Tranexamic acid (TXA) significantly reduces blood loss in a wide range of surgical procedures and improves survival rates in obstetric and trauma patients with severe bleeding. Although it mainly ...acts as a fibrinolysis inhibitor, it also has an anti-inflammatory effect, and may help attenuate the systemic inflammatory response syndrome found in some cardiac surgery patients. However, the administration of high doses of TXA has been associated with seizures and other adverse effects that increase the cost of care, and the administration of TXA to reduce perioperative bleeding needs to be standardized.
Tranexamic acid is generally well tolerated, and most adverse reactions are considered mild or moderate. Severe events are rare in clinical trials, and literature reviews have shown tranexamic acid to be safe in several different surgical procedures. However, after many years of experience with TXA in various fields, such as orthopedic surgery, clinicians are now querying whether the dosage, route and interval of administration currently used and the methods used to control and analyze the antifibrinolytic mechanism of TXA are really optimal. These issues need to be evaluated and reviewed using the latest evidence to improve the safety and effectiveness of TXA in treating intracranial hemorrhage and bleeding in procedures such as liver transplantation, and cardiac, trauma and obstetric surgery.
Se identifican los desafíos de una integración disciplinar en los espacios dedicados a la práctica docente de un programa de licenciatura que declara la interdisciplinariedad como enfoque curricular. ...Mediante el seguimiento de un modelo de investigación acción mixto y sustentado en la teoría de autoevaluación curricular (Palos, 2000 Posner, 2004; Martinello & Cook, 2000), el diagnóstico revela la falta de articulación entre teoría y práctica. El proceso de la investigación permite, por un lado, valorar cómo profesores, estudiantes y administrativos asumen la interdisciplinariedad en el proceso de formación docente y, por otro, construir como resultado unos lineamientos interdisciplinarios orientados a favorecer las relaciones entre campos de formación para dar coherencia y validez a los núcleos problémicos. Los resultados sugieren que las intervenciones curriculares posteriores basadas en la implementación de lineamientos interdisciplinarios ofrecen un marco de participación más activo de docentes y estudiantes para la autoevaluación y solución de problemas específicos. Palabras clave: currículo interdisciplinario, lineamientos, interdisciplinariedad, currículo problémico y práctica docente. This article identifies the challenges lived in an attempt to a disciplinary integration in the subjects dedicated to teaching practice of a Bachelor of Arts in Education. This B.A. program declares an interdisciplinary curriculum. Through a model of mixed action research, supported on the theory of curriculum evaluation (Palos, 2000; Posner, 2004; Martinello y Cook, 2000), the diagnosis reveals a lack of articulation between theory and practice; a break- up between what is declared in the official curriculum towards the interdisciplinary relationships between fields of training and what happens in practice. That is, a disconnection on the horizons of training in teaching practices and problems in its direction and guidance. The research process allows, on the one hand, assessing information about how teachers, students and administrative assume interdisciplinarity in the process of teacher education. On the other hand, the process permitted to provide some guidelines aimed at encouraging interdisciplinary relationships among fields of training as a result. Those guidelines attempt to give coherence and validity to the problematic nucleus. Findings suggest that curriculum interventions based on the implementation of those guidelines provide a framework for more active participation of teachers and students to self-assessment and solution of specific problems. Keywords: interdisciplinary curriculum, guidelines, interdisciplinarity, problem centered curriculum and teaching practicum.
The risk for venous thromboembolism (VTE) is high patients with multiple myeloma (MM) receiving thalidomide or lenalidomide with dexamethasone based induction treatment (IMiDs-Dex), especially in the ...first 6 months. There are multiple scores for risk stratification (IMPEDE and SAVED for example), that give different points for the same variable and can be classified in low or high risk depending which is used, the same patient can receive Aspirin in one score or LMWH in the other. In our country, Mexico, the prevalence of overweight and obesity is 75.2%, hypertension 49.4% and diabetes 16.8% (Salud Publica Mex 2021;63:692-704); factors that contribute to develop VTE. In 2018 we reported the use of Aspirin or Rivaroxaban in low risk patient with DM or obesity: could be intermediate risk (Blood 2018;132:5068); since then we adapted a risk score based in the high prevalence comorbidities of our population.
From January 2018 to December 2022, 117 patients were diagnosed with active MM and 109 patients that received IMiDs-Dex based triplet induction and maintenance with IMiDs were eligibles for study. Patients were assigned into three groups for prophylaxis: a) low risk (treatment only) Aspirin 100 mg daily, b) intermediate risk (treatment and one from overweight or obesity, hypertension and diabetes) randomized 1:1 to Aspirin 100 mg or Rivaroxaban 10 mg daily, c) high risk (treatment and 2 or 3 from overweight or obesity, hypertension and diabetes; or treatment and another known high risk) Rivaroxaban 10 mg daily. Lower limbs doppler ultrasound was performed every two months or as medical indication, pulmonary CT scan if pulmonary embolism was suspected.
Twenty-three patients (21.1%) had low risk and received Aspirin, one patient developed DVT from right lower limb, she received anticoagulation with Rivaroxaban for 6 months and then placed in prophylactic dose, no further DVT developed. Thirty-eight patients (34.9%) had intermediate risk; 19 received Aspirin, one patient developed DVT with pulmonary embolism and received anticoagulation with Rivaroxaban for 6 months and then placed in prophylactic dose, no further thrombosis developed; 19 received Rivaroxaban, no patient developed thrombosis. Forty-eight patients (44.0%) had high risk and received Rivaroxaban; two patients developed DVT, none with pulmonary embolism, both with more than four risk factors, they received anticoagulation with Rivaroxaban for 6 months and then placed in prophylactic dose, no further thrombosis developed. In all groups less than 5 percent of patients had easy bruising and mild epistaxis or gingivorrhagia that no required hold of dose; no major bleeding was detected.
In low risk patients that received Aspirin, 4.34% developed DVT; the change to Rivaroxaban was beneficial as no further thrombosis developed. In intermediate risk, 2.6% developed DVT-PE in the Aspirin arm and none in the Rivaroxaban, demonstrating the efficacy of Rivaroxaban. In the high risk patients all received Rivaroxaban, 4.16% developed DVT, similar result as Aspirin in the low risk patients, but the patients had more than four risk factors, that could be a very high group and a more intense prophylactic or complete anticoagulation is advised; in high risk patients with less than three factors Rivaroxaban is effective in preventing thrombosis episodes. The safety of Rivaroxaban is demonstrating again, as the bleeding in both groups were similar. An external cohort is needed to validate our results and this comorbidity risk adapted score can be national and international-wide used, as the prevalence of overweight or obesity, hypertension and diabetes are high among occidental countries, especially Mexico, as they impact in the morbidity and mortality not only in neoplastic diseases (Arch Med Res 2022;53:100-108) . A very high risk patients group will be considered for Rivaroxaban in dose of 15 or 20 mg in following studies. As a final statement, these results complement our first report and give more solid evidence in the efficacy and safety of Rivaroxaban as thromboprophylaxis in Multiple Myeloma patients with IMiDs-Dex based triplet induction and maintenance with IMiDs.
The main objectives of the pre-anaesthesia consultation are to establish the patient’s anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information ...and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies - e-Health - has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit.
The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.
La consulta de preanestesia es un acto cuyos principales objetivos son establecer el riesgo anestésico y quirúrgico, evaluar y optimizar el estado de salud del paciente, informar y emitir las recomendaciones preoperatorias y cumplimentar las obligaciones burocráticas legalmente establecidas. La incorporación de las Tecnologías de la información, e-Health, supone un avance que permite optimizar eficientemente las consultas, aportando valor para el paciente.
El Grupo de Trabajo de la SEDAR diseña un marco de trabajo digital alternativo al convencional, con recomendaciones normativas y tecnológicas para la incorporación de las diversas modalidades de telemedicina en las consultas de anestesia de nuestros servicios. Proponemos una herramienta de evaluación con indicadores de calidad para la mejora continua de la actividad asistencial.
Backyards for rural households represent a strategy that ensures the production of plant foods and animal come to enrich and supplement their diet. Unfortunately there is no evidence of the ...contribution made by the horticultural component of biodiversity of species in relation to food, income generation and exchange of vegetables, based on the above plan the need for research aimed was to analyze the subsystem comprising the backyards vegetable operated by the State Program for Food Security (SPFS State) establishing productive inputs, economic and social component that obtains horticultural peasant household (UDC), communities of Canoas- Atempan, Tezotepec-Mazatonal-Yaonáhuac Chignautla and the Northeastern Sierra Puebla state. In this northeastern region of 16 municipalities are located high deprivation and 8 highly marginalized state, population is of Náhuatl origin and it is common that women are responsible for the management and operation of the backyard based on their traditional knowledge and survival strategies. Fieldwork was conducted in the months of March to June 2011, with the participation of 37 rural women. Some of the findings are: Canoes and communities Mazatonal, 77% of horticultural production was assigned to food, 15% and 8% marketing to strengthen social relations within the community. In contrast, community of Tezotepec which earmarked 53% to the marketing, 46% to food and only 1% strengthening of social relations. There are also differences between communities in relation to the number of children, the diversity of vegetable grown, and the frequency of seeding and transplanting of vegetables contributing to the food security of the UDC.
Recent research suggested that women are shifting their needs in a potential partner, from previously desiring instrumental qualities to desiring expressive qualities (O’Reilly, Knox & Zusman, 2009). ...Reasons for this shift include social and cultural changes that have been linked to WWII and the Women’s Movement. However, other research has shown this trend is not reflected within the African American population (King & Allen, 2009). Several studies have identified socioeconomic status, education level, and mate availability as the assumed influential factors for the minority population desiring instrumental characteristics over expressive characteristics in their ideal mate (Catanzarite & Ortiz, 2002; King, 1999; King & Allen, 2009; Tucker & Mitchell-Kernan, 1995). However, these factors have been discussed in order to justify the differences in the trend of characteristic preferences rather than to confirm their influence on mate selection. Moreover, there is an overall lack of research on preferences in characteristics within the minority population (i.e. African American, Hispanic, and Asian). As such, this study focused on increasing awareness of preferred qualities in under-researched populations. This study also focused on exploring whether the assumed influential factors do, in fact, have an effect on the found heightened desire of instrumental versus expressive qualities in their ideal partner within the minority population. Lastly, due to numerous research on the influence and moderating effects resilience has on other barriers minority experience (i.e., Goklani, 2013; Hartley, 2011; Ong, Bergeman, Bisconti, & Wallace, 2006), this study focused on exploring whether resilience has an influence on desired characteristics as well as whether resilience could be considered a moderating factor to desired characteristics. Data was collected from 287 female heterosexual participants within the southeast region. The analyses showed (1) Hispanic and African American women preferred instrumental qualities over expressive when compared to Caucasian women, (2) level of education and mate availability play a significant role in characteristic preferences, and (3) level of resilience does influence characteristic preferences but was not proven to be a moderating factor. In providing information on under-research populations, this study contributed to future research on similar topics while also contributing to increasing multicultural competence.
Hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients admitted to intensive care unit (ICU) for medical indications. We conducted a cohort ...study to evaluate the renal safety of modern 6% HES solutions in high-risk patients having cardiac surgery.
In this multicentre prospective cohort study, we recruited 261 consecutive patients at high-risk for developing cardiac surgery-associated AKI, based on a Cleveland score ≥ 4 points, from July to December 2017th in 14 hospitals in Spain and the United Kingdom. Multivariable logistic regression modeling and propensity-score matched-pairs analysis were used to determine the adjusted association between administration of HES and AKI.
Of the cohort, 95 patients (36.4%) received 6% HES 130/0.4 either intraoperatively or postoperatively. Postoperative AKI occurred in 145 patients (55.5%). The unadjusted odds of AKI was significantly higher in the HES group, when compared to those not receiving HES (OR 2.22, 95% CI 1.30–3.80, p = 0.003). In multivariable logistic regression models, modern HES was not associated with significantly increased risk of AKI (adjusted OR 0.84, 95% CI 0.41–1.71, p = 0.63). In propensity score match-pairs analysis of 188 patients, the HES group experienced similar adjusted odds of AKI (OR 1.05, CI 95% 0.87–1.27, p = 0.57) and RRT (OR 1.06, CI 95% 0.92–1.22, p = 0.36).
The use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with an increased risk of AKI nor dialysis in this cohort of patients at elevated risk for developing AKI after cardiac surgery.
•This is a multicenter prospective cohort study, with high-risk patients for developing CSA-AKI.•Modern Hydroxyethyl starch was not associated with an increased risk of AKI in high-risk patients for developing CSA-AKI.•Multivariable logistic regression modeling and propensity-score matched-pairs analysis were used.
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