Final de la vida en la UCI neonatal

Final de la vida en la UCI neonatal End of life in the neonatal intensive care unit. Moura H, Costa V, Rodrigues M, Almeida F, Maia T, Guimarães H. Serviço de Neonatologia do Centro Hospitalar Porto, Portugal. Clinics (Sao Paulo). 2011;66(9):1569-72. Abstract PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005) in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7% of the infants received invasive ventilatory support, 76.3% received antibiotics, 58.1% received inotropics, and 25.8% received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5%) were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort), but only 21.5% of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164406/pdf/cln-66-09-1569.pdf   Final de la vida despues del nacimiento: la muerte y el morir en una unidad neonatal de cuidados intensivos  End-of-life after birth: death and dying in a neonatal intensive care unit. Singh J, Lantos J, Meadow W. Department of Pediatrics, University of Chicago, and the MacLean Center for Clinical Medical Ethics, Chicago, Illinois 60637, USA. Pediatrics. 2004 Dec;114(6):1620-6. Abstract OBJECTIVE: In canonical modern bioethics, withholding and withdrawing medical interventions for dying patients are considered morally equivalent. However, electing not to administer cardiopulmonary resuscitation (CPR) struck us as easily distinguishable from withdrawing mechanical ventilation. Moreover, withdrawing mechanical ventilation from a moribund infant "feels" different from withdrawing mechanical ventilation from a hemodynamically stable child with a severe neurologic insult. Most previous descriptions of withdrawing and withholding intervention in the neonatal intensive care unit (NICU) have blurred many of these distinctions. We hypothesized that clarifying them would more accurately portray the process of end-of-life decision-making in the NICU. METHODS: We reviewed the charts of all newborn infants who had birth weight >400 g and died in our hospital in 1988, 1993, and 1998 and extracted potential ethical issues (resuscitation, withdrawal, withholding, CPR, do-not-resuscitate orders, neurologic prognosis, ethics consult) surrounding each infant's death. RESULTS: Using traditional definitions, roughly half of all deaths in our NICU in 1993 and 1998 were associated with "withholding or withdrawing." In addition, by 1998, >40% of our NICU deaths could be labeled "active withdrawal," reflecting the extubation of infants regardless of their physiologic instability. This practice is growing over time. However, 2 important conclusions arise from our more richly elaborated descriptions of death in the NICU. First, when CPR was withheld, it most commonly occurred in the context of moribund infants who were already receiving ventilation and dopamine. Physiologically stable infants who were removed from mechanical ventilation for quality-of-life reasons accounted for only 3% of NICU deaths in 1988, 16% of NICU deaths in 1993, and 13% of NICU deaths in 1998. Moreover, virtually none of these active withdrawals took place in premature infants. Second, by 1998 infants, who died without CPR almost always had mechanical ventilation withdrawn. Finally, the median and average day of death for 100 nonsurvivors who received full intervention did not differ significantly from the 78 nonsurvivors for whom intervention was withheld. CONCLUSIONS: In our unit, a greater and greater percentage of doomed infants die without ever receiving chest compressions or epinephrine boluses. Rather, we have adopted a nuanced approach to withdrawing/withholding NICU intervention, providing what we hope is a humane approach to end-of-life decisions for doomed NICU infants. We suggest that ethical descriptions that reflect these nuances, distinguishing between withholding and withdrawing interventions from physiologically moribund infants or physiologically stable infants with morbid neurologic prognoses, provide a more accurate reflection of the circumstances of dying in the NICU. http://pediatrics.aappublications.org/content/114/6/1620.full.pdf+html

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

Internet seguro!!!!

http://ticsyformacion.com/2012/05/18/disfruta-de-internet-seguro-infografia-infographic-internet/

Gendarme

Alain Bernard, plusmarquista mundial de los 100 metros libres (2008), contratado por la gendarmería francesa. gendarme Miembro de la policía, inicialmente de Francia, que tiene la función de mantener el orden interno. Se registra por primera vez en francés en el siglo XIII, bajo la forma actual 'gendarme'. Voz tomada del plural francés gens d'armes 'personas de armas', 'gente de armas'.

El libro electrónico: presente y futuro en la Biblioteca universitaria

El libro electrónico: presente y futuro en la Biblioteca universitaria.

Jornadas de encuentro para usuarios, profesionales y bibliotecarios. 24 y 25 de mayo de 2012

La biblioteca de la Universidad de Zaragoza, ha organizado para los día 24 y 25 de mayo un encuentro entre diversos proveedores de libros electrónicos y los usuarios, bibliotecarios y profesionales del sector.

La irrupción del libro electrónico en el mercado editorial ha convertido un sistema de lectura, hasta hace poco tiempo novedoso, en algo cotidiano. En el mundo universitario, el libro electrónico resulta todavía novedoso, sobre todo si lo comparamos con la enorme implantación de las revistas en formato electrónico, que predominan sobre el papel en algunas disciplinas científicas.
La biblioteca de la Universidad de Zaragoza, ha querido reunir en este encuentro a diversos proveedores de libros electrónicos, especializados en el mercado universitario, que presentarán el estado de la cuestión en cuanto a la oferta existente de este tipo de materiales, para enriquecer la oferta y mejorar el servicio de una manera innovadora.

El objetivo del encuentro, que se espera no será el último de este tipo, es ayudar tanto al usuario a conocer la realidad del libro electrónico en la Universidad como al bibliotecario a decidir la mejor integración de estos recursos en los procesos y servicios de la biblioteca.

Consulta el programa de las jornadas: jornadas libro electronico (pdf 1.2 MB )

 

Fuente: http://blog.biblioteca.unizar.es/investigacion/el-libro-electronico-presente-y-futuro-en-la-biblioteca-universitaria/

Medicina de rehabilitación. Alerta

Expertos apuestan por la estimulación eléctrica en el tratamiento ... Europa Press Especialistas en rehabilitación y medicina física han apostado este viernes, en el 50 Congreso Nacional de la Sociedad Española de esta especialidad que se ha celebrado en Córdoba, por la estimulación eléctrica en el tratamiento de la incontinencia ... Ver todos los artículos sobre este tema »

Aplican estimulación eléctrica para mejorar la incontinencia de ... Ideal Digital Los organizadores del 50 Congreso Nacional de la Sociedad Española de Rehabilitación yMedicina Física (Sermef) que finaliza hoy en Córdoba han informado en un comunicado de que la nueva técnica, denominada estimulación percutánea del nervio tibial ... Ver todos los artículos sobre este tema »

Estimulación eléctrica en el tratamiento de la incontinencia Asturi.as El quincuagésimo congreso nacional de la Sociedad Española de Rehabilitación y MedicinaFísica (SERMEF), que se celebra en Córdoba del 15 al 18 de mayo, va a formar a parte de sus asistentes en el uso de una técnica innovadora para el tratamiento de la ... Ver todos los artículos sobre este tema »

Voz- ¿Cómo nos comunicamos los humanos?

Voz- ¿Cómo nos comunicamos los humanos? Voice - How humans communicate? Tiwari M, Tiwari M. J Nat Sc Biol Med [serial online] 2012 [cited 2012 May 9];3:3-11. Voices are important things for humans. They are the medium through which we do a lot of communicating with the outside world: our ideas, of course, and also our emotions and our personality. The voice is the very emblem of the speaker, indelibly woven into the fabric of speech. In this sense, each of our utterances of spoken language carries not only its own message but also, through accent, tone of voice and habitual voice quality it is at the same time an audible declaration of our membership of particular social regional groups, of our individual physical and psychological identity, and of our momentary mood. Voices are also one of the media through which we (successfully, most of the time) recognize other humans who are important to us-members of our family, media personalities, our friends, and enemies. Although evidence from DNA analysis is potentially vastly more eloquent in its power than evidence from voices, DNA cannot talk. It cannot be recorded planning, carrying out or confessing to a crime. It cannot be so apparently directly incriminating. As will quickly become evident, voices are extremely complex things, and some of the inherent limitations of the forensic-phonetic method are in part a consequence of the interaction between their complexity and the real world in which they are used. It is one of the aims of this article to explain how this comes about. This subject have unsolved questions, but there is no direct way to present the information that is necessary to understand how voices can be related, or not, to their owners. Keywords: Forensic phonetic, phonetic, sound, voice http://www.jnsbm.org/text.asp?2012/3/1/3/95933

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

May 18, 2012 Books Update

May 18, 2012 Books Update

On the Cover of Sunday's Book Review Illustration of Toni Morrison by Tina Berning ‘Home’ By TONI MORRISON Reviewed by LEAH HAGER COHEN In Toni Morrison's novel, a traumatized soldier returns from the Korean War to his segregated hometown in Georgia. Also in the Book Review Let's Go Reading in the Car By JUDITH SHULEVITZ Audiobooks and road trips offer a chance to reacquaint children, and their parents, with the joy of listening to stories. The Voice By JOHN SCHWARTZ A great audiobook experience depends on the reader as much as the text. 'This Will Be Difficult to Explain' By JOHANNA SKIBSRUD Reviewed by JESSICA LOUDIS Whether in Paris or the Great Plains, failures to communicate fray the relationships in these tales. 'The Lower River' By PAUL THEROUX Reviewed by PATRICK McGRATH In Paul Theroux's novel, an American seeks a fresh start in Africa after a 40-year absence. 'The Cause' By ERIC ALTERMAN and KEVIN MATTSON Reviewed by JEFF SHESOL Eric Alterman's history of liberalism from the New Deal to the present concentrates on the men and women who have defined it. 'The Tyranny of Clichés' By JONAH GOLDBERG Reviewed by JOE KLEIN Jonah Goldberg accuses liberals of lazy thinking and worse. 'Horseshoe Crabs and Velvet Worms' By RICHARD FORTEY Reviewed by CONSTANCE CASEY The paleontologist Richard Fortey searches out species that have endured hundreds of millions of years of planetary turmoil. 'Wichita' By THAD ZIOLKOWSKI Reviewed by NATALIE BAKOPOULOS Fleeing the pressures of academia, Thad Ziolkowski's Midwestern hero is sucked into his family's schemes and strife. 'Farther Away' By JONATHAN FRANZEN Reviewed by PHILLIP LOPATE Jonathan Franzen's essays express his love of birds and of writers, especially his friend David Foster Wallace.  Up Front: Phillip Lopate 'Billy Lynn's Long Halftime Walk' By BEN FOUNTAIN Reviewed by GEOFF DYER A firefight with Iraqi insurgents is caught on tape and turns a band of soldiers into media heroes in Ben Fountain's satire. 'Chasing Venus' By ANDREA WULF Reviewed by JoANN C. GUTIN With a Venusian transit imminent, 18th-century astronomers risked their lives for a chance to measure the solar system. 'Oblivion: A Memoir' By HECTOR ABAD. Translated by ANNE McLEAN and ROSALIND HARVEY Reviewed by MICHAEL GREENBERG Héctor Abad creates a sociopolitical portrait of Colombia through the telling of his family's story. Silver Linings By ADAM PLUNKETT Lucia Perillo's two collections, poems and stories, draw upon her experiences in a world that often hurts her.

BEST SELLERS Combined Print & E-Book Fiction Combined Print & E-Book Nonfiction Hardcover Fiction Hardcover Nonfiction Paperback Trade Fiction Paperback Mass-Market Fiction Paperback Nonfiction All the Lists Hugh Dancy: By the Book Hugh Dancy, currently on Broadway in "Venus in Fur" and in the film "Hysteria," wishes David Mitchell would match Philip Roth's output.  By the Book: Archive Back Page Books With 140 Characters By JEFF HOWE At 64,000 members and counting, the Twitter-based reading group 1book140 is a global concern. Inside the List By GREGORY COWLES Toni Morrison, whose novel "Home" enters the hardcover fiction list at No. 9 this week, remembers being confronted by a stark image of race relations as a freshman at Howard University. Editors' Choice Recently reviewed books of particular interest. Paperback Row By IHSAN TAYLOR Paperback books of particular interest. Book Review Podcast This week, Joe Klein talks about Jonah Goldberg's "The Tyranny of Clichés"; Jeff Shesol discusses Eric Alterman's history of liberalism from the New Deal to the present; Julie Bosman has notes from the field; and Gregory Cowles has best-seller news. Sam Tanenhaus is the host. Mapping Sebald's Trek, and His Mind Lauren Child's Favorite Books from Childhood Amateur Hour: Jack Hitt Talks About an American Tradition REVIEWS BY THE TIMES'S CRITICS 'David Hockney: A Rake's Progress' by Christopher Simon Sykes 'The Amateur: Barack Obama in the White House' by Edward Klein 'I Am Forbidden' by Anouk Markovits 'Father's Day' by Buzz Bissinger 'A Disposition to Be Rich' by Geoffrey C. Ward Sea Rescue ARCHIVE Crime Columns Children's Books The New York Times Book Review: Back Issues Editor's Note Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond. John Williams Books Producer The New York Times on the

Nadezhda Konstantinovna Krupskaya (1869-1939): Feminista y bibliotecaria

Nadezhda Konstantinovna Krupskaya, feminista, pedagoga, dirigente bolchevique y figura principal en la Revolución Rusa, creó el nuevo sistema educativo soviético y puso en pie las bibliotecas del estado obrero impulsando el sistema bibliotecario soviético, impartió conferencias y escribió extensamente sobre la importancia de las bibliotecas y la lectura en la sociedad socialista. 

 

Referencia bibliográfica:

MUÑOZ-MUÑOZ, Ana Mª. Nadezhda Konstantinovna Krupskaya (1869-1939): Feminista y bibliotecaria. En: MUÑOZ-MUÑOZ, Ana Mª y BALLARÍN DOMINGO, Pilar (edas.). Mujeres y libros. Homenaje a la profesora a Ia profesora Dña. Isabel de Torres Ramírez. Granada: Universidad de Granada, Servicio de Publicaciones, 2010, pp. 143-156. ISBN: 978-84-338-5153-6.

Texto completo en:

http://www.ugr.es/~anamaria/documents/2010_CL_NadezhdaKrupskaya.pdf

Duración optima de la anticoagulación en pacientes con tromboembolismo venoso

Duración optima de la anticoagulación en pacientes con tromboembolismo venoso Optimal duration of anticoagulation in patients with venous thromboembolism. Prandoni P, Piovella C, Spiezia L, Valle FD, Pesavento R. Indian J Med Res [serial online] 2011 [cited 2012 May 3];134:15-21. The risk of recurrent venous thromboembolism (VTE) approaches 40 per cent of all patients after 10 yr of follow up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low molecular weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, these have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE. Keywords: Anticoagulation - deep venous thrombosis - pulmonary embolism - thrombophilia - venous thromboembolism http://www.ijmr.org.in/text.asp?2011/134/1/15/83319

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

Novedades en la Ortografìa

Reglas de Ortografía		Boletín n.º 41
http://www.reglasdeortografia.com		Morón de la Frontera, 17 de mayo de 2012

 

Editorial: Examen polémico

 

En Las Palmas de Gran Canaria se organizó el pasado mes de enero una polémica por la prueba ortográfica a la que tuvieron que hacer frente los aspirantes a policías locales. El problema se originó cuando 138 de los 168 que opositaban para obtener las 71 plazas convocadas no superaron el ejercicio. Los afectados argumentaron que 10 minutos es un tiempo insuficiente para descubrir las 47 faltas ortográficas que se habían introducido en 22 frases, pues, la consideraban ‘excesiva’ para los requisitos de este puesto  y, también, que se trataba más de una prueba de destreza mental que de conocimientos. Por su parte, algunos sindicatos pidieron al ayuntamiento que repitiera el examen o convocara una nueva oposición. Ahora, en el mes de mayo de 2012, la presión de los suspendidos ha obligado a repetir las oposiciones de policía local.

En reglasdeortografia.com tienes la posibilidad de hacer la prueba: Si bien, el planteamiento es distinto, toda vez, que el enmarque es totalmente educativo y podrás realizar el ejercicio las veces que quieras con la particularidad, eso sí, de que no verás ninguna pista de las palabras con errores a la hora de comprobar el ejercicio corregido y, en su lugar, las respuestas solo señalarán en rojo las frases que contengan palabras mal escritas.

¿Aprobarías el examen en el que suspendieron 138 policías grancanarios? Sería bueno que conocieras tu nivel:

http://www.reglasdeortografia.com/examenpolicia2012.php