University of Las Palmas de Gran Canaria
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Hemodynamic Management Guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial
No full textBackground: Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI; Edwards Lifesciences, USA) may aid in managing intraoperative hemodynamic instability. This study assessed whether HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate- to high-risk elective abdominal surgery patients.
Methods: This multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. A total of 917 patients (65 yr or older or older than 18 yr with American Society of Anesthesiologists Physical Status greater than II) undergoing moderate- to high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality.
Results: Median age was 71 yr (interquartile range, 65 to 77) in the HPI group and 70 yr (interquartile range, 63 to 76) in standard care group. American Society of Anesthesiologists Physical Status III/IV was 58.3% (268 of 459) in the HPI group and 57.9% (263 of 458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28 of 459) in the HPI group and 7.0% (32 of 458) in the standard care group (risk ratio, 0.89; 95% CI, 0.54 to 1.49; P = 0.66). Overall complications occurred in 31.9% (146 of 459) of the HPI group and 29.7% (136 of 458) of the standard care group (risk ratio, 1.08; 95% CI, 0.85 to 1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (interquartile range, 4 to 10) in both groups. The 30-day mortality was 1.1% (5 of 459) in the HPI group versus 0.9% (4 of 458) in standard care group (risk ratio, 1.35; 95% CI, 0.36 to 5.10; P = 0.66).
Conclusions: HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.654639161,9729,3Q1Q1SCIE11,
Engagement Markers in Medical Recipes: Evidence from G.U.L. MS Hunter 93 (T.4.10)
No full text188163Q
Mixotrophy emerges as the optimal strategy in mature waters of the Amazon River plume
No full textCurrent evidence shows that phytoplankton are mixotrophs, combining photoautotrophy with osmotrophy (i.e., uptake of dissolved organic matter). Additionally, some unicellular eukaryotes are also capable of phagotrophy, representing an intermediate step between autotrophs and herbivores named mixoplankton. Mixoplankton seem to provide higher-quality food for metazoans, and to improve energy transfer to higher trophic levels. However, field studies on all aspects of mixotrophy are difficult due to the challenge of distinguishing their activity from that of autotrophs. Our April/May 2018 and 2021 cruises focused on the base of the surface planktonic food web in the distinct Amazon River plume habitats, where we used nitrogen stable isotopes of amino acids (CSIA AA) in seston within a multidisciplinary framework for resolving trophic function. Mixotrophy dominates in the Outer Plume Margin, a region with mature waters aged ca. 27 days. Mixotrophy seems the optimal strategy for growth in these heterogeneous outer margins as part of the succession of phytoplankton functional diversity along the plume. Our study supports the growing evidence for the cosmopolitan distribution of mixotrophy among unicellular aquatic organisms, underscores the urgent need to study it in situ, and paves the way for a novel application of the CSIA AA in field research.2,095,2Q1Q110,
Bloque Cuidados del paciente quirúrgico
No full text<p>Módulo de contenidos teóricos de la asignatura CEA-I </p>
ESTRATEGIAS DE INTERVENCIÓN ENFERMERA PARA PROMOCIONAR LA SALUD MENTAL POSITIVA
No full text<p>Este manual forma parte de los contenidos de la Maestría de Enfermería Escolar que se desarrolla en la ULPGC. Aborda la salud mental desde una perspectiva positiva, alejada de la enfermedad, incidiendo en la promoción de factores protectores como la resiliencia, la autoestima, las competencias sociales, las habilidades para la toma de decisiones y la resolución de conflictos. Describe instrumentos de evaluación, así como intervenciones en el entorno escolar que han resultado eficaces en esta promoción de la salud mental.</p>
Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES
No full textObjective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection. Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality- adjusted life year and cost data were prospectively collected. The primary aim was to assess the costeffectiveness of robotic rectal resection and laparoscopic rectal resection . Secondary aims included clinical outcomes and quality of life. Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 +/- 51.68 vs 131.68 +/- 191.92, P < .001), lower pain score at day 1 (-1.04 visual analog scale, P < .001) and day 7 (-0.81, P < .001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P = .005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection. Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.80,175Q48,
Módulos VIII. Parte 3. Cuidados paliativos desde la perspectiva enfermera
No full text<p>Módulos teóricos de la asignatura CEA-I</p>
Four Years of Promising Trap-Neuter-Return (TNR) in Córdoba, Spain: A Scalable Model for Urban Feline Management
No full textUrban free-roaming cat populations (or community cats, according to the Spanish legislation) present complex challenges, including public health risks, coexistence conflicts with residents, animal welfare, and threats to biodiversity conservation. In 2020, C & oacute;rdoba, Spain, initiated one of the most extensive citywide trap-neuter-return (TNR) programs, incorporating 225 groups of cats (usually named colonies) into a meticulously structured management framework. Over four years, the program stabilized cat populations, achieving 95% sterilization coverage and effectively limiting population growth despite external challenges, including abandonment, influxes from unmanaged areas, and compensatory effects. Although the overall population showed a modest decline of 2.68%, this outcome reflects not only the recent inclusion of numerous colonies still undergoing stabilization but also the prevention of an estimated 70% population growth without intervention, as projected by our population viability analysis (PVA). Key results highlight the program's cost-effectiveness, with an average annual cost of EUR 0.62 per person. The long-term projections from a population viability analysis (PVA) using demographic modeling suggest a potential 55% population reduction by 2028, contingent on sustained efforts. The program's integration of citizen science, systematic data collection, and adaptive management demonstrates its scalability and replicability as a model for urban and peri-urban feline management globally. Its significance lies not only in its scope and scale but also in demonstrating the ethical and practical feasibility of large-scale TNR initiatives in urban contexts. C & oacute;rdoba's program, which predates Spain's Animal Welfare Law 7/2023 mandating structured feline colony management plans, demonstrates a pioneering framework for compliance and innovation in urban animal management. These findings underscore the critical role of sustained interventions, community collaboration, and legal frameworks in ensuring long-term success and addressing global challenges in urban animal welfare and biodiversity conservation.260,6982,7Q1Q1SCIE10,
Transcultural Adaptation and Evaluation of the Psychometric Properties of the Spanish Version of the FCR7 Questionnaire for Assessing Fear of Recurrence in Cancer Patients: FCR6/7-SP
No full textBackground/Objectives: Fear of recurrence is one of the main issues affecting cancer patients after the completion of treatment. Despite the development of various assessment tools at the international level, there is a lack of validated questionnaires in Spanish. For this reason, the aim of this study is to conduct a transcultural adaptation and evaluate the psychometric properties of the Spanish version of the Fear of Cancer Recurrence (FCR7) questionnaire. Methods: We carried out translation and transcultural adaptation of the FCR7 scale, content validity through expert review, and face validity with a pilot test in the first phase. In the second phase, construct validity was evaluated through confirmatory factor analysis and Rasch analysis, along with reliability (internal consistency), convergent-divergent validation, and known-groups validation in a sample of 315 individuals with a history of cancer. Descriptive and inferential analysis was performed using JAMOVI (c) v.2.3.24., confirmatory factor analysis with FACTOR (c) v.12.02.01x64 bits, and Rasch analysis with JMetrik (c) v.2.0. Results: Aiken's coefficient exceeded 0.75 for all items, indicating acceptable face validity for the instrument. Two unidimensional models were obtained for the instrument, FCR7-SP and FCR6-SP, both showing acceptable fit values and adequate reliability (omega coefficient = 0.933 [95% CI: 0.922-0.944] and 0.942 [95% CI: 0.931-0.951], respectively). Conclusions: The Spanish version of the FCR7 is valid and reliable for assessing fear of cancer recurrence in the Spanish population, with two models available for its application (FCR7-SP and FCR6-SP). The availability of this tool will enable the evaluation of this phenomenon in clinical practice and a more effective approach to addressing its consequences.191,3914,5Q1Q110,
Estudio de las cojeras y su evaluación por técnicas biomecanicas y escalas subjetivas.
No full textPrograma de Doctorado en Investigación en Biomedicina por la Universidad de Las Palmas de Gran CanariaLa cojera se define como una disfunción en la marcha de los animales,
caracterizada por alteraciones en la capacidad de apoyo de las miembros
torácicos y/o pelvianos. Este síntoma puede ser causado por diversas
patologías, incluyendo dolor, debilidad muscular y trastornos articulares, y es
relevante para el diagnóstico de trastornos musculoesqueléticos.
Las causas de la cojera son multifactoriales e incluyen lesiones musculares,
óseas, infecciones, problemas neurológicos, objetos extraños, enfermedades
sistémicas y neoplasias. En muchos casos severos, la amputación del miembro
afectado se considera necesaria.
Para la evaluación de la cojera, se emplean métodos subjetivos, tales como
escalas visuales y funcionales, junto con métodos objetivos que abarcan análisis
cinéticos y cinemáticos. La utilización de sensores de medición inercial (IMU) ha
demostrado ser eficaz en la evaluación objetiva de la cojera en medicina humana
y equina; sin embargo, los estudios realizados en la especie canina son aún
considerados insuficientes.
Por todo lo expuesto anteriormente, el objetivo común de esta tesis doctoral
consiste en estudiar nuevos métodos de diagnóstico y evaluación de la cojera. Y
por este motivo, se han diseñado tres estudios diferentes:
- Un primer estudio utilizando 30 perros con rotura de ligamento cruzado.
En este estudio los animales fueron separados en dos grupos según la técnica y
el implante utilizado (Porous TTA® o Model Xgen®). Con el objetivo de
comprobar la utilidad de los métodos subjetivos en la valoración de cojeras, se
ha utilizado la escala Bioarth para comparar el éxito de dos técnicas quirúrgicas
usadas.
- Un segundo estudio utilizando 10 perros con un miembro anterior
amputado, con el objetivo de profundizar de manera objetiva en el conocimiento
sobre las modificaciones biomecánicas (posturales y dinámicas) en perros
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amputados de las extremidades delanteras mediante el uso de plataformas de
fuerza y presión.
- Un tercer estudio utilizando 15 perros, con el propósito de investigar si
las redes neuronales artificiales podrían utilizarse para determinar la cojera en
las extremidades traseras de los perros únicamente mediante medios
computacionales