Anestesia en geriatría / Geriatric in anesthesia

Sedación adecuada con dosis única de dexmedetomidina en pacientes programados para RTU con raquia. Estudio de dosis respuesta por grupo de edad Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose-response study by age group. Kim J, Kim WO, Kim HB, Kil HK. BMC Anesthesiol. 2015 Jan 27;15:17. doi: 10.1186/1471-2253-15-17. PDF Hipotensión postraquia en ancianos de cirugía ortopédica, efedrina profiláctica vs poligelina 3.5%. Postspinal hypotension in elderly patients undergoing orthopedic surgery, prophylactic ephedrine versus polygeline 3.5. Singh S, Shah TD, Gupta R, Kaur P, Walia CS, Sehrawat S. Anesth Essays Res. 2014 Sep-Dec;8(3):334-8. doi: 10.4103/0259-1162.143132. PDF La edad avanzada se asocia con resultados graves y una respuesta genómica única en pacientes gravemente heridos con shock hemorrágico. Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock. Vanzant EL, Hilton RE, Lopez CM, Zhang J, Ungaro RF, Gentile LF, Szpila BE, Maier RV, Cuschieri J, Bihorac A, Leeuwenburgh C, Moore FA,Baker HV, Moldawer LL, Brakenridge SC, Efron PA; Inflammation and Host Response to Injury Investigators. Crit Care. 2015 Mar 4;19(1):77. [Epub ahead of print] PDF El paciente geriátrico y el acto anestésico G López, J. López Rev Col Anest 2008 PDF Manejo anestésico del paciente geriátrico Guevara OP Rev Mex Anestesiol 2007 PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Geriatría / Geriatrics

De la investigación a la realidad: Minimizando los efectos de la hospitalización en adultos viejos From research to reality: minimizing the effects of hospitalization on older adults. Admi H1, Shadmi E2, Baruch H1, Zisberg A2. Rambam Maimonides Med J. 2015 Apr 29;6(2):e0017. doi: 10.5041/RMMJ.10201. eCollection 2015. Abstract This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability. KEYWORDS: Functional decline; geriatric nursing; hospitalization; older adults PDF Polifarmacia en el anciano Polypharmacy in the elderly. Golchin N, Frank SH, Vince A, Isham L, Meropol SB. J Res Pharm Pract. 2015 Apr-Jun;4(2):85-8. doi: 10.4103/2279-042X.155755. Abstract OBJECTIVE:The objective was to assess the frequency of polypharmacy and potential complications among local seniors. METHODS: A cross-sectional convenience sample of 59 adults aged above 65 years was interviewed at Cuyahoga county (U.S. state of Ohio) senior programs. Polypharmacy was defined as more than five prescribed medications. Primary outcomes were frequent missed doses, one or more duplicate drug/s, and equal or more than one contraindicated drug combinations. FINDINGS: Among seniors with the mean age of 76.9 years (25.4% male), 40.6% used multiple pharmacies and 35.6% had polypharmacy. Of all seniors with polypharmacy, about 57% had contraindicated drug combinations. Polypharmacy was associated with duplication (P = 0.02), but not frequent missed doses (P = 0.20). CONCLUSION: As shown by this study, polypharmacy was associated with duplicated therapy and contraindicated drug combinations. Improved communications among seniors, physicians, and pharmacists is necessary to minimize adverse consequences of polypharmacy. KEYWORDS: Elderly; drug adherence; polypharmacy PDF La posibilidad de utilizar una Lista de Medicamentos Universal (UMS) para mejorar la adherencia en pacientes que toman múltiples medicamentos en el Reino Unido: Una evaluación cualitativa. The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation. Kenning C, Protheroe J, Gray N, Ashcroft D, Bower P. BMC Health Serv Res. 2015 Mar 11;15:94. doi: 10.1186/s12913-015-0749-8. Abstract BACKGROUND: Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involvespolypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the 'Universal Medication Schedule' (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings. METHODS: Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data. RESULTS: Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient's care was a key theme. CONCLUSIONS: The UMS chart provides consolidated medicines information that might help to improve patients' knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Estudian por qué las mujeres viven más años

#longevidad en mujeres
Fuente
Este artículo es originalmente publicado en:
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63855&origen=notiweb&dia_suplemento=lunes

Estudian por qué las mujeres viven más años

Un número especial de Cell Stem Cell analiza diversos factores del envejecimiento.

FUENTE | Tendencias21 Un número especial de Cell Stem Cell publicado incluye una serie de artículos sobre el envejecimiento. Entre ellos destaca uno que aborda por qué las mujeres viven más años. Más del 95 por ciento de las personas bicentenarias son mujeres. Los científicos han observado mucho las diferencias entre los sexos en lo que respecta a la edad, pero no hay una explicación clara de por qué las mujeres viven más tiempo. Lea el artículo completo AQUÍ

Más de cirugía plástica / More on plastic surgery

Complicaciones anestésicas en cirugía plástica Anaesthetic complications in plastic surgery. Nath SS, Roy D, Ansari F, Pawar ST. Indian J Plast Surg. 2013 May;46(2):445-52. doi: 10.4103/0970-0358.118626. Abstract Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome. KEYWORDS: Anaesthesia; complications; plastic; surgery Artículo en HTML/HTML article Actualización y revisión. Cambiando el uso de anestesia local en la mano Update/Review: changing of use of local anesthesia in the hand. Al Youha S1, Lalonde DH1. Plast Reconstr Surg Glob Open. 2014 Jun 6;2(5):e150. doi: 10.1097/GOX.0000000000000095. eCollection 2014 Abstract SUMMARY: Among the many advances in local anesthesia of the hand, some of the most significant changes in the last 5 years have been the following: (1) the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation,brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma. (2) The elimination of the 2 injection finger block technique in favor of the single injection palmar block. (3) Local anesthesia can now be consistently injected in the hand with minimal pain. (4) Liposomal release of local anesthetic after injection into the surgical site can provide pain control up to 3 days. This article reviews the impact and best evidence related to these changes. PDF Profilaxis para prevenir tromboembolismo venoso; preocupaciones con respecto a la eficacia y ética. Chemoprophylaxis for venous thromboembolism prevention: concerns regarding efficacy and ethics. Swanson E. Plast Reconstr Surg Glob Open. 2013 Jul 8;1(3):e23. doi: 10.1097/GOX.0b013e318299fa26. eCollection 2013. Abstract SUMMARY: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the VenousThromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives. PDF El propofol en cirugía plástica en el consultorio. Propofol in office-based plastic surgery. Friedberg BL. Semin Plast Surg. 2007 May;21(2):129-32. doi: 10.1055/s-2007-979214. Abstract Propofol is the nearly ideal agent for office-based plastic surgery. Among all anesthetic agents, only propofol has the ability to elicit happiness in this special group of patients. Cosmetic surgery patients will tolerate discomfort in preferencPDFe to postoperative nausea and vomiting. Propofol is a powerful antiemetic agent. Patient safety will not be optimized unless the person responsible for the administration of propofol has airway management skills. Dedicated anesthesia providers are highly skilled in airway management. Although the short half-life of propofol is seductive for a fast-acting, rapid emerging anesthetic, interindividual differences in propofol response make measurement of the target organ (i.e., the brain) with a bispectral index (BIS) monitor very important. BIS levels < 45 for > 1 hour are associated with increased 1-year anesthesia mortality thought to be associated with an inflammatory response. The only currently available way to avoid overmedicating with propofol is to monitor with a level of consciousness monitor like BIS. KEYWORDS: BIS monitor; Propofol; anesthesia; ketamine; office-based plastic surgery PDF Anestesia espinal para cirugía ambulatoria y de corta estancia en procedimientos de cirugía plástica Spinal Anaesthesia for Ambulatory and Short-Stay Plastic Surgery Procedures Víctor M. Whizar-Lugo, Juan C. Flores-Carrillo, Susana Preciado-Ramírez, Jaime Campos-León, Víctor Silva "Topics in Spinal Anaesthesia", book edited by Victor M. Whizar-Lugo, ISBN 978-953-51-1720-9, Published: September 3, 2014 under CC BY 3.0 license. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Cirugía Plástca / Plastic surgery

Embolismo graso como una complicación rara de liposucción de gran volumen en un paciente de cirugía plástica Fat Embolism as a Rare Complication of Large-volume Liposuction in a Plastic Patient. J Fu X, Gao S, Hu Z, Guo Y, Cai J. Forensic Sci Med 2015;1:68-71 Fat embolism is a dreaded complication in of procedures of multiple disciplines including plastic surgery. As the popularity of liposuction increases, cases of pulmonary embolism after liposuction are increasingly reported. However, documents of cerebral embolism after liposuction are rarely presented. The degree of disability with respect to Fat fat Embolism embolism Symdrome syndrome (FES) is a Gordian Knot in the evaluation of legal medicine. Therefore, it is of great significance for us to that we report the case of a 30-year-old woman who underwent a large-volume liposuction that resulted in serious complications, especially cerebral embolism. Untypical symptoms of fat embolism hamper the clinical diagnosis, particularly after a surgical procedure such as liposuction. Such a seldom-seen case would easily trigger medical disputes, especially in countries like China suffering increasing claims of medical malpractice and, medical negligences and lawsuits. Detailed descriptions of this case are presented below along with the discussion of the clinical symptoms and the diagnostic approaches to fat embolism. Keywords: Cerebral embolism, complication, fat embolism, liposuction PDF Revisión sistemática de los principios éticos en la literatura de cirugía plástica A systematic review of ethical principles in the plastic surgery literature. Chung KC, Pushman AG, Bellfi LT. Plast Reconstr Surg. 2009 Nov;124(5):1711-8. doi: 10.1097/PRS.0b013e3181b98a9f. Abstract BACKGROUND: This purpose of this study was to perform a systematic review to identify articles that discuss ethical issues relating to the field ofplastic and reconstructive surgery and to evaluate whether ethical issues are underrepresented in the plastic surgery literature. METHODS: Four medical databases were selected to search through the medical literature with specific inclusion criteria to disqualify irrelevant articles from the study. Appropriate articles were extracted, and their quality and validity were assessed by multiple investigators to maximize reproducibility. The data were then synthesized and analyzed for associations among the ethical principles. RESULTS: Of a total library search of more than 100,000 plastic surgery-oriented articles, only 110 clearly focused on ethical principles. Autonomy (53 percent) was the most common major theme, whereas distributive justice (15 percent) represented the least frequently emphasized ethicalprinciple. The proportions of each ethical principle were tested against each other for equality using Cochran's Q test; the Q test reached statistical significance (Q = 67.04, df = 3, p < 0.0001), indicating that the ethical principles were not discussed equally in plastic surgery literature, which was expected because autonomy represented 53 percent of the articles, whereas distributive justice represented only 15 percent of articles. When examining both major and minor themes, more than half of the articles (61 percent) addressed two or more ethical principles. Beneficence and nonmaleficence were strongly associated (Pearson's chi = 55.38, df = 1,p < 0.0001). CONCLUSION: Despite the extensive number of ethical issues that plastic surgeons face, a relatively small proportion of plastic surgery literaturewas dedicated to discussing ethical principles.PDF El caso contra la quimioprofilaxis para Prevención de Tromboembolismo Venoso y la Justificación de SAFEAnesthesia. The Case against Chemoprophylaxis for Venous Thromboembolism Prevention and the Rationale for SAFEAnesthesia. Swanson E. Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e160. doi: 10.1097/GOX.0000000000000116. eCollection 2014. Abstract SUMMARY: The Venous Thromboembolism Prevention study concludes that anticoagulation is effective in reducing the risk of thromboembolism in patients who are identified as higher risk by Caprini scores. This report critically assesses the statistics used in the Venous Thromboembolism Prevention study, its method of data presentation, and its conclusions. The usefulness of risk stratification and the value of anticoagulation-both prevailing concepts in risk reduction today-are challenged. Actual data show that chemoprophylaxis has no proven benefit in plastic surgery. Complications of anticoagulation predictably include excessive bleeding and hematomas, which may be serious and life-threatening. Several large published series of patients undergoing elective plastic surgery under total intravenous anesthesia have shown a much reduced risk of thromboembolism. A SAFE (Spontaneous breathing, Avoid gas, Face up, Extremities mobile) anesthesia method is discussed as a safer and more effective alternative to traditional general endotracheal anesthesia and anticoagulation. The choice for plastic surgeons is not between a venous thromboembolism and a hematoma. The choice is between a thromboembolism and adjusting our anesthesia and surgery habits to reduce the risk to a baseline level.PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Malformaciones de pared torácica

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 10 de Junio 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Malformaciones de pared torácica” por el “Dr. Ivan Antonio Rivas Rivera”, Cirujano Pediatra de la Cd. de México D.F. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador 

http://connectpro60196372.adobeconnect.com/malformaciones_torax/

2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

Más sobre cannabis/More on cannabis

Riesgos asociados con el uso no médico de cannabis Risks associated with the non-medicinal use of cannabis. Hoch E, Bonnetn U, Thomasius R, Ganzer F, Havemann-Reinecke U, Preuss UW. Dtsch Arztebl Int. 2015 Apr 17;112(16):271-8. doi: 10.3238/arztebl.2015.0271. Abstract BACKGROUND: Cannabis is the most commonly consumed illicit drug around the world; in Germany, about 4.5% of all adults use it each year. Intense cannabis use is associated with health risks. Evidence-based treatments are available for health problems caused by cannabis use. METHODS: Selective literature review based on a search of the PubMed database, with special emphasis on systematic reviews, meta-analyses, cohort studies, randomized controlled trials (RCTs), case-control studies, and treatment guidelines. RESULTS: The delta-9-tetrahydrocannabinol content of cannabis products is rising around the world as a result of plant breeding, while cannabidiol, in contrast, is often no longer detectable. Various medical conditions can arise acutely after cannabis use, depending on the user's age, dose, frequency, mode and situation of use, and individual disposition; these include panic attacks, psychotic symptoms, deficient attention, impaired concentration, motor incoordination, and nausea. In particular, intense use of high doses of cannabis over many years, and the initiation of cannabis use in adolescence, can be associated with substance dependence (DSM-5; ICD-10), specific withdrawal symptoms, cognitive impairment, affective disorders, psychosis, anxiety disorders, and physical disease outside the brain (mainly respiratory and cardiovascular conditions). At present, the most effective way to treat cannabis dependence involves a combination of motivational encouragement, cognitive behavioral therapy, and contingency management (level 1a evidence). For adolescents, family therapy is also recommended (level 1a evidence). No pharmacological treatments can be recommended to date, as evidence for their efficacy is lacking. CONCLUSION: Further research is needed to elucidate the causal relationships between intense cannabis use and potential damage to physical and mental health. Health problems due to cannabis use can be effectively treated. PDF Los efectos potenciales de cannabidiol como un agente "promotor de la atención" Potential effects of cannabidiol as a wake-promoting agent. Murillo-Rodríguez E, Sarro-Ramírez A, Sánchez D, Mijangos-Moreno S, Tejeda-Padrón A, Poot-Aké A, Guzmán K, Pacheco-Pantoja E, Arias-Carrión O. Curr Neuropharmacol. 2014 May;12(3):269-72. doi: 10.2174/1570159X11666131204235805. Abstract Over the last decades, the scientific interest in chemistry and pharmacology of cannabinoids has increased. Most attention has focused on ∆(9)-tetrahydrocannabinol (∆(9)-THC) as it is the psychoactive constituent of Cannabis sativa (C. sativa). However, in previous years, the focus of interest in the second plant constituent with non-psychotropic properties, cannabidiol (CBD) has been enhanced. Recently, several groups have investigated the pharmacological properties of CBD with significant findings; furthermore, this compound has raised promising pharmacological properties as a wake-inducing drug. In the current review, we will provide experimental evidence regarding the potential role of CBD as a wake-inducing drug. KEYWORDS: Dopamine; hypothalamus; marijuana; sleep; sleepiness. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

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Préstamo, Renovación, Reserva, Devolución
Sistemas de Bibliotecas Universidad de Concepción
¿Cómo puedo pedir un libro que no está en las Bibliotecas UdeC? Usted puede obtener libros que están en otras instituciones del Consejo de ...



Soluciones para bibliotecas
Baratz
Las bibliotecas han hecho la civilización y constituyen el más importante y destacado depósito de


29 Mayo, 2015
cepal.org
Consulta las nuevas adquisiciones de las Bibliotecas de Santiago, México y Puerto España, en un solo lugar. Listado de adquisiciones de mayo: ...