44 research outputs found
Improving the quality of geriatric nursing care: Enduring outcomes from the Geriatric Nursing Education Consortium
No full textThe nation's aging demographics, few nursing faculty with gero-expertise, and insufficient geriatric content in nursing programs has created a national imperative to increase the supply of nurses qualified to provide care for older adults. GNEC, the Geriatric Nursing Education Consortium, a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the NYU Nursing Hartford Institute for Geriatric Nursing was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, processes, and development of GNEC evidence-based curricular materials, and the dissemination of these materials through six, two and a half day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended an FDI. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over two years. Administrative and faculty level recommendations to sustain and expand GNEC are highlighted.Peer reviewe
Adaptive management of the climate change problem: bridging the gap between research and public policy
No full textThere are important differences between adaptation to normal climate and adaptation to climate change. One scientific community is organized to address extreme probabilities in current distributions, and their disaster potential. Another scientific community addresses the longer-term changes in the climate system. There are important differences between natural hazard (extreme and unpredictable events) and disaster as natural hazard with disastrous economic and social consequences as a matter of enormous concern. Finally, disaster management means a forecast for the real disaster events and after these disasters occurred, a post disaster attitude is necessary to ameliorate the situation and to take measures for rapid recovery. In this paper the author tries to address the description, understanding and prediction of extreme events in the weather system and their impact across a range of natural and socio-economic phenomena. Other goals of the paper are to present the weather and climate characteristics, the statistics of extreme events and to evaluate their impact on economy. Thus one major task of the work is to address the management of natural disasters caused by weather: the management of event forecast, risk assessment for various regions, and disaster management after the event occur. At the intersection between Economics, Management and Science of Weather Processes, this interdisciplinary study will provide the reader with insight and tools to address contemporary climate and weather hazard management problems.weather disasters, natural hazard, human vulnerability, extreme events, statistics and impact, management of event forecast, regional risk assessment, post disaster management
Intravenous bisphosphonate treatment and pregnancy: Its effects on mother and infant bone health
No full textIntroduction: Type 1 Gaucher's disease (GD1) is a lysosomal storage disorder associated with disabling bone involvement. The choice treatment for Gaucher's disease is enzyme replacement therapy (ERT). The use of bisphosphonate treatment for osteopenia and osteoporosis has been suggested. Case: A 22-year-old woman diagnosed with GD1 had received ERT intermittently, depending on availability of the enzyme since the enzyme was not always available. Due to severe bone involvement and multiple vertebral fractures, intravenous administration of 60 mg of pamidronate every 3 months and safe contraception were indicated. Fifteen days after receiving the fourth infusion, the patient informed us she was pregnant. A baby girl was born by cesarean delivery at week 37, showing no evidence of skeletal abnormality or clinical signs of hypocalcemia. The baby developed normally, presenting no significant pathology. At present (age 15 months), height, body weight, and bone mineral density by DXA are within normal range. The mother showed stable total skeleton and right femoral neck bone mineral density (BMD) values, no new fractures, and only ~3% decrease in lumbar spine BMD 15 months post-delivery and after a 1 year breastfeeding period (expected average ~7-8%). Conclusion: It could be posited that pamidronate exerted a positive protective effect on the mother's skeleton with no evidence of adverse effects on pregnancy or on the baby's health to date.Fil: Mastaglia, Silvina Rosana. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Watman, N. P.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Oliveri, María Beatriz. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin
A reappraisal of Gaucher disease-diagnosis and disease management algorithms
No full textType 1 (non-neuronopathic) Gaucher disease was the first lysosomal storage disorder for which an effective enzyme replacement therapy was developed and it has become a prototype for treatments for related orphan diseases. There are currently four treatment options available to patients with Gaucher disease, nevertheless, almost 25% of Type 1 Gaucher patients do not gain timely access to therapy because of delays in diagnosis after the onset of symptoms. Diagnosis of Gaucher disease by enzyme testing is unequivocal, but the rarity of the disease and nonspecific and heterogeneous nature of Gaucher disease symptoms may impede consideration of this disease in the differential diagnosis. To help promote timely diagnosis and optimal management of the protean presentations of Gaucher disease, a consensus meeting was convened to develop algorithms for diagnosis and disease management for Gaucher disease
Gaucher disease diagnostic and disease management algorithms : a guide for hematologists
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THYROID ACTIVITY AND RESISTANCE TO HISTAMINE-INDUCED PEPTIC ULCER AND TO ACUTE HISTAMINE POISONING
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Enfermedad de Gaucher en Argentina. Un informe del Registro Internacional de Gaucher y del Grupo Argentino de Diagnóstico y Tratamiento de la Enfermedad de Gaucher
No full textFil: Drelichman, G. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Fernández Escobar, N. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Basack, N. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Aversa, L. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Kohan, R. Registro Argentino de Gaucher; Argentina.Fil: Watman, N. Hospital Ramos Mejía; Argentina.Fil: Bolesina, M. Hospital Ramos Mejía; Argentina.Fil: Elena, G. Hospital de Niños Pedro de Elizalde; Argentina.Fil: Veber, S. E. Hospital de Niños Pedro de Elizalde; Argentina.Fil: Dragosky, M. Hospital de Oncología Marie Curie; Argentina.Fil: Annetta, I. Hospital de Oncología Marie Curie; Argentina.Fil: Feliu, A. Hospital de Pediatría Prof. Dr Juan P. Garrahan; Argentina.Fil: Sciuccati, G. Hospital de Pediatría Prof. Dr Juan P. Garrahan; Argentina.Fil: Cuello, M. F. Hospital de Niños Superiora Sor María Ludovica; Argentina.Fil: Fynn, A. Hospital de Niños Superiora Sor María Ludovica; Argentina.Fil: Dodelson de Kremer, R. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Angaroni, C. J. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Giner-Ayala, A. N. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Oller de Ramirez, A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Guelbert, N. B. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Delgado, M. A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Becerra, A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Oliveri, B. Hospital de Clínicas José de San Martín, Argentina.Fil: Larroudé, M. S. Centro Médico TIEMPO; Argentina.Fil: Masllorens, F. M. Hospital Nacional “Prof. Dr.
A. Posadas; Argentina.Fil: Szlago, M. Fundación para el estudio de las enfermedades Neurometabólicas; Argentina.Fil: Szlago, M. Laboratorio de Neuroquímica “Dr. N. A. Chamoles”; Argentina.Fil: Schenone, A. B. Fundación para el estudio de las enfermedades Neurometabólicas; Argentina.Fil: Schenone, A. B. Laboratorio de Neuroquímica “Dr. N. A. Chamoles”; Argentina.La Enfermedad de Gaucher por su baja frecuencia está incluida dentro de las enfermedades huérfanas. En 1991 comenzó el ingreso de pacientes en el Registro Internacional de Gaucher. En 1992 se incorporaron los primeros dos pacientes de Latinoamérica. En 2006 se creó el Grupo Argentino de Diagnóstico y Tratamiento de la Enfermedad de Gaucher siendo sus objetivos principales el entendimiento de la prevalencia, presentación, manejo y tratamiento de la Enfermedad de Gaucher en Argentina.Hasta el 1 de febrero del 2013 ingresaron al Registro Internacional 5.986 pacientes provenientes de 60 países, de los cuales 133 (2.22%) fueron argentinos. El análisis de esta publicación fue realizado sobre 133 pacientes con Enfermedad de Gaucher. Esta es la primera publicación del Grupo Argentino de Diagnóstico y Tratamiento en base a los datos del Registro Internacional. La casuística argentina mostró un predominio femenino y la forma clínica más frecuente fue el tipo 1 (97.7%, n=128). El genotipo fue identificado en 57 pacientes (42.9%), siendo el más frecuente el N370S/ otro alelo (82.5%). Entre los pacientes con datos reportados, los síntomas basales predominantes, previos al inicio del tratamiento con Imiglucerasa que predominaron fueron la esplenomegalia (100%, n=13) y la hepatomegalia (88.9%, n=8) y como citopenias más frecuentes, la trombocitopenia (64.2%, n=34) y la anemia (45.9%, n=28). La infiltración de la médula ósea como un marcador específico de enfermedad ósea se encontró en el 50% de los pacientes. En total, el 85.7% de los pacientes argentinos reciben terapia de reemplazo enzimático con Imiglucerasa, lográndose las metas terapéuticas, en la mayoría de los casos, en la última evaluación. Las metas terapéuticas más frecuentemente alcanzadas resultaron: el control de las manifestaciones óseas (dolor óseo y crisis ósea, 81.9% y 99% respectivamente) y la normalización de la hemoglobina (86.5%). La terapia de reemplazo enzimática con Imiglucerasa, a largo plazo en la población argentina demostró ser una herramienta eficaz para mejorar los parámetros clínicos y bioquímicos de la Enfermedad de Gaucher tipo1publishedVersionFil: Drelichman, G. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Fernández Escobar, N. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Basack, N. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Aversa, L. Hospital de Niños “Ricardo Gutiérrez”; Argentina.Fil: Kohan, R. Registro Argentino de Gaucher; Argentina.Fil: Watman, N. Hospital Ramos Mejía; Argentina.Fil: Bolesina, M. Hospital Ramos Mejía; Argentina.Fil: Elena, G. Hospital de Niños Pedro de Elizalde; Argentina.Fil: Veber, S. E. Hospital de Niños Pedro de Elizalde; Argentina.Fil: Dragosky, M. Hospital de Oncología Marie Curie; Argentina.Fil: Annetta, I. Hospital de Oncología Marie Curie; Argentina.Fil: Feliu, A. Hospital de Pediatría Prof. Dr Juan P. Garrahan; Argentina.Fil: Sciuccati, G. Hospital de Pediatría Prof. Dr Juan P. Garrahan; Argentina.Fil: Cuello, M. F. Hospital de Niños Superiora Sor María Ludovica; Argentina.Fil: Fynn, A. Hospital de Niños Superiora Sor María Ludovica; Argentina.Fil: Dodelson de Kremer, R. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Angaroni, C. J. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Giner-Ayala, A. N. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Oller de Ramirez, A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Guelbert, N. B. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Delgado, M. A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Becerra, A. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Centro de Estudios
de las Metabolopatías Congénitas; Argentina.Fil: Oliveri, B. Hospital de Clínicas José de San Martín, Argentina.Fil: Larroudé, M. S. Centro Médico TIEMPO; Argentina.Fil: Masllorens, F. M. Hospital Nacional “Prof. Dr.
A. Posadas; Argentina.Fil: Szlago, M. Fundación para el estudio de las enfermedades Neurometabólicas; Argentina.Fil: Szlago, M. Laboratorio de Neuroquímica “Dr. N. A. Chamoles”; Argentina.Fil: Schenone, A. B. Fundación para el estudio de las enfermedades Neurometabólicas; Argentina.Fil: Schenone, A. B. Laboratorio de Neuroquímica “Dr. N. A. Chamoles”; Argentina.Otras Ciencias de la Salu
Influence of TNF and IL6 gene polymorphisms on the severity of cytopenias in Argentine patients with myelodysplastic syndromes
No full textMyelodysplastic syndromes (MDS) represent a heterogeneous group of hematologic disorders characterized by cytopenia(s) and predisposition to leukemic progression. An immune dysregulation and an aberrant bone marrow microenvironment seem to be key elements in the physiopathological process of MDS. In order to evaluate a possible association between susceptibility and clinic-pathologic features, we genotyped 153 MDS patients for functional cytokine polymorphisms: TNF (−308 G/A), IFNG (+874 A/T and +875 CAn), IL6 (−174 G/C), and TGFB1 (+869 C/T and +915 G/C). The frequency of TNF and IL6 polymorphisms was different between patients and healthy controls (n = 131), suggesting a relatedness to MDS susceptibility in our population. Furthermore, the presence of each or both high-producing genotypes [TNF: p = 0.048, odds ratio (OR): 3.979; IL6: p = 0.001, OR: 6.835; both: p = 0.010, OR: 6.068] and thrombocytopenia at platelet counts of <50,000/μL (p = 0.004, OR: 4.857) were independently associated with an increased risk of manifesting a hemoglobin level of <8 g/dL at diagnosis. In particular, a severe bicytopenia was more frequently observed in patients with the TNF (high)_IL6 (high) combined genotype (p = 0.004, OR: 8.357), who consistently became transfusion dependent earlier (2.9 vs. 34.6 months; p = 0.001); and this likelihood was more evident in patients with lower bone marrow blast counts. The contribution of the remaining functional polymorphisms to the disease phenotype was less relevant. Our results demonstrate that TNF and IL6 gene polymorphisms, as underlying host features, are likely to play a key role in influencing the severity of the cytopenias in MDS and they may be instrumental for tailoring cytokine-target therapies.Fil: Bestach, Yesica Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Palau Nagore, Maria Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Flores, María G.. Hospital General de Agudos “C.G. Durand”; ArgentinaFil: González, Jacqueline. Hospital General de Agudos “C.G. Durand”; ArgentinaFil: Arbelbide, Jorge. Hospital Italiano; ArgentinaFil: Watman, Nora. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Sieza, Yamila. Hospital Interzonal General de Agudos “Gral. San Martín”; ArgentinaFil: Larripa, Irene Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Belli, Carolina Bárbara. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin
