sábado, 23 de junio de 2012

Riesgo de fracturas y utilización de medicamentos antiosteoporóticos: una relación desproporcionada


Riesgo de fracturas y utilización de medicamentos antiosteoporóticos: una relación desproporcionada.

Publicado por ABZ (15:30) en la categoría Estudios observacionalesPublicaciones originales
La revista Osteoporos Int acaba de publicar un revelador estudio sobre la prevalencia de factores de riesgo de fractura por osteoporosis y la prevalencia de tratamientos antiosteoporoticos en la Comunidad Valenciana a partir de los datos recogidos de la cohorte ESOSVAL. 
 
Se trata de un estudio transversal, que analizó datos de 5.310 mujeres y 5.725 hombres de edad igual o superior a 50 años atendidos  en 272 centros de salud de atención primaria de la Comunidad valenciana entre los años 2009 y 2010. Se recogieron los datos demográficos, antropométricos, clínicos y de tratamiento de los pacientes registrados en ABUCASIS, herramienta informática que recoge los datos clínicos y de prescripción de los pacientes atendidos por la Agencia Valenciana de Salud. 
  
Entre otros datos clínicos se registraron los factores de riesgo de fractura, como historia de fractura de cadera en padres o hermanos, antecedentes personales de fractura osteoporótica en cualquier localización, ingesta de alcohol regular, hábito tabáquico, sedentarismo, nº de caídas en el año anterior, ingesta diaria de calcio a través de la alimentación y uso de glucocorticoides. 
 
 
En cuanto al tratamiento farmacológico se  recogió el uso de suplementos de calcio y vitamina D así como de fármacos antiosteoporóticos (bifosfonatos, raloxifeno, ranelato de estroncio, calcitonina, hormona paratiroidea y teriparatida). Se consideró que el paciente estaba en tratamiento con alguno de estos medicamentos si había recibido cualquiera de ellos tres meses antes de la fecha de su inclusión en la cohorte de estudio. 
 
Se empleó la herramienta FRAX® calibrada para España que calcula el riesgo a 10 años de fractura osteoporótica principal (vertebral patológica, cadera, antebrazo o húmero) y el riesgo a 10 años de fractura de cadera en cada paciente. Para definir la población con alto o bajo riesgo se emplearon los criterios del Scientific Advisory Council of Osteoporosis in Canadaque clasifica las puntuaciones FRAX en bajo riesgo (riesgo de fractura a los 10 años <10%), riesgo intermedio (10-19%) y alto riesgo (≥20%) para  fracturas osteoporóticas principales, y bajo riesgo (<3%) o alto riesgo (≥3%) para  fracturas de cadera. 
 
Señalamos algunos de los resultados encontrados:
 
 - Los factores de riesgo de fractura en mujeres fueron la vida sedentaria (22,2%) y fractura previa (15,8%), mientras que en hombres destacaron la baja ingesta de calcio (21,4%) y el tabaquismo (20,9%).  
 
- Con respecto al riesgo de fractura el estudio mostró que el 28,8% del total de las  mujeres tenían un riesgo de fractura de cadera a los 10 años ≥3%, pero en el tramo de edad de mujeres de 50 – 64 años este porcentaje  bajaba hasta un 0,7% de las mujeres.
 
- Al 23,8% de las mujeres y al 5,2% de los hombres se les había realizado una densitometría ósea (DMO), llamando los autores la atención que, en el grupo de mujeres de 50 a 65 años, a 1 de cada 4 se les había realizado una DMO, a pesar del bajo riesgo de fractura en este tramo de edad. La densitometría en mujeres de menos de 65 años es una de las pruebas identificadas como de escaso valor clínico en un trabajo recientemente  publicado en Annals of Internal Medicine.  
  
- Con respecto a la utilización de medicamentos: el 27,7% de las mujeres y el 3,5% de los hombres tomaban suplementos de calcio y/o vitamina D. Y el 28,2% de las mujeres estaban en tratamiento con algún fármaco antiosteoporótico.
 
- Centrándonos en el grupo de mujeres de 50 a 64 años, el 22% de éstas recibían tratamiento antiosteoporótico (recordemos, esas mismas donde solo un 0,7% de ellas tenían un riesgo ≥3% de fractura de cadera a los 10 años). Es decir, para estos casos en los que no hay necesidad de tratamiento, no se aporta beneficio pero si algún efecto adverso (necrosis mandibular, fracturas atípicas).
 
 
El articulo llama la atención sobre el contraste entre altos niveles de tratamiento farmacológico y baja prevalencia de factores de riesgo en adultos jóvenes que, sumado a la sobreutilización  de la DMO, se traduciría todo ello en un impacto muy importante en el gasto sanitario ya que ese grupo de edad (mujeres de 50 -64 años) representa  mas de la mitad de las mujeres mayores de 50 años. En “roman paladino”: un despilfarro.

Manual de buenas prácticas en dinamización virtual (elaborado en comunidad de aprendizaje)


El caparazón: Manual de buenas prácticas en dinamización virtual (elaborado en comunidad de aprendizaje)

Link to El caparazon


Posted: 22 Jun 2012 12:32 PM PDT
Trabajé con ellos en 2011 y me enorgullece que hoy presenten ya las Comunidades de aprendizaje como modalidad formativa. Os dejo uno de los documentos que elaboraron durante el período en que asesoré y trabajé con los profesores delServicio de Formación de la Diputación de Valencia.
En su blog nos dicen:
Podríamos definir la Comunidad de Práctica como un grupo de personas que unidos por un interés profesional común aprenden juntos durante un tiempo y producen para el resto de profe­sionales un documento que puede ser referente en determinados aspectos de la práctica profesional.
Hasta la fecha, el Servicio de Formación ha editado tres publicaciones que son el resultado del trabajo de una Comunidad de Práctica:
  • Buenas prácticas para la dinamización de entornos virtuales
Este documento es una guía sobre la tutorización de cursos online, donde se abordan, entre otros aspectos, consejos sobre la gestión del tiempo, reglas de participación en entornos en línea, trabajo en grupo, motivación, evaluación y creatividad. Este documento ha sido producido por tutores que cuentan con una amplia experiencia en los planes de formación y ha contado con la participación de la experta en innovación educativa Dolors Reig.

He pensado que podía ser de interés para vosotros, así que aquí os lo dejo…

Feliz verbena de San Juan :)
   
Posted: 22 Jun 2012 12:38 PM PDT
Estas eran las preguntas y en el pdf tenéis las respuestas completas a la entrevista que me hacía Ester Plaza sobre la parte más orientada a lo socio-profesional de Socionomía para la revista Profesiones que acaba de salir publicada:
1. ¿Cómo transmitiría en un tuit y en un estado de Facebook qué es
Socionomía?
2. En su libro hace referencia a la necesidad de aprender durante toda la vida.
¿Qué papel desempeñan en este aprendizaje el contacto con las redes
sociales?
3. Desde la perspectiva profesional, ¿hasta qué punto se encuentra vinculado
el conocimiento a la adaptación a lo digital?
4. Se refiere a la empatía como ‘motor de la civilización’ ¿El paso del ‘yo’
al ‘nosotros’ es imprescindible para avanzar socialmente?
5. ¿De qué manera aconsejaría a los nuevos profesionales la importancia de la
cooperación y la coopetición en el mundo laboral al que se enfrentan?
6. ¿Cuáles son las claves para llegar a obtener una actitud 2.0, desde el punto
de vista organizacional?
7. ¿Qué consejos deberíamos seguir para convivir en socionomía?
8. ¿Qué podemos esperar que suceda después de la revolución creativa y
cognitiva?


Nota: Sobre el libro Socionomía dejo enlace a su microsite, con material complementario y enlaces para su compra y descarga tanto en versión papel como en versión ebook en distintos lugares del mundo.

‘Lunch Hour NYC’ Opens at the New York Public Library


EXHIBITION REVIEW

Filling Up on a Midday Bite of New York History

‘Lunch Hour NYC’ Opens at the New York Public Library

Chester Higgins Jr./The New York Times
Lunch Hour NYC The entrance to the exhibition.
The evening restaurant meal is an elaborate ritual in which exquisitely prepared foods are eaten in a particular order, using fine utensils in select company.
ArtsBeat
Breaking news about the arts, coverage of live events, critical reviews, multimedia and more.
Arts & Entertainment Guide
A sortable calendar of noteworthy cultural events in the New York region, selected by Times critics.
Chester Higgins Jr./The New York Times
A section of the exhibition includes a section on Horn & Hardart Automats.
And then there’s lunch hour.
“Everybody talks at once; everybody orders at once; everybody eats at once; and everybody seems anxious to pay at once” is how a New York observer described the scene in 1868.
In 1901 Munsey’s Magazine observed, “Haste seems to be a controlling factor in the luncheon of the worker.”
All of which means that lunch hour is probably not the ideal time to see the new exhibition “Lunch Hour NYC” at the New York Public Library, because time will be too short, the galleries too crowded and the need to grab a bite too great.
This show should ideally be seen at a more leisurely pace, to savor the repast prepared by its curators — the culinary historian Laura Shapiro and the library’s Rebecca Federman, who has worked with the culinary collections — and to leave room to digest their offerings.
Really? Can an exhibition about the history of lunchtime in the city have that much to say? Yes: Going to this show is a bit like heading out to a street cart or a food truck and finding that there is much more to choose from than you thought possible.
And so it is here. There are sections on street foods, on Horn & Hardart Automats, on home lunches, school lunches, charity lunches and power lunches. There are selections from the library’s 45,000-strong collection of menus, a manuscript by Jack Kerouac written at a cafeteria and W. H. Auden’s piquant 1947 poem “In Schrafft’s,” perhaps drafted on site.
It is all playfully and elegantly designed. The Web resources are rich as well, including detailed links to images and invitations to help transcribe menus from the library’s collection.
Even after a quick visit, you might echo the young Parisians who have become fans of the American-inspired gourmet-food trucks in Paris: “Très Brooklyn,” they say — a term “that signifies a particularly cool combination of informality, creativity and quality,” The New York Times reported recently.
You begin at the library with the mundane: New York’s street scenes. The central gallery is almost a stage set in which carts and storefronts present their offerings: pretzels (which we learn once had a disreputable reputation because of their association with saloons); hot dogs (“before the Federal Meat Inspection Act of 1906,” they were “the sort of food that mothers warned their children never to eat”); pizza (the Pizza Principle: “Since 1960, the cost of a subway ride and a slice of pizza has been nearly the same”).
You see a 1932 menu from a Japanese restaurant on West 47th Street, and learn how Japanese restaurateurs have packaged their immigrant tastes for New York customers. (A “Suki-Yaki Dinner” includes “beef tenderloin,” olives and celery hearts, for $1.25.) A display about “Chinese takeout” has a delivery bicycle with plastic bags wrapped over the seat that looks as if it had just pulled up on the sidewalk. And there is a video interview with Ed Beller, who invented the Admar stainless-steel hot dog cart, which became the standard.
But all of this is something of an appetizer; street foods are a small slice of a larger phenomenon. The New York lunch is far more complicated and unusual.
Historically, we learn, lunch had negligible importance. In English rural life the main meal during the day was known as “dinner.” And you still can find a leisurely approach to the midday meal in Mediterranean climes.
In his 1755 Dictionary of the English Language, Samuel Johnson suggested that “lunch” was derived from foreign words referring to “a small piece” or “clutch.” “Lunch” means “as much food as one’s hand can hold.” An 1841 version of Noah Webster’s dictionary is here too, in which lunch is defined as “a portion of food taken at any time, except at a regular meal.”
Lunch, in other words, was traditionally unconnected to the rituals of dining; it was unscheduled, informal, eaten using the hands rather than utensils. Lunch is perhaps the perfect description for the food offered on street carts.
But while this informality still thrives, lunch was transformed with the growth of New York as a trading, manufacturing and finance center. The midday meal could no longer be treated as a dinner. Nor could lunches be grabbed haphazardly. Eating schedules were codified. As the city expanded, and workers downtown could no longer return home to eat during the day, the lunch hour took off.
The exhibition even suggests that New York gave the lunch hour a modern identity. The city “reinvented lunch in its own image.” Even 150 years ago, the “crowds, the rush and the dizzying range of foods” during lunchtime in New York were startling to visitors.
Chester Higgins Jr./The New York Times
The central gallery of "Lunch Hour NYC" is a stage set of carts and storefronts.
ArtsBeat
Breaking news about the arts, coverage of live events, critical reviews, multimedia and more.
Arts & Entertainment Guide
A sortable calendar of noteworthy cultural events in the New York region, selected by Times critics.
Chester Higgins Jr./The New York Times
A cart on display at the exhibition.
Was New York unique in this? That is uncertain here, but the evidence is compelling. We know that in industrialized towns, both in the United States and England, lunch scheduling was standardized. But educated Parisian civil servants in the novels of Zola, for example, seem to have inordinate flexibility in their midday schedules.
And in late-19th-century New York? The exhibition quotes the journalist George G. Foster, who wrote in the book“New York in Slices” in 1849: “Everything is done differently in New York from anywhere else — but in eating the difference is more striking than in any other branch of human economy.” The schedule was firm, and haste was the rule.
An industry developed out of the lunch hour. One wall-size 1888 etching here, “A Down-Town Lunch-Room in New York,” shows waiters and top-hatted diners pressed together in a tumult of food and conversation.
The automat, a few decades later, was almost the opposite: Tumult was replaced by metallic compartments and magically sleek mechanisms. Drop a coin, turn a knob, and a glass door would open, revealing individual servings seemingly untouched by human hands. The automated office was answered by the automated cafeteria.
The library has a collection of Horn & Hardart papers, and if you recall those marble emporiums only in their decades of decline, you can get a sense here of the impact they once had. In the early 1930s there were 41 automats in New York. Press a button here on a Horn & Hardart coffee spout (it was the Starbucks of its day), and you hear tributes to the automat in Moss Hart and Irving Berlin’s 1932 musical, “Face the Music.” By the 1950s, though, automats were struggling. Soon they were all facing the music.
There is much more here, as the history unfolds: samplings of luncheonette slang from 1940, in which a waitress might call out for some “nervous pudding” (gelatin) or a bowl of “belly wash” (soup).
There is a too brief account of company lunchrooms that suggests a rich and unexplored subject. We see here a lunchroom at the Metropolitan Life Insurance Company’s main office on Madison Avenue, which opened in 1909 and served more than 4,000 clerks a day. Each had filled out cards listing menu preferences: “Men and women ate in separate lunchrooms, and everyone had an assigned seat so that waitresses could quickly deliver the right meal to each person. The clerks were allowed 35 minutes for lunch, and the meal was free.”
And there is a survey of the home lunch as well. Immigrant families might mix cooking traditions at lunch in ways they would not at dinner. Families with different economic status might end up eating similar lunches.
We learn too of sandwiches and of the “quintessential American sandwich filling,” peanut butter, once considered “an elegant treat.” And the quintessential American bread? Wonder Bread, whose sliced uniformity eliminated “a century’s worth of social distinctions among sandwiches.”
People will always find ways of reinventing differences. But despite power lunches and charity lunches, despite lunchrooms for clerks and executive dining halls for top brass, a strong tradition can be seen here right through the final gallery, with its photographs of contemporary lunch sites. Lunch is the democratic meal, the great leveler, a break in the rituals of social and economic life. Anybody could be standing next to you, grabbing as much food as the hand can hold.
Très Brooklyn!

Sedación y analgesia en UCI


Guías alemanas para el manejo de la analgesia, sedación y delirio en cuidados intensivos. Versión corta
Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care-short version.
Martin J, Heymann A, Bäsell K, Baron R, Biniek R, Bürkle H, Dall P, Dictus C, Eggers V, Eichler I, Engelmann L, Garten L, Hartl W, Haase U, Huth R, Kessler P, Kleinschmidt S, Koppert W, Kretz FJ, Laubenthal H, Marggraf G, Meiser A, Neugebauer E, Neuhaus U, Putensen C, Quintel M, Reske A, Roth B, Scholz J, Schröder S, Schreiter D, Schüttler J, Schwarzmann G, Stingele R, Tonner P, Tränkle P, Treede RD, Trupkovic T, Tryba M, Wappler F, Waydhas C, Spies C.
Department of Anesthesiology and Operative Intensive Care, Klinik am Eichert, Göppingen, Germany.
Ger Med Sci. 2010 Feb 2;8:Doc02.
Abstract
Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2(nd) Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006-2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3(rd) Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade "A" (very strong recommendation), Grade "B" (strong recommendation) and Grade "0" (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3(rd) Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830566/pdf/GMS-08-02.pdf 

 
Estrategias para optimizar analgesia y sedación 
Strategies to optimize analgesia and sedation.
Schweickert WD, Kress JP.
Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Medical Center, Spruce Street, Philadelphia, Pennsylvania 19104, USA.
Crit Care. 2008;12 Suppl 3:S6. Epub 2008 May 14.
Abstract
Achieving adequate but not excessive sedation in critically ill, mechanically ventilated patients is a complex process. Analgesics and sedatives employed in this context are extremely potent, and drug requirements and metabolism are unpredictable. Clinicians must have heightened awareness of the potential for enduring effects and are encouraged to employ strategies that maximize benefit while minimizing risk. Successful sedation protocols have three basic components: frequent assessments for pain, anxiety, and agitation using a reproducible scale; combination therapy coupling opioids and sedatives; and, most importantly, careful communication between team members, with a particular recognition that the bedside nurse must be empowered to pair assessments with drug manipulation. In recent years, two broad categories of sedation protocols have achieved clinical success in terms of decreasing duration of mechanical ventilation and intensive care unit length of stay by minimizing drug accumulation. Patient-targeted sedation protocols (the first category) rely on structured assessments to guide a careful schema of titrated drug escalation and withdrawal. Variation exists in the assessment tool utilized, but the optimal goal in all strategies is a patient who is awake and can be readily examined. Alternatively, daily interruption of continuous sedative infusions (the second category) may be employed to focus care providers on the goal of achieving a period of awakening in the earliest phases of critical illness possible. Newer literature has focused on the safety of this strategy and its comparison with intermittent drug administration. Ongoing investigations are evaluating the broad applicability of these types of protocols, and currently one may only speculate on whether one strategy is superior to another
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391265/pdf/cc6151.pdf 

Atentamente
Anestesiología y Medicina del Dolor

Books Update


The New York Times

June 22, 2012

Books Update

On the Cover of Sunday's Book Review

'Victory: The Triumphant Gay Revolution'

By LINDA HIRSHMAN
Reviewed by RICH BENJAMIN
Linda Hirshman's popular history traces the gay rights movement from the early 20th century to the present.

Also in the Book Review

'Mission to Paris'

By ALAN FURST
Reviewed by MAX BYRD
An actor stumbles into the clutches of Nazi conspirators in Alan Furst's thriller.
Mario Vargas Llosa

'The Dream of the Celt'

By MARIO VARGAS LLOSA. Translated by EDITH GROSSMAN.
Reviewed by LIESL SCHILLINGER
A Nobel laureate reimagines the life of the human rights advocate and Irish nationalist Roger Casement.

'Seating Arrangements'

By MAGGIE SHIPSTEAD
Reviewed by DYLAN LANDIS
A WASP clan performs its tribal rituals in this first novel.
Susan Sontag

'As Consciousness is Harnessed to Flesh'

By SUSAN SONTAG. Edited by DAVID RIEFF.
Reviewed by JAMES CAMPBELL
The second volume of Sontag's diaries looks behind the mask.

'Mrs. Robinson's Disgrace'

By KATE SUMMERSCALE
Reviewed by ANDREA WULF
Kate Summerscale looks at an early divorce case for insight into Victorian novels, health fads and views of marriage.
A protest against school integration in Little Rock, Ark., in 1959.

'The Harm in Hate Speech'

By JEREMY WALDRON
Reviewed by MICHAEL W. McCONNELL
A legal philosopher urges Americans to punish hate speech.

'Finance and the Good Society'

By ROBERT J. SHILLER
Reviewed by SEBASTIAN MALLABY
The way to a stronger economy is to encourage the financial industry, Robert J. Shiller argues.
Witold Pilecki with his nephew, not long before volunteering to enter Auschwitz as a prisoner in 1940.

'The Auschwitz Volunteer'

By WITOLD PILECKI. Translated by JAREK GARLINSKI.
Reviewed by TIMOTHY SNYDER
The long-suppressed account of life in Auschwitz by a Polish officer.
The Philip K. Dick android.

'How to Build an Android'

By DAVID F. DUFTY
Reviewed by LAWRENCE DOWNES
An android of the author Philip K. Dick has a story of his own.

'Hitler'

By A. N. WILSON
Reviewed by DAGMAR HERZOG
A. N. Wilson's brief biography examines how a ludicrously run-of-the-mill man like Hitler rose to a position of such terrible power.
INFRA: Photographs by Richard MosseWith an essay by Adam Hochschild.136 pp. Aperture/Pulitzer Center on Crisis Reporting. $50.Using an infrared film originally developed for military reconnaissance - rendering green landscapes in vivid hues of lavender, crimson and pink - Mosse depicts the intractable conflict in the Democratic Republic of Congo. Above, a hut in North Kivu Province.

Fiction Chronicle

By JOHN WILLIAMS
New fiction by Nick Dybek, Cristina Comencini, Dan Barden and Marcel Beyer.

'A Small Fortune'

By ROSIE DASTGIR
Reviewed by JULIET LAPIDOS
A financial windfall bedevils this novel's Pakistani patriarch.

'The Land of Decoration'

By GRACE McCLEEN
Reviewed by AMITY GAIGE
A troubled 10-year-old hears a divine voice in Grace McCleen's first novel.

Richard Ford

Richard Ford: By the Book

The author of "Independence Day" and "The Sportswriter" says he's not a tough cry under any circumstances. "My own book 'Canada' made me cry the last time I read it."

Back Page

From This Day Forward

By CHRISTOPHER BRAM
Marriage, in one form or another, has figured prominently in gay and lesbian fiction for quite some time.

Inside the List

By GREGORY COWLES
When the homey South Carolina novelist Dorothea Benton Frank signed books after a reading recently, one octogenarian in the audience asked if he could suck her toes.

Editors' Choice

Recently reviewed books of particular interest.

Paperback Row

By IHSAN TAYLOR
Paperback books of particular interest.

Book Review Podcast

This week, Linda Hirshman talks about "Victory," her history of the gay rights movement; Julie Bosman has notes from the field; Lawrence Downes discusses the android Philip K. Dick; and Gregory Cowles has best-seller news. Sam Tanenhaus is the host.
ArtsBeat