Efectividad de la electroacupuntura y moxibustión en el tratamiento del dolor postquirúrgico del injerto por plastia del ligamento cruzado anterior con remodelación meniscal. Estudio de caso UNEVT 2022 / Effectiveness of electroacupuncture and moxibustion in the treatment of postoperative anterior cruciate ligament graft pain with meniscal remodeling. Case study UNEVT 2022

Objetivo: Analizar la respuesta del dolor postquirúrgico ante la aplicación de electroacupuntura y moxibustión mediante la escala IKDC. Método: Estudio cuasiexperimental en la clínica integral de la Universidad Estatal del Valle de Toluca. El tratamiento consistió en la aplicación consentida de diez sesiones de electroacupuntura y moxibustión distribuidas en dos sesiones semanales de 30 minutos para el monitoreo del dolor postquirúrgico en plastia del ligamento cruzado anterior. Resultados: Se obtuvo disminución del dolor al 100 % (EVA 0/10) a partir de la sexta sesión (21 días) observó recuperación de las heridas quirúrgicas al 100 %, disminución del edema al 75 % (signo Godet 1+/4+) y aumento de la movilidad al 59 % IKDC (47,4/80 puntos totales). Conclusiones: Se evidenció la efectividad de la terapia con electroacupuntura (1) y moxibustión (2,3) en el tratamiento del dolor postquirúrgico por medio de la escala IKDC (4) al concluir las diez sesiones, además de cicatrización acelerada, disminución del edema y aumento en la movilidad articular en menor tiempo, siendo una opción terapéutica en la analgesia y recuperación de procedimientos quirúrgicos siempre que se practique conforme a las bases científicas, clínicas.(AU)

Objective: To analyze the response of post-surgical pain to the application of electroacupuncture and moxibustion using the IKDC scale. Methods: Quasi-experimental study in the integral clinic of the Universidad Estatal del Valle de Toluca, the treatment consisted of the consented application of ten sessions of electroacupuncture and moxibustion distributed in two weekly sessions of 30 minutes for the monitoring of postoperative pain in anterior cruciate ligament plasty. Results: 100 % pain reduction (VAS 0/10) was obtained from the sixth session (21 days), 100 % recovery of the surgical wounds was observed, edema was reduced to 75 % (Godet sign 1+/4+) and mobility was increased to 59% IKDC (47.4/80 total points). Conclusions: The effectiveness of therapy with electroacupuncture (1) and moxibustion (2,3) in the treatment of post-surgical pain was evidenced by means of the IKDC (4) scale at the end of the ten sessions, in addition to accelerated healing, decreased edema and increased joint mobility in less time, being a therapeutic option in analgesia and recovery from surgical procedures as long as it is practiced according to the scientific, clinical bases.(AU)

Responses of macroinvertebrate communities to land use specific sediment food and habitat characteristics in lowland streams.

The input of land use specific organic matter into lowland streams may impact sediment characteristics in terms of food resources and habitat structure, resulting in differences in macroinvertebrate community composition. Therefore, we investigated to what extent land use specific sediment food and habitat characteristics structure macroinvertebrate communities. To this purpose linear multiple regression models were constructed, in which macroinvertebrate biotic indices were considered as response variables and sediment characteristics as predictor variables, analysed in 20 stream stretches running through five different land use types. Sediment characteristics and macroinvertebrate community composition were land use specific. The carbon/nitrogen (C/N) ratio, woody debris substrate cover and the origin of fatty acids influenced macroinvertebrate community composition. Shannon-Wiener diversity was better explained by fatty acids origin, such as in grassland streams, where a higher relative content of plant derived fatty acids related to a higher macroinvertebrate diversity. In cropland and wastewater treatment plant (WWTP) streams with a low C/N ratio and dominated by microbial derived fatty acids, higher abundances of Oligochaeta and Chironomus sp. were observed. Ephemeroptera, Plecoptera, and Trichoptera (EPT) richness was positively related to woody debris substrate cover, which only occurred in forest streams. Hence, macroinvertebrate community composition was influenced by the origin of the organic material, being either allochthonous or autochthonous and when autochthonous being either autotrophic or heterotrophic. It is therefore concluded that sediment food and habitat characteristics are key ecological filters.

Costs of multiple sclerosis in Panama from societal, patient perspectives and health-related quality of life.

The purpose of this work is to estimate the costs associated with managing patients with MS in Panama and evaluating the impact of the disease on their health-related quality of life (HRQoL). Multicentric observational, retrospective, cross-sectional study. The costs were estimated from societal and patient perspectives and expressed in USD, 2015. The focus of the study is based on prevalence and on a "bottom-up" approach. To estimate the total cost per patient, annual reported use for each resource was multiplied by its unit cost. To evaluate HRQoL, patients completed the EQ-5D-3L questionnaire. 108 patients took part in the study. 82.41% were women with 44.78 (SD: 12.27) years. 61.11% presented mild (EDSS = 0-3.5), 25.93% moderate (EDSS = 3.5-6) and 12.96%, severe disability (EDSS≥6.5). The mean annual cost from the patient's perspective was estimated at 777.99 USD (SD: 1,741.45) per patient. The mean cost from a societal perspective was estimated at 23,803.21 USD (SD: 13,331.83) per patient. Disease-modifying therapies (DMT) accounted for the main component of the cost. A deterioration in HRQoL was observed as the disease advances and as disability increases, with mobility and usual activities being the areas most affected by its progression. From both perspective, the cost per MS patient in Panama is high. In addition to the high economic impact, MS also exerts a negative impact on patient HRQoL, which increases as the disease advances.

Effect of triage-based use of the Ottawa foot and ankle rules on the number of orders for radiographic imaging.

CONTEXT: Reducing unnecessary testing lessens the cost burden of medical care, but decreasing use depends on consistently following evidence-based clinical decision rules. The Ottawa foot and ankle rules (OFARs) are validated, longstanding evidence-based guidelines to predict fractures. Frequently, radiography is automatically ordered for acute ankle injuries despite findings from OFARs suggesting no fracture. OBJECTIVES: First, to determine whether implementation of protocol-driven use of the OFARs at triage would decrease the number of radiography orders and length of stay (LOS) in the emergency department. Second, to quantify the incidence of OFARs use at triage and to assess patient expectations of radiography use and patient satisfaction as rated by both patients and clinicians. METHODS: In this prospective, 2-stage sequential pilot study, patients with acute ankle and foot injuries were screened in the emergency department between January 2013 and October 2013. In the first stage, clinicians (physician assistants, residents, and attending physicians) performed their usual practice habits for radiography use in the control group. For the second stage, they were educated to appropriately apply the OFARs before ordering radiography. For patients who were suspected of having a fracture at triage, nursing staff ordered radiography. For patients who were not suspected of having a fracture at triage, a clinician reassessed them using the OFARs after their triage assessment. Radiography was then ordered at the discretion of the clinician. Results gathered after training in the OFARs comprised the intervention group. After discharge, patients were surveyed regarding their expectations and satisfaction, and clinicians were surveyed on their perceptions of patient satisfaction. RESULTS: A total of 131 patients were screened, 62 patients were enrolled in the study after consent was obtained, and 2 patients withdrew from the study prematurely, leaving 30 patients in each group. Fifty-eight of the 60 patients (97%) underwent radiography. Emergency department LOS decreased from 103 minutes to 96.5 minutes (P=.297) after the OFARs were applied. There was also a decrease in LOS in patients with a fracture (137 minutes vs 103 minutes [P=.112]). Radiography was expected to be ordered by 27 of 30 patients in the control group (90%) and 24 of 30 in the intervention group (80%) (P=.472). Patients were equally satisfied among the groups (54 of 60 [90%]) (with no difference between groups), and 27 of 30 (90%) vs 30 of 30 (100%) clinicians in the control and intervention groups, respectively, perceived that patients were satisfied with their treatment. CONCLUSION: There was no statistical evidence that application of the OFARs decreases the number of imaging orders or decreases LOS. This observation suggests that even when clinicians are being observed and instructed to use clinical decision rules, their evaluation bias tends toward recommendations for testing.

Food marketing to children on U.S. Spanish-language television.

Latino children in particular are at risk of childhood obesity. Because exposure to televised food marketing is a contributor to childhood obesity, it is important to examine the nutritional quality of foods advertised on Spanish-language children's programming. The authors analyzed a sample of 158 Spanish-language children's television programs for its advertising content and compared them with an equivalent sample of English-language advertising. The authors evaluated nutritional quality of each advertised product using a food rating system from the U.S. Department of Health and Human Services. In addition, the authors assessed compliance with industry self-regulatory pledges. The authors found that amount of food advertising on Spanish-language channels (M = 2.2 ads/hour) was lower than on English-language programs, but the nutritional quality of food products on Spanish-language channels was substantially poorer than on English channels. Industry self-regulation was less effective on Spanish-language channels. The study provides clear evidence of significant disparities. Food advertising targeted at Spanish-speaking children is more likely to promote nutritionally poor food products than advertising on English-language channels. Industry self-regulation is less effective on Spanish-language television channels. Given the disproportionately high rate of childhood obesity among Latinos, the study's findings hold important implications for public health policy.

Educação à distância: uma ferramenta para educação permanente de enfermeiros que trabalham com assistência perioperatória / Distance learning: a tool for ongoing education of nurses who work with perioperative care

A Educação à Distância (EAD) vem se constituindo como uma estratégia concreta e eficaz para formação de profissionais. Os objetivos deste estudo foram: identificar experiências anteriores dos enfermeiros com EAD; identificar se há interesse dos enfermeiros em participar de cursos de EAD; e apreender com os enfermeiros sugestões de temas para os cursos de EAD. Os resultados mostraram que a maioria (59 por cento) tinha título de especialista e trabalhava há mais de 10 anos na assistência perioperatória (41 por cento). Observou-se que 88 por cento possuíam computador em casa e 100 por cento deles tinham acesso à internet, no entanto, apenas 35 por cento a utilizavam. Quanto à experiência com EAD 53 por cento disseram não ter nenhuma experiência. A maioria dos participantes (88 por cento) interessou-se na abertura de cursos de EAD e fizeram várias sugestões de temas.

Standing by, ready to serve: the case for forensic nurses in uniform.

The purpose of this article was to give a brief synopsis of the background and history of forensic nursing and how it can be translated into a military application. The unique setting of military health care and equally distinctive stressors placed upon members of the military calls for greater commitment by the Department of Defense to meet those needs with trained professionals who can offer holistic and appropriate care, both at home and abroad.