domingo, 27 de enero de 2013

Anestesia obstétrica/Obstetric anaesthesia



http://www.smo.edu.mx/


Manejo anestésico para operación cesárea urgente: revisión sistemática de la literatura de técnicas anestésicas para cesárea urgente


José V. Rueda Fuentes, Carlos E. Pinzón Flórez, y Mauricio Vasco Ramírez
r e v c o l o m b a n e s t e s i o l . 2 0 1 2;4 0(4):273-286
No existen publicaciones recientes basadas en la evidencia que contengan información específica del manejo anestésico de cesárea urgente, por lo que se propuso evaluar sistemáticamente la literatura existente del manejo anestésico en pacientes obstétricas sometidas
a cesárea urgente con el fin de definir las intervenciones más adecuadas basadas en la evidencia. Se realizó una rev isión sistemática de la literatura en: MEDLINE, 1966 a diciembre de 2010; Cochrane Collaboration registro de ensayos clínicos; Cochrane database de revisiones sistemáticas, y LILACS. La selección de los estudios se llevó a cabo de manera independiente por 2 investigadores-revisores que identificaron estudios de ensayos clínicos controlados y estudios de cohorte de manejo anestésico de cesárea urgente. En duplicado, los datos fueron extraídos, revisados y evaluados en calidad. De cada una de las fuentes se obtuvieron, respectivamente, 2.297, 36, 221 y 16 artículos potencialmente relevantes, 9 ensayos clínicos y 7 artículos bservacionales. Se realizó un análisis de heterogeneidad utilizando I2, el cual arrojó un resultado del 52%, por lo cual no se realizó metaanálisis. Conclusiones: El anestesiólogo es parte fundamental en el cuidado del binomio madre-hijo. La adecuada priorización de la urgencia en operación cesárea, la extensión anestésica peridural con lidocaína al 2% más coadyuvantes (fentanilo más adrenalina fresca), el uso de vasopresores
(fenilefrina, efedrina) para el manejo agresivo de la hipotensión, la utilización de oxígeno suplementario y un adecuado manejo de la anestesia general cuando está indicada permiten impactar favorablemente en los desenlaces del binomio madre-hijo. Los desenlaces neonatales a largo plazo no están influenciados por el tipo de anestesia suministrada a
la madre.


http://www.revcolanest.com.co/es/manejo-anestesico-operacion-cesarea-urgente/articulo/90156571/

Efecto étnico y del IMC sobre la distancia de la piel al espacio peridural lumbar en parturientas


Effect of ethnicity and body mass index on the distance from skin to lumbar epidural space in parturients.
Sharma V, Swinson AK, Hughes C, Mokashi S, Russell R.
Singapore General Hospital, Singapore, Singapore. drvvs@rediffmail.com
Anaesthesia. 2011 Oct;66(10):907-12.
Abstract
With the current prevalence of obesity and trends in ethnic diversity amongst parturients in UK maternity units, we performed a prospective, observational study to establish the effect of ethnicity and body mass index on the distance from skin to epidural space in parturients. A total of 1210 parturients participated in this study. The mean (SD) distance from skin to lumbar epidural space was 5.4 (1.1) cm. When tested in a multiple regression model, both body mass index and ethnicity significantly influenced the distance from skin to lumbar epidural space in parturients. The distance from skin to lumbar epidural space amongst ethnic groups differed at any given body mass index. It was significantly greater in Black/British Black and White parturients compared with their Asian and Chinese counterparts. You can respond to this article athttp://www.anaesthesiacorrespondence.com.


http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06812.x/pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org


Delirio en pediatría

http://www.smo.edu.mx/




Consideraciones diagnósticas sobre delirio en pediatría. Revisión y propuesta de un algoritmo para las UCIs pediátricas


Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.
Schieveld JN, van der Valk JA, Smeets I, Berghmans E, Wassenberg R, Leroy PL, Vos GD, van Os J.
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.jan.schieveld@mumc.nl
Intensive Care Med. 2009 Nov;35(11):1843-9. doi: 10.1007/s00134-009-1652-8.
Abstract
CONTEXT: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. OBJECTIVE: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. RESULTS: Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers. DISCUSSION: It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. CONCLUSION: This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765651/pdf/134_2009_

Article_1652.pdf


Sobre la utilidad de los instrumentos de diagnóstico del delirio en niños graves: evaluación de la escala Pediatric Anesthesia Emergence Delirium, de Delirium Rating Scale 88, y de Delirium Rating Scale-Revised R-98.


On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98.
Janssen NJ, Tan EY, Staal M, Janssen EP, Leroy PL, Lousberg R, van Os J, Schieveld JN.
Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, Maastricht University Medical Centre, SEARCH, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Intensive Care Med. 2011 Aug;37(8):1331-7. doi: 10.1007/s00134-011-2244-y. Epub 2011 May 13.
Abstract
PURPOSE: Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated for use in PICU settings. The aim of the present study was to investigate the use of the DRS/PAED instruments as diagnostic tools for PD in the PICU. METHODS: A prospective panel study was conducted, under circumstances of routine clinical care, investigating the diagnostic properties of the PAED, DRS-88, and DRS-R-98 in PICU patients at a tertiary university medical center. A total of 182 non-electively admitted, critically ill pediatric patients, aged 1-17 years, were included between November 2006 and February 2010. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated. Three psychometric properties were analyzed: (1) internal consistency (2) proportion of items not rateable, and (3) discriminative ability. RESULTS: The PAED could be completed in 144 (93.5%) patients, much more frequently than either the DRS-88 (66.9%) or the DRS-R-98 (46.8%). Compared with the clinical gold standard diagnosis of delirium, the PAED had a sensitivity of 91% and a specificity of 98% (AUC 0.99). The optimal PAED cutoff score as a screening instrument in this PICU setting was 8. Cronbach's alpha was 0.89; discriminative ability was high. CONCLUSIONS: The PAED is a valid instrument for PD in critically ill children, given its reliance on routinely rateable observational signs and symptoms.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136686/pdf/134_2011_

Article_2244.pdf



Delirio; Una frontera emergente en el manejo de los niños graves
Delirium: an emerging frontier in the management of critically ill children.
Smith HA, Fuchs DC, Pandharipande PP, Barr FE, Ely EW.
Pediatrics and Anesthesiology Division of Critical Care, Department of Pediatrics, 5121 Doctor's Office Tower, 2200 Children's Way, Nashville, TN 37232-9075, USA. heidi.smith@vanderbilt.edu
Crit Care Clin. 2009 Jul;25(3):593-614, x. doi: 10.1016/j.ccc.2009.05.002.
Abstract
The objectives of this article are (1) to introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations (2) to understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics (3) to understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population (4) to discuss the pathophysiology of delirium as currently understood, and (5) to provide general management guidelines for delirium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793079/pdf/nihms135370.pdf



Delirio en los niños graves: fenomenología, correlación clínica y respuesta terapéutica

Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit.
Schieveld JN, Leroy PL, van Os J, Nicolai J, Vos GD, Leentjens AF.
University Hospital Maastricht, Division of Child and Adolescent Psychiatry, Department of Psychiatry, 5800, 6202, AZ Maastricht, The Netherlands.jan.schieveld@spsy.azm.nl
Intensive Care Med. 2007 Jun;33(6):1033-40. Epub 2007 Apr 25.
Abstract
OBJECTIVE: To study the phenomenology, clinical correlates, and response to treatment of delirium in critically ill children in the pediatric intensive care unit (PICU). DESIGN, SETTING AND PATIENTS: Descriptive study of a cohort of child psychiatric consultations from a tertiary PICU between January 2002 and December 2005. Demographic data, clinical presentation, and response to treatment of children subsequently diagnosed with delirium were analyzed. RESULTS: Out of 877 admissions (age distribution 0-18 years) arose 61 requests for psychiatric assessment. Of the 61 children, 40 (15 girls and 25 boys) were diagnosed with delirium (cumulative incidence 5%; mean age 7.6 years). Age-specific incidence rates varied from 3% (0-3 years) to 19% (16-18 years). In addition to the classical hypoactive and hyperactive presentations, a third presentation was apparent, characterized mainly by anxiety, with a higher prevalence in boys. All but 2 of the 40 children received antipsychotic medication: 27 (68%) haloperidol, 10 (25%) risperidone, and 1 both in succession. Two children treated with haloperidol experienced an acute torticollis as side effect. All children made a complete recovery from the delirium; five, however, died of their underlying disease. CONCLUSION: The rate of delirium in critically ill children on a PICU is not negligible, yet prospective studies of the phenomenology, risk factors and treatment of childhood delirium are very rare. Once pediatric delirium has been recognized, it generally responds well to treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1915613/pdf/134_2007_
Article_637.pdf


Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

sábado, 26 de enero de 2013

Administración transdérmica de drogas en el manejo del dolor

Administración transdérmica de drogas en el manejo del dolor


Transdermal drug delivery in pain management
Sanjay Bajaj MD DNB FRCA, Abigail Whiteman MA MB BChir FRCA, Brigitta Brandner MD FRCA FFFPMRCA
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 11 Number 2 2011
Key points
Transdermal drug delivery offers pharmacokinetic and practical advantages over the oral or parenteral routes for some patients. Patch design has important implications, for example, reservoir patches should never be cut whereas matrix patches can be trimmed. Topical diclofenac is at least as effective as the oral form; it may be superior. Development of a local subcutaneous drug reservoir beneath the patch means that buprenorphine and fentanyl patches require 24-72 h before the peak effect is achieved and there is delayed elimination after patch removal. New technology to actively drive drug molecules through the transdermal barrier may reduce time to onset and allow patch delivery to be useful in the management of acute pain.

http://ceaccp.oxfordjournals.org/content/11/2/39.full.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Bibliotecas. Alerta


La biblioteca de Alcalá de Guadaíra recibió la visita de más de ...
20minutos.es
El Servicio Municipal de Biblioteca, que incluye el trabajo y las acciones de las dos bibliotecaspúblicas de Alcalá de Guadaíra, cierra 2012 con la realización de numerosas actividades culturales y otras destinadas al fomento de la lectura dirigidas a ...
Ver todos los artículos sobre este tema »


Biblioteca mueve a ficción libros de Lance Armstrong (videos)
El Diario
Sídney, Australia - Una biblioteca de Sídney trasladó todos los libros sobre el exciclista estadounidense Lance Armstrong a la sección de ficción, después de que éste confesara que consumió sustancias dopantes, informaron hoy medios locales. “Todos los ...
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Broma de biblioteca australiana sitúa libros de ciclista Armstrong en ...
El Sentinel
SIDNEY (Reuters) - Una nota de broma de una biblioteca australiana declarando que los libros sobre el desacreditado ciclista Lance Armstrong serían trasladados a la sección de ficción se propagó masivamente en internet, y un comentarista afirmó que "el ...
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La Biblioteca Nacional Francesa puja por el libro más escandaloso ...
Qué.es
La Biblioteca Nacional de Francia (BNF) está dispuesta a pagar unos 5 millones de dólares para poseer el manuscrito original de «Las 120 jornadas de Sodoma y Gomorra», el legendario relato escrito por el Marqués de Sade en la prisión de la Bastilla ...
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Qué.es



Inauguran biblioteca denominada ´Dra. Flora Adelaida Bolívar ...
Radio Programas del Perú
El presidente de la Junta de Fiscales Superiores del Cusco, Carlos Alberto Pérez Sánchez, inauguró labiblioteca institucional denominada “Dra. Flora Adelaida Bolívar Arteaga”. En total son 466 textos de diversas editoriales, tanto nacionales como ...
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CHIRIGOTA MURCIANA con asalto a la biblioteca Regional ...
YouTube
Chema Ruiz y los locos de AVIMUR.com asaltan la biblioteca regional de Murcia en plenos exámenes para alegrar un poco la vida de los estudiantes cantando una chirigota murciana para promocionar el viaje a los carnavales de Cádiz que organiza ...
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¿donde consultar una biblioteca virtual de pedagogia.? - Yahoo ...
hola que tal quisiera saber si alguien me podria recomendar alguna biblioteca ... Ricon del vago todo gunto xd ...
espanol.answers.yahoo.com/question/index?qid...




Biblioteca australiana desplaza libros de Armstrong a estantería de ...
Una biblioteca del norte de Sídney anunció este lunes que los libros en su poder sobre el exciclista estadounidense Lance Armstrong iban a pasar a est.
entretenimiento.kolbi.msn.com/biblioteca-australiana-desplaza...




Biblioteca Derecho (BiblioDerecho) on Twitter
Biblioteca Derecho. @BiblioDerecho. Twitter no official de La biblioteca salmantina de mas glamour!! Donde lo que hace el de al lado, es lo mas importante!
https://twitter.com/BiblioDerecho


Biblioteca australiana desplaza libros de Armstrong a estantería de ...
Biblioteca australiana desplaza libros de Armstrong a estantería de ficción ♢ Una biblioteca del norte de Sídney anunció este lunes que los libros en su poder ...
www.paginanoticias.com/.../Biblioteca-australiana-desplaza-lib...

Bibliotecas. Alerta

Cincuenta jóvenes se encerraron anoche en las bibliotecas de ...
Lainformacion.com
Alrededor de 30 personas se han mantenido encerradas, desde la madrugada de este martes hasta este miércoles por la mañana, en la biblioteca Central de Madrid, en Iglesia, y otras 20 lo han hecho en la de Retiro para reclamar a la Comunidad de ...
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¿clasificacion de las bibliotecas..? porfavor ayuda =|? - Yahoo ...
Encuentra las respuestas de la pregunta ¿clasificacion de las bibliotecas..? porfavor ayuda =|?, Ayuda con los estudios en Yahoo! Respuestas. Descubre ...
espanol.answers.yahoo.com/question/index?qid...



BiblioTech: hacia las bibliotecas sin libros (físicos) | Think Big
Se ha puesto en marcha el proyecto para construir la primera biblioteca sin libros físicos en ...
blogthinkbig.com/bibliotech-bibliotecas-sin-libros-fisicos/

Encerrados en las #bibliotecas para que abran las 24 horas ...
Encerrados en las #bibliotecas para que abran las 24 horas http://t.co/Arb9o07k by Madridiario 294140306344001537.
inagist.com/all/294140306344001537/

e-book´s. Alerta


Si vendes entre 1.000 y 4.000 `e-books´ ya eres un escritor ...
según David González | aviondepapel.tv
Un autor se considera superventas en formato papel cuando supera los más de 100.000 ejemplares vendidos; pero el mundo digital maneja otros registros. . Noticias, última hora, vídeos y fotos de Literatura en lainformacion.com.

Papyrus, una herramienta sencilla para crear ebooks >> Sin Tinta ...
Casi una cuarta parte de los libros que se publican en España son electrónicos. En 2012, según los datos que proporciona la Agencia del ISBN, se publicaron ...
blogs.elpais.com/.../papyrus-una-herrramienta-sencilla-para-cr...




España lee ebooks | Blogs de edirectivos
http://www.rubenalonso.es/2013/01/espana-lee-ebooks.htmlSí sí, aunque no os lo creáis, España lee y ¡muchos ebooks! Según la Agencia del International S...
www.edirectivos.com/blogs/9332.../3750-Espana-lee-ebooks




¿Dónde puedo encontrar 'ebooks' de anatomía? - Yahoo! Respuestas
Encuentra las respuestas de la pregunta ¿Dónde puedo encontrar 'ebooks' de anatomía?, Libros y Autores en Yahoo! Respuestas. Descubre respuestas de las ...
espanol.answers.yahoo.com/question/index?qid...




Hojas Mágicas: Clanes 1. Los Iniciados - Lanzamiento en ebooks
Por el momento el libro solamente estará disponible en ebooks, pero si al cabo de un tiempo consigue una cuota de ventas establecida por la editorial, también ...
hojasmagicas.blogspot.com/.../clanes-1-los-iniciados-lanzamie...


Los niños leen más e-books - Leer en Pantalla - Libros electrónicos ...
Estudios por aquí y por allá que pretenden dar forma y entender lo que está ocurriendo con el mundo editorial y sus destinatarios, los lectores. En cuanto.
leerenpantalla.com/los-ninos-leen-mas-e-books/

Delirio posoperatorio/Postoperative delirium


http://www.smo.edu.mx/











Disfunción postoperatoria cognoscitiva temprana y delirio postoperatorio después de anestesia con varios hipnóticos: protocolo de estudio randomizado y controlado- Estudio PINOCCHIO.
Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial--the PINOCCHIO trial.
Bilotta F, Doronzio A, Stazi E, Titi L, Zeppa IO, Cianchi A, Rosa G, Paoloni FP, Bergese S, Asouhidou I, Ioannou P, Abramowicz AE, Spinelli A, Delphin E, Ayrian E, Zelman V, Lumb P.
Department of Anaesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. bilotta@tiscali.it
Trials. 2011 Jul 6;12:170. doi: 10.1186/1745-6215-12-170.
Abstract
BACKGROUND: Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient.We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. METHODS/DESIGN: After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl.The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation.Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index for delirium. DISCUSSION: The results of this comparative anaesthesiological trial should whether each the three hypnotics tested is related to a significantly different postoperative delirium rate. This information could ultimately allow us to select the most appropriate hypnotic to maintain anaesthesia for specific subgroups of patients and especially for those at high risk of postoperative delirium. REGISTERED AT TRIAL.GOV NUMBER: ClinicalTrials.gov: NCT00507195.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155116/pdf/1745-6215-12-170.pdf

Trayectorias cognitivas después de delirio postoperatorio
Cognitive trajectories after postoperative delirium.
Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN.
Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA.jane.saczynski@umassmed.edu
N Engl J Med. 2012 Jul 5;367(1):30-9. doi: 10.1056/NEJMoa1112923.
Abstract
BACKGROUND: Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery. METHODS: We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type. RESULTS: The 103 participants (46%) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop (25.8 vs. 26.9, P<0.001). In adjusted models, those with delirium had a larger drop in cognitive function (as measured by the MMSE score) 2 days after surgery than did those without delirium (7.7 points vs. 2.1, P<0.001) and had significantly lower postoperative cognitive function than those without delirium, both at 1 month (mean MMSE score, 24.1 vs. 27.4; P<0.001) and at 1 year (25.2 vs. 27.2, P<0.001) after surgery. With adjustment for baseline differences, the between-group difference in mean MMSE scores was significant 30 days after surgery (P<0.001) but not at 6 or 12 months (P=0.056 for both). A higher percentage of patients with delirium than those without delirium had not returned to their preoperative baseline level at 6 months (40% vs. 24%, P=0.01), but the difference was not significant at 12 months (31% vs. 20%, P=0.055). CONCLUSIONS: Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment. (Funded by the Harvard Older Americans Independence Center and others.).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433229/pdf/nihms396197.pdf
Atentamente


Anestesiología y Medicina del Dolor


www.anestesia-dolor.org



Cultured Chondrocytes Implantation Live Surgery in a Course 1 st March

http://www.smo.edu.mx/





https://dl.dropbox.com/u/42022195/kneecoursesevilleprogram.pdf


Cultured Chondrocytes Implantation Live Surgery in a Course 1 st March, ESSKA Approved
Hi Friends.
We will show a Cultured Chondrocytes Implantation in a Live Surgery Course next 1 st March 2013, in Sevilla, Spain.
This ESSKA Approved Course is organized by a non profit Organization and fee is a ridiculous €95.
I think is a good opportunity to discuss details with surgeon during the procedure, meet each other and share experience and knwoledge.
Here you are scientific program

https://dl.dropbox.com/u/42022195/kneecoursesevilleprogram.pdf

I hope you find it interesting. I think it is the first time this surgery will be shown in a real time.
dl.dropbox.com dl.dropbox.com

http://colegiomexicanodeortopediaytrauma.blogspot.mx/2013/01/cultured-chondrocytes-implantation-live.html









Las personas mayores deben “darse prisa y morir”



Hasta en los paises desarrolados los politicos muestran su falta de sensibilidad, en fin quiero ver que él se de prisa para morir


EL PAÍS Madrid 22 ENE 2013 - 16:00 CET408


Taro Aso en una rueda de prensa en 2008. / EFE

Taro Aso, ministro japonés de Finanzas, no se anda con medias tintas. El pasado lunes declaró que las personas mayores deben “darse prisa y morir” para aliviar los gastos del Estado en su atención médica. Declaraciones especialmente alarmantes en una sociedad en la que el 25% de la población tiene más de 60 años. El propio Aso tiene 72 años.

El ministro arremetió en una reunión del Consejo Nacional de Seguridad Social contra las tácticas de reanimación y los tratamientos para prolongar de vida, según publica hoyThe Guardian. “Se ven obligados a vivir cuando quieren morir. Yo me despertaría sintiéndome mal si sé que el tratamiento está pagado por el Gobierno". El ministro nipón no se quedó ahí. Se refirió a los ancianos que ya no pueden alimentarse a sí mismos como "gente de tubo".

A los pocos días tuvo que rectificar. Reconoció que sus declaraciones habían sido "inadecuadas" en un foro público e insistió en que estaba hablando solo de su preferencia personal. "Es importante que la gente pueda pasar los últimos días de su vida en paz", sentenció.

No es la primera vez que las declaraciones de este ministro tienen que ser matizadas. Aso, uno de los políticos japoneses más ricos y veteranos, ha cuestionado otras veces el papel del Estado con los mayores. En 2008, cuando era primer ministro, calificó de "chochos" a los pensionistas. En otra ocasión, en una reunión de economistas afirmó: "Veo a gente de 67 años o 68 constantemente ir al médico. ¿Por qué tengo que pagar por las personas que sólo comen y beben y no hacen ningún esfuerzo?".


En 50 años un 40% de la población japonesa será mayor de 60 años

Un cuarto de los 128 millones de habitantes de Japón tienen más de 60 años. Es el país más envejecido del mundo y en 50 años este sector de población supondrá el 40% de la población. Esto implica importantes gastos sociales en pensiones y sanidad, que han llevado al Gobierno conservador a aumentar un 10% los impuestos sobre el consumo a pesar de que recortará en los próximos presupuestos, que entran en vigor en abril, esta aportación.

El 40% de los hogares japoneses que reciben asistencia social tiene algún miembro mayor de 65 años, según un informe publicado esta semana. Aumenta el número de mayores que viven solos. En 2010, 4,6 millones de personas mayores vivían solas, y el número de los que murieron en el hogar aumentó un 61% entre 2003 y 2010, según la oficina de bienestar social y de salud pública en Tokio.

viernes, 25 de enero de 2013

Nuevos hábitos de lectura, los niños ya son lectores digitales


http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=55596&origen=notiweb&dia_suplemento=viernes

Nuevos hábitos de lectura, los niños ya son lectores digitales


Casi la mitad de los niños norteamericanos lee e-books en Estados Unidos, según el sondeo realizado por Scholastic Inc. Esta cifra supone una gran noticia para el sector digital, ya que implica que el número de lectores infantiles de formatos electrónicos se ha duplicado respecto a 2010, año en que solo alcanzaba el 25%.
FUENTE | media-tics

Coma y dolor/Coma and pain evaluation

Investigaciones electrofisiológicas de la función del cerebro en coma, en pacientes en estado vegetativo y con mínima conciencia.


Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients.
Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, Laureys S, Noirhomme Q.
Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium. Email: remy.lehembre@ulg.ac.be.
Arch Ital Biol. 2012 Jun;150(2-3):122-39. doi: 10.4449/aib.v150i2.1374.
Abstract
Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.
http://www.architalbiol.org/aib/article/view/150122/23165873


Fiabilidad y validez de la herramienta del comportamiento facial, piernas, actividad, y llanto en la en la evaluación del dolor agudo en pacientes en estado crítico


Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.
Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S.
University of Michigan Health System, Ann Arbor, USA. terriv@umich.edu
Am J Crit Care. 2010 Jan;19(1):55-61; quiz 62. doi: 10.4037/ajcc2010624.
Abstract
BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included.CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.


http://ajcc.aacnjournals.org/content/19/1/55.full.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Bibliotecas. Alerta

De las bibliotecas y los bibliófilos en ''Vida entre libros''
Informador.com.mx
Corina Armella presentó esta noche ''Vida entre libros'', publicación que retrata lasbibliotecas de 43 reconocidos personajes en la Ciudad de México y la relación que estos tienen para con los libros. El acto llevado a cabo en el auditorio del Archivo ...
Ver todos los artículos sobre este tema »
Informador.com.mx

Dopaje en las bibliotecas | InVito
según Francisco J. Sáenz de Valluerca López
En la Manly Library de Sydney (Australia), ha aparecido recientemente este aviso de que todos los libros de Lance Armstrong se pasarán a la sección de literatura de ficción. Según Wendy Ford, la bibliotecaria de relación con la comunidad ...
InVito


El Centro de Documentación Europea se integra en la red Europe ...
según Bibliotecas
El astronauta - Bibliotecas USAL ... El nuevo centro compartirá instalaciones con el Centro de Documentación Europea, dirigido por Luis Norberto González Alonso y situado en la BibliotecaFrancisco de Vitoria del Campus Unamuno.
El astronauta - Bibliotecas USAL

Gangnam Style en las bibliotecas | InVito
Parece que el Gangnam Style ha tenido éxito también en las bibliotecas, y hay unas cuantas que ...
diarium.usal.es/vito/2013/.../gangnam-style-en-las-bibliotecas/

Books Update NYT

http://www.nytimes.com/indexes/2013/01/25/books/booksupdate/index.html


January 25, 2013
Books Update



On the Cover of Sunday's Book Review

'The Insurgents'
By FRED KAPLAN
Reviewed by THANASSIS CAMBANIS


"The Insurgents," by Fred Kaplan, tells the story of David H. Petraeus and the small fraternity of strategists that changed the way America conceived of, and actually fought, war.




Also in the Book Review

'Invisible Armies'
By MAX BOOT
Reviewed by MARK MAZOWER


Max Boot's "Invisible Armies" covers much of the globe to recount the history of guerrilla warfare.

Alain de Botton: By the Book


The author of "How to Think More About Sex" was impressed as a young man by Kierkegaard's claim to read only "writings by men who have been executed."
By the Book: Archive

APPLIED READING
The Heat of Battle
By J. D. BIERSDORFER


Apps that explore the events of the Civil War and World Wars I and II.

'Kind of Kin'
By RILLA ASKEW
Reviewed by JONATHAN EVISON


A fraught issue - illegal immigration - divides an Oklahoma family and their town in Rilla Askew's novel.

'The Inventor and the Tycoon'
By EDWARD BALL
Reviewed by CANDICE MILLARD


Edward Ball explains how Eadweard Muybridge's work for a railroad magnate led to the movies.
Up Front: Candice Millard

'Rage Is Back'
By ADAM MANSBACH
Reviewed by KEVIN BAKER


In this novel, a graffiti crew reunites after 18 years to avenge one of its members.

'On Extinction: How We Became Estranged From Nature'
By MELANIE CHALLENGER
Reviewed by PAUL GREENBERG


Melanie Challenger travels in search of the species, cultures and industries touched by extinction.

Poetry Chronicle
By ERIC McHENRY


New poetry collections by Michael Robbins, Rowan Ricardo Phillips, Paula Bohince and Natalie Diaz.

'The Marlowe Papers'
By ROS BARBER
Reviewed by CHARLES NICHOLL


In Ros Barber's verse-novel, Christopher Marlowe fakes his own death in order to keep writing.

'Venice: A New History'
By THOMAS F. MADDEN
Reviewed by ADAM BEGLEY


A history of Venice, from the city's origins as a lagoon refuge to its apex as a maritime empire to its rebirth as a modern tourist hub.

'One for the Books'
By JOE QUEENAN
Reviewed by LIGAYA MISHAN


Joe Queenan considers his relationship with the printed word.
ArtsBeat Q. & A.: Joe Queenan

'Soundings'
By HALI FELT
Reviewed by MICHAEL WASHBURN


Marie Tharp mapped the seafloor and hit the glass ceiling.


jueves, 24 de enero de 2013

Perdida ósea humeral. Caso clínico.

http://www.smo.edu.mx/



Dr Benjamin Joel Torres Fernanez

Tumores de Columna. Generalidades



http://www.smo.edu.mx/



Dr Rogelio Solano Pérez