Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol.

AIMS: Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS: As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION: Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.

Waste metrics in the framework of circular economy.

There are several sustainability issues that the linear economy of today's society cannot adequately tackle (i.e. resource depletion, waste treatment, etc.). As a result, the scientific community and policymakers give high priority to the implementation of the circular economy concept. The sustainable development goals of the United Nations are in line with the European Union's (EU) commitment to a smooth transition to a circular economy. Circular business models require a shift in technical elements involving R strategies to replace traditional business models (i.e. reuse, reduce, recycle, etc.). Monitoring circular economy to provide quantifiable, measurable data is necessary for a successful transition. Monitoring tools (i.e. Key Performance Indicators, quality protocols) enable decision-makers to measure circular economy performance and identify circularity's advantages and disadvantages. To stimulate the adoption of a circularity model addressing critical issues of excessive waste production and resource use, this mini review aims to address the literature gap of waste metrics in the framework of circular economy and offer insights on circular economy indicators to aid for a seamless transition to a more sustainable society. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analysis method was chosen to assess literature. The authors collected and analysed data from 101 records, 70 articles and 31 reports related to the topic under consideration. Through the literature review, it is obvious that moving away from linear production model frequently leads to the development of new internal capabilities along the value chain and, eventually, high efficiency that reduces costs, increasing productivity, encourages brand names, minimizes threats, creates new products and fulfils regulations and green consumer expectations.

Nitrogen management in farming systems under the use of agricultural wastes and circular economy.

Population growth leads to an increase in the demand for energy, water, and food as cities grow and urbanize. However, the Earth's limited resources are unable to meet these rising demands. Modern farming practices increase productivity, but waste resources and consume too much energy. Agricultural activities occupy 50 % of all habitable land. After a rise of 80 % in 2021, fertilizer prices have increased by nearly 30 % in 2022, representing a significant cost for farmers. Sustainable and organic farming has the potential to reduce the use of inorganic fertilizers and increase the utilization of organic residues as a nitrogen (N) source for plant nutrition. Agricultural management typically prioritizes nutrient cycling and supply for crop growth, whereas the mineralization of added biomass regulates crop nutrient supply and CO2 emissions. To reduce overconsumption of natural resources and environmental damage, the current economic model of "take-make-use-dispose" must be replaced by "prevention-reuse-remake-recycle". The circular economy model is promising for preserving natural resources and providing sustainable, restorative, and regenerative farming. Technosols and organic wastes can improve food security, ecosystem services, the availability of arable land, and human health. This study intends to investigate the nitrogen nutrition provided by organic wastes to agricultural systems, reviewing the current state of knowledge and demonstrating how common organic wastes can be utilized to promote sustainable farming management. Nine waste residues were selected to promote sustainability in farming based on circular economy and zero waste criteria. Using standard methods, their water content, organic matter, total organic carbon, Kjeldahl nitrogen, and ammonium levels were determined, along with their potential to improve soil fertility via N supply and technosol formulation. 10 % to 15 % of organic waste was mineralized and analysed during a six-month cultivation cycle. Through the results, the combination of organic and inorganic fertilization to increase crop yield is recommended, as is the search for realistic and practical methods of dealing with massive amounts of organic residues within the context of a circular economy.

Colecistectomía laparoscópica. Análisis de 334 casos en el hospital Eugenio Espejo de la ciudad de Quito / Laparoscopic cholecystectomy. Analysis of 334 cases in hospital Eugenio Espejo de Quito

Se presentan resultados de la colecistectomía laparoscópica, pretendiendo dar una visión real de la aplicación de este procedimiento en el HEE. Se revisó retrospectivamente una serie de 786 historias clínicas de pacientes ingresados al Servicio de Cirugía General con patología de vesícula y vía biliar de enero del 2007 a diciembre del 2007, analizándose 334 casos de colecistectomías por vía laparoscópica. Se constataron los datos de distintas variables y se los compararon con los resultados de publicaciones similares. Se calcularon promedios, porcentajes y frecuencias en cada una de ellas. La edad promedio fue de 48 años. El 81.1 por ciento fueron mujeres. La categorización ASA I fue hallada en un 92 por ciento. El diagnóstico de litiasis fue confirmado por ecografía. El hallazgo intraoperatorio mas frecuente fue litiasis vesicular no complicada. El tiempo quirúrgico promedio fue de 90 minutos y la estadía hospitalaria fue de +/- 2 días. Las complicaciones quirúrgicas y la tasa de conversión no fueron representativas. En este estudio se observaron que los datos estadísticos son similares al compararlos con resultados de publicaciones sobre el tema; llamando la atención que dicho procedimiento se realice en un menor porcentaje al reportado en otras publicaciones nacionales e internacionales. La colecistectomía laparoscópica es el gold estándar en el tratamiento de la patología vesicular por cuanto la técnica en nuestro medio se está perfeccionando por el equipo quirúrgico, pues las complicaciones, reintervenciones y tasa de conversión están dentro de parámetros internacionales, sin embargo el procedimiento no se realiza ampliamente.

Nutrición del adulto / Nutrition of the adult

El adulto sano debe conservar un balance cero de energía: ingestión=gasto; un aumento en el gasto de energía induce un aumento en la ingestión de alimentos, y a una disminución de gasto ocurre una disminución de ingestión. Algunos estudios muestran que cuando el gasto es bajo, la ingestión no se reduce en la misma proporción, induciendo problemas de obesidad, principalmente en individuos que realizan actividades sedentarias. El gasto energético se divide en interno y externo. El interno incluye el gasto basal y la termogénesis alimentaria; el externo es la actividad física. A partir de los 30 años de edad los requerimientos disminuyen un 0.4 por ciento cada año. Apartados del presente trabajo: 1) Requerimientos energéticos del adulto. 2) Sustratos energéticos para el trabajo. 3) Evaluación del estado de nutrición: indicadores antropométricos, bioquímica. 4) Alimentación del adulto: prevención de enfermedades; alimentación para individuos con diferentes niveles de actividad física; comidas fuera de casa. 5) Nutrición y problemas frecuentes en la edad adulta: alcohol y alcoholismo; tabaquismo

Aspectos básicos de calorimetría / Basic aspects of calorimetry

Calorimetría: estimación del gasto energético que consume una persona y/o cuantificación de sus necesidades energéticas y de carbono, ácidos grasos y aminoácidos. Apartados del trabajo: Introducción. 1) Requerimientos de energía. 2) Método tradicional para estimar las necesidades de energía: gasto energético basal; termogénesis alimentaria; gasto energético por actividad física. 3) Método FAO/OMS/UNU: gasto energético basal; gasto energético por actividad física; gasto energético total