Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients.

BACKGROUND: Home telemonitoring is a modern and effective disease management model that is able to improve medical care, quality of life, and prognosis of chronically ill patients, and to reduce expenditure. The objective of this study was to evaluate the efficacy, costs, and patients' and caregivers' acceptance of our model of telemedicine in a high-risk chronic heart failure (CHF) older population. METHODS: Patients with high risk/refractory CHF were included. In the case of alarm parameters' modifications, a cardiologist decided to inform the emergency department (ED), the patient's General Practioner, or to programme a clinical ambulatory control. RESULTS: Forty-eight CHF patients (28 males; 58.3%), with a mean age of 80.4 ± 7.7 years, entered this clinical experience. During the 20-months follow-up, four patients dropped out from counselling (8.3%), ambulatory clinical control within-24 h was planned in 18% of patients, 11% of patients were admitted to an ED, and 18% were hospitalized. Thirteen patients (29.5%) died a cardiac death; hospital admissions for heart failure decreased during the year after the enrolment when compared to the year before (from 35 to 12 acute HF hospitalizations/year; p = 0.0001). Moreover, in these HF patients followed, accesses to an ED for an acute episode of HF decompensation reduced from 21/year to five/year (p = 0.0001). The economic expenditure, calculated for the year before and after the enrolment, reduced from 116.856 Euros to 40.065 Euros/year. CONCLUSIONS: A telemedicine surveillance in high-risk older CHF patients determines a continuous and active contact between patients/caregivers, the Heart Failure Clinic, and family physicians, permitting an early evaluation of signs and symptoms of acute decompensation.

Dispositivo pedagógico-didactico para desarrollar habilidades argumentativas escritas académicas y actitud epistémica del conocimiento disciplinar en alumnos ingresantes a la universidad / Pedagogica didactic-divice for the promotion of argumentative academic writing skills and an epistemic attitude of disciplinary knowledge in university entrants

Este artículo constituye una contribución al debate actual acerca del problema del diseño, la implementación y la evaluación de estrategias para la promoción de alfabetización académica y del desarrollo de las habilidades argumentativas escritas académicas. Se presentan las cuatro fases de la investigación que corresponden al trabajo realizado, en primer término, para conocer la concepción que tenían los docentes de la cátedra de psicología de CBC de UBA respecto de la lectura y escritura académica; en segundo término, para concientizar a los docentes respecto de su función, como agentes mediadores, para la promoción de habilidades de lectura y escritura académicas, en tercer término, y vinculado con el trabajo de concientización, para diseñar un dispositivo pedagógico didáctico que utilizara la lectura y escritura argumentativa académica colaborativa para el desarrollo de una actitud epistémica del conocimiento disciplinar, y finalmente, para realizar una prueba piloto del dispositivo pedagógico didáctico que evaluara la efectividad del mismo. Se presentan los resultados obtenidos.

This article is a contribution to the current debate about the problem of the design, implementation and evaluation of strategies for the promotion of academic literacy and the development of argumentative academic writting skills. The four phases of the research that correspond to the work done in the first place were presented, to know the conception that teachers of the chair of Psychology at CBC UBA had in respect of academic reading and writing; secondly, to raise awareness among teachers with regard to its role as mediator agents, for the promotion of academic reading and writing skills, thirdly, and linked with the work of awareness, to design a didactic pedagogical device that will use argumentative academic collaborative reading and writing for the development of an epistemic attitude of disciplinary knowledge, and finally, to conduct a pilot test of the didactic pedagogical device that will evaluate the effectiveness of the it. The results are presented.

Una aproximación al estudio de la relación entre habilidad argumentativa escrita académica y dominio conceptual del conocimiento disciplinar / An approach to study of relationship between argumentative academic writing skills and conceptual domain of disciplinary knowledge

La habilidad argumentativa escrita se aborda desde el marco conceptual de la escuela Histórico-Cultural. Objetivos: 1) Evaluar presencia de argumentación escrita académica en textualizaciones producidas por estudiantes de la asignatura Psicología del CBC-UBA. 2) Evaluar nivel de conocimiento conceptual específico de la disciplina en los mismos estudiantes. 3) Explorar presencia de relación entre los factores evaluados. Hipótesis: Las textualizaciones que manifiestan mayor dominio de la argumentación escrita académica, también presentan mayor nivel de conocimiento conceptual específico de la disciplina. Metodología: diseño descriptivo, estudio relacional asociacional, la muestra está conformada por 50 textualizaciones producidas por estudiantes que cursaron Psicología del CBC-UBA, al finalizar el segundo cuatrimestre del año 2013. El plan de categorías de análisis se basa en la perspectiva pragmadialéctica de la argumentación. Los resultados son consistentes con la hipótesis. Se sugiere seguir trabajando en esta línea para investigar en profundidad el nivel de significación de la relación hallada.

Argumentative writing skills are studied from Cultural Historical theory. Objectives: 1) to assess presence of academic argumentation in first year student´s written productions, CBC UBA; 2) to assess the level of conceptual domain of disciplinary knowledge in these same students; 3) to compare the results obtained in objectives 1 and 2. Hypothesis: the argumentation in student´s academic written productions correlates with expertise in conceptual domain of disciplinary knowledge.Methodology: descriptive quasi-experimental design. Sample type: Convenience sampling. 50 CBC Psychology student´s written productions will be taken, at the end of second semester 2013.The study is based on a pragmadialectic perspective of argumentation.The results would support the hypothesis. It is recommended to keep working along this line in order to deepen the level of significance of this study.

Infective endocarditis or myxoma? Description of a patient with new diagnosis of congestive heart failure.

Infective endocarditis (IE) is an inflammatory disease which interests heart endothelium and mostly heart valves. IE is not a uniform disease, but presents in a variety of different forms that makes the diagnosis difficult. Echocardiography is a crucial diagnostic tool for the diagnosis, especially in those patients who have no typical symptoms as in the case here presented, in which the possibility of a myxoma was also considered.

Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation.

INTRODUCTION: Risk stratification in congestive heart failure (CHF) patients is based on a variety of clinical and laboratory variables. We analysed renal function, BNP, water composition, echocardiographic and functional determinations in predicting mid-term outcome in CHF patients discharged after decompensation. MATERIAL AND METHODS: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHA class, BNP, water body composition, non-invasive cardiac output and echocardiogram were analysed. Death, cardiac transplantation and hospital readmission for CHF were scheduled. RESULTS: Two-hundred and thirty-seven (64.5% males, age 71.1±10.1) patients were discharged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was 43.2±16.2%, cardiac output was 3.8±1.1 l/min and BNP at discharge resulted 401.3±501.7 pg/ml. During the 14-month follow-up 15 patients (6.3%) died, 1 (0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF (event group); in 203 (85.6%) no events were observed (no-event group). Higher NYHA class (2.1±0.7 vs. 1.9±0.4, p=0.01), BNP at discharge (750.2±527.3 pg/ml vs. 340.7±474.3 pg/ml, p=0.002) and impaired LVEF (33.7±15.7% vs. 44.5±15.8%, p=0.0001) and creatinine (1.7±0.6 vs. 1.2±0.8 mg/dl, p=0.004) were noticed in the event group. At multivariate Cox analysis LVEF (p=0.0009), plasma creatinine (p=0.006) and BNP at discharge (p=0.001) were associated with adverse mid-term outcome. Kaplan-Meier survival curves demonstrated that adding cut-off points for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated significantly prognosis (p=0.0001; log rank 21.09). CONCLUSIONS: In predicting mid-term clinical prognosis in CHF patients discharged after acute decompensation, BNP at discharge ≥ 250 pg/ml added with plasma creatinine > 1.5 mg/dl are strong adverse predictors.

Investigación documental sobre escritura académica en tres universidades nacionales: Período 1990-2011 / Documentary research on academic writing in three national universities: Period 1990-2011

We present a documental research, period 1990-2011, which wanted to know the course of research published in scientific events of three national universities: National University of La Plata, National University of Mar del Plata and University of Buenos Aires. The issue was the written production of students in higher education. We identified and classified the documentary source (N=72) according to their place of publication, publication subject area, temporal distribution, place of establishment of research projects, unit of analysis, instructional intervention, skills trying to be promoted. Encouraging results are available showing a positive trend in researches that present contextual analysis units.

Se presenta un trabajo de investigación documental, periodo 1990-2011, en el que se quiso conocer el decurso de investigaciones publicadas en memorias de eventos científicos y anuarios de investigación de las facultades de psicología de tres universidades nacionales: Universidad Nacional de La Plata, Universidad Nacional de Mar del Plata y Universidad de Buenos Aires. El tema explorado fue la producción escrita de estudiantes del nivel superior. Se identificó y clasificó la fuente documental (N=72) según su lugar de publicación, área temática de publicación, distribución temporal, lugar de radicación de los proyectos de investigación, unidad de análisis, intervención instruccional, habilidades que se quieren promover. Se ofrecen resultados alentadores que muestran tendencia positiva de las investigaciones con unidades de análisis contextuales.

Investigación documental sobre escritura académica en tres universidades nacionales: Período 1990-2011 / Documentary research on academic writing in three national universities: Period 1990-2011

We present a documental research, period 1990-2011, which wanted to know the course of research published in scientific events of three national universities: National University of La Plata, National University of Mar del Plata and University of Buenos Aires. The issue was the written production of students in higher education. We identified and classified the documentary source (N=72) according to their place of publication, publication subject area, temporal distribution, place of establishment of research projects, unit of analysis, instructional intervention, skills trying to be promoted. Encouraging results are available showing a positive trend in researches that present contextual analysis units.(AU)

Se presenta un trabajo de investigación documental, periodo 1990-2011, en el que se quiso conocer el decurso de investigaciones publicadas en memorias de eventos científicos y anuarios de investigación de las facultades de psicología de tres universidades nacionales: Universidad Nacional de La Plata, Universidad Nacional de Mar del Plata y Universidad de Buenos Aires. El tema explorado fue la producción escrita de estudiantes del nivel superior. Se identificó y clasificó la fuente documental (N=72) según su lugar de publicación, área temática de publicación, distribución temporal, lugar de radicación de los proyectos de investigación, unidad de análisis, intervención instruccional, habilidades que se quieren promover. Se ofrecen resultados alentadores que muestran tendencia positiva de las investigaciones con unidades de análisis contextuales.(AU)

Effects of levosimendan/furosemide infusion on plasma brain natriuretic peptide, echocardiographic parameters and cardiac output in end-stage heart failure patients.

BACKGROUND: Acute decompensation heart failure (ADHF) remains a cause of hospitalization in patients with end-stage congestive HF. The administration of levosimendan in comparison with a standard therapy in CHF patients admitted for ADHF was analysed. MATERIAL/METHODS: Consecutive patients admitted for ADHF (NYHA class III-IV) were treated with levosimendan infusion 0.1 µg/kg/min or with furosemide infusion 100-160 mg per day for 48 hours (control group). All subjects underwent determination of brain natriuretic peptide (BNP), non-invasive cardiac output (CO), and echocardiogram at baseline, at the end of therapy and 1 week after therapy. RESULTS: Seven patients admitted for 20 treatments in 16 months (age 66 years; mean admission/year 5.4) were treated with levosimendan and compared with 7 patients admitted for 15 treatments (age 69.1 years; mean admission/year 6.1). At the end of levosimendan therapy, BNP decreased (from 679.7 ± 512.1 pg/ml to 554.2 ± 407.6 pg/ml p = 0.03), and 6 MWT and LVEF improved (from 217.6 ± 97.7 m to 372.2 ± 90.4 m p = 0.0001; from 22.8 ± 9.1% to 25.4 ± 9.8% p = 0.05). Deceleration time, E/A, E/E', TAPSE, pulmonary pressure and CO did not change significantly after levosimendan therapy and after 1 week. At follow-up, only 6-min WT and NYHA class showed a significant improvement (p = 0.0001, p = 0.001 respectively). The furosemide infusion reduced NYHA class and body weight (from 3.4 ± 0.6 to 2.3 ± 0.5 p = 0.001; from 77.5 ± 8.6 kg to 76 ± 6.6 kg p = 0.04), but impaired renal function (clearances from 56.3 ± 21.9 ml/min to 41.2 ± 10.1 ml/min p = 0.04). CONCLUSIONS: Treating end-stage CHF patients with levosimendan improved BNP and LVEF, but this effect disappeared after 1 week. The amelioration of 6 MWT and NYHA class lasted longer after levosimendan infusion.

[Antianginal efficacy of ivabradine in a very old patient with aortic stenosis: effects on cardiac output and transvalvular aortic gradients]. / Efficacia antianginosa dell'ivabradina in un grande anziano con stenosi aortica: analisi dell'effetto sulla portata cardiaca e sui gradienti transvalvolari.

Ivabradine is a selective I(f) current inhibitor in the sinus node that decreases heart rate without negative inotropic effects. We report the case of an 88-year-old diabetic patient with arterial hypertension and peripheral arterial disease who experienced an antero-lateral non-ST-elevation myocardial infarction following post-surgical anemia. After admission, the patient complained of anginal pain at rest with ischemic alterations of ST-T at the ECG and mild increase in troponin T levels. According to the clinical status, the association of ivabradine with beta-blockers was started. The addition of ivabradine reduced heart rate, improved symptoms (CCS class I-II) without modifying the main hemodynamic (non-invasively measured cardiac output, stroke volume and cardiac index) and echocardiographic parameters (left ventricular ejection fraction and aortic transvalvular gradients). In conclusion, the antianginal effect of ivabradine seems to be sure in very old ischemic patients with aortic stenosis.

[Prevention of left ventricular remodeling after myocardial infarction: efficacy of physical training]. / La prevenzione del rimodellamento cardiaco nel post-infarto miocardio acuto: efficacia del training fisico.

Post-myocardial infarction left ventricular remodelling should be considered an important therapeutic target in patients after an acute myocardial infarction, considering the heavy prognostic implication. The therapies used in these patients should reduce the progression of the left ventricular dysfunction to refractory heart failure. In order to prevent post-myocardial infarction cardiac remodelling, different therapies have been tested, and for ACE-inhibitors and beta-blockers a clear demonstration of efficacy has been obtained. Losartan and valsartan, two widely used angiotensin receptor blockers, demonstrated to be safe and equally useful compared to ACEI. The addition of spironolactone to the standard therapy for heart failure has a clear beneficial effect but the clinical use has been refrained by the risk of iperkaliemia. Aerobic physical training improves the left ventricular ejection fraction in patients with systolic dysfunction, reducing the progressive enlargement after myocardial infarction. The positive effect of aerobic training on cardiac remodelling might be related to the positive effect on neurhormonal assessment, to he improvement of microcirculatory myocardial perfusion and of endothelial function.