y se compara con el estándar recomendado de cumplimiento. Resultados: La media de las estimaciones de cumplimiento se encuentra dentro de los estándares propuestos en nueve (26%) de los 35 indicadores. De los otros 26 indicadores, en 20(77%) la diferencia respecto al estándar superaba el 10%. No se consideró que se alcanzasen los estándares en ninguno de los 16 indicadores que exigían un cumplimiento del100%. La media de cumplimiento fue de 9,5 estándares (límites: 8-12) por hospital. Solo se estimó que cuatro (11%) de los 35 indicadores se cumplían adecuadamente en todos los hospitales (..) (AU)

Introduction: In 2006 the Sociedad Española de Cuidados Paliativos (Spanish Society of Palliative Care, SECPAL) and the Spanish Ministry of Health published a proposal of quality standards on Palliative Care. It included a reference of the proposed acceptable percentage of compliance of these indicators. Many advanced cancer patients are treated in Medical Oncology Units, but there are no data on how these standards are observed in these patients. Objective: To obtain an estimate of the compliance with these standards in the care of advanced cancer patients admitted to Medical Oncology Units. Methods: Six oncologists and six nurses from four different Medical Oncology Units gave an estimate of the compliance rate of the 35 quality indicators proposed by SECPAL. For each standard, the mean of the estimations was compared with the recommended standard of compliance. Results: The mean estimates of compliance is within the proposed standards in nine (26%) of the35 indicators. On the remaining 26 indicators, in 20 (77%) the difference between the estimated value and the reference rate was above 10%. No indicator that required 100% compliance was considered achieved. In every Hospital a mean of 9.5 standards (range: 8 to 12) were fulfilled. Only in four (11%) indicators were the estimations entered within standards in all the four (..) (AU)

Daño arterial por escleroterapia / Arterial lesion by sclerotherapy

El uso de fleboesclerosis para el tratamiento de las várices es una antigua técnica con un rango de indicaciones claramente establecido, que ha recobrado vigencia en este último tiempo. Como toda técnica invasiva presenta complicaciones inherentes al fármaco: pigmentación de la piel, trombosis venosa profunda, embolia pulmonar, o dependientes de la técnica de punción, donde la más temida es la necrosis por inyección arterial del medio esclerosante. Se presenta un caso clínico de necrosis distal de extremidad inferior, con pérdida del antepié, y manejado con trombólisis en forma tardía. Se describen las opciones terapéuticas, remarcándose la importancia de realizar terapias invasivas por profesionales adecuadamente entrenados en las técnicas y manejo de sus complicaciones, las que si se presentan, deben ser abordadas por un especialista a la brevedad, ya que es la única manera de evitar exéresis o grandes pérdidas de tejido