COPD patient profiles in primary care. Referral criteria.

COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.

Phytoaccumulation of trace elements (As, Cd, Co, Cu, Pb, Zn) by Nicotiana glauca and Euphorbia segetalis growing in a Technosol developed on legacy mine wastes (Domingo Rubio wetland, SW Spain).

Sulfidic mine wastes have the potential to generate acid mine drainage (AMD) and release acid leachates containing high levels of iron, sulfate and potentially toxic elements (PTEs). Soils receiving AMD discharges are generally devoid of vegetation. Only a few metal-tolerant plant species can survive under such adverse soil conditions. This work investigates two plant species, Nicotiana glauca and Euphorbia segetalis, that have successfully colonized an AMD-impacted wetland area in south-western Spain. The uptake of PTEs from the soil by roots and their transfer and accumulation in the above-ground biomass were quantified. Results showed that these pioneer plants grew in patches of neutral soil within the wasteland despite the high concentrations of PTEs in the rhizosphere soil (up to: 613 mg kg-1 As, 18.7 mg kg-1 Cd, 6370 mg kg-1 Cu, 2210 mg kg-1 Pb and 5250 mg kg-1 Zn). The target organs of As, Cu and Pb accumulation were: root > leaf > stem in N. glauca, and root > stem > leaf in E. segetalis. Zinc and Cd showed a significant decrease in roots relative to aerial parts of N. glauca, and Co was preferentially partitioned in stems of N. glauca and leaves of E. segetalis. The soil-plant transfer coefficient values of PTEs in all parts of both plants were well below unity with the only exception of Cd in leaves of N. glauca (1.254), suggesting that roots acted as a barrier limiting the uptake of PTEs by plants. Interestingly, under the same soil conditions, N. glauca absorbed Cd in considerable proportions from soil and accumulated it in its leaves, while E. segetalis was not effective in transferring PTEs from roots shoots except for Co. In conclusion, soil pH and plant-related factors greatly influence the stabilization of PTE in the rhizospheric soil and produce inconsistencies in PTE phytoavailability. The findings of this study provide criteria to assist in natural remediation in other legacy contaminated sites worldwide.

Modelo teórico y marcos conceptuales de las lesiones por presión y otras heridas crónicas. Historia y desarrollo / Theoretical model and conceptual frameworks of pressure injuries and other chronic wounds. History and development

El presente artículo hace un repaso histórico por los marcos conceptuales sobre las lesiones por presión y otros tipos de heridas crónicas. En esta revisión se presentan 4 de los modelos más influyentes y representativos de las últimas décadas: a) el modelo conceptual de Braden-Bergstrom, que se desarrolló en 1987 como base teórica para el desarrollo de la escala de Braden y que identifica los factores etiológicos definidos, el aumento de la presión y la disminución de la tolerancia de los tejidos; b) el modelo teórico de las lesiones cutáneas relacionadas con la dependencia, que analiza el principal marco teórico de estas lesiones crónicas, desde su origen en 2011, su difusión en 2014 y las últimas modificaciones realizadas en 2021, en las que ya se incluyen hasta 10 tipos de lesiones distintas; c) el modelo conceptual de la dermatitis asociada a la incontinencia, este modelo hace referencia a la más frecuente de todas las lesiones cutáneas asociadas a la humedad, la dermatitis asociada a la incontinencia, de la que se analizan sus dos grandes factores etiológicos, la sobrehidratación y el aumento del pH, y d) el modelo conceptual de las lesiones por compromiso vital grave, finalmente se analiza el último y más reciente de los modelos, el de las lesiones inevitables y que se dan en las personas cuya situación vital es extremadamente grave, e incluso son el anuncio de una muerte inminente, distinguiendo entre las lesiones por fracaso multiorgánico y las lesiones por vasoconstricción extrema (AU)

This article takes a historical review through the theoretical frameworks of pressure injuries and other chronic wounds. In this review, 4 of the most influential and representative models of the last decades are presented: a) the Braden-Bergstrom conceptual framework, developed in 1987 is presented as the theoretical basis for the development of the Braden scale and the defined etiological factors are identified: increased pressure and decreased tissue tolerance; b) the theoretical model of dependence-related skin lesions, the main theoretical model of these chronic lesions is also analyzed, from its origin in 2011, its dissemination in 2014 and the latest modifications made in 2021 in which up to ten different types of lesions are already included; c) the conceptual model of incontinence-associated dermatitis, this model analyzed refers to the most important of all moisture-associated skin lesions: incontinence-associated dermatitis, analyzing the two major etiological factors: overhydration and increased pH; and d) the conceptual model of severe life-threatening injuries, finally, the last and most recent model is analyzed, that of unavoidable injuries that occurin people whose life situation is extremely serious, and even heralds imminent death, distinguishing between multiorgan dysfunction syndrome skin injuries and skin injuries by extreme vasoconstriction (AU)

Asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería: competencias y propuesta de contenidos / A course on care for people with skin lesions for the undergraduate nursing programme: competencies and proposed contents

El presente artículo pretende desarrollar una propuesta marco sobre una asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería. Esta ha sido realizada por consenso de expertos, profesores con experiencia en el cuidado de heridas y fue sometida a modificaciones en el marco del Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. Con ello se presenta una propuesta de competencias sobre el cuidado de las personas con lesiones cutáneas para la enfermera graduada, así como la propuesta curricular, con su estructura pedagógica basada en unidades didácticas y la propuesta de carga docente y ubicación de la asignatura de cuidados de las personas con lesiones cutáneas en el grado en enfermería. Finalmente se presentan documentos de apoyo al profesorado y estudiantado para la creación de la asignatura de cuidados de las personas con lesiones cutáneas para el grado en enfermería (AU)

This article aims to develop a framework proposal for a course on the care of people with skin lesions in the nursing degree. It has been developed by consensus of experts, professors with experience in wound care and was subject to modifications in the framework of the Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. This includes a proposal of competencies on the care of people with skin lesions for the graduate nurse, as well as the Curricular proposal, with its pedagogical structure based on didactic units and the proposed teaching load and location of the subject of care for people with skin lesions in the nursing degree. Finally, support documents are presented for the teaching staff and students for the creation of the subject of care of people with skin lesions for the degree in nursing (AU)

Influence of an external electric field on the rapid synthesis of MoO3 micro- and nanostructures by Joule heating of Mo wires.

The growth mechanism of layered α-MoO3 nano- and microplates on the surface of Mo wires during Joule heating has been investigated by application of an external electric field to the current carrying wire. The observed rapid growth of the structures, involving enhanced diffusion processes associated to the intense electric current, is further enhanced by the external field leading to a near instantaneous formation of MoO3 plates. Thermally assisted electromigration in the Mo wire with the additional effect of the electric field appears as a very time effective method to grow MoO3 layered low dimensional structures. Other molybdenum oxide nanostructures, such as nanospheres and nanocrystallites with different shapes, have been found to grow by deposition from the Mo wire on the electrodes used to apply the external electric field. The growth on the electrodes takes place by a thermally assisted electric-field-driven process.

Identificación de Helicobacter pylori por medio de la coloración especial de Warthin-Starry en biopsias de pacientes con gastritis crónica folicular, previamente negativas en la tinción de hematoxilina-eosina / Warthin-Starry stain identification of Helicobacter pylori in biopsies of patients who previously tested negative in hematoxylin-eosin staining for follicular gastritis

Resumen Las técnicas empleadas para la detección del Helicobacter pylori (H. pylori) son no invasivas e invasivas. En estas últimas, la presencia del H. pylori se determina a partir de la tinción de hematoxilina-eosina (HE), prueba rutinaria, mientras que en pocas ocasiones se aplica la tinción de Warthin-Starry (WS) como coloración especial. Objetivo: identificar la presencia de H. pylori por medio de la coloración especial de la WS en biopsias de pacientes con gastritis crónica folicular, previamente negativas en la tinción HE. Materiales y métodos: se desarrolló un estudio de tipo descriptivo transversal, en un período de 12 meses. Se tomaron los bloques de parafina de las muestras de la mucosa gástrica de pacientes con diagnóstico de gastritis crónica e hiperplasia folicular. Además, se extrajo un corte histológico del mismo bloque, al cual se le aplicó HE y se determinó la presencia o ausencia de H. pylori. Así, de estar ausente, se tomó del mismo bloque un corte adicional y se aplicó WS. Esto se evaluó con el fin de identificar la existencia o no del bacilo. Resultados: se recolectaron 314 muestras; 209 fueron negativas y 105 fueron positivas para HE. El 45 % (94) de estas muestras fueron positivas respecto a la presencia del bacilo, al aplicar la segunda coloración, y el 55 % (115) de las muestras persistieron negativas. Conclusión: el hallazgo de H. pylori es significativamente alto al aplicar la coloración de WS a muestras cuyo estudio histológico evidenció la ausencia del bacilo en biopsias de la mucosa gástrica, especialmente en muestras con escasa cantidad de bacterias.

Abstract Non-invasive and invasive techniques can be used for detection of Helicobacter pylori. An invasive technique identifies the bacteria through routine hematoxylin-eosin staining. Warthin-Starry stain is rarely used. Objective: Our objective was to identify H. pylori by Warthin-Starry staining of patient's biopsies with chronic follicular gastritis who had previously tested negative in hematoxylin-eosin staining. Materials and methods: This is a descriptive, cross-sectional descriptive study that was carried out over a period of 12 months. The study examined paraffin blocks of samples taken from the gastric mucosa of patients diagnosed with chronic gastritis and follicular hyperplasia. A histological section was extracted from a block and tested with hematoxylin-eosin staining for the presence or absence of H. pylori. If absent, an additional cut was taken from the same block and Warthin-Starry staining was used to retest for the presence of the bacteria. Results: Of the 314 samples collected, 209 tested negative, and 105 tested positive for H. pylori when hematoxylin-eosin staining was used. Of the 209 negative samples, 45% (94) tested positive when Warthin Starry stain was used, and 55% (115) still tested negative. Conclusion: Findings of H. pylori are significantly higher when Warthin Starry stain was used to test samples whose previous histological study had evidenced an absence of the bacillus, especially in samples with a small amount of bacteria.

Quantum nanoconstrictions fabricated by cryo-etching in encapsulated graphene.

We report on a novel implementation of the cryo-etching method, which enabled us to fabricate low-roughness hBN-encapsulated graphene nanoconstrictions with unprecedented control of the structure edges; the typical edge roughness is on the order of a few nanometers. We characterized the system by atomic force microscopy and used the measured parameters of the edge geometry in numerical simulations of the system conductance, which agree quantitatively with our low temperature transport measurements. The quality of our devices is confirmed by the observation of well defined quantized 2e2/h conductance steps at zero magnetic field. To the best of our knowledge, such an observation reports the clearest conductance quantization in physically etched graphene nanoconstrictions. The fabrication of such high quality systems and the scalability of the cryo-etching method opens a novel promising possibility of producing more complex truly-ballistic devices based on graphene.

Study of the exceptional meteorological conditions, trace gases and particulate matter measured during the 2017 forest fire in Doñana Natural Park, Spain.

In late June 2017, a forest fire occurred in Doñana Natural Park, which is located in southwestern Europe. Many animal and plant species, some of which are threatened, suffered from the impact of this fire, and important ecosystems in the European Union were seriously affected. This forest fire occurred under exceptional weather conditions. The meteorological situation was studied at both the synoptic scale and the local scale using meteorological fields in the ERA-Interim global model from ECMWF (European Centre for Medium Range Weather Forecasts), the WRF (Weather Research and Forecasting) mesoscale model and ground observations collected at El Arenosillo observatory. Anomalies were obtained using records (observations and simulations) over the last two decades (1996-2016). An anticyclonic system dominated the synoptic meteorological conditions, but a strong pressure gradient was present; positive high pressure anomalies and negative low pressure anomalies resulted in intense NW flows. At the surface, wind gusts of 80 km h-1, temperatures up to 35 °C and relative humidity values <20% were observed. In terms of anomalies, these observations corresponded to positive temperature anomalies (differences of 12 °C), positive wind speed anomalies (>29 km h-1) and negative relative humidity anomalies (differences of 40%). The forest fire reached El Arenosillo observatory approximately 8 h after it began. When the fire started, record-setting maximum values were measured for all gases monitored at this site (specifically, peaks of 99,995 µg m-3 for CO, 951 µg m-3 for O3, 478 µg m-3 for NO2, 116 µg m-3 for SO2 and 1000 µg m-3 for PM10). According to the temporal evolution patterns of these species, the atmosphere over a burnt area can recover to initial atmospheric levels between 48 and 96 h after an event. The impact of the Doñana plume was studied using hourly forward trajectories computed with the HYSPLIT (Hybrid Single-Particle Lagrangian Integrated Trajectory) model to analyse the emission source for the burnt area. The Doñana fire plume affected large metropolitan areas near the Mediterranean coast. Air quality stations located in the cities of Seville and Cadiz registered the arrival of the plume based on increases in CO and PM10. Using CO as a tracer, measurements from the AIRS and MOPITT instruments allowed us to observe the transport of the Doñana plume from the Strait of Gibraltar to the Mediterranean. Finally, after two days, the Doñana forest fire plume reached the western Mediterranean basin.

Documento de recomendaciones para el diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica en Andalucía / No disponible

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) se define como una enfermedad respiratoria, caracterizada esencialmente por una limitación crónica al flujo aéreo, que no es totalmente reversible y que, en nuestro medio, se relaciona fundamentalmente con el consumo de tabaco. La EPOC se caracteriza también por la presencia de agudizaciones y comorbilidades que contribuyen a la gravedad en algunos pacientes. La EPOC es una enfermedad muy prevalente y en España afecta al 10,2% de la población entre los 40 y 80 años, con un gran impacto en la calidad de vida de pacientes y cuidadores y un importante consumo de recursos económicos y sanitarios. En la actualidad, la EPOC es la cuarta causa de muerte a nivel mundial, por detrás de la cardiopatía isquémica, los accidentes cerebrovasculares y las infecciones de las vías respiratorias inferiores. El diagnóstico de la EPOC se basa en la exposición a un factor de riesgo, habitualmente el tabaco (≥10 paquetes-año), en un paciente mayor de 35 años en presencia de síntomas (disnea, tos y/o expectoración) y confirmación del patrón obstructivo en la espirometría tras broncodilatador con una relación FEV1 /FVC < 0,70 en fase estable de la enfermedad. Pese a todos los esfuerzos realizados, la EPOC sigue teniendo un elevado infradiagnóstico (73%) que es mayor en mujeres que en hombres. La EPOC es una enfermedad muy heterogénea, por lo que es necesario realizar una correcta caracterización clínica que nos permita identificar grupos homogéneos de pacientes que se puedan beneficiar de una intervención terapéutica específica e incluso personalizada. Las sociedades científicas aquí representadas han trabajado para elaborar unas recomendaciones, basadas en la evidencia científica actual, para el diagnóstico y tratamiento de la EPOC en Atención Primaria y Neumología en Andalucía, con una visión adaptada a la práctica clínica en la vida real

No disponible

Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria / Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care

Objetivos. La satisfacción del paciente con los servicios sanitarios juega un rol importante en los programas de mejora de la calidad asistencial. Los objetivos de este estudio fueron: identificar las características sociodemográficas del paciente relacionadas con su satisfacción respecto a la atención proporcionada por el médico de familia en los centros de Atención Primaria de Salud (APS) y describir la variabilidad geográfica de este fenómeno en el Servicio Nacional de Salud español. Material y métodos. Los datos se obtuvieron de la Encuesta Europea de Salud de 2009. Se analizaron las razones de prevalencia (brutas y ajustadas) de las características asociadas tanto con una satisfacción excelente como de insatisfacción mediante regresión de Poisson, así como su variabilidad geográfica. Resultados. Aproximadamente uno de cada 3 usuarios de la APS consideró que la atención proporcionada había sido excelente, mientras que el 6,7% se mostró insatisfecho. Existió una amplia variabilidad en la percepción de satisfacción entre los distintos servicios regionales de salud, prevalencias que oscilaron entre el 10,9 y el 55,2%. Por otra parte, esta valoración estuvo estrechamente relacionada con la edad, el nivel de salud autopercibida, la salud mental, los ingresos hospitalarios previos, el estatus de enfermedad crónica y las limitaciones en las actividades diarias. Conclusiones. La satisfacción con la atención proporcionada por el médico de APS es relativamente alta. No obstante, presenta una distribución heterogénea entre las comunidades autónomas y las características sociodemográficas y el nivel de salud del usuario (AU)

Background. Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. Material and methods. The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. Results. About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. Conclusions. Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous (AU)

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care]. / Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria.

BACKGROUND: Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS: The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS: About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS: Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Classification of dependence-related skin lesions: a new proposal.

A new theoretical framework on the development of pressure ulcers and other dependence-related lesions requires continued in-depth analysis of their conceptual bases. This study reports the historical background, definitions, and production mechanisms of these lesions, describing the differential pathognomonic features of pressure and/or shear ulcers, moisture-associated skin damage, and lesions from rubbing or friction. It also discusses the combined/multifactorial lesions that can be found in the clinical setting. Finally, it presents the new classification of these lesions proposed by the Spanish Pressure Ulcers and Chronic Wounds Advisory Panel.

Introducción de un sistema de acreditación para los documentos de consentimiento informado hospitalario / Introduction of an accreditation system for hospital informed consent forms

Objetivo: Describir la creación y funcionamiento de un sistema de acreditación de documentos de consentimiento informado (DCI) como intervención para mejorar su calidad formal y comprobar la mejora obtenida. Material y métodos: Tras una evaluación externa de la calidad de los DCI en un hospital de Murcia (España), se consensuaron los requisitos para los DCI y se diseñaron procedimientos de acreditación y uso. La efectividad se valoró comparando 2 evaluaciones externas del Programa EMCA (2011 y 2013), basadas en 19 criterios y muestras de 60 DCI para cada hospital público de la región. Resultados: Para ser acreditado un DCI debería cumplir 24 criterios: los 19 utilizados en evaluaciones externas, más 3 sobre legibilidad y 2 sobre validez científico-técnica. Se acordó un formulario para implementar los contenidos de cada DCI, que serían revisados y aprobados con vigencia de 5 años. Inicialmente se detectaron 8,2 defectos/DCI. La mejora obtenida fue del 89% (0,9 defectos/DCI), evidenciado mejoras significativas en 18 criterios y marcando benchmark para 16 de los 19 evaluados. Discusión: La acreditación supuso una mejora sustancial de los DCI del hospital (obteniendo el mejor resultado en las evaluaciones externas de su servicio de salud) y garantiza su contenido, legibilidad y comprensión. Ello obliga a valorar la conveniencia de su extensión a otros hospitales, aunque no esté clara la bondad de disponer de DCI comunes. Sin embargo, esta mejora es estructural y no garantiza que la globalidad del proceso de información/consentimiento que soporta se realice adecuadamente, precisando estrategias complementarias para su medición y mejora (AU)

Objective: To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. Material and methods: Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. Results: To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. Discussion: The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required (AU)

[Introduction of an accreditation system for hospital informed consent forms]. / Introducción de un sistema de acreditación para los documentos de consentimiento informado hospitalario.

OBJECTIVE: To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. MATERIAL AND METHODS: Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. RESULTS: To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. DISCUSSION: The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required.

Study of mechanical resonances of Sb2O3 micro- and nanorods.

Sb2O3 microrods with orthorhombic phase were grown by an evaporation-deposition method from a pure antimony source and substrate. The incorporation of Cr into the substrate has been found to enhance the growth of thinner rods with high crystalline quality, as is revealed by high resolution transmission electron microscopy (HRTEM). Electric field-induced mechanical resonances of Sb2O3 nanorods were studied by in situ measurements in a scanning electron microscope (SEM). Young's modulus of rods with different lengths and cross-sectional dimensions was calculated from the resonance frequency. The E values for the different rods were in the range of 16-48 GPa. For comparison, Young's moduli of several rods were also measured from the force-displacement curve recorded in an atomic force microscope (AFM). The slight difference between the E values obtained by the resonance and by the AFM techniques is within the accepted experimental error.

Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales / Formal quality assessment of informed consent documents in 9 hospitals

Introducción. Los formularios de consentimiento informado tienen una gran importancia en el proceso de información médica. El objetivo de este estudio es diseñar criterios de calidad formal para estos documentos, que sean fiables, y su utilización para la valoración de los utilizados por los hospitales de un servicio regional de salud. Material y métodos. El diseño de los criterios se ha realizado a partir del análisis de la normativa vigente, estudios anteriores y consulta con expertos clave. El grado de concordancia interobservador se valoró mediante el índice kappa. La evaluación de los criterios se realizó en 1.425 documentos de 9 hospitales. Resultados. Se han diseñado 19 criterios con los que se evaluó la calidad de los formularios. Los valores kappa eran mayores de 0,60 en 17 de ellos y superiores a 0,52 en los otros 2. El promedio de defectos por documento fue de 7,6 con una razón de variación entre hospitales de 1,84. Más del 90% de los documentos presentaban defectos en la información sobre las consecuencias y contraindicaciones, y en cerca del 90% no constaba la entrega de copia. Más del 60% tenían incumplimientos relacionados con la finalidad del procedimiento, la declaración de haber comprendido y aclarado dudas y las alternativas. Conclusiones. Se ha obtenido una herramienta que permite valorar de modo fiable la calidad formal de los documentos de consentimiento informado. Los formularios valorados tienen un amplio margen para la mejora, relacionada con la entrega de copia y algunos aspectos de la información específica que el paciente debe recibir(AU)

Introduction. Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. Material and methods. Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. Results. A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. Conclusions. A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive(AU)

[Formal quality assessment of informed consent documents in 9 hospitals]. / Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales.

INTRODUCTION: Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. MATERIAL AND METHODS: Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. RESULTS: A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. CONCLUSIONS: A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive.

An adenine insertion in exon 6 of human GP6 generates a truncated protein associated with a bleeding disorder in four Chilean families.

BACKGROUND: Glycoprotein VI (GPVI), 60-65 kDa, is a major collagen receptor on platelet membranes involved in adhesive and signaling responses. Mice lacking GPVI have impaired platelet response to collagen and defective primary adhesion and subsequent thrombus formation. Complete or partial deficiency of GPVI in humans is a rare condition presenting as a mild bleeding disorder. The defect in most of the reported patients is acquired and associated with other diseases. To date, only two patients have been characterized at the molecular level who carry different compound heterozygous mutations in the GP6 gene. OBJECTIVE: To report four unrelated patients from non-consanguineous families who presented with mucocutaneous bleeding. They had absent platelet aggregation and (14) C-5-HT secretion with collagen, convulxin and collagen-related peptide. RESULTS: Flow cytometry and immunofluorescence-confocal microscopy showed an absence of GPVI in non-permeabilized platelets. All the patients had an adenine insertion in exon 6 (c.711_712insA), changing the reading frame and generating a premature 'stop codon' in site 242 of the protein. The mutation predicts the synthesis of the truncated protein before the trans-membrane domain, corresponding to a band of ≈49 kDa observed in western blots and in permeabilized platelets by immunofluorescence. Platelet mRNA from all the patients was sequenced and contained the corresponding adenine insertion. Heterozygous relatives had no pathological bleeding, normal response to collagen and convulxin and intermediate membrane expression of GPVI. CONCLUSIONS: The identification of four unrelated homozygous patients with an identical defect suggests that inherited GPVI deficiency is more frequent than previously suspected, at least in Chile.

Cathodoluminescence of rare earth implanted Ga2O3 and GeO2 nanostructures.

Rare earth (RE) doped gallium oxide and germanium oxide micro- and nanostructures, mostly nanowires, have been obtained and their morphological and optical properties have been characterized. Undoped oxide micro- and nanostructures were grown by a thermal evaporation method and were subsequently doped with gadolinium or europium ions by ion implantation. No significant changes in the morphologies of the nanostructures were observed after ion implantation and thermal annealing. The luminescence emission properties have been studied with cathodoluminescence (CL) in a scanning electron microscope (SEM). Both ß-Ga(2)O(3) and GeO(2) structures implanted with Eu show the characteristic red luminescence peak centered at around 610 nm, due to the (5)D(0)-(7)F(2) Eu(3+) intraionic transition. Sharpening of the luminescence peaks after thermal annealing is observed in Eu implanted ß-Ga(2)O(3), which is assigned to the lattice recovery. Gd(3+) as-implanted samples do not show rare earth related luminescence. After annealing, optical activation of Gd(3+) is obtained in both matrices and a sharp ultraviolet peak centered at around 315 nm, associated with the Gd(3+) (6)P(7/2)-(8)S(7/2) intraionic transition, is observed. The influence of the Gd ion implantation and the annealing temperature on the gallium oxide broad intrinsic defect band has been analyzed.

La profilaxis con sellado de gentamicina de las ramas del catéter venoso central crónico tunelizado no causa resistencia bacteriana / Prophylaxis with gentamicin locking of chronic tunneled central venous catheters does not cause bacterial resistance

Introducción: La profilaxis con sellado de gentamicina de las ramas del catéter venoso central tunelizado en hemodiálisis crónica disminuye la morbimortalidad infecciosa bacteriana asociada a la bacteriemia del catéter. Objetivo: Valorar en un estudio prospectivo observacional de siete años de duración de 101 pacientes en hemodiálisis crónica con catéter tratados con profilaxis la aparición de resistencia bacteriana al antibiótico en gérmenes habitualmente sensibles a su acción. Material y métodos: Protocolo de asepsia universal en el manejo del catéter. Sellado intraluminal de las ramas posdiálisis con gentamicina 5 mg/rama + heparina sódica al 1%, monitorizando su nivel valle en sangre y (..) (AU)

Introduction: Prophylaxis with gentamicin locking of chronic tunnelled central venous catheter branches in chronic haemodialysis patients reduces bacterial infections and morbidity and mortality associated with catheter bacteraemia. Aim: We undertook a 7-year, prospective, observational study involving 101 patients on chronic haemodialysis with catheters treated with prophylaxis to evaluate the appearance of bacterial resistance to the antibiotic in pathogens usually sensitive to its action. Material and Methods: A protocol of universal asepsis in catheter management. Postdialysis intraluminal locking of the branches with gentamicin at 5mg/branch + 1% heparin sodium, monitoring trough levels in blood and modifying the dose according to the established protocol. The diagnosis of bacteraemia was based on usual criteria. The main study variables were: Diagnosis by the bacteriology department of bacterial resistance in pathogens sensitive to gentamicin. Diagnosis of clinical ototoxicity. Secondary variables were: Patients hospitalised/bacteraemia; number of bacteraemia/catheter/1000 days; infectious mortality; and catheter withdrawal/bacteraemia. Pathogens found in blood culture. Results: Main variables: We found no resistance of pathogens usually sensitive to the antibiotic. Nor was there clinical ototoxicity. The mean number of months each patient remained in the study was 23 (1-84). Secondary variables: Three patients (3%) were hospitalized due to bacteremia; number of bacteremias, 8; number of (..) (AU)