Practical considerations in the management of proton-pump inhibitors

Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a new-generation PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.

Management of the clinical issue of constipation with abdominal complaints in adults: a national survey of Primary Care physicians and gastroenterologists

Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort) with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care). Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation) and a response rate potentially biased by professional motivation.

Promoting oral interaction in the EFL classroom through the use of speaking activities

Este trabajo de investigación es sobre el uso de un folleto con actividades de expresión oral utilizados en una clase de Inglés de estudiantes de primer año del colegio "Integración Iberoamericano" y discute intereses de los estudiantes en desarrollo estas actividades para una interacción oral significativa entre (estudiantes y profesores) y (estudiantes-estudiantes). Además, este trabajo de investigacióntiene 5secciones: la primera secciónes una introducciónacerca de laimportancia de la comunicaciónen nuestra vidadiaria, la segunda secciónpresenta laliteratura, sección en la quese mencionandiferentesautores quepresentanalgunas perspectivassobreel desarrollo de comunicación oralen el EFL clase, así como en la tercera secciónse mencionala metodología utilizadadurante el desarrollodel trabajo de investigación. Por otra parte, en la cuarta secciónse presentaelanálisis de los datoscon los resultadosobtenidospor los participantesdespués de haber sido aplicado elfolleto conlasactividades de expresión oral, y, finalmente,en la quinta sección, se presentanlas conclusiones yrecomendacionesdespués de haberterminado el trabajo de investigación. Esimportante mencionarque el usode este folletoserá considerado como una opcióndiferente yuna metodología innovadoraque los futurosprofesores pueden utilizaren las clasescomo una herramientaútily significativa parael desarrollo deloshabilidades para hablar y una buena comunicación oral de los estudiantes.

Trajectory Privacy Preservation in Mobile Wireless Sensor Networks

In recent years, there has been an enormous growth of location-aware devices, such as GPS embedded cell phones, mobile sensors and radio-frequency identification tags. The age of combining sensing, processing and communication in one device, gives rise to a vast number of applications leading to endless possibilities and a realization of mobile Wireless Sensor Network (mWSN) applications. As computing, sensing and communication become more ubiquitous, trajectory privacy becomes a critical piece of information and an important factor for commercial success. While on the move, sensor nodes continuously transmit data streams of sensed values and spatiotemporal information, known as ``trajectory information". If adversaries can intercept this information, they can monitor the trajectory path and capture the location of the source node. This research stems from the recognition that the wide applicability of mWSNs will remain elusive unless a trajectory privacy preservation mechanism is developed. The outcome seeks to lay a firm foundation in the field of trajectory privacy preservation in mWSNs against external and internal trajectory privacy attacks. First, to prevent external attacks, we particularly investigated a context-based trajectory privacy-aware routing protocol to prevent the eavesdropping attack. Traditional shortest-path oriented routing algorithms give adversaries the possibility to locate the target node in a certain area. We designed the novel privacy-aware routing phase and utilized the trajectory dissimilarity between mobile nodes to mislead adversaries about the location where the message started its journey. Second, to detect internal attacks, we developed a software-based attestation solution to detect compromised nodes. We created the dynamic attestation node chain among neighboring nodes to examine the memory checksum of suspicious nodes. The computation time for memory traversal had been improved compared to the previous work. Finally, we revisited the trust issue in trajectory privacy preservation mechanism designs. We used Bayesian game theory to model and analyze cooperative, selfish and malicious nodes' behaviors in trajectory privacy preservation activities.

Centralization of cleft care in the UK. Part 6:a tale of two studies

OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.

A stakeholder perspective on heritage branding and digital communication

How does an archaeological museum understand its function in a digital environment? Consumer expectations are rapidly shifting, from what used to be a passive relationship with exhibition contents, towards a different one, in which interaction, individuality and proactivity define the visitor experience. This consumer paradigm is much studied in fast moving markets, where it provokes immediately measurable impacts. In other fields, such as tourism and regional development, the very heterogeneous nature of the product to be branded makes it near to impossible for only one player to engage successfully. This systemic feature implies that museums, acting as major stakeholders, often anchor a regional brand around which SME tend to cluster, and thus assume responsibilities in constructing marketable identities. As such, the archaeological element becomes a very useful trademark. On the other hand, it also emerges erratically on the Internet, in personal blogs, commercial websites, and social networks. This forces museums to enter as a mediator, authenticating contents and providing credibility. What might be called the digital pull factor poses specific challenges to museum management: what is to be promoted, and how, in order to create and maintain a coherent presence in social media? The underlying issue this paper tries to address is how museums perceive their current and future role in digital communication.

Medición de la cultura de seguridad del paciente en un hospital público de primer nivel en el municipio de Villeta

Esta investigación midió la percepción del personal asistencial sobre la cultura de seguridad de los pacientes en un hospital de primer nivel de complejidad por medio de un estudio descriptivo de corte transversal. Se utilizó como herramienta de medición la encuesta ‘Hospital Survey on Patient Safety Cultura’ (HSOPSC) de la Agency of Healthcare Research and Quality (AHRQ) versión en español, la cual evalúa doce dimensiones. Los resultados mostraron fortalezas como el aprendizaje organizacional, las mejoras continuas y el apoyo de los administradores para la seguridad del paciente. Las dimensiones clasificadas como oportunidades de mejora fueron la cultura no punitiva, el personal, las transferencias y transiciones y el grado en que la comunicación es abierta. Se concluyó que aunque el personal percibía como positivo el proceso de mejoramiento y apoyo de la administración también sentía que era juzgado si reportaba algún evento adverso.

Computer and laboratory simulation in the teaching of neonatal nursing: innovation and impact on learning

Objectives: to evaluate the cognitive learning of nursing students in neonatal clinical evaluation from a blended course with the use of computer and laboratory simulation; to compare the cognitive learning of students in a control and experimental group testing the laboratory simulation; and to assess the extracurricular blended course offered on the clinical assessment of preterm infants, according to the students. Method: a quasi-experimental study with 14 Portuguese students, containing pretest, midterm test and post-test. The technologies offered in the course were serious game e-Baby, instructional software of semiology and semiotechnique, and laboratory simulation. Data collection tools developed for this study were used for the course evaluation and characterization of the students. Nonparametric statistics were used: Mann-Whitney and Wilcoxon. Results: the use of validated digital technologies and laboratory simulation demonstrated a statistically significant difference (p = 0.001) in the learning of the participants. The course was evaluated as very satisfactory for them. The laboratory simulation alone did not represent a significant difference in the learning. Conclusions: the cognitive learning of participants increased significantly. The use of technology can be partly responsible for the course success, showing it to be an important teaching tool for innovation and motivation of learning in healthcare.

Progress in analytical approaches integrating Livestock and Biodiversity to identify HNV Montados

The World Congress Silvo-Pastoral Systems 2016 aims to gather researchers from different disciplines, practitioners and policy makers at different governance levels that deal with the management and sustainability of silvo-pastoral systems. In this way the congress will create a fertile context to progress through interdisciplinarity research approaches that can help translate scientific knowledge into new adaptive management solutions, and thus bridge from science to practice. The aim is also to gather and compare knowledge from silvo-pastoral systems around the world, which share drought as a limiting factor, so that they can be discussed and evaluated.

A qualidade da comunicação dos técnicos e auxiliares de ressonância magnética num serviço de radiologia: um programa de intervenção

O presente estudo preliminar teve como finalidade analisar a qualidade da comunicação dos técnicos e auxiliares de ação médica nos exames de Ressonância Magnética, partindo da observação da linguagem verbal e não-verbal. Por analogia com outros domínios, desenvolveu-se um programa de intervenção que incidiu na formação dos técnicos e auxiliares ação médica do Serviço de Radiologia de um hospital público. Recorrendo a uma grelha de observação, avaliou-se o efeito do treino de competências no aumento dos comportamentos adequados durante as Ressonâncias Magnéticas. De uma forma geral, os resultados analisados demonstraram que a formação teve um efeito significativo nos técnicos e nos auxiliares das ressonâncias magnéticas, originando mudanças positivas no local de trabalho, tal como o desenvolvimento de uma relação mais adequada com os doentes que potencie o sucesso do diagnóstico; "Analysis of communication quality of technicians and auxiliaries of MRI radiology service" Abstract: With this preliminary study, we intented to analyze the quality of communication in magnetic resonance imaging exams, starting from the observation of verbal and non-verbal language. By analogy with other areas, it was developed an intervention program focused on the training of technicians and operational assistants of the Radiology service of public hospital. Using a grid note, we assessed the effect of skills training in the increased of appropriate behaviour during the MRIs. In General, the results examined showed that the training had a significant effect on operational assistants and technicians of MRIs, resulting in positive changes in the workplace, such as developing a proper relationship with patients to promote the success of the diagnosis.

Assessing the role of small farms in sustainable Food and Nutrition Security: What to consider t what scale?,

The AgroMed International Conference 2016 aims to discuss the current land use changes, with a particular interest on farm and land system dynamics, also considering the possible competition with other uses (urban and/or natural land uses). It is focused on “Farm and land system dynamics in the Mediterranean basin: integrating spatial scales, from the local to the global one”. Teresa Pinto Correia presented H2020 project SALSA “Small farms, small food businesses and sustainable food security”