e-books. Alerta

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



'E-book' de Spasmo Teatro abre las actividades culturales en las ...
20minutos.es
La programación de las Bibliotecas Municipales de Salamanca prevista para este primer trimestre del año se estrena este sábado, 26 de enero, con la puesta en escena de la obra de teatro infantil 'E-book', a cargo de la compañía Spasmo Teatro.
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La Comunidad apuesta por racionalizar el horario nocturno de las ...
Qué.es
La Comunidad de Madrid ha recordado este martes que 12 bibliotecas abren hasta la 1 horas hasta el 14 de febrero para facilitar la preparación de los exámenes y ha indicado que hace dos años la caída de usuarios del servicio a partir de esta hora fue ...
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Qué.es

Dispondrán bibliotecas formas para los impuestos
Bajo el Sol
Personal de la biblioteca estará encantado de ayudar con las búsquedas en Internet para los formularios e instrucciones, sin embargo, tenga en cuenta que el personal de la biblioteca no está capacitado en materia fiscal, y por lo tanto no puede ...
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Informe Horizon 2012 & bibliotecas | BiblogTecarios
El Informe Horizon de 2012, tradicional iniciativa del New Media Consortium, fija, mediante tres periodos, las tendencias y tecnologías que parece que ...
www.biblogtecarios.es/juanjoseprieto/horizon-2012-bibliotecas




Abuelitos formaron su propio club en bibliotecas de Bogotá ...
Del proyecto nació el libro Andariego, que cuenta con recetas y consejos caseros escritos por ellos mismos.Video para usuarios registrados: NoEmision: ...
www.noticiascaracol.com/.../video-284674-abuelitos-formaro...


Abuelitos formaron su propio club en bibliotecas de Bogotá - 21 de ...
Del proyecto nació el libro Andariego, que cuenta con recetas y consejos caseros escritos por ellos mismos. - 21 de enero de 2013 Visita: http://www. noticias...
www.youtube.com/watch?v=KOfeZXjCv9o&list...

Bibliotecas. Alerta

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




Un tiroteo en la biblioteca de una universidad de EEUU dejó 3 heridos
Diario Uno
Testigos informaron que un hombre fue llevado fuera de la biblioteca esposado a una camilla, añadió el canal, que indicó también que decenas de policías corrían a través del campus en busca de un segundo sospechoso que habría escapado.
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La Biblioteca “José Manuel Estrada” abrió sus puertas en un nuevo ...
Tiempo de San Juan
Se llevó a cabo el acto de reinauguración de la Biblioteca Popular que pasó a funcionar en las instalaciones de CIC de Médano de Oro. Durante el evento el Intendente Gioja donó 39 libros de diversos géneros literarios.
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Tiempo de San Juan



Importante reconocimiento para la biblioteca popular de Seguí.
nuevazona
A través de una nota enviada al presidente de la Biblioteca Popular “Teresita Yugdar”, José Gabriel Cabrera, la CONABIP, por Disposición N° 044 reconoció a dicha entidad de Seguí como BibliotecaPopular Nacional, habiendo sido incorporada al registro ...
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La Biblioteca del Congreso de los EEUU archivará mensajes de ...
iprofesional.com (Comunicado de prensa)
400 millones de "tuits" diarios archivará la Biblioteca del Congreso de EE.UU., bajo el criterio de que son una pequeña pero muy importante parte de la narrativa estadounidense. "Una parte de nuestra misión en la Biblioteca del Congreso es recoger la ...
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iprofesional.com (Comunicado de prensa)


Biblioteca clasifica libros de Armstrong en la sección de ficción
Diario Metro de Puerto Rico
Una biblioteca de Sidney, Australia, anunció el lunes que los libros que tienen sobre el exciclista estadounidense Lance Armstrong iban a estar clasificados dentro de la sección de ficción, informó la prensa del país. Esta decisión vino tras las ...
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Diario Metro de Puerto Rico


La Biblioteca Nacional Francesa puja por el libro más escandaloso ...
Qué.es
La Biblioteca Nacional de Francia (BNF) está dispuesta a pagar unos 5 millones de dólares para poseer el manuscrito original de «Las 120 jornadas de Sodoma y Gomorra», el legendario relato escrito por el Marqués de Sade en la prisión de la Bastilla ...
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Qué.es


San Fernando: Polémica. Intendente le habría cortado subsidios a ...
Impulso Baires
San Fernando - A casi 140 años de su creación, la Biblioteca y Museo Popular “Juan N. Madero” de San Fernando, faro de cultura de una comunidad que la defendió siempre con orgullo y por donde pasaron figuras de la historia argentina, y con más de ...
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Impulso Baires


Video: Biblioteca Nicanor Parra / Mathias Klotz por Pablo Casals ...
según Katerina Gordon
Les presentamos este interesante video realizado por Pablo Casals-Aguirre de la esta obra del arquitecto chileno Mathias Klotz. Se trata de la Biblioteca Nicanor Parra, la nueva biblioteca central de la Universidad Diego Portales ubicada en ...
Plataforma Arquitectura

La Biblioteca del Congreso de los EE.UU. archivará mensajes de ...
400 millones de "tuits" diarios archivará la Biblioteca del Congreso de EE.UU., bajo el criterio de que son una pequeña pero muy importante parte de la ...
ar.noticias.yahoo.com/biblioteca-congreso-eeuu-archivará-me...

Secret Ingredient for Success

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


Fuente: http://www.nytimes.com/2013/01/20/opinion/sunday/secret-ingredient-for-success.html?src=me&ref=general

OPINION

Secret Ingredient for Success
By CAMILLE SWEENEY and JOSH GOSFIELD
Published: January 19, 2013


WHAT does self-awareness have to do with a restaurant empire? A tennis championship? Or a rock star’s dream?
Enlarge This Image
Marion Fayolle




David Chang’s experience is instructive.

Mr. Chang is an internationally renowned, award-winning Korean-American chef, restaurateur and owner of the Momofuku restaurant group with eight restaurants from Toronto to Sydney, and other thriving enterprises, including bakeries and bars, a PBS TV show, guest spots on HBO’s “Treme” and a foodie magazine, Lucky Peach. He says he worked himself to the bone to realize his dream — to own a humble noodle bar.

He spent years cooking in some of New York City’s best restaurants, apprenticed in different noodle shops in Japan and then, finally, worked 18-hour days in his tiny restaurant, Momofuku Noodle Bar.

Mr. Chang could barely pay himself a salary. He had trouble keeping staff. And he was miserably stressed.

He recalls a low moment when he went with his staff on a night off to eat burgers at a restaurant that was everything his wasn’t — packed, critically acclaimed and financially successful. He could cook better than they did, he thought, so why was his restaurant failing? “I couldn’t figure out what the hell we were doing wrong,” he told us.

Mr. Chang could have blamed someone else for his troubles, or worked harder (though available evidence suggests that might not have been possible) or he could have made minor tweaks to the menu. Instead he looked inward and subjected himself to brutal self-assessment.

Was the humble noodle bar of his dreams economically viable? Sure, a traditional noodle dish had its charm but wouldn’t work as the mainstay of a restaurant if he hoped to pay his bills.

Mr. Chang changed course. Rather than worry about what a noodle bar should serve, he and his cooks stalked the produce at the greenmarket for inspiration. Then they went back to the kitchen and cooked as if it was their last meal, crowding the menu with wild combinations of dishes they’d want to eat — tripe and sweetbreads, headcheese and flavor-packed culinary mashups like a Korean-style burrito. What happened next Mr. Chang still considers “kind of ridiculous” — the crowds came, rave reviews piled up, awards followed and unimaginable opportunities presented themselves.

During the 1970s, Chris Argyris, a business theorist at Harvard Business School (and now, at 89, a professor emeritus) began to research what happens to organizations and people, like Mr. Chang, when they find obstacles in their paths.

Professor Argyris called the most common response single loop learning — an insular mental process in which we consider possible external or technical reasons for obstacles.

LESS common but vastly more effective is the cognitive approach that Professor Argyris called double-loop learning. In this mode we — like Mr. Chang — question every aspect of our approach, including our methodology, biases and deeply held assumptions. This more psychologically nuanced self-examination requires that we honestly challenge our beliefs and summon the courage to act on that information, which may lead to fresh ways of thinking about our lives and our goals.

In interviews we did with high achievers for a book, we expected to hear that talent, persistence, dedication and luck played crucial roles in their success. Surprisingly, however, self-awareness played an equally strong role.

The successful people we spoke with — in business, entertainment, sports and the arts — all had similar responses when faced with obstacles: they subjected themselves to fairly merciless self-examination that prompted reinvention of their goals and the methods by which they endeavored to achieve them.

The tennis champion Martina Navratilova, for example, told us that after a galling loss to Chris Evert in 1981, she questioned her assumption that she could get by on talent and instinct alone. She began a long exploration of every aspect of her game. She adopted a rigorous cross-training practice (common today but essentially unheard of at the time), revamped her diet and her mental and tactical game and ultimately transformed herself into the most successful women’s tennis player of her era.

The indie rock band OK Go described how it once operated under the business model of the 20th-century rock band. But when industry record sales collapsed and the band members found themselves creatively hamstrung by their recording company, they questioned their tactics. Rather than depend on their label, they made wildly unconventional music videos, which went viral, and collaborative art projects with companies like Google, State Farm and Range Rover, which financed future creative endeavors. The band now releases albums on its own label.

No one’s idea of a good time is to take a brutal assessment of their animating assumptions and to acknowledge that those may have contributed to their failure. It’s easy to find pat ways to explain why the world has not adequately rewarded our efforts. But what we learned from conversation with high achievers is that challenging our assumptions, objectives, at times even our goals, may sometimes push us further than we thought possible. Ask David Chang, who never imagined that sweetbreads and duck sausage rice cakes with kohlrabi and mint would find their way beside his humble noodle dishes — and make him a star.


Camille Sweeney and Josh Gosfield are the authors of the forthcoming book “The Art of Doing: How Superachievers Do What They Do and How They Do It So Well.”


A version of this op-ed appeared in print on January 20, 2013, on page SR4 of the New York edition with the headline: Secret Ingredient For Success.

You Are Going to Die

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


http://opinionator.blogs.nytimes.com/2013/01/20/you-are-going-to-die/?src=me&ref=general



ANXIETY January 20, 2013, 9:00 pm560 Comments
You Are Going to DieBy TIM KREIDER


Anxiety: We worry. A gallery of contributors count the ways.

TAGS:

AGING, DEATH AND DYING,ELDERLY, LONGEVITY,RETIREMENT COMMUNITIES AND ASSISTED LIVING





My sister and I recently toured the retirement community where my mother has announced she’ll be moving. I have been in some bleak clinical facilities for the elderly where not one person was compos mentis and I had to politely suppress the urge to flee, but this was nothing like that. It was a very cushy modern complex housed in what used to be a seminary, with individual condominiums with big kitchens and sun rooms, equipped with fancy restaurants, grills and snack bars, a fitness center, a concert hall, a library, an art room, a couple of beauty salons, a bank and an ornate chapel of Italian marble. You could walk from any building in the complex to another without ever going outside, through underground corridors and glass-enclosed walkways through the woods. Mom described it as “like a college dorm, except the boys aren’t as good-looking.” Nonetheless I spent much of my day trying not to cry.

You are older at this moment than you’ve ever been before, and it’s the youngest you’re ever going to get.



At all times of major life crisis, friends and family will crowd around and press upon you the false emotions appropriate to the occasion. “That’s so great!” everyone said of my mother’s decision to move to an assisted-living facility. “It’s really impressive that she decided to do that herself.” They cited their own stories of 90-year-old parents grimly clinging to drafty dilapidated houses, refusing to move until forced out by strokes or broken hips. “You should be really relieved and grateful.” “She’ll be much happier there.” The overbearing unanimity of this chorus suggests to me that its real purpose is less to reassure than to suppress, to deny the most obvious and natural emotion that attends this occasion, which is sadness.

My sadness is purely selfish, I know. My friends are right; this was all Mom’s idea, she’s looking forward to it, and she really will be happier there. But it also means losing the farm my father bought in 1976, where my sister and I grew up, where Dad died in 1991. We’re losing our old phone number, the one we’ve had since the Ford administration, a number I know as well as my own middle name. However infrequently I go there, it is the place on earth that feels like home to me, the place I’ll always have to go back to in case adulthood falls through. I hadn’t realized, until I was forcibly divested of it, that I’d been harboring the idea that someday, when this whole crazy adventure was over, I would at some point be nine again, sitting around the dinner table with Mom and Dad and my sister. And beneath it all, even at age 45, there is the irrational, little-kid fear: Who’s going to take care of me? I remember my mother telling me that when her own mother died, when Mom was in her 40s, her first thought was: I’m an orphan.
Daehyun Kim

Plenty of people before me have lamented the way that we in industrialized countries regard our elderly as unproductive workers or obsolete products, and lock them away in institutions instead of taking them into our own homes out of devotion and duty. Most of these critiques are directed at the indifference and cruelty thus displayed to the elderly; what I wonder about is what it’s doing to the rest of us.

RELATED
More From Anxiety

Read previous contributions to this series.

Segregating the old and the sick enables a fantasy, as baseless as the fantasy of capitalism’s endless expansion, of youth and health as eternal, in which old age can seem to be an inexplicably bad lifestyle choice, like eating junk food or buying a minivan, that you can avoid if you’re well-educated or hip enough. So that when through absolutely no fault of your own your eyesight begins to blur and you can no longer eat whatever you want without consequence and the hangovers start lasting for days, you feel somehow ripped off, lied to. Aging feels grotesquely unfair. As if there ought to be someone to sue.

We don’t see old or infirm people much in movies or on TV. We love explosive gory death onscreen, but we’re not so enamored of the creeping, gray, incontinent kind. Aging and death are embarrassing medical conditions, like hemorrhoids or eczema, best kept out of sight. Survivors of serious illness or injuries have written that, once they were sick or disabled, they found themselves confined to a different world, a world of sick people, invisible to the rest of us. Denis Johnson writes in his novel “Jesus’ Son”: “You and I don’t know about these diseases until we get them, in which case we also will be put out of sight.”

My own father died at home, in what was once my childhood bedroom. He was, in this respect at least, a lucky man. Almost everyone dies in a hospital now, even though absolutely nobody wants to, because by the time we’re dying all the decisions have been taken out of our hands by the well, and the well are without mercy. Of course we hospitalize the sick and the old for some good reasons (better care, pain relief), but I think we also segregate the elderly from the rest of society because we’re afraid of them, as if age might be contagious. Which, it turns out, it is.

Because of all the stories we’ve absorbed, we vaguely imagine that our lives will take the shape of a narrative — the classic Aristotelian ramp diagram of gradual rising action (struggle and setbacks), climax (happy marriage, professional success), and a brief, cozy denoument (kicking back with family and friends, remembering the good times on a porch someplace pretty). But life is not shaped like a story; it’s an elongate and flattened bell curve, with an attenuated, anticlimactic decline as long as its beginning. Friends have described seeing their parents lose their faculties one by one, in more or less the reverse order that their young children are acquiring them.

Another illusion we can’t seem to relinquish, partly because large and moneyed industries thrive on sustaining it, is that with enough money and information we’ll be able to control how we age and die. But one of the main aspects of aging is the loss of control. Even people with the money to arrange to age in comfort can die in agony and indignity, gabbling like infants, forgetting their own children, sans everything. Death is a lot like birth (which people also gird themselves for with books and courses and experts) — everyone’s is different, some are relatively quick and painless and some are prolonged and traumatic, but they’re all pretty messy and unpleasant and there’s not a lot you can do to prepare yourself.

I’m not trying to romanticize the beauty of osteoporosis, the wisdom of Alzheimer’s or the dignity of incontinence. More than one old person has ordered me, “Do not get old.” They did not appear to be kidding. I’m not talking about Learning from the Invaluable Life Experience of Our Elders, or even suggesting we need to accept the inevitable with grace. I am all for raging against the dying of the light, and if they ever develop DNA rejuvenation or some other longevity technique I will personally claw, throttle and gouge my way through Warren Buffett, Rupert Murdoch and any number of other decrepit billionaires in order to be first in line.

But we don’t have a choice. You are older at this moment than you’ve ever been before, and it’s the youngest you’re ever going to get. The mortality rate is holding at a scandalous 100 percent. Pretending death can be indefinitely evaded with hot yoga or a gluten-free diet or antioxidants or just by refusing to look is craven denial. “Facing it, always facing it, that’s the way to get through,” Conrad wrote in “Typhoon.” “Face it.” He was talking about more than storms. The sheltered prince Siddartha Gautama was supposedly set on the path to becoming the Buddha when he was out riding and happened to see an old man, a sick man and a dead man. Today he’d be spared the discomfiture, and the enlightenment, unless he were riding mass transit.

Just yesterday my mother sent me a poem she first read in college — Langston Hughes’s “Mother to Son.” She said she could still remember where she was, in her dorm room at Goshen College, when she came across it in her American Lit book. The title notwithstanding, it does not make for Hallmark-card copy. Life for me ain’t been no crystal stair. It tells us that this life is not a story or an adventure or a journey of spiritual self-discovery; it’s a slog. And it orders us to keep going, don’t you dare give up, no matter what. Because I’m your mother, that’s why.

(Anxiety welcomes submissions at anxiety@nytimes.com. Unfortunately, we can only notify writers whose articles have been accepted for publication.)


Tim Kreider is the author of “We Learn Nothing,” a collection of essays and cartoons. His cartoon, “The Pain — When Will It End?” has been collected in three books by Fantagraphics.

This post has been revised to reflect the following correction:

Correction: January 21, 2013

An earlier version of this article misspelled Warren Buffett's surname.

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012​

El CMO en linea
http://www.smo.edu.mx/


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


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


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

Fuente: http://www.survivingsepsis.org/guidelines/Pages/default.aspx
Guidelines
The third edition of "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012​" appear in the February 2013 issues of Critical Care Medicine and Intensive Care Medicine.

Tables summarizing the recommendations can be a useful tool in clinical settings.

Initial Resuscitation and Infection Issues
Hemodynamic Support and Adjunctive Therap​y
Other Supportive Therapy of Severe Sepsis
Special Considerations in Pediatrics​​

Más de melatonina/More melatonine

CMO en linea http://www.smo.edu.mx/

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


Melatonina y sus metabolitos: nuevos datos relacionados a su producción y las acciones de sus radicales libres
Melatonin and its metabolites: new findings regarding their production and their radical scavenging actions.
Reiter RJ, Tan DX, Terron MP, Flores LJ, Czarnocki Z.
Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio 78229-3900, USA.reiter@uthscsa.edu
Acta Biochim Pol. 2007;54(1):1-9. Epub 2007 Mar 9.
Abstract
This review summarizes some of the recent findings concerning the long-held tenet that the enzyme, N-acetyltransferase, which is involved in the production of N-acetylserotonin, the immediate precursor of melatonin, may in fact not always control the quantity of melatonin generated. New evidence from several different laboratories indicates that hydroxyindole-O-methyltransferase, which O-methylates N-acetylserotonin to melatonin may be rate-limiting in some cases. Also, the review makes the point that melatonin's actions are uncommonly widespread in organs due to the fact that it works via membrane receptors, nuclear receptors/binding sites and receptor-independent mechanisms, i.e., the direct scavenging of free radicals. Finally, the review briefly summarizes the actions of melatonin and its metabolites in the detoxification of oxygen and nitrogen-based free radicals and related non-radical products. Via these multiple processes, melatonin is capable of influencing the metabolism of every cell in the organism.
http://www.actabp.pl/pdf/1_2007/1.pdf


CMO en linea http://www.smo.edu.mx/

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


Revisión de melatonina y reproducción
Melatonin and reproduction revisited.
Reiter RJ, Tan DX, Manchester LC, Paredes SD, Mayo JC, Sainz RM.
Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, Texas, USA. reiter@uthscsa.edu
Biol Reprod. 2009 Sep;81(3):445-56. doi: 10.1095/biolreprod.108.075655. Epub 2009 May 13.
Abstract
This brief review summarizes new findings related to the reported beneficial effects of melatonin on reproductive physiology beyond its now well-known role in determining the sexual status in both long-day and short-day seasonally breeding mammals. Of particular note are those reproductive processes that have been shown to benefit from the ability of melatonin to function in the reduction of oxidative stress. In the few species that have been tested, brightly colored secondary sexual characteristics that serve as a sexual attractant reportedly are enhanced by melatonin administration. This is of potential importance inasmuch as the brightness of ornamental pigmentation is also associated with animals that are of the highest genetic quality. Free radical damage is commonplace during pregnancy and has negative effects on the mother, placenta, and fetus. Because of its ability to readily pass through the placenta, melatonin easily protects the fetus from oxidative damage, as well as the maternal tissues and placenta. Examples of conditions in which oxidative and nitrosative stress can be extensive during pregnancy include preeclampsia and damage resulting from anoxia or hypoxia that is followed by reflow of oxygenated blood into the tissue. Given the uncommonly low toxicity of melatonin, clinical trials are warranted to document the protection by melatonin against pathophysiological states of the reproductive system in which free radical damage is known to occur. Finally, the beneficial effects of melatonin in improving the outcomes of in vitro fertilization and embryo transfer should be further tested and exploited. The information in this article has applicability to human and veterinary medicine.
http://www.biolreprod.org/content/81/3/445.full.pdf


CMO en linea http://www.smo.edu.mx/

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



La melatonina mitiga la disfunción mitocondrial


Melatonin mitigates mitochondrial malfunction.
León J, Acuña-Castroviejo D, Escames G, Tan DX, Reiter RJ.
Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
J Pineal Res. 2005 Jan;38(1):1-9.
Abstract
Melatonin, or N-acetyl-5-methoxytryptamine, is a compound derived from tryptophan that is found in all organisms from unicells to vertebrates. This indoleamine may act as a protective agent in disease conditions such as Parkinson's, Alzheimer's, aging, sepsis and other disorders including ischemia/reperfusion. In addition, melatonin has been proposed as a drug for the treatment of cancer. These disorders have in common a dysfunction of the apoptotic program. Thus, while defects which reduce apoptotic processes can exaggerate cancer, neurodegenerative disorders and ischemic conditions are made worse by enhanced apoptosis. The mechanism by which melatonin controls cell death is not entirely known. Recently, mitochondria, which are implicated in the intrinsic pathway of apoptosis, have been identified as a target for melatonin actions. It is known that melatonin scavenges oxygen and nitrogen-based reactants generated in mitochondria. This limits the loss of the intramitochondrial glutathione and lowers mitochondrial protein damage, improving electron transport chain (ETC) activity and reducing mtDNA damage. Melatonin also increases the activity of the complex I and complex IV of the ETC, thereby improving mitochondrial respiration and increasing ATP synthesis under normal and stressful conditions. These effects reflect the ability of melatonin to reduce the harmful reduction in the mitochondrial membrane potential that may trigger mitochondrial transition pore (MTP) opening and the apoptotic cascade. In addition, a reported direct action of melatonin in the control of currents through the MTP opens a new perspective in the understanding of the regulation of apoptotic cell death by the indoleamine.
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-079X.2004.00181.x/pdf



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



CMO en linea http://www.smo.edu.mx/

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

CMO en linea http://www.smo.edu.mx/

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

3er Curso taller de diseño y elaboración de manuscritos médicos en ortopedia

Buenos días!!!
Recordando que para esta semana, este sábado, de 9 a 2 pm, tenemos el 3er Curso
taller de diseño y elaboración de manuscritos médicos en ortopedia, ademas de ser SIN COSTO, TIENE VALOR CURRICULAR, toda la información en el siguiente enlace:

http://www.smo.edu.mx/pdf/curso-taller_RMMO-CMO-2013.pdf

Remiifentanilo y analgesia obstétrica/Remifentanil in obstetrics

Seguridad y eficacia del remifentanilo por vía intravenosa mediante un sistema de analgesia controlada por la paciente durante el trabajo de parto


Jose Novoa Apumayta, Sergio Rodriguez Benavides
Actas Peruanas de Anestesiología
http://sisbib.unmsm.edu.pe/BVRevistas/actas_anestesiologia/v20n2/

pdf/a03v20n2.pdf


Analgesia con remifentanil controlada por el pacientes versus analgesia epidural en trabajo de parto. Estudio multicéntrico aleatorizado y controlado


Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial.
Freeman LM, Bloemenkamp KW, Franssen MT, Papatsonis DN, Hajenius PJ, van Huizen ME, Bremer HA, van den Akker ES, Woiski MD, Porath MM, van Beek E, Schuitemaker N, van der Salm PC, Fong BF, Radder C, Bax CJ, Sikkema M, van den Akker-van Marle ME, van Lith JM, Lopriore E, Uildriks RJ, Struys MM, Mol BW, Dahan A, Middeldorp JM.
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands. l.m.freeman@lumc.nl
BMC Pregnancy Childbirth. 2012 Jul 2;12:63. doi: 10.1186/1471-2393-12-63.
Abstract
BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day.
TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551,http://www.trialregister.nl.



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464937/pdf/1471-2393-12-63.pdf



Comparación entre remifentanil y meperidina en analgesia para trabajo de parto: revisión sistemática.
A comparison between remifentanil and meperidine for labor analgesia: a systematic review.
Leong WL, Sng BL, Sia AT.
Department of Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Rd., Singapore 228988. wlleong101@gmail.com
Anesth Analg. 2011 Oct;113(4):818-25. doi: 10.1213/ANE.0b013e3182289fe9. Epub 2011 Sep 2.
Abstract
BACKGROUND: Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined. METHODS: MEDLINE, CINAHL, Embase, Cochrane CENTRAL, and Maternity and Infant Care databases were searched without language restriction using multiple keywords for labor analgesia, remifentanil, and meperidine. Published abstracts from 5 key research meetings and references from retrieved articles were examined for additional studies. Randomized controlled trials in laboring parturients comparing remifentanil with meperidine were selected. Risk of bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed for adequacy of sequence generation, allocation concealment, blinding, and completeness of follow-up. Data were extracted from each study using a standardized data collection form. The primary outcome was reduction in pain scores (visual analog scale [VAS], 0-100 mm). We also evaluated maternal side effects (sedation, oxygen desaturation, and bradypnea) and effects on the neonate (Apgar scores, umbilical cord pH, and Neurologic and Adaptive Capacity Scores). RESULTS: Seven studies (349 patients) were identified for inclusion; only 3 studies were suitable for quantitative synthesis in a meta-analysis (233 patients). We found that remifentanil reduces the mean VAS score at 1 hour by 25 mm more than meperidine (P < 0.001) (95% confidence interval = 19-31 mm). Limited conclusions can be made regarding the side-effect profile of remifentanil because of insufficient data. CONCLUSION: Compared with meperidine, remifentanil is superior in reducing mean VAS scores for labor pain after 1 hour.
http://www.anesthesia-analgesia.org/content/113/4/818.full.pdf



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

Dolor postoperatorio

La implementación de la calidad de sistemas de manejo mejora el tratamiento del dolor postoperatorio: estudio prospectivo mediante preguntas pre/post intervención.


Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study.
Usichenko TI, Röttenbacher I, Kohlmann T, Jülich A, Lange J, Mustea A, Engel G, Wendt M.
Department of Anaesthesiology and Intensive Care Medicine.
Br J Anaesth. 2013 Jan;110(1):87-95. doi: 10.1093/bja/aes352. Epub 2012 Oct 9.
Abstract
BACKGROUND: An organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients' requirements. METHODS: Patients from the orthopaedic, gynaecological, visceral, and trauma surgery departments of the university hospital were involved in two prospective surveys. Survey 1 was performed at baseline and survey 2 was performed after the implementation of QMS within an interval of 1 year. The patients were asked to report pain intensity on the visual rating scale, incidence of analgesia-related side-effects, and incidence of pain interference with the items of life quality and their satisfaction with the treatment of POP. RESULTS: Patients from Survey 2 (n=251) reported 25-30% less pain than those from Survey 1 (n=269) (P<0.0001). Nausea was reported by 40% of the patients from Survey 1 vs 17% from Survey 2, vomiting by 25 vs 11% and fatigue by 76% in Survey 1 vs 30% in Survey 2 (P<0.0001). Life quality and patients' satisfaction improved in Survey 2 vs Survey 1 (P<0.001). CONCLUSIONS: The implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction.


http://bja.oxfordjournals.org/content/110/1/87.full.pdf


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

José Guadalupe Posada

El CMO en linea.....http://www.smo.edu.mx/




La muerte y la cultura popular Mexicana.
José Guadalupe Posada.
José Guadalupe Posada (Aguascalientes, 2 de febrero de 1852 - Ciudad de México, 20 de enero de 1913) fue un pintor, ilustrador y caricaturista mexicano. Célebre por sus dibujos de escenas costumbristas, folclóricas, de crítica socio-política y por sus ilustraciones de «calacas» o calaveras, entre ellas La Catrina. Litógrafo por excelencia, publicó caricaturas con críticas políticas, humor, drama, vida cotidiana de los mexicanos. Las calaveras y versos alusivos a la muerte fueron su expresión más característica.

http://comunicacion.sociales.uba.ar/tesinas_publicadas/1245.pdf

http://www.uacj.mx/IADA/dise%C3%B1o/dg/Documents/Portal%20de%20Lecturas/Nivel%20Intermedio/Grafica%20Nacional_Omar%20Morales/Grabadores%20mexicanos.pdf

José Guadalupe Posada (Aguascalientes, February 2, 1852 - Mexico City, January 20, 1913) was a Mexican painter, illustrator and cartoonist. Famous for his drawings of genre scenes, folklore, socio-political criticism and for his illustrations of skeletons and skulls, including his most famous named La Catrina. Quintessential lithographer, published cartoons with political criticism, humor, drama, daily life of Mexicans. The skulls and verses alluding to the death were his most characteristic expression

http://publicdomainreview.org/2012/11/02/the-calaveras-of-jose-guadalupe-posada/

Bibliotecas. Alerta

El colegio mexicano de ortopedia en lia......

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

Integración latinoamericana en la mira de la Biblioteca Ayacucho
Prensa Latina
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La Tribuna.hn
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El PSOE pide al Gobierno en el Congreso que conserve la ...
La Voz Libre
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¿Si hicieras una biblioteca con las obras fundamentales de la ...
Encuentra las respuestas de la pregunta ¿Si hicieras una biblioteca con las obras fundamentales de la filosofía, ¿qué obras incluirías?, Filosofía en Yahoo!
espanol.answers.yahoo.com/question/index?qid...


Internet gratuito en bibliotecas de Kazajistán « Beyond Access
Como resultado del servicio de capacitaciones a jóvenes e información sobre empleo de la Bibliotecade Pushkin, financiado por el Programa para la ...
www.beyondaccess.net/.../internet-gratuito-en-bibliotecas-de-k...


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Bibliotecas Públicas de Gwinnett cierran más tarde :: Telemundo ...
Bibliotecas Públicas de Gwinnett cierran más tarde :: Telemundo Atlanta :: Atlanta, portal de noticias y mucho más.
www.telemundoatlanta.com/.../1892364_bibliotecas-publicas-...

UTPL BIBLIOTECAS [(CIENCIAS EDUCACIÓN) (TÉCNICAS Y ...
Universidad Técnica Particular de Loja Ciencias de la Educación Técnicas y Recursos Didácticos ...
www.youtube.com/watch?v=ksBNzTLPqoc

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Bibliotecas escolares, cómo sacar partido a sus servicios | EROSKI CONSUMER. Las bibliotecasescolares, además de prestar libros, facilitan la conexión ...
www.consumer.es/web/es/educacion/.../2013/.../215407.php

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Materia
Y sus palabras parecen flotar en el aire en la nueva biblioteca del Palacio de Doñana, recién creada en una antigua capilla propiedad del Consejo Superior de Investigaciones Científicas (CSIC) en pleno Parque Nacional, a caballo entre Huelva y Sevilla.
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Materia



Estados Unidos tendrá una biblioteca sin libros
FayerWayer
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La Biblioteca General de Navarra realizó 166.371 préstamos de ...
20minutos.es
La colección de la Biblioteca General de Navarra, ubicada en el barrio pamplonés de Mendebaldea, a 31 de diciembre de 2012, podía cifrarse en 500.000 documentos, de los cuales el número de ejemplares accesibles a través del catálogo automatizado ...
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Una biblioteca sin libros físicos
ABC.es
¿Cómo serán las bibliotecas en la era del libro electrónico? La respuesta es, teniendo en cuenta cómo se hace la transición del mundo analógico al digital en este terreno, un espacio sin libros. Lasbibliotecas ya no serán esas fascinantes torres de ...
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La Biblioteca Reina Sofía de la Universidad de Valladolid crea un ...
Qué.es
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Visión 7: Tiflolibros, Biblioteca digital para ciegos
TVPublica Argentina
Informe especial de Verónica González sobre: Tiflolibros es la primera Biblioteca Digital para Ciegos de Habla Hispana. Se trata de un servicio gratuito y exclusivo para personas con discapacidad visual. Hoy cuenta con más de 41.600 ejemplares, ...
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Una biblioteca sin papel - www.remolacha.net
según Gabriela
Una biblioteca 100% digital. ''Si quieres saber cómo será, vete a una Apple Store''... [Seguir Leyendo]
www.remolacha.net

Website nobo pa biblioteca
ORANJESTAD -- Tabata tempo pa cambia e website di biblioteca. E compania YFMG web consulting a diseña un otro website pa biblioteca. E website ...
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Ya es oficial: la Biblioteca Nacional fue bautizada "Doctor Mariano ...
La Prensa (Argentina)
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La Biblioteca Reina Sofía de la Universidad de Valladolid crea un ...
20minutos.es
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Una iglesia convertida en biblioteca científica
Materia
Y sus palabras parecen flotar en el aire en la nueva biblioteca del Palacio de Doñana, recién creada en una antigua capilla propiedad del Consejo Superior de Investigaciones Científicas (CSIC) en pleno Parque Nacional, a caballo entre Huelva y Sevilla.
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Materia

La Biblioteca General de Navarra realizó 166.371 préstamos de ...
20minutos.es
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Bibliotecas sin libros, el futuro de los libros en Estados Unidos
WebAdictos
Con la llegada de los libros electrónicos, es obvio que se ha dado un cambio significativo en la forma de comercializar y leer libros, sin embargo hablar de bibliotecas ficticias, o bibliotecas sin libros no es tan común, pero es la idea que tienen en ...
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Estados Unidos tendrá una biblioteca sin libros - FayerWayer
según Cony Sturm
Quienes asistan a la biblioteca podrán leer el libro que elijan en cualquiera de los dispositivos de labiblioteca, arrendar un e-reader por un periodo de tiempo, o llevar sus propios e-readers y cargar libros en ellos. La instalación realizará ...
FayerWayer

::Hipermedula.org :: Inscripciones para Taller La Biblioteca Inmaterial
Madrid, España. Del 23 al 25 de enero de 2013. La Biblioteca Inmaterial: Tradición oral y pertenencia. Relatos del Viento Museo de América Av. Reyes.
hipermedula.org/.../inscripciones-para-taller-la-biblioteca-inma...
La Biblioteca Municipal de Campana recibió obras literarias de ...
El Secretario de Cultura y Educación, Fito Tolassi, y la Coordinadora General Ejecutiva de laBiblioteca Pública Municipal, Marta Magistratti de Demousselle, ...
www.enlacecritico.com/.../la-biblioteca-municipal-de-campana...
El Club y Biblioteca Agustín Alvarez pone en marcha las inferiores y ...
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www.cadenanueve.com/.../el-club-y-biblioteca-pone-en-march...

CRASH-2

Prediciendo la muerte temprana en pacientes con sangrado por trauma: desarrollo y validación de un modelo pronóstico
Predicting early death in patients with traumatic bleeding: development and validation of prognostic model.
Perel P, Prieto-Merino D, Shakur H, Clayton T, Lecky F, Bouamra O, Russell R, Faulkner M, Steyerberg EW, Roberts I.
Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. pablo.perel@lshtm.ac.uk
BMJ. 2012 Aug 15;345:e5166. doi: 10.1136/bmj.e5166.
Abstract
OBJECTIVE: To develop and validate a prognostic model for early death in patients with traumatic bleeding. DESIGN: Multivariable logistic regression of a large international cohort of trauma patients. SETTING: 274 hospitals in 40 high, medium, and low income countries. PARTICIPANTS:
Prognostic model development: 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury in the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial. External validation: 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN), which included mainly patients from the UK. OUTCOMES: In-hospital death within 4 weeks of injury. RESULTS: 3076 (15%) patients died in the CRASH-2 trial and 1765 (12%) in the TARN dataset. Glasgow coma score, age, and systolic blood pressure were the strongest predictors of mortality. Other predictors included in the final model were geographical region (low, middle, or high income country), heart rate, time since injury, and type of injury. Discrimination and calibration were satisfactory, with C statistics above 0.80 in both CRASH-2 and TARN. A simple chart was constructed to readily provide the probability of death at the point of care, and a web based calculator is available for a more detailed risk assessment (http://crash2.lshtm.ac.uk). CONCLUSIONS: This prognostic model can be used to obtain valid predictions of mortality in patients with traumatic bleeding, assisting in triage and potentially shortening the time to diagnostic and lifesaving procedures (such as imaging, surgery, and tranexamic acid). Age is an important prognostic factor, and this is of particular relevance in high income countries with an aging trauma population.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419468/pdf/bmj.e5166.pdf




CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage). Estudio de sangrado intracranial: efecto del ácido tranexámico en el daño cerebral traumático.


CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury--a nested randomised, placebo-controlled trial.
Perel P, Al-Shahi Salman R, Kawahara T, Morris Z, Prieto-Merino D, Roberts I, Sandercock P, Shakur H, Wardlaw J.
London School of Hygiene and Tropical Medicine, London, UK.pablo.perel@lshtm.ac.uk
Health Technol Assess. 2012;16(13):iii-xii, 1-54. doi: 10.3310/hta16130.
Abstract
BACKGROUND: Tranexamic acid (TXA) has been shown to reduce blood loss in surgical patients and the risk of death in patients with traumatic bleeding, with no apparent increase in vascular occlusive events. These findings raise the possibility that it might also be effective in traumatic brain injury (TBI). OBJECTIVE: The Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage Intracranial Bleeding Study (CRASH-2 IBS) was conducted to quantify the effect of an early short course of TXA on intracranial haemorrhage and new focal cerebral ischaemic lesions in patients with TBI. DESIGN: CRASH-2 IBS was a prospective randomised controlled trial nested within the CRASH-2 trial. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight. We used a local pack system that selected the lowest numbered treatment pack from a box containing eight numbered packs. Apart from the pack number, the treatment packs were identical. The pack number was recorded on the entry form, which was sent to the international trial co-ordinating centre in London, UK. Once the treatment pack number was recorded, the patient was included in the trial whether or not the treatment pack was opened or the allocated treatment started. All site investigators and trial co-ordinating centre staff were masked to treatment allocation. SETTING: Ten hospitals: (India) Aditya Neuroscience Centre, Sanjivani Hospital, CARE Hospital, Christian Medical College, Medical Trust Hospital, Jeevan Jyoti Hospital and (Colombia) Hospital Universitario San Vicente de Paul, Hospital Pablo Tobón Uribe, Hospital Universitario San José de Popayán and Fundación Valle del Lili. PARTICIPANTS: The trial was conducted in a subset of 270 CRASH-2 trial participants. Patients eligible for inclusion in the CRASH-2 IBS fulfilled the inclusion criteria for the CRASH-2 trial, and also had TBI [Glasgow Coma Scale score of ≤ 14 and a brain computerised tomography (CT) scan compatible with TBI]. Pregnant women and patients for whom a second brain CT scan was not possible were excluded. INTERVENTIONS: Participants were randomly allocated to receive either a loading dose of 1 g of TXA infused over 10 minutes followed by an intravenous infusion of 1 g over 8 hours or matching placebo.
MAIN OUTCOME MEASURE: The primary outcome was the increase in size of intracranial haemorrhage growth between a CT scan at hospital admission and a second scan 24-48 hours later. RESULTS: One hundred and thirty-three patients were allocated to TXA and 137 to placebo, of whom information on the primary (imaging) outcome was available for 123 (92%) and 126 (92%) respectively. The analysis suggested that TXA was likely to be associated with a reduction in haemorrhage growth [adjusted difference -3.8 ml, 95% credibility interval (CrI) -11.5 ml to 3.9 ml], fewer focal ischaemic lesions [adjusted odds ratio (OR) 0.54, 95% CrI 0.20 to 1.46] and fewer deaths (adjusted OR 0.49, 95% CrI 0.22 to 1.06). CONCLUSIONS: This was the first randomised controlled study to evaluate the effect of TXA in TBI patients and it found that neither moderate benefits nor moderate harmful effects can be excluded. However, although uncertainty remains, our analyses suggest that TXA administration might improve outcome in TBI patients and provide grounds for evaluating this hypothesis in future research.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN86750102.
SOURCE OF FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 13. See the HTA programme website for further project information.


http://www.hta.ac.uk/execsumm/summ1613.htm



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