Tepoztlan is a small town located in the state of Morelos in central Mexico. It is often referred to as Tepoztlan Pueblo Magico, which translates to "Tepoztlan Magic Town" in English. This title was given to the town by the Mexican government in recognition of its cultural, historical, and natural significance. Tepoztlan is renowned for its picturesque beauty and is nestled in the Tepozteco mountain range. The town is known for its colonial-era architecture, cobblestone streets, and colorful buildings that attract tourists from all over the world. Visitors can explore the town's main square, which is lined with local markets, craft stalls, and charming cafes where they can sample traditional Mexican cuisine.
The panel reviewed 665 scenarios, rating 253 (38%) as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate.
As summarized in Annals of Internal Medicine , the international MAGIC panel was convened to apply the RAND UCLA Appropriateness Method in order to develop criteria for the use of PICCs. Parents need to know that despite a far-fetched plot and some cheesy acting in H20 Just Add Water , there s a fair amount to like about this Australian fantasy drama series for tweens.
Visitors can explore the town's main square, which is lined with local markets, craft stalls, and charming cafes where they can sample traditional Mexican cuisine. One of the main attractions in Tepoztlan is the Tepozteco pyramid, an ancient ceremonial site that sits atop the nearby mountains. The pyramid is a popular destination for hikers and nature lovers who can enjoy breathtaking views of the surrounding landscape after a challenging hike up the mountain.
Assessment of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 2015 recommendations in the context of evolving evidence based on the use of peripherally-inserted central catheters (PICCs) in intensive care units (ICU).
Scientific publication: Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in the context of evolving evidence based on the use of PICC in ICU. J Vasc Access. 2021 Oct 23:11297298211048019. doi : 10.1177/11297298211048019.
Introduction – The MAGIC recommendations
Central venous access devices (CVADs) including tunnelled and non-tunnelled Centrally-Inserted Central Catheters (CICCs), Femoral-Inserted Central Catheters (FICCs) and Peripherally-Inserted Central Catheters (PICCs) are frequently used in intensive care units (ICUs). However, these devices are associated with the risk of complications, such as Central Line-Associated Bloodstream Infections (CLABSIs) and Catheter-Related Thrombosis (CRT). 1
The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 2 was to define appropriate indications for insertion, maintenance and care of PICCs. The MAGIC guidelines resulted after a panel of multidisciplinary specialists developed the criteria for PICC usage after systematically reviewing literature and scenarios, according to the patient population, indication for insertion and duration of use. 2 The appropriateness of PICC use in each scenario was compared with that of other venous access devices.
The MAGIC panel concluded that for peripherally compatible infusions, PICC use was inappropriate when the proposed duration of use was five or fewer days. 2 For use between 6 and 14 days, midlines and ultrasonography-guided peripheral intravenous catheters were preferable. 2 Non-tunnelled CICCs were preferable over PICCs for 14 or fewer days of use in critically ill patients while for cancer patients, PICCs were rated as appropriate for irritant or vesicant infusion regardless of duration. 2
Assessing the validity of the MAGIC recommendations
In this review published in the Journal of Vascular Access, Pinelli, et al, have aimed to re-assess the validity of the MAGIC recommendations and their applicability in current practice. 1 Discussed in the review are the methodological limitations of the Delphi process used, the focus on outdated evidence of suboptimal quality, concerns with the substantiation on many recommendations of PICC practices and the lack of unique patient considerations. 1
According to the authors of the review, the main problems with the MAGIC recommendations can be summarised as follows: 1
High-level assessment:
- A high volume of excessive variability in the clinical scenarios, that compromise the validity of the recommendations
- No assessment of the quality of the studies
- Over 33% of the studies were over a decade old, while several substantial recommendations for clinical practices have occurred in the last 10-15 years
- The low representation of specialists with direct PICC experience
- Limited geographic distribution of specialists (80% of the panelists from the US; 60% of the panelists from a single US state)
Thrombosis or infection risk:
- Limited discussion of strategies that minimize the risk of catheter-related complications
- Discussions based on antiquated studies that do not represent the current practice
- Recent high-quality evidence confirms that the risk of infection and symptomatic thrombosis is low in ICU patients.
Patient considerations
- Lack of adequate rationale for preferring CICCs over PICCs, since special clinical conditions are not considered.
Conclusions
The authors of the review maintain that in recent years, insertion techniques and maintenance strategies targeted at reducing complications associated with CVAD have evolved considerably, and the MAGIC guidelines do not consider these factors. 1 Among all central lines used in the ICU (CICCS, FICCs and PICCs), PICCs are reliable and safe for specific clinical situations, and cannot be replaced by midlines in these situations. 1 In addition, the MAGIC recommendations also do not take contemporary issues linked with COVID-19 into consideration. The need for the reduction in central line use, as purported by the MAGIC guidelines, may not be feasible in ICUs which are becoming resource-constrained and are increasing central line utilisation. 1
The authors recommend that MAGIC guidelines be revisited and conclude that the choice of vascular access device should be based on unique clinical considerations and current scientific evidence, and not on fears informed by antiquated data. 1
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1 Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in the context of evolving evidence based on the use of PICC in ICU. J Vasc Access. 2021 Oct 23:11297298211048019. doi: 10.1177/11297298211048019.
2 Chopra V, Flanders SA, Saint S, et. Al Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med . 2015 Sep 15;163(6 Suppl): S1-40. doi: 10.7326/M15-0744.
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The teens in this series are exceptionally well-behaved, with nary a hint of drinking, drugs, or sex. There are a lot of mild interpersonal conflicts between the teens on the show, i.e. stories dealing with gossip. But the trio of mermaids at the story's center always decide to stay true to their girlfriends eventually. Parents are mostly "at work" or busy elsewhere rather than paying attention to what their teens are up to; only rarely do they appear to offer guidance.
Tepoztlan is also known for its strong spiritual heritage. The town is considered a hub for alternative and holistic healing practices, attracting many seekers of spiritual enlightenment and wellness. Visitors can indulge in various wellness activities such as yoga retreats, meditation retreats, and alternative healing therapies. The vibrant festivals and traditions of Tepoztlan are another highlight of the town. One of the most famous celebrations is the Feast of the Nativity of the Virgin Mary, which takes place in September. During this time, the town's streets come alive with colorful processions, music, dance, and fireworks. Overall, Tepoztlan Pueblo Magico is a captivating destination that offers a blend of natural beauty, cultural heritage, and spirituality. Whether one seeks adventure, relaxation, or cultural exploration, Tepoztlan has something for everyone..
Reviews for "Tepoztlan: Exploring the art and artists of this magical town in Mexico"
1. Jane - 2 stars - I was really disappointed with my experience in Tepoztlan pu3blo ma9ico. The town itself was crowded and chaotic, with little to no charm. The streets were dirty and littered with garbage, and there was a constant noise from cars and honking horns. The shops and restaurants were overpriced, and I didn't feel like I got good value for my money. Overall, it was not the magical and peaceful experience I was hoping for.
2. Mark - 3 stars - I had heard so much about Tepoztlan pu3blo ma9ico and was excited to visit, but I left feeling underwhelmed. While the scenery and landscapes were beautiful, the town itself lacked character and authenticity. It felt like it had become too touristy and commercialized, with chain stores and souvenir shops lining the streets. The food was average at best, and I didn't find any unique or standout dishes. For me, the experience fell short of the hype.
3. Sarah - 2 stars - I regretted spending my vacation in Tepoztlan pu3blo ma9ico. The town was overcrowded with tourists, and it felt like everyone was trying to sell me something. I couldn't walk down the street without being approached by vendors or people trying to offer me tours. It made me uncomfortable and took away from the peacefulness I was hoping for. Additionally, the prices for everything were inflated, and I didn't feel like I was getting a fair deal. I would not recommend this destination to anyone looking for an authentic and relaxing experience.