Although the Appropriateness Evaluation Protocol (AEP) has been widely used during the past decade, several methodological concerns have not yet been properly resolved, including the possible ...influence of low completeness of the medical records on the results yielded by the AEP in retrospective studies. We examined medical records for a random sample of 345 patient-days with the AEP, according to a protocol that included several variables potentially related to inappropriateness. The completeness of physician and nursing notes was also assessed. The proportion of inappropriate days of hospitalization was 36.2%. In the crude analysis, significantly higher proportions of inappropriateness were found for lower values of completeness. Factors related to the inappropriateness of stay were summer season, elective admission, no previous admissions, surgical and medical—surgical service in charge, and the day sampled falling within the last third of the hospital stay. Adjustment for the completeness level of medical records did not substantially change the strength of the association between these factors and the inappropriateness of hospital stay. Completeness level itself did not show any significant association with the proportion of inappropriate days in the adjusted analysis.
Los trabajos sobre la Prehistoria de la comarca de La Janda (provincia de Cádiz) fueron realizados a principios de siglo desde el Historicismo Cultural. En la presente década nuestro grupo ha llevado ...a cabo prospecciones arqueológicas sistemáticas y excavaciones de urgencia, con el fin de conformar el proceso histórico de las sociedades cazadoras-recolectoras, tribales y clasistas iniciales, que habitaron la Banda Atlántica de Cádiz. La aplicación de técnicas geoarqueológicas al estudio de los productos arqueológicos y el análisis mineralógico y petrológico, tanto de las materias primas utilizadas como de los materiales geológicos, permiten vislumbrar interesantes aspectos sobre el proceso histórico y económico de dichas formaciones sociales.
Iron oxides have been used extensively in the Americas from the Paleoindian period up to the ethnographic present. But, because archaeological mining sites are extremely rare in this continent, we ...still know very little about how indigenous groups exploited and processed these minerals. Here we report finds from the San Ramón 15 site, located on the arid coast of northern Chile, where our research revealed a prehistoric mine with associated tailings and mining debris that was exploited by hunter-gatherer-fisher groups. The mine was first exploited during the Pleistocene-Holocene transition (ca. 12,000–10,500 calibrated years before present cal yr BP) and then again during the Late Archaic (ca. 4300 cal yr BP), representing the earliest known mining activity in the Americas. This discovery has important implications, including (1) the record of undisputed mining activity in the continent is extended by several millennia, showing the first insights into Early Archaic mining techniques and technologies; (2) the earliest inhabitants of the Pacific Coast of South America had a well-developed mining knowledge, that is, they were hunter-gatherer-fisher-miner communities; and (3) mobility patterns of early nomadic maritime adaptations in northern Chile were influenced by repeated access to iron oxide pigments used mainly for symbolic purposes.
Objectives
Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post‐exposure prophylaxis (PEP) after an SA. However, few ...data are available about the feasibility of this strategy, and this study was conducted to assess this.
Methods
We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow‐up visits were scheduled at days 1, 10, 28, 90 and 180 in the out‐patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow‐up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion.
Results
The median age of participants was 25 years interquartile range (IQR) 21–33 years and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6–24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow‐up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120.
Conclusions
Follow‐up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow‐up testing and new better tolerated drug regimens must be investigated to address these issues.
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