If the figure of Janus is familiar to Niklaus Manuel Güdel – and gives his name to the film dedicated to him by Claude Stadelmann (release planned for the beginning of November) – it is because the artist with the first name inherited from the Bernese painter and reformer Niklaus Manuel Deutsch seems to have been placed, from birth, under the sign of a double identity. Of Swiss and Costa Rican origin, Niklaus grew up in Switzerland, between the Jura and the Bernese countryside, but also in Costa Rica where, from early childhood, he made regular trips. He says he was “born cut in two” and “always wanted to write and paint at the same time”. Intellectual and artist, art historian and painter, also director of the Ferdinand Hodler Institute (previously Archives Jura Brüschweiler) and curator of exhibitions, Niklaus Manuel Güdel contradicts all the simplistic divisions between left brain and right brain, between spirit of geometry and spirit of finesse.
Le pronostic Canalturf.com
3 – ROUVRAYdriveAdrien Fouassier (photo), remains on two good second places, in Bordeaux-Le Bouscat and Saint-Malo. It’s a first chance. 6 – QUIVIVE et 8 – TRIMLIGHT are highly recommendable judged on what they have done best. 1 – ROMANELLO, 4 – WAITING et 2 – SAGA TIMGAD may also be retained.
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PMU customers – Play on this race
Nicolas Labourasse’s selection
| CHANCES REGULIERES | |
|---|---|
| 6 | QUIVIVE |
| 8 | TRIMLIGHT |
| OUTSIDERS | |
|---|---|
| 1 | ROMANELLO |
| 4 | UNEXPECTED |
| 2 | SAGA TIMGAD |
Summary of the prognosis:
Favorite
3 – ROUVRAY
Falling for something
6 – QUIVIVE
Moment of madness
2 – SAGA TIMGAD
Le pronostic ZEturf.fr
Benefiting from the weight reduction granted to Frida Valle Skar, Romanello can hit the bull’s eye from its first participation in a sale. He will have to pull out all the stops to get rid of Rouraywho gets on well with Maryline Eon, and Unexpected, who disappointed his entourage during his last attempts in handicaps. Pay attention to Yellowblueback in the sellings with Mickaël Barzalona at the maneuver, and at quiviven, who removed a handicap on this course in July. where is it really Saga Timgad ?
The ZEturf.fr selection
| N° | Cheval | Jockey |
|---|---|---|
| 1 | ROMANELLO | VALLE SKAR MLLE F. |
| 3 | ROUVRAY | EON MISS M. |
| 4 | UNEXPECTED | LECOEUVRE C. |
| 5 | YELLOWBLUE | BARZALONA M. |
| 6 | QUIVIVE | GUYON M. |
| 2 | SAGA TIMGAD | MOLINS MME AMB. |
Le pronostic Genybet.fr
Excellent finisher last time in Bordeaux, Rouvray (3) can bring everyone to their senses. Romanello (1) showed commendable regularity in such company. Yellowblue (5) should progress on his comeback.
The Genybet.fr selection
| N° | Cheval | Jockey |
|---|---|---|
| 3 | ROUVRAY | EON MISS M. |
| 1 | ROMANELLO | VALLE SKAR MLLE F. |
| 5 | YELLOWBLUE | BARZALONA M. |
| 4 | UNEXPECTED | LECOEUVRE C. |
| 7 | SOARING EAGLE | DUPORTE Mlle A. |
| 8 | TRIMLIGHT | Tomorrow A. |
| 6 | QUIVIVE | GUYON M. |
| 2 | SAGA TIMGAD | MOLINS MME AMB. |
| 11 | ZHIVAGO | BAILS MISS L. |
| 10 | SAGE DREAM | HARDOUIN E. |
The SEMI deals with novelties regarding complex chronic patients.
Internal medicine doctors Spanish Society of Internal Medicine (SEMI) have participated last Friday and Saturday in the IX Complex Chronic Patient Meeting of the SEMI, to address novelties regarding the approach and management of this type of patient, which is increasingly common in the Internal Medicine Services of the country’s hospitals. In this meeting, it has been revealed that “61 percent of patients admitted to Internal Medicine are already complex chronic and 40 percent are pluripathological”, according to data from the Cronicom study, carried out within the Group of Multipathological and Elderly Patients of the SEMI.
These are patients with a high burden of chronic diseaseusually elderly, frequent fragilitydecrease in personal autonomydeterioration functional y cognitivepolypharmacy, and with high needs for social support and socio-health resources.
Patient pluripathological is one who “has two or more chronic diseases complex that evolve over the years, generally from a group of pathologies that are characterized by producing a significant deterioration in quality of life”. But in pluripathology, in addition, there is usually a special susceptibility y clinical frailty. It is important to identify those patients who have “a frequent demand for care due to exacerbations and the appearance of interrelated pathologies that aggravate their situation, with progressive functional deterioration and a high risk of falling into the dependency and disability cascade.” The latter are complex chronic patients (CCP).
As highlighted at the meeting, the profile of complex chronic and polypathological patients hospitalized in Internal Medicine services changed in recent years. “Now they are older, more functionally impaired, dependent, and have a higher risk prognostic stratification,” he says. Roman Cube Pillarcoordinator of the Group of Multipathological and Elderly Patients of the SEMI and Head of the Internal Medicine Service of the Infanta Cristina University Hospital of Parla
The most prevalent pathologies of chronic patients
The most prevalent pathologies of complex chronic patients with multiple pathologies admitted to the Internal Medicine Services are the diseases heart (68 percent), followed by disease chronic kidney (49 percent), diseases neurological (43 percent) and respiratory (32 percent). In addition, 60 percent have a high degree of dependency for basic activities of daily living (ABCV).
“This population has a high mortality during admissions and, in clinical follow-up, a low quality of life related to perceived health and a high prevalence of dependence on the caregiver. It presents a special susceptibility and clinical fragility that entails the frequent demand for care”, he recalls. Pilar Roman Sanchezinternal medicine member of SEMI and coordinator of the IX Complex Chronic Patients Meeting.
During the course of the meeting, the focus was placed on “the global multidimensional assessment” should be key in dealing with these patients and that “a strategy is needed in which they are truly the center of the system”. “It is the health system, and not the patient, that must adapt to offer the best care and avoid harm to the patient himself. Collaboration with other services, through interdisciplinary teams and, above all, the close and ongoing relationship with Primary Careis the key to keeping complex chronic patients in their place of residence for as long as possible, bringing health care closer to the patient’s home”.
Individualized plans between care levels
In Cubo’s words, “every patient should have a individualized plan and shared between the different levels of care that promotes the empowerment of the patient or their caregiver and specifies the actions to be taken in case of alarm due to possible decompensation”.
In these patients, in addition, Roman recalls that “it is important avoid hospitalization as far as possible since the loss of functionality that occurs during hospitalizations has been demonstrated; promote specific care programs during admission to avoid functional deterioration and avoid fragmentation in multiple consultations that increases the number of hospital visits to the detriment of quality of life and the risk of polypharmacy”.
So much Roman Cube Pillar as Pilar Roman SanchezWith Jesus Diez Manglanopresident of SEMI, have been in charge of inaugurating this IX Meeting of Complex Chronic Patients of SEMIin which they discussed aspects such as the future of Internal Medicine from the perspective of residents and young internists in the specialty, clinical reasoning and decision-making in complex clinical situations, health management and a paradigm shift following pandemic.
Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend the reader that any questions related to health be consulted with a health professional.
We now know the players ranked from 30th (6 ex-aequoi to 25th) to 11th place in the 2022 Ballon d’Or ranking:
11. Heung-Min Son (CDS, 30 ans, Tottenham)
12. Riyad Mahrez (ALG, 31 ans, Manchester City)
13. Sébastien Haller (CIV, 28, Ajax Amsterdam then Borussia Dortmund)
14. Rafael Lion (POR, 23 ans, AC Milan)
14. Fabinho (BRE, 28 ans, Liverpool)
16. Virgil Van Dijk (NLD, 31 ans, Liverpool)
17. Twelve Vlahovic (SER, 22, Fiorentina then Juventus)
17. Luis Diaz (COL, 25, Porto then Liverpool)
17. casemiro (BRE, 30, Real Madrid then Manchester United)
20. Cristiano Ronaldo (POR, 37, Juventus then Manchester United)
21. Harry Kane (ANG, 29 years, Tottenham)
22. Bernardo Silva (POR, 28 ans, Manchester City)
22. Phil The foot (ANG, 22 years, Manchester City)
22. Trent Alexander-Arnold (ANG, 24 years, Liverpool)
25. Darwin Nunez (URU, 23, Benfica then Liverpool)
25. Christopher Nkunku (FRA, 24 ans, RB Leipzig)
25. Joao cancel (POR, 28 ans, Manchester City)
25. Antonio Ruediger (ALL, 29, Chelsea then Real Madrid)
25. Mike Maignan (FRA, 27 years, AC Milan)
25. Joshua Kimmich (ALL, 27 years, Bayern Munich).