TDAH y manejo por el Pediatra. “Dr. Manuel Katz .”

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 16 de Enero 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “TDAH y manejo por el Pediatra” por el “Dr. Manuel Katz .” Cirujano Pediatra de la Cd. Tel Aviv, Israel . 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/tda_manejo_por_rediatrico/

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

Subrayar las lecturas no sirve para aprender: algunos mitos y realidades sobre técnicas de estudio

El caparazón: Subrayar las lecturas no sirve para aprender: algunos mitos y realidades sobre técnicas de estudio




Subrayar las lecturas no sirve para aprender: algunos mitos y realidades sobre técnicas de estudio

Posted: 11 Jan 2013 08:46 AM PST


¿Y la de tiempo que habré perdido haciéndolo? Me conformaré con pensar que puede servir como resumen, como recordatorio posterior e incluso forma de compartir con otros lectores, en el caso de Amazon, los fragmentos más destacados del ebook en cuestión. Y es que un equipo de psicólogos acaba de publicar un estudio comprensivo para la American Psychological Science Association, examinando 10 estrategias personales de aprendizaje y si son o no verdaderamente útiles y concluye que no, que subrayar, resaltar partes de la lectura, no sirve para nada.

No está claro en muchos casos pero me llamaba especialmente la atención el tema: la peor de las técnicas de estudio analizadas parece esa, la de marcar, subrayar las lecturas. No existe un beneficio real entre, simplemente leer el texto y marcarlo. Incluso, afirman, este tipo de prácticas pueden ser perjudiciales: cuando destacamos elementos concretos podemos perder en enfoque global, centrándonos en exceso en ideas aisladas. Igualmente inefectivas son las relecturas, algo que se hace a menudo cuando se estudia y que también resulta, para los autores, una pérdida de tiempo.

Algo más efectivo es resumir o anotar las ideas principales, aunque los estudios coinciden en que tampoco esta es la mejor estrategia si no se combina con las que siguen.

Lo mejor es la práctica distribuida, repartir las sesiones de estudio más que centrarnos en una única maratón de aprendizaje, cuyo contenido tendemos a olvidar pronto. Además, cuanto más tiempo queramos retener la información en nuestros cerebros, más largos serán esos intervalos entre sesiones.

La práctica de tests, como veíamos también en la entrada que dejo al final, es la segunda estrategia más valorada. Hace que se vuelvan a rememorar los datos, facilitando también la memorización y, añadiría facilitando algo tan importante como el “aprender haciendo”, poner a prueba el aprendizaje.

En cartón en otros tiempos, las tarjetas recordatorias, hoy digitalizadas mediante apps (Quizlet, StudyBlue, FlashCardMachine, por ejemplo) pueden ser interesantes desde la perspectiva TIC en el aula. Tomo de la Wikipedia su definición:


Las flash cards (o tarjetas didácticas) son un conjunto de tarjetas que contienen información, como palabras y números, en uno o ambos lados usadas para adquirir diversos conocimientos a través de la relectura del conjunto de tarjetas. En un lado de la tarjeta se escribe una pregunta y en el otro la respuesta. Las flashcards pueden ser de vocabulario, datos históricos, fórmulas o cualquier cosa que pueda ser aprendida por medio de preguntas y respuestas. Las flashcards se usan ampliamente como un ejercicio de aprendizaje para ayudar a la memorización por medio de la repetición espaciadas.

Empiezo a entender mi práctica adolescente de crear múltiples chuletas que nunca utilizaba después, en los exámenes, porque el mero hecho de crearlas había hecho que lo aprendiese todo. Creo que me ocurre algo parecido con las presentaciones e incluso con los posteos en el blog hoy, que el mismo hecho de elaborarlas e ir rescatándolas en diversos periodos de tiempo (al volver a enlazar una entrada, por ejemplo) es una forma excelente, diría que la mejor que conozco, de solidificar aprendizajes.

En cuanto a otras técnicas, como la imagen mental, completar lo leído con imágenes o esquemas, el cuestionamiento, preguntarnos los porqué de lo leído, la mezcla de distintos problemas para que se creen conexiones o el memorizado de palabras clave, así como técnicas específicas en el aprendizaje de idiomas, como enlazar palabras nuevas con otras que ya se sepan y suenen similares, muestran una eficiencia moderada o baja.

En fin.. dejad que os recomiende, para complementar este, otro artículo sobre Mitos del aprendizaje que creo que lo amplía.

Tending the Body’s Microbial Garden

http://www.nytimes.com/2012/06/19/science/studies-of-human-microbiome-yield-new-insights.html?pagewanted=all&_r=0#

Tending the Body’s Microbial Garden
By CARL ZIMMER
Published: June 18, 2012

Enlarge This ImageFor a century, doctors have waged war against bacteria, using antibiotics as their weapons. But that relationship is changing as scientists become more familiar with the 100 trillion microbes that call us home — collectively known as the microbiome.

                                      
Hank Osuna

                 
NIAID, Agriculture Department, via Associated Press

A JUNGLE IN THERE A clump of Staphylococcus epidermidis bacteria.
                
NIAID, Agriculture Department, via Associated Press

Enterococcus faecalis, a bacterium that lives in the human gut.


“I would like to lose the language of warfare,” said Julie Segre, a senior investigator at the National Human Genome Research Institute. “It does a disservice to all the bacteria that have co-evolved with us and are maintaining the health of our bodies.”

This new approach to health is known as medical ecology. Rather than conducting indiscriminate slaughter, Dr. Segre and like-minded scientists want to be microbial wildlife managers.

No one wants to abandon antibiotics outright. But by nurturing the invisible ecosystem in and on our bodies, doctors may be able to find other ways to fight infectious diseases, and with less harmful side effects. Tending the microbiome may also help in the treatment of disorders that may not seem to have anything to do with bacteria, including obesity and diabetes.

“I cannot wait for this to become a big area of science,” said Michael A. Fischbach, a microbiologist at the University of California, San Francisco, and an author of a medical ecology manifesto published this month in the journal Science Translational Medicine.

Judging from a flood of recent findings about our inner ecosystem, that appears to be happening. Last week, Dr. Segre and about 200 other scientists published the most ambitious survey of the human microbiome yet. Known as the Human Microbiome Project, it is based on examinations of 242 healthy people tracked over two years. The scientists sequenced the genetic material of bacteriarecovered from 15 or more sites on their subjects’ bodies, recovering more than five million genes.

The project and other studies like it are revealing some of the ways in which our invisible residents shape our lives, from birth to death.

A number of recent reports shed light on how mothers promote the health of their children by shaping their microbiomes. In a study published last week in the journal PLoS One, Dr. Kjersti Aagaard-Tillery, an obstetrician at Baylor College of Medicine, and her colleagues described the vaginal microbiome in pregnant women. Before she started the study, Dr. Aagaard-Tillery expected this microbiome to be no different from that of women who weren’t pregnant.

“In fact, what we found is the exact opposite,” she said.

Early in the first trimester of pregnancy, she found, the diversity of vaginal bacteria changes significantly. Abundant species become rare, and vice versa.

One of the dominant species in the vagina of a pregnant woman, it turns out, is Lactobacillus johnsonii. It is usually found in the gut, where it produces enzymes that digest milk. It’s an odd species to find proliferating in the vagina, to say the least. Dr. Aagaard-Tillery speculates that changing conditions in the vagina encourage the bacteria to grow. During delivery, a baby will be coated by Lactobacillus johnsonii and ingest some of it. Dr. Aagaard-Tillery suggests that this inoculation prepares the infant to digest breast milk.

The baby’s microbiome continues to grow during breast-feeding. In a study of 16 lactating women published last year, Katherine M. Hunt of the University of Idaho and her colleagues reported that the women’s milk had up to 600 species of bacteria, as well as sugars called oligosaccharides that babies cannot digest. The sugars serve to nourishcertain beneficial gut bacteria in the infants, the scientists said. The more the good bacteria thrive, the harder it is for harmful species to gain a foothold.

As the child grows and the microbiome becomes more ecologically complex, it also tutors the immune system. Ecological disruptions can halt this education. In March, Dr. Richard S. Blumberg of Harvard and his colleaguesreported an experiment that demonstrates how important this education is.

The scientists reared mice that lacked any microbiome. In their guts and lungs, the germ-free mice developed abnormally high levels of immune cells called invariant natural killer T cells. Normally, these cells trigger a swift response from the immune system against viruses and other pathogens. In Dr. Blumberg’s microbe-free mice, however, they caused harmful inflammation. As adults, the mice were more likely to suffer from asthma and inflammatory bowel disease.

This experiment parallels studies of children in recent years. Children who take high levels of antibiotics may be at greater risk of developing allergies and asthma later on, many researchers have suggested.

Dr. Blumberg and his colleagues found that they could prevent the mice from becoming ill by giving them bacteria while they were still young. Acquiring a microbiome as an adult did not help the rodents.

The Good With the Bad

The diversity of species that make up the microbiome is hard to fathom. But it is even more difficult to understand how the immune system copes with this onslaught. In any one person’s mouth, for example, the scientists of the Human Microbiome Project found about 75 to 100 species. Some that predominate in one person’s mouth may be rare in another person’s. Still, the rate at which they are being discovered indicates that there may be as many as 5,000 species of bacteria that live in the human mouth.

“The closer you look, the more you find,” said Susan M. Huse of the Marine Biological Laboratory in Woods Hole, Mass., a contributor to the microbiome project.

Although the project has focused largely on bacteria, the microbiome’s diversity is wider. For example, our bodies also host viruses.

Many species in the human “virome” specialize in infecting our resident bacteria. But in the DNA samples stored in the Human Microbiome Project’s database, Kristine Wylie of Washington University and her colleagues are finding a wealth of viruses that target human cells. It is normal, it seems, for people to have a variety of viruses busily infecting their human hosts. “It’s really pretty striking that even in these healthy people, there really is a virome,” Dr. Wylie said.

The microbiome also includes fungi. In the June 8 issue of the journal Science, David Underhill, a research scientist at Cedars-Sinai hospital in Los Angeles, and his colleaguesreported on a wealth of fungal species in the guts of humans and other mammals. In mice, for example, they cataloged 100 species of fungi that are new to science, along with 100 already known. This diversity is all the more remarkable when you consider that it is tolerated by an immune system that has evolved to fight off microbes. Scientists have only a dim understanding of how the system decides which to kill and which to tolerate.

Immune cells fight fungal infections, for example, with a protein called dectin-1, which attaches only to fungi. But Dr. Underhill and his colleagues found that dectin-1 is also essential for tolerating harmless fungi. When they engineered mice that couldn’t produce dectin-1, the mice responded to harmless fungi by producing so much inflammation that their own tissues were damaged.

It’s a good thing that the immune system can rein itself in, because the microbiome carries out many services for us. In the gut, microbes synthesize vitamins and break down tough plant compounds into digestible bits.

Skin bacteria are also essential, Dr. Segre said. “One of the most important functions of the skin is to serve as a barrier,” she said. Bacteria feed on the waxy secretions of skin cells, and then produce a moisturizing film that keeps our skin supple and prevents cracks — thus keeping out invading pathogens.

Restoring Order to the System

Antibiotics kill off harmful bacteria, but broad-spectrum forms can kill off many desirable species, too. Dr. Fischbach likens antibiotics to herbicides sprayed on a garden. The herbicide kills the unwanted plants, but also kills off the tomatoes and the roses. The gardener assumes that the tomatoes and roses will grow back on their own.

In fact, there’s no guarantee the microbial ecosystem will automatically return to normal. “It’s one of those assumptions we make today that will seem silly in retrospect,” Dr. Fischbach said. Indeed, some bacteria are adapted for invading and establishing themselves in disrupted ecosystems. A species called Clostridium difficile will sometimes invade a person’s gut after a course of antibiotics. From 2000 to 2009, the number of hospitalized patients in the United States found to have C. difficile more than doubled, to 336,600 from 139,000. Once established, the antibiotic-resistant C. difficile can be hard to eradicate.

Now that scientists are gaining a picture of healthy microbiomes, they are optimistic about restoring devastated ones. “I don’t know that we’re quite on the cusp of being able to do that well at this point. But I think at least the data is starting to argue that these might be possibilities,” said Barbara Methé of the J. Craig Venter Institute, a principal investigator on the microbiome project.

One way to restore microbiomes may be to selectively foster beneficial bacteria. To ward off dangerous skin pathogens like Staphylococcus aureus, for instance, Dr. Segre envisions applying a cream infused with nutrients for harmless skin bacteria to feed on. “It’s promoting the growth of the healthy bacteria that can then overtake the staph,” she said.

Bacterial Transplants

Adding the bacteria directly may also help. Unfortunately, the science of so-called probiotics lags far behind their growth in sales. In 2011, people bought $28 billion of probiotic foods and supplements, according to the research firm EuroMonitor International. But few of them have been tested as rigorously as conventional drugs.

“I think the science has been shoddy and flimsy,” said Dr. Fischbach (who is on the scientific advisory board of Schiff Nutrition International).

Nonetheless, he sees a few promising probiotic treatments. A growing number of doctors are treating C. difficile with fecal transplants: Stool from a healthy donor is delivered like a suppository to an infected patient. The idea is that the good bacteria in the stool establish themselves in the gut and begin to compete with C. difficile. This year, researchers at the University of Alberta reviewed 124 fecal transplants and concluded that the procedure is safe and effective, with 83 percent of patients experiencing immediate improvement as their internal ecosystems were restored.

Dr. Alexander Khoruts of the University of Minnesota and his colleagues want to make fecal transplants standard practice. They can now extract bacteria from stool, “removing the ‘ick’ factor,” as he puts it.

Dr. Khoruts and his colleagues have federal approval to start formal clinical trials on fecal transplants. Eventually, he would like to develop probiotic pills that contain just a few key species required to build the intestinal ecosystem.

“People are starting to take this seriously,” Dr. Fischbach said. “This is a therapy that’s going to help a lot of people.”

Other conditions potentially could be treated by manipulating the microbiome. Scientists have linked obesity, for example, to changes to the gut’s ecosystem. When scientists transfer bacteria from obese mice to lean ones, the lean mice put on weight.

How this happens is still unclear, but some studies suggest that an “obese” microbiome sends signals to the body, changing how cells use sugar for energy and leading the body to store extra fat.

Researchers at the Academic Medical Center in Amsterdam are running a clinical trial to see if fecal transplants can help treat obesity. They have recruited 45 obese men; some are getting transplants from their own stool, while others get transplants from lean donors. The scientists are finding that the transplants from lean donors are changing how the obese subjects metabolize sugar.

While these initial results are promising, there is no evidence yet that the obese subjects are losing weight. Dr. Fischbach cautions that it may take a while to figure out how to manipulate the microbiome to make people healthy.

And it may take even longer to persuade doctors to think like ecologists.

“The physicians I know really like things that are clear and crisp,” Dr. Fischbach said. “But like any ecosystem, the microbiome is not the kind of place to find simple answers.”

A version of this article appeared in print on June 19, 2012, on page D1 of the New York edition with the headline: Tending the

Body’s Microbial Garden.

Related

In Good Health? Thank Your 100 Trillion Bacteria (June 14, 2012)

Bacterial Ecosystems Divide People Into 3 Groups, Scientists Say (April 21, 2011)

How Microbes Defend and Define Us (July 13, 2010)

Bacteria Thrive in Inner Elbow; No Harm Done (May 23, 2008)

Red Flags

Red Flags



Más que un texto científico, pretendo que sea divulgativo, y que llame la atención de algo que deberíamos usar en nuestra práctica diaria, pero que en realidad, para muchos nos es desconocido.

Como profesionales sanitarios, donde hasta el 80% trabajamos en consulta privada, muchos pacientes vienen directamente. Debido a esto, hemos de ser conscientes de que nuestro abordaje debe ser lo suficientemente completo, tanto en la historia como en la exploración, para conseguir los siguientes objetivos:
Identificar contraindicaciones a nuestro abordaje.
Precauciones a tener en cuenta.
Estado del problema.
Estadio del problema.
Medidas de referencias para reevaluar nuestro abordaje.
Tener una hipótesis.
Confirmar o rechazar la hipótesis.
Establecer una pauta de tratamiento o remitir a otro especialista para una investigación más profunda.

En esta entrada el énfasis lo voy a hacer en el punto uno y dos. Más específicamente sobre las red flags.

La definición de red flags es la siguiente:


“Signos y síntomas que nos alertan de una posible o probable presencia de problemas médicos graves, que pueden causar incapacidad irreversible o incluso la muerte si no se abordan adecuadamente”.



A pesar de lo contundente de la definición, realmente lo que nos dice es que en caso de encontrar algo que nos alerte de algo no mecánico o no músculo-esquelético, debemos remitirlo para que lo investiguen.

El hecho de que encontremos un síntoma que nos haga estar alerta, por sí solo no dice nada. Es cuando o bien se combina con otros o cuando viendo al paciente en su totalidad, esto nos llama la atención. Por ejemplo, el dolor nocturno se tiene como señal de algo malo, pero sin embargo un problema mecánico nos puede producir dolor nocturno, así como por ejemplo un problema de compresión nerviosa.

La edad, también es un factor a tener en cuenta, por ejemplo dolor lumbar, persona mayor de 50 años, historia previa de cáncer, pérdida no explicada de peso y fracaso del tratamiento conservador, tenemos un 100% de posibilidades de estar ante un problema secundario.



Por eso, a pesar de ser necesario e importante el reconocerlas, hemos de relativizar su importancia, sobre todo debido a que la prevalencia es baja, en cuanto a los pacientes que llegan a la consulta de fisioterapia. En el caso de dolor lumbar, se estima que menos del 1% es debido a problemas graves (infección, cáncer, tumor, fracturas). De hecho, las fracturas son con diferencia las más habituales. Para ellas, la combinación de mujer, mayor de 70 años, con toma de corticoides continuada, y caída, supone sospecha de fractura hasta que se demuestre lo contrario.

En nuestro país no conozco, o al menos en mi colegio profesional no tenemos, una guía para fisioterapeutas red flags, como sí lo hay en otros países, por lo que el conocimiento de las mismas así como la experiencia y habilidad para detectarlas son claves. En toda historia clínica deberíamos incluir un apartado para ello, incluyendo preguntas del estilo de:

- ¿Cómo te encuentras de salud?

- Alguna historia pasad de enfermedad importante, tipo cáncer, diabetes, corazón,…

- ¿Alguna caída o accidente importantes? ¿Secuelas?

- ¿Tomas medicación por alguna causa?

- …

El estudio de las red flags es observacional y retrospectivo.

Una característica en la literatura, es que habla de muchos falsos positivos, lo cual hace que pueda suponer un aumento de los costes, es decir, que pensemos que estamos ante un problema grave, porque hemos detectado una red flag, y lo enviemos a hacerse pruebas y no sea nada. Por eso es importante no solo detectarla, sino contextualizarla.



La mejor forma para ello, es la toma de una historia exhaustiva y adecuada al problema del paciente (soy repetitivo, y lo seré hasta la saciedad), una exploración y el seguimiento del paciente. De hecho, algunos problemas son evidentes en el seguimiento, más que en una primera visita, puesto que pueden darse varias circunstancias:
Que sea un problema grave, pero que al mismo tiempo se combine con un problema mecánico, y que al abordar el problema mecánico haya una mejoría inicial, pero que no se vea respaldada con las siguientes visitas.
Que el problema grave, se comporte como un problema mecánico, y por lo tanto el primer día lo diagnostiquemos como tal y apliquemos un tratamiento específico, pero encontraríamos que luego no habría una consistencia entre tratamiento y resultado.
Que tengamos una presentación muy llamativa, pero que responda favorablemente al tratamiento, con lo que tendríamos un problema mecánico/músculo-esquelético, que parecía ser un problema grave.

Por ello, ante todo lo que haya sido con un comienzo brusco o reciente, o tras traumatismo violento, o con una presentación escandalosa (p.ej. déficit neurológico generalizado y/o progresivo) y que empeore rápidamente, o que no responda favorablemente a nuestro abordaje, debe hacernos sospechar, sobre todo si los síntomas son nuevos para el paciente.

Por ejemplo, es raro que una persona de más de 50 años tenga su primer dolor de cabeza en esa edad, por lo que hay que tenerlo presente. Pero si a esto se le añade una historia de menos de 3 meses, con empeoramiento progresivo y se añaden vómitos a la presentación, seguramente estaremos ante un caso de metástasis o tumor intracraneal.

Un patrón restrictivo no capsular de hombro, sin historia de traumatismo previo también sería indicativo de problema grave. En caso de mastectomías, es bastante común y sería una complicación del proceso, más que la presencia de un problema grave. Pero en este tipo de pacientes, tan común en nuestros días, el hecho de haber padecido cáncer de mama supone un riesgo de reproducción o metástasis incluso a largo plazo (25 años) y en el caso de mastectomías por esta razón, hasta 10 años después se pueden dar metástasis. La necesidad de saber que sigue sus chequeos con el médico especialista, es obligatorio. En caso de dolor nuevo persistente con historia previa de cáncer de mama, debería alertarnos.

La columna torácica, también es objeto de alerta, ya que la metástasis por cáncer de próstata, pulmón, mama y riñón en esa zona es habitual, así como que el 50% de los tumores primarios de la columna son en esa región.

Los peligros de las red flags, vienen determinados por diferentes motivos:
Los pacientes: Que ante síntomas que puedan indicar un problema, como tos, ronquera o bultos, lo consideren normal y no vayan a consultarlo.
Los profesionales, que lo pasen por alto o no lo busquen.
El desconocimiento de su existencia y relevancia.


Red Flags que más aparecen en la literatura

Pérdida inexplicada de peso
Historia previa de cáncer
Dolor nocturno
> 50 años de edad
Trauma violento
Fiebre
Anestesia en silla de montar
Dificultad con la micronutrición
Abuso de medicación intravenosa (drogadictos)
Déficit neurológico generalizado y/o progresivo
Esteroides sistémicos


Hay presentaciones silenciosas (sleeper presentation), que hay que tener en cuenta, y que es importante que se detecten de forma precoz, ya que en vez de dolor, dan otros síntomas.

Algunos ejemplos son:

Estreñimiento (problema muy común. Hasta 2,5 millones de visitas al médico/año)

Pero si a esto le añadimos pérdida inexplicada de peso, quizás estemos ante un cáncer de colon.

Otro que podemos encontrarnos los fisioterapeutas:

Hinchazón unilateral tobillo + Dolor de pecho + Disnea =EMBOLIA PULMONAR
CONCLUSIÓN:

A pesar de que es poco probable que nos encontremos con este tipo de problemas en la consulta, es posible, por lo que hemos de ser consistentes en nuestros abordajes y de forma sistemática, ser conscientes de la existencia de las red flags. Lo mejor para ello, es tenerlas siempre presentes en nuestro diagnóstico diferencial en la historia y exploración.

Al no haber un manual ni “receta”, hemos de ser conocedores de las más habituales, y sobre todo de las específicas. El seguimiento y evolución del problema, si no van por donde hemos pronosticado debe hacernos reflexionar de si nuestro diagnóstico ha sido erróneo, que el tratamiento no ha sido llevado adecuadamente o de si en realidad el problema sea debido a otro problema grave o no músculo-esquelético. Si queremos convertirnos en profesionales de primera intervención, hemos de incorporar estos detalles a nuestro trabajo y práctica diaria.
RECOMENDACIONES:

Los colegios profesionales debería ser los encargados de crear las guías de actuación en estos casos, y las red flags sin duda son un tema lo suficientemente importante para que se tomen cartas en el asunto. Y si alguno ya las tiene, sería conveniente compartirlas y publicarlas para el acceso de todos los fisioterapeutas.
BIBLIOGRAFÍA RECOMENDADA:
Chaniotis SC.2012.Clinical reasoning for a patient with neck and upper extremity symptoms: A case requiring referral. Journal of Bodywork and Movement Therapies, 16; 359-363.
Ferguson F, Holdsworth L, Rafferty D. 2010. Low back pain and physiotherapy use of red flags: the evidence from Scotland. Physiotherapy. 96; 282-288
Goodman, C. Snyder, T. 2001. Patología médica para fisioterapeutas. McGraw Hill-Interamericana 3ª ed.
Greenhalgh S, Selfe J.2004. Margaret: a tragic case of spinal Red Flags and Red Herrings. 2004. [Full Text PDF] Physiotherapy. 95; 73-76.
Greenhalgh S, Selfe J. 2006. Red Flags: A guide to indentifying Serious pathology of the Spine. Churchill Livingstone ed. 1.
Greenhalgh S, Selfe J. 2009. A qualitative investigation of Red Flags for serious spinal pathology.Physiotherapy. 95; 223-226
Harding IJ, Davies E, Buchanan E, et al. 2005. The symptom of night pain in a back pain triage clinic.Spine. 30(17); 1985-8
Henschke N, Maher C, Refshauge K M,Herbert,R D et al. 2009. Prevalence of and Screening for Serious Spinal Pathology in Patients Presenting to Primary Care Settings With Acute Low Back Pain. Arthritis and Rheumatism. Vol. 60, 10; 3072–3080
Leerar, P. Boissonnault W, Domholdt E et al. 2007. Documentation of red flags by Physical therapists for patients with low back pain. The Journal of Manual and Manipulative Therapy. 15(1); 42-49.
Sizer J, Brismée JM, Cook C. 2007. Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain. Family Pain Practice. 7(1); 53-71.
Soerensen B. 2011. Mechanical diagnosis and therapy (MDT) approach for assessment and identification of serious pathology. Manual Therapy. 16; 406-408.

Ser nativo digital es una actitud, no una condición

http://sociedad.elpais.com/sociedad/2013/01/07/actualidad/1357581236_335734.html

“Ser nativo digital es una actitud, no una condición”

El pedagogo cree que tabletas y teléfonos deben estar integrados en clase

ANDRÉS GARCÍA DE LA RIVA 7 ENE 2013 - 21:52 CET7



Otto Benavides no se separa de su portátil, su tableta y su teléfono. / SERGIO ESPINOSA

El colombiano Otto Benavides visita España en el marco de un proyecto de investigación de la Universidad de La Rioja sobre la aplicación de la tecnología en educación secundaria y enseñanza media. Nos citamos en el café Bretón de Logroño, uno de los establecimientos con mayor pedigrí artístico de la ciudad, con sus propios certámenes literarios y de cortometrajes, y provisto siempre de buena prensa impresa; un símbolo de la cultura más analógica donde compartimos un tentempié para hablar de tecnología digital.

A sus 70 años, Benavides es un hombre vital que aparenta 10 menos de los que tiene y conjuga la mirada incisiva de un emprendedor estadounidense con la elegancia y el carácter afable del latinoamericano refinado. Se considera un nativo digital: “No importa la edad; ser un nativo digital es una actitud, no una condición. Mi mamá tiene 97 años, usa Skype y también es nativa digital”. Benavides utiliza seis redes sociales, vive conectado a Internet 24 horas al día y no da un paso sin su smartphone, su tableta y su portátil. Es director del Centro de Recursos Académicos de la NASA y del Centro de Recursos Educativos de la Universidad Estatal de California (Fresno, Estados Unidos); educador distinguido de Apple; y expresidente del Concejo Internacional de Medios Educativos.

Referencia mundial en la aplicación de la tecnología a la educación, abandera su particular cruzada contra la resistencia habitual de los profesores a que los alumnos usen el teléfono móvil en clase: “Trabajo para integrar los móviles y tabletas en el aula. Estos dispositivos se inspiran en las pizarras que teníamos cuando éramos pequeños y para los niños resulta muy natural usarlos de forma táctil. Los estudiantes se involucran más y el costo económico es muy bajo. Pueden llevar todos los libros que necesitan metidos en una tableta y comunicarse con profesores a través del móvil. Pero los profesores los ven como una distracción, no como una herramienta académica. Esto demora su implementación, pero yo creo que en 10 años su uso será común en todo el mundo”.


Benavides sigue las lecturas de la misa en su iPad

Lo dice alguien que ha demostrado ser un visionario en la aplicación tecnológica desde que a principios de los años noventa impulsara en Fresno el primer edificio conectado a Internet en una universidad de California. Cuestionado por el futuro, augura que el siguiente paso de las tabletas será el 3D: “La clave serán las tres dimensiones reales sin necesidad de gafas; esto lo veremos en menos de dos años. Y lo siguiente será la holografía, con la posibilidad de proyectarme en otro lugar y visitar a alguien virtualmente, o proyectar en clase una batalla en 3D cuando se estudie una guerra; esto lo veremos en los próximos 10 años”.

Otto Benavides emigró de Colombia hace 37 años con la maleta cargada de temores a fracasar en una sociedad tan competitiva como la estadounidense. Pero ha terminado cumpliendo, y con nota, el sueño americano. “Eran los planes que tenía Dios para mí. Él nos pone donde quiere, es mi motor”, reconoce este hombre que profesa casi la misma fe en la tecnología que en el Todopoderoso. Cuando va a la iglesia, sigue la lectura de las sagradas escrituras con su iPad: “Tengo tres versiones de la Biblia”, asegura.

Paciente Geriátrico en Urgencias

http://luisgomezemergencia.blogspot.mx/2013/01/paciente-geriatrico-en-urgencias.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+MedicinaDeUrgenciasYEmergencias+(Medicina+de+Urgencias+y+Emergencias)&utm_content=Yahoo!+Mail

Paciente Geriátrico en Urgencias

Los pacientes mayores de 65 años son cada vez más frecuentes en los Servicios de Urgencias Hospitalarios (SUH), lo que obliga al internista que trabaja en Urgencias a una formación específica en aspectos relativos al anciano. El anciano frágil o de alto riesgo es aquel que tiene una alta probabilidad de sufrir un suceso adverso. La detección de dicho paciente es fundamental en los SUH cara a la toma de decisiones. Un posible modelo de atención al anciano en los SUH consistiría en el cribado de fragilidad por parte de Enfermería a todo paciente mayor de 65 años que acude a Urgencias y, en aquellos clasificados de alto riesgo, realizarles una valoración geriátrica adaptada a Urgencias por parte del médico y/o enfermera con formación en aspectos geriátricos. Dicha información complementaria va a ser de gran ayuda a la hora de la ubicación definitiva y el plan de seguimiento tras el alta.


Así, prodriamos concluir que los primero a hacer con este tipo de pacientes en los servicios de urgencias hospitalarias sería el cribado del paciente para establecer si se trata de un paciente anciano frágil o en riesgo; mediante escalas como la ISAR (Identification Senior at Risk) y TSRT (Triage Risk Screening Tool). En un segundo momento se realizaría una evaluación integral geriátrica, pudiendo estar a cargo de una enfermera o médico con experiencia en manejo de pacientes geriátricos. Para este fin se podría utilizar el DAI (Deficit Acumulation Index), que es una escala que resume una serie de factores predictivos de mala evolución y permite estratificar el riesgo de sucesos adversos a corto plazo.


Artículos:


Medicina Clínica (Revisión): Puntos clave en la asistencia al anciano frágil en Urgencias. Med Clin (Barc). 2013;140(1):24–29. Descargar.
Emergencias (Revisión): Valoración del Paciente Frágil en Urgencias. Emergencias 2009;21:362-369. Descargar.
Anales del Sistema Sanitario de Navarra (Revisión): El Paciente Geriátrico en Urgencias. Anales Sis San Navarra v.33 supl.1 Pamplona 2010. Descargar.
Revista Española de Geriatría y Gerontología (Revisión): Unidad de observación de urgencias para pacientes geriátricos: beneficios clínicos y asistenciales. RevEspGeriatrGerontol.2009;44(4):175–179. Descargar.

XLIII Congreso Internacional SATO-SOTIMI-SMACOT

XLIII Congreso Internacional SATO-SOTIMI-SMACOT
Córdoba, 31 de enero, 1 y 2 de febrero del 2013
 

Web del congreso SATO: www.congresosatocordoba2013.com

Articulos sobre Dolor Gratuitos

Articulos sobre Dolor Gratuitos

Todo el volumen de Enero 2013 tiene acceso abierto gratuito.
European Journal of Pain January 2013; Volume 17, Issue 1; Pages 1-140.

Free pain articles from Eur Pain J, Jan 2013

http://onlinelibrary.wiley.com/doi/10.1002/ejp.2013.17.issue-1/issuetoc

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

Asociación Mexicana de Cirugía de Mano A.C.

Próximo 16 de enero, miércoles tenemos....

The Surgery Waiting Room and Patient Anxiety

http://wellbe.me/blog/The-Surgery-Waiting-Room-and-Patient-Anxiety?goback=%2Egde_1170817_member_201872826

The Surgery Waiting Room and Patient Anxiety
7

Submitted by James.Dias on Wed, 06/27/2012 - 21:35


Dr. Kevin Campbell recently blogged about being on the other side of a surgery, in the dreaded waiting room. He noted four things:
Unoccupied time feels longer than occupied time
Anxiety makes waits seem longer
Uncertain waits seem longer than known finite waits
Solo waits seem longer than group waits

I'll focus on #2 here. Much has been written about patient anxiety before surgery. Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period.

Anxiety is usually reduced by knowledge. So the more information you can arm a patient and their caregivers with before the big day, the more comfortable they should feel during the actual event. If they have benefited from proactive patient education, then they will know all the procedure steps going on behind those closed doors.

MJ Pritchard recently wrote in Reducing anxiety in elective surgical patients: "Effective communication is the cornerstone of good healthcare yet it can be a difficult skill to master. Poor communication can have serious consequences for patients and cause irreparable damage to the nurse-patient relationship... Communication tools should be straightforward, easy to use and flexible."

The Wellbe.me Patient Guidance System allows patients to include their caregivers in on their treatment plans so they can be informed and help with the process. Communication between the doctor, patient and the patient's trusted home caregivers is vitally important to good outcomes.

James.Dias's blog

ABOUT THE AUTHOR
Founder & Chief Executive Officer

Needed: More Attention to Boys’ Development

http://well.blogs.nytimes.com/2013/01/07/needed-more-attention-to-boys-development/?src=me&ref=general

18 AND UNDER 

JANUARY 7, 2013
Needed: More Attention to Boys’ Development

By PERRI KLASS, M.D.

Joyce Hesselberth

18 AND UNDER

Dr. Perri Klass on family health.

When you learn how to examine the female reproductive system in medical school, you generally work with a professional surrogate patient, and there is often a humiliating moment when you try to palpate the ovaries only to be told, in no uncertain terms, that you are way off-target. At such a moment, the male reproductive system seems quite simple and accessible.

Yet simple it is not. Recent research suggests that we should be paying closer attention to male development, not just to help boys understand and care for a particularly sensitive and vulnerable part of their anatomy — but also to help answer larger questions about what is happening to boys and their growth.

As part of examining every baby boy, pediatricians check for a relatively common condition known as cryptorchidism, which means a hidden or secret testicle. Between 3 and 5 percent of newborn boys have at least one testicle that fails to descend into the scrotum, with a higher incidence inpremature babies.

In cases of cryptorchidism, the testicle may descend of its own accord during the first months after birth. If it doesn’t, there’s an operation,orchiopexy, that releases it into the scrotum. Most surgeons prefer to operate when the boy is about a year old. If the testicle remains in the abdomen, where the body temperature is higher, germ cells don’t mature properly and future sperm production and fertility are at risk.

Doctors also worry about those undescended testicles because of a link to cancer down the line. A major new analysis published this month in The Archives of Disease in Childhood found that boys born with undescended testicles have three times the usual risk of developing testicular cancer. Boys who had this problem at birth need to know about it as they grow up, and need to learn how to do regular testicular self-exams.

“The message for parents is get them seen and checked by a specialist,” said Dr. Robert Carachi, professor of surgical pediatrics at the University of Glasgow and one of the authors of the study. “Adolescent men should be examining themselves. If there’s swelling or enlargement, get it checked early.”

Regular self-exams for all — that is, for those not at higher risk of cancer — are not currently recommended because they can cause anxiety and have not been shown to improve outcomes in boys or men who aren’t at particular risk.

Pediatricians discuss other risks with boys who play sports, and we urge them to wear proper protection, a message that is sometimes lost, and not just on adolescents.

For all their protective equipment, professional football players, for example, tend not to wear protective cups to shield their genitals from the dangers on the field. According to Dr. Stephen G. Rice, director of the Jersey Shore Sports Medicine Center in Neptune, N.J., cups are rarely worn in soccer and football, where the players must change direction frequently as they run, as opposed to baseball, where most of the running is in a straight line.

“For a lot of sports, it’s going to get in the way,” said Dr. Rice, who was one of the lead authors of the 2012 American Academy of Pediatrics policy statement on how to keep children safe when playing baseball and softball. The statement recommended cups for all participants. “Baseball is the exception because of how hard the ball is and how fast it comes,” he said. “It’s random chance, nothing to do with your skill level.”

An injury from a flying baseball can cause excruciating pain, and learning to take responsibility for protecting yourself is part of maturity. And there is new evidence, also related to the testicular exam, that the pace of maturity may be shifting in disturbing ways for boys, as it is for girls. As boys grow toward puberty, the first invisible changes brought on by the hormonal signals occur in the testicles. They begin to grow and enlarge. Compared with the physical development of girls, these modest increases in testicular volume are not really noticeable to parents, or even to the boys themselves, said Marcia E. Herman-Giddens, adjunct professor of maternal and child health at the University of North Carolina.

But a 2012 study of 4,131 boys by Dr. Herman-Giddens and her colleagues found that subtle testicular enlargement, which signals the onset of puberty, is happening earlier than seen in previous studies. The changes could be measured, on average, by the age of 10. Over all, the researchers concluded, male puberty seems to be beginning 6 months to 2 years earlierthan it used to.

Dr. Herman-Giddens was also one of the lead authors on the comparable study published in 1997 that caused an uproar by suggesting that female puberty was coming earlier. Some of the factors thought to be associated with earlier female puberty — obesity, diet changes, chemicals in the environment that affect hormones — may be at work in boys, too, but the mechanisms aren’t understood.

Dr. Herman-Giddens said there was much less media attention to the news about puberty in boys, pointing out that the early changes in males — in particular the enlargement of the testicles — are much less visible than early breast development is in girls. But parents — and fourth- and fifth-grade teachers — need to be aware that relatively young boys may be dealing with the confusions and hormonal effects of early puberty.

“The sex hormones and especially testosterone are increasing in the boy’s body, and that’s what’s making the testes start to grow and that’s going to have an effect on the boy’s behavior,” Dr Herman-Giddens said. “Judgment, other aspects of psychological maturity — that’s not happening any faster.”

These subtle physiological changes tell us something more: that boyhood itself may be changing in ways we don’t completely understand, and that we need to be attentive to helping boys and young men take care of themselves as they grow.
A version of this article appeared in print on 01/08/2013, on page D5 of the NewYork edition with the headline: Needed: More Attention to Boys’ Development.

Combinar ejercicio físico e intelectual y mantener las relaciones sociales ayuda a preservar la memoria

http://www.rrhhdigital.com/ampliada.php?id=89679&sec=45&goback=%2Egde_3089472_member_202233918

Combinar ejercicio físico e intelectual y mantener las relaciones sociales ayuda a preservar la memoria
Actualizado Domingo 06/01/2013 01:17

EP



RRHH Digital Ejercitarse intelectualmente, hacer diariamente ejercicio físico, mantener las relaciones sociales y seguir la dieta mediterránea ayuda a no perder la memoria, especialmente cuando se llega a la vejez. Y es que, diversos estudios han mostrado que entre el 30 y el 50 por ciento de los mayores de 65 años sufren olvidos cotidianos como, por ejemplo, los nombres de personas.

No obstante, esta pérdida de memoria también afecta a la población más joven. De hecho, las investigaciones señalan que al menos una de cada cuatro personas de entre 25 años y 35 años está preocupada por "olvidos inexplicables". Un porcentaje que asciende al 35 por ciento en las personas de más de 40 años.

Así lo ha explicado a Europa Press la neuropsicóloga Gema Mejuto quien participa en un taller de memoria organizado por la Fundación Vianorte-Laguna en el Hospital Centro de Cuidados Laguna de Madrid y que tiene como objetivo ayudar a las personas a mantener la memoria activa.

Al llegar a una cierta edad las conexiones neuronales se van debilitando provocando que "ciertas partes del cerebro" se vayan desconectando y produzcan la aparición de ciertos tipos de demencia que, en muchas ocasiones, conllevan una pérdida de memoria.

Entre los olvidos más frecuentes se encuentran la llamada 'punta de lengua' que es cuando no salen las palabras más comunes --le ocurre a casi el 94% de los mayores--, el olvido de los nombres de personas --al 94%--, las dificultades para aprender una nueva habilidad --76%-- o cuando no se recuerda de lo que se acaba de decir --76%--.

Ahora bien, según ha explicado Mejuto, estos olvidos comienzan a ser preocupantes cuando se convierten en habituales y duran más de seis meses. En estos casos, la experta ha recomendado que, además de acudir a talleres como el que organiza la Fundación, el afectado vaya a un médico para que le realice un diagnóstico.

Por todo ello, la neuropsicóloga ha insistido en la necesidad de que, sobre todo, las personas mayores de 65 años realicen ejercicios intelectuales que refuercen la memoria y, por tanto, las conexiones neuronales y que, además, se entrenen físicamente dado que este ejercicio tiene repercusiones "muy positivas en el funcionamiento cerebral".

Además, Mejuto ha subrayado la importancia que tienen las relaciones sociales recordando que las sociedades "más abiertas" tienen menos problemas de demencia y ha insistido en los beneficios que aporta al cerebro la dieta mediterránea basada en el pescado azul, en las frutas y en las verduras.

Supraglóticos en niños/Supraglotic pediatric airway

Comparación de I-Gel 2.5. con ML Proseal en niños anestesiados y paralizados para cirugía electiva


Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery.
Mitra S, Das B, Jamil SN.
Department of Anaesthesiology, Jawaharlal Nehru Medical College, A.M.U., Aligarh, India.
N Am J Med Sci. 2012 Oct;4(10):453-7. doi: 10.4103/1947-2714.101983.


Abstract
BACKGROUND: The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. AIMS: This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. MATERIALS AND METHODS: Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H(2)O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H(2)O). CONCLUSION: Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482775/

Comparación del dispositivo perilaríngeo Cobra con la ML flexible en términos de estabilidad del dispositivo y características de ventilación en cirugía oftalmológica en niños


Comparison of Cobra perilaryngeal airway (CobraPLA™) with flexible laryngeal mask airway in terms of device stability and ventilation characteristics in pediatric ophthalmic surgery.
Sunder RA, Sinha R, Agarwal A, Perumal BC, Paneerselvam SR.
Department of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):322-5. doi: 10.4103/0970-9185.98324.
Abstract
BACKGROUND: Supraglottic airway devices play an important role in ophthalmic surgery. The flexible laryngeal mask airway (LMA™) is generally the preferred airway device. However, there are no studies comparing it with the Cobra perilaryngeal airway (CobraPLA™) in pediatric ophthalmic procedures. AIMS: To analyze the intraoperative device stability and ability to maintain normocarbia of CobraPLA™ and compare it to that with flexible LMA™. MATERIALS AND METHODS: Ninety children of American Society for Anesthesiologists physical status 1 and 2, aged 3-15 years scheduled for elective ophthalmic surgeries were randomly assigned to either the CobraPLA™ or the flexible LMA™ group. After placement of each airway device, oropharyngeal leak pressure (OLP) was noted. Adequate seal of the devices was confirmed at an inspired pressure of 15 cm H(2)O and pressure-controlled ventilation was initiated. Device displacement was diagnosed if there was a change in capnograph waveform, audible or palpable gas leak, change in expired tidal volume to <8 ml/kg, end-tidal carbon-dioxide persistently >6 kPa, or need to increase inspired pressure to >18 cm H(2)O to maintain normocarbia. RESULTS: Demographic data, duration, and type of surgery in both the groups were similar. A higher incidence of intraoperative device displacement was noted with the CobraPLA™ in comparison to flexible LMA™ (P < 0.001). Incidence of displacement was higher in strabismus surgery (7/12). Insertion characteristics and ventilation parameters were comparable. The OLP was significantly higher in CobraPLA™ group (28 ± 6.8 cm H(2)O) compared to the flexible LMA™ group (19.9 ± 4.5 cm H(2)O) (P < 0.001). Higher surgeon dissatisfaction (65.9%) was seen in the CobraPLA™ group. CONCLUSION: The high incidence of device displacement and surgeon dissatisfaction make CobraPLA™ a less favorable option than flexible LMA™ in ophthalmic surgery.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409940/



Dispositivos supraglóticos en niños


Supraglottic airway devices in children.
Ramesh S, Jayanthi R.
Department of Anaesthesia, Senior Consultants, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.
Indian J Anaesth. 2011 Sep;55(5):476-82. doi: 10.4103/0019-5049.89874.Abstract


Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237147/

Comparación de tres dispositivos supraglóticos en niños anestesiados paralizados para cirugía electiva


Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery.
Das B, Mitra S, Jamil SN, Varshney RK.
Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Saudi J Anaesth. 2012 Jul;6(3):224-8. doi: 10.4103/1658-354X.101212.


Abstract
CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498659/




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

Bibliotecas. Alerta

CAI amplía el horario de sus bibliotecas
20minutos.es
La Obra Social de Caja Inmaculada ampliará a partir de este martes y hasta el próximo jueves 31 de enero los horarios de sus bibliotecas CAI Mariano de Pano (Val-Carreres Ortiz, 12) y Espacio CAI (Alfonso, 29) para facilitar a los estudiantes la ...
Ver todos los artículos sobre este tema »


CALENDARIO DE EVENTOS DE LAS BIBLIOTECAS
Bajo el Sol
El viernes 18 de enero en la Biblioteca de Foothills, Cal Kelley, jardinero de Yuma presentará un programa sobre los diferentes tipos de cactus que se encuentran en Arizona. El programa "Cactus 101" empezará a las 10:30 AM en la biblioteca localizada ...
Ver todos los artículos sobre este tema »

Bibliotecas móviles en enero y febrero – Hub Oaxaca
según admin
Las Bibliotecas Móviles son un proyecto de la Fundación Alfredo Harp Helú Oaxaca, coordinado por laBiblioteca Andrés Henestrosa y la BS Biblioteca Infantil de Oaxaca. Dos camiones llevan libros a comunidades, agencias y colonias de la ...
Hub Oaxaca

Bibliotecas y elección de universidad | BiblogTecarios
Vaya por delante que no me cabe la menor duda de la importancia de la Biblioteca como parte de un todo que es la Universidad, pero viendo la situación ...
www.biblogtecarios.es/.../bibliotecas-y-eleccion-de-universida...


Gestión de bibliotecas escolares: Abies 2.0 - Departamento ...
Organizar el espacio de una biblioteca escolar y gestionar dicho fondo de forma que sea ... ABIES: Programa de automatización de las bibliotecas escolares. 2.
dfeiesanisidro.blogspot.com/.../gestion-de-bibliotecas-escolares...

Más dispositivossupraglóticos/More supraglottic airways

Uso del tubo laríngeo por paramédicos noruegos fuera del hospital durante paro cardiaco
Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20(1):84.
Abstract
ABSTRACT: BACKGROUND: Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. METHODS: Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. RESULTS: A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%), problematic initial tube positioning (n = 85, 24.5%), air leakage (n = 61, 17.6%), vomitus/aspiration (n = 44, 12.7%), and tube dislocation (n = 17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult". CONCLUSIONS: We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.
http://www.sjtrem.com/content/pdf/1757-7241-20-84.pdf


Laicos puede colocar con éxitos los dispositivos supraglóticos con tres minutos de entrenamiento. Comparación en cuatros maniquís diferentes
Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.
Schälte G, Stoppe C, Aktas M, Coburn M, Rex S, Schwarz M, Rossaint R, Zoremba N.
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany. gschaelte@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2011 Oct 24;19:60. doi: 10.1186/1757-7241-19-60.
Abstract
INTRODUCTION: Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. METHODS: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. RESULTS: The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. CONCLUSION: Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213203/pdf/1757-7241-19-60.pdf


Experiencia inicial con el dispositivo supraglótico I-gel por residentes en pacientes pediátricos


Initial experience of the i-gel supraglottic airway by the residents in pediatric patients.
Abukawa Y, Hiroki K, Ozaki M.
Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp
J Anesth. 2012 Jun;26(3):357-61. doi: 10.1007/s00540-011-1322-1. Epub 2012 Feb 7.Abstract
PURPOSE: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients. METHODS: With approval from the local ethics committee and parental informed consent, 70 children undergoing minor surgery in the supine position, ASA score I-II, were investigated. Exclusion included patients having thoracic, neurosurgical, spine, and otolaryngological procedures. Patients were divided into three groups: group 1 was airway size 1.5 for patients weighing 5-12 kg, group 2 was size 2 for 10-25 kg, and group 3 was size 2.5 for those weighing 25-35 kg. The following seven characteristics were evaluated: (1) ease of the i-gel and gastric tube insertion; (2) leak pressure; (3) tidal volume/body weight at leak pressure point; (4) fiberscope score; (5) insertion time; (6) hypoxia rate (laryngospasm); and (7) coughing and trace of bleeding. RESULTS: The overall insertion success rate and the success rate at first attempt were 99% and 94%, respectively. Gastric tube insertions were easy in all patients. The overall leak pressure was 23 ± 5 cmH(2)O. The tidal volume per body weight was 24 ± 10 ml/kg. A good view of the fiberscope was achieved in 79%. In group 1 (size 1.5), one failed insertion, two dislocations, and one dysphonia were observed. Hypoxia rate was 1%. There was no case with coughing and trace of bleeding. CONCLUSION: These results show that the i-gel airway is a safe and effective device for use by residents who do not have experience with insertion of a pediatric LMA. However, using size 1.5, special caution should be taken to protect the infant airway, similar to what has been previously reported for other airway devices.


http://link.springer.com/content/pdf/10.1007%2Fs00540-011-1322-1



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Anestesiología y Medicina del Dolor
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