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Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

World Journal of Clinical Cases 2025年第3期13卷 35-41页

作者： Andres Fontalba-Navas Francisco Pozo Muñoz Rogelio Garcia Cisneros maria Jose Garcia Larrosa maria del Mar Callejon Gil Ignacio Garcia Delgado maria belen jimenez martinez Antequera Hospital Northern Málaga Integrated Healthcare AreaAntequera 29200AndalusiaSpain Department of Public Health and Psychiatry University of MálagaMálaga 29010Spain Antequera Hospital Northern Málaga Antequera Integrated Healthcare AreaAntequera 29200MálagaSpain

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot *** diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient *** proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid *** To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital *** The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary *** coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient *** superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of ca

关键词： High complexity unit Chronic multimorbidity Patient-centered care Integrated care Healthcare management

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COVID-19 pandemic,as experienced in the surgical service of a district hospital in Spain

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World Journal of Clinical Cases 2021年第23期9卷 6582-6590页

作者： Francisco Javier Pérez Lara maria belen jimenez martinez Francisco Pozo Muñoz Andres Fontalba Navas Rogelio Garcia Cisneros maria Jose Garcia Larrosa Ignacio Garcia Delgado maria del Mar Callejon Gil Department of Surgery Hopital de AntequeraAntequera 29200MálagaSpain North Malaga Healthcare District Hopital de AntequeraAntequera 29200MálagaSpain

The coronavirus disease 2019,which is caused by severe acute respiratory syndrome coronavirus 2,was first identified in December 2019 in Wuhan,China,and has since spread rapidly,evolving into a full-blown *** would like to report our experience after 1 year of this pandemic in the surgical service of a district hospital in *** have been many changes(including new protocols)that our service and the hospital have undergone,to adapt to the new *** believe that this experience can be useful for other professionals who have lived and are living a similar situation.

关键词： COVID-19 Hospital Experience Surgery Service Treatment

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The Latin American Publishing Circuit in the 21st Century:Following the Trajectory of Cesar Aira

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Journal of Foreign Languages and Cultures 2021年第2期5卷 56-64,156页

作者： maria belen Riveiro University of Buenos Aires

This essay poses a question about the identity of Latin American literature in the 21st *** the 1960s and 1970s,the Latin America Boom received recognition both locally and internationally,becoming the dominant means of defining Latin American literature up to the *** essay explores new ways to understand this notion of Latin America in the literary *** case of the Argentine writer Cesar Aira is relevant for analyzing alternative publishing circuits that connect various points of the *** publishing houses foster a defiant way of establishing the value of literature.

关键词： Latin American literature publishing houses Cesar Aira international literary geography

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Review of incomplete macroscopic resections(R2)in rectal cancer:Treatment,prognosis and future perspectives

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World Journal of Gastrointestinal Oncology 2021年第9期13卷 1062-1072页

作者： Francisco Javier Pérez Lara maria Luisa Hebrero jimenez Francisco Javier Moya Donoso Jose Manuel Hernández Gonzalez maria Pitarch martinez Tatiana Prieto-Puga Arjona Department of Surgery Antequera HospitalMálaga 29200Spain Department of Oncologic Radiotherapy Hopital Regional de MálagaMálaga 29010Spain

Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent ***,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic *** this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.

关键词： Rectal cancer Surgery Treatment Incomplete resection Local recurrence

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Degradation of indomethacin in river water under stress and non-stress laboratory conditions:degradation products,long-term evolution and adsorption to sediment

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Journal of Environmental Sciences 2017年第1期29卷 13-20页

作者： Juan J.jimenez maria I.Sanchez Rafael Pardo Beatriz E.Munoz Department of Analytical Chemistry Faculty of SciencesCampus Miguel DelibesUniversity of ValladolidPaseo de Belen 747012 ValladolidSpain I.U.CINQUIMA Campus Miguel DelibesUniversity of ValladolidPaseo de Belen 547011 ValladolidSpain Department of Analytical Chemistry School of Industrial EngineersUniversity of ValladoliclFrancisco Mendizdbal 147014 ValladolidSpain

The pharmaceutical compound indomethacin is not totally removed in wastewater treatment plants,whose effluents flow into aquatic environments;concentrations in the 0.1-100 ng/L range are commonly found in surface waters,and its fate is ***,biological,photochemical and thermal degradation assays were conducted under stress and non-stress conditions to estimate its degradation rate in river water and establish its degradation products over *** results revealed that direct sunlight irradiation promoted the complete degradation of indomethacin（2 μg/L） in less than 6 hr,but indomethacin was detected over a period of 4 months when water was kept under the natural day-night cycle and the exposure to sunlight was partially limited,as occurs inside a body of *** biological degradation in water was negligible,while the hydrolysis at pH 7.8 was *** were monitored by ultra-pressure liquid chromatography/quadrupole time-of-flight/mass spectrometry after solid-phase extraction,and six degradation products were found;their structures were proposed based on the molecular formulae and fragmentation observed in high-resolution tandem mass spectra.4-Chlorobenzoic and 2-acetamido-5-methoxybenzoic acids were the long-term transformation products,persisting for at least 30 weeks in water kept under non-stress ***,the degradation in the presence of sediment was also monitored over time,with some differences being *** adsorption coefficients of indomethacin and degradation products on river sediment were calculated;long-term degradation products did not have significant adsorption to sediment.

关键词： Indomethacin Degradation products River water Adsorption coefficients High-resolution mass spectrometry

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Historical evolution,overview,and therapeutic manipulation of costimulatory molecules

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World Journal of Immunology 2022年第1期12卷 1-8页

作者： Henry Velazquez-Soto Fernanda Real maria C jimenez-martinez Department of Immunology and Research Unit Institute of Ophthalmology“Conde de Valenciana”Mexico City 06800Mexico Department of Biochemistry Faculty of MedicineNational Autonomous University of MexicoMexico City 04510Mexico

Co-stimulatory molecules are key mediators in the regulation of immune responses and knowledge of its different families,structure,and functions has improved in recent *** the role of co-stimulatory molecules in pathological processes has allowed the development of strategies to modulate cellular ***,modulation of co-stimulatory and co-inhibitory molecules has been applied in clinical applications as therapeutic targets in diseases and promising results have been achieved.

关键词： Co-stimulatory molecules Immune modulation Monoclonal antibodies Biological therapy Autoimmune diseases Oncological diseases

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The Mexican Environmental Flow Standard:Scope,Application and Implementation

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Journal of Environmental Protection 2014年第1期5卷 71-79页

作者： maria Antonieta Gomez-Balandra maria del Pilar Saldana-Fabela Maricela martinez-jimenez Hydrobiology and Environmental Assessment Department Mexican Institute of Water TechnologyJiutepecMexico

With the implementation of the Official Mexican Standard NOM-011-CONAGUA-2000 [1], the water balance of 730 basins has been calculated and its water availability agreement is published. This rule points out to allocate water for the environment only as an annual volume since methods for estimating environmental flows were not standardized in the country. For this reason, The Water Agency (CONAGUA) issued the standard NMX-AA-159-SCFI-2012 [2], to assess environmental flows needed both, at the strategic level in Integrated Water Resources Management (IWRM), or as part of the Environmental Impact Assessment (EIA) of large hydraulic projects. For over ten years, this standard was developed and finally published in September 2012 [3]. It explains different methods from hydrological to holistic approaches, with examples for the country. Its application will cover the urgent need to preserve water for ecosystems in watersheds with high ecological importance and low stress for water use. In this paper, an analysis of the environmental flow standard and examples of the suggested hydrological methods are presented. For its implementation, some steps are taking place, mainly establishing environmental water reserves and building capacities. In addition, environmental allocations are becoming a common practice for all water projects, as well as setting limits to hydrological alterations by hydroelectric dams. The standard promotes the use of technical integration tools to analyze the responses of ecosystems to changes in the flow regime and adaptive management under different scenarios of water use. Although the main steps have been taken, its implementation as mandatory rule will take time.

关键词： Environmental Flows Hydrological Methods Mexican Standard

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Effectiveness of dry needling on reducing pain intensity in patients with myofascial pain syndrome： a Meta-analysis

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Journal of Traditional Chinese Medicine 2016年第1期36卷 1-13页

作者： Juan Rodriguez-Mansilla Blanca Gonzalez-Sanchez Alvaro De Toro Garcia Enrique Valera-Donoso Elisa maria Garrido-Ardila maria jimenez-Palomares maria Victoria Gonzalez Lopez-Arza Department of Medicine and Surgery University of Extremadura School of MedicineAdolor Research Group of the University of ExtremaduraBadajoz 06006Spain IMC Physiotherapy clinic Department of Physiotherapy.Caceres 10001Spain Physical and Rehabilitation Medicine Department Complutense University School of MedicineMadrid 28040Spain

OBJECTIVE: To summarize the literature about the effectiveness of dry needling(DN) on relieving pain and increasing range of motion(ROM) in individuals with myofascial pain syndrome(MPS).METHODS: Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Database(PEDro) and Spanish Superior Council of Scientific Research(CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with ***: Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Meta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d =-0.49; 95% CI(-3.21, 0.42)] and with the control group [d =-9.13;95% CI(- 14.70,- 3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54;95% CI(-0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI(0.78, 7.68)].DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00;95% CI(1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d =-1.42;95% CI(-1.84,-0.99)].CONCLUSION: DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM,DN was more effective comparing to that of placebo group, but less than other treatments.

关键词： Dry needling Myofascial pain syndromes Rehabilitation Meta-analysis

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Arabidopsis CPR5 regulates ethylene signaling via molecular association with the ETR1 receptor

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Journal of Integrative Plant Biology 2017年第11期59卷 810-824页

作者： Feifei Wang Lijuan Wang Longfei Qiao Jiacai Chen maria belen Pappa Haixia Pei Tao Zhang Caren Chang Chun-Hai Dong College of Life Sciences Qingdao Agricultural University Department of Cell Biology and Molecular Genetics University of Maryland

The plant hormone ethylene plays various functions in plant growth, development and response to environmental stress. Ethylene is perceived by membranebound ethylene receptors, and among the homologous receptors in Arabidopsis, the ETR1 ethylene receptor plays a major role. The present study provides evidence demonstrating that Arabidopsis CPR5 functions as a novel ETR1 receptor-interacting protein in regulating ethylene response and signaling. Yeast split ubiquitin assays and bifluorescence complementation studies in plant cells indicated that CPR5 directly interacts with the ETR1 receptor. Genetic analyses indicated that mutant alleles of cpr5 can suppress ethylene insensitivity in both etr1-1 and etr1-2, but not in other dominant ethylene receptormutants. Overexpression of Arabidopsis CPR5 either in transgenic Arabidopsis plants, or ectopically in tobacco,significantly enhanced ethylene sensitivity. These findings indicate that CPR5 plays a critical role in regulating ethylene signaling. CPR5 is localized to endomembrane structures and the nucleus, and is involved in various regulatory pathways, including pathogenesis, leaf senescence, and spontaneous cell death. This study provides evidence for a novel regulatory function played by CPR5 in the ethylene receptor signaling pathway in Arabidopsis.

关键词： Arabidopsis CPR5 regulatesmolecular association withethylene signaling viathe ETR1 receptor

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Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1638-1650页

作者： Francisco Javier Perez Lara Rogelio Zubizarreta jimenez Francisco Javier Moya Donoso Jose Manuel Hernández Gonzalez Tatiana Prieto-Puga Arjona Arturo del Rey Moreno maria Pitarch martinez Surgery Service Antequera HospitalRincón de la Victoria 29730MálagaSpain DOXA Microfluidics Rincon de la Victoria 29738MálagaSpain

BACKGROUND Giant hiatal hernias still pose a major challenge to digestive surgeons,and their repair is sometimes a highly complex *** is usually performed by laparoscopy,while the role of the thoracoscopic approach has yet to be clearly *** To preoperatively detect patients with a giant hiatal hernia in whom it would not be safe to perform laparoscopic surgery and who,therefore,would be candidates for a thoracoscopic *** In the present study,using imaging test we preoperatively simulate the field of vision of the camera and the working area(instrumental access)that can be obtained in each patient when the laparoscopic approach is *** From data obtained,we can calculate the access angles that will be obtained in a preoperative computerised axial tomography coronal section,according to the location of the *** also provide the formula for performing the angle calculations If the trocars are placed in loss common situations,thus enabling us to determine the visibility and manoeuvrability for any position of the *** The working area determines the cases in which we can operate safely and those in which certain areas of the hernia cannot be accessed,which is when the thoracoscopic approach would be safer.

关键词： Hiatal hernia Angles Approach Laparoscopy Thoracoscopy

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