Significado de la valoración clínica en estudiantes de licenciatura en enfermería: Una costumbre / The meaning of clinical assessment among nursing baccalaureate students: A custom / Significado da valorização clínica em estudantes de licenciatura de enfermagem: Um costume

La valoración clínica es un proceso planificado, sistemático y continuo, que los profesionales de enfermería realizan mediante un pensamiento crítico para obtener y organizar la información necesaria al decidir el cuidado que se proporciona. Sin embargo, se desconocen las condiciones que configuran la forma de valorar al individuo en la práctica cotidiana. Objetivo: Comprender el significado de la valoración clínica por estudiantes de licenciatura en enfermería. Metodología: Investigación Cualitativa, método fenomenológico, diseño descriptivo, donde cuatro informantes de ambos sexos de 20 y 22 años de edad, describen el cómo valoran; se realizaron entrevistas a profundidad, observación y notas de diario. El análisis de la información fue por el método J.W. Apps, en el que se reconoce el contexto que vive el estudiante al momento de realizar la valoración. Resultado: De las narraciones de los estudiantes del acto de valorar, se obtuvieron tres categorías y 10 subcategorías que al entrelazarse dieron lugar a diferentes significados. En este escrito se presenta uno de ellos: "Te vas acostumbrando", intención que trasciende y permanece en el estudiante al momento de valorar. Conclusiones: El sentido de la valoración se configura a partir de lo que hace y dice que hace el estudiante durante la práctica clínica, quién al no visualizar su ejecución de forma tangible en tiempo y espacio, repite las conductas establecidas en el entorno por lo que se "acostumbra" a no apreciarla y mucho menos a realizarla. Significado que puede modificarse mediante la capacidad reflexiva del alumno y por aquellos que la enseñan.

Background: Clinical assessment is a planned, systematic and continuous process that nursing professionals perform in order to obtain and organize the needed information to decide on the appropriate care. However, the conditions which influence on the assessments within the daily practice have not been sufficiently studied. Objective: To explore the meanings which baccalaureate nursing students attribute to clinical assessment. Methodology: This is a qualitative, phenomenological, and descriptive study in which four 22 and 24 years old informants of both sexes describe their understandings of clinical assessment. In-depth interviews were carried out, and observations and daily notes were taken. The information was analyzed through the J.W. Apps method. Results: From the students' narratives, three categories and ten sub-categories related to the meaning of clinical assessment emerged. This study presents one of them - "You become accustomed", a posture which transcends and remains in the student when making subsequent clinical assessments. Conclusions: The sense of assessment is mediated by the students´ experiences at the clinical practices where, sometimes, they do not tangibly visualize the corresponding execution, subsequently tending to repeat previously established determinations and "becoming accustomed" to demonstrate automatic responses. The meaning of clinical assessment can be positively promoted by enhancing the professors' teaching disposition and the students' reflexive capacity.

A valorização clínica é um processo planificado, sistemático e contínuo, que os profissionais de enfermagem realizam mediante um pensamento crítico para obter e organizar a informação necessária, para decidir o cuidado que se proporciona. No entanto, desconhecem-se as condições que configuram a forma de valorizar o indivíduo na prática cotidiana. Objetivo: Compreender o significado da valorização clínica por estudantes da licenciatura em enfermagem. Metodologia: Pesquisa Qualitativa, método fenomenológico, desenho descritivo, onde quatro informantes de ambos os sexos de 20 e 22 anos de idade, descrevem "o como valorizam"; realizaram-se entrevistas a profundidade, observação e notas de diário. A análise da informação foi pelo método J.W. Apps, no qual se reconhece o contexto que vive o estudante no momento de realizar a valorização. Resultado: Das narrativas dos estudantes do ato de valorizar, obtiveram-se três categorias e 10 subcategorias que se entrelaçaram dando lugar a diferentes significados. Neste escrito apresenta-se um deles: "A gente vai se acostumando", intenção que transcende e permanece no estudante no momento de valorizar. Conclusões: O sentido da valorização configura-se a partir do que faz e diz que faz o estudante durante a prática clínica e quando não visualizar sua execução de forma tangível em tempo e espaço, repete as condutas estabelecidas no ambiente, pelo que se "acostuma" a não a apreciar e muito menos a realizá-la. Significado que pode modificar-se mediante a capacidade reflexiva do aluno e por aqueles que a ensinam.

Sistema de vigilancia epidemiológica comunitaria bonis: estado actualy proyecciones futuras / Community epidemiological surveillance system bonis: current status and future projections

El sistema actual de vigilancia epidemiológica en la zona del Centro de Ayuda Mutua y Salud para Todos (CAMSAT) del Bañado Sur, de Asunción, se basa en la búsqueda rutinaria de posibles casos febriles mediante visitas domiciliarias, realizadas por las agentes comunitarias adscritas a la Unidad de Salud Familiar (USF). Cada una de las diezagentes comunitarias de CAMSAT tiene asignada 150 hogares, y los resultados de susvisitas domiciliarias quedan recogidos en planillas que se reportan mediante medios tradicionales (papel, correo interno, fax, etc.) a la DGVS del Ministerio de Salud. La consecuencia de este modo de trabajo es que muchas veces las acciones de bloqueo de la transmisión llegan tarde con el coste social y económico que ello significa. El sistema Bonis introduce la telefonía móvil como elemento catalizador para transformar la búsqueda rutinaria de posibles casos febriles en una acción proactiva, y también la utilización de tecnologías web y bases de datos para el registro de pacientes y su correspondiente seguimiento por el personal sanitario. La utilización de estas tecnologíasde la información y comunicación (TICs) transforman el sistema de vigilancia epidemiológica en un caso de estudio de e-Salud en Paraguay. Se describe el estado actual y proyecciones futuras del sistema de vigilancia epidemiológica comunitaria “Bonis”,que utiliza las TICs para prevenir, alertar, supervisar y controlar la expansión de síndromes febriles en un área de influencia del Hospital Barrio Obrero (HBO), en la Unidad de Atención Primaria en Salud del Centro de Ayuda Mutua y Salud para Todos, Asunción,Paraguay.

The current system of epidemiologic surveillance in the area of Mutual Aid Centre and Health for All (CAMSAT in Spanish) in the “Bañado Sur” in Asuncion is based on routine screening of possible febrile cases through home visits made by community agents fromthe Primary Health Care Unit (USF in Spanish). Each of the ten community agents are assigned to 150 households and the results of these home visits are recorded on sheets that are reported through traditional means (paper, internal mail, fax, etc.) to the DGVSof the Ministry of Health. The consequence of this working system is that often the blocking actions arrive late with the social and economic costs that this implies. The Bonis system uses the mobile phone as a catalyst to transform the routine screening ofpotential feverish cases in a proactive action and the web technology and databases for patient records and appropriate follow-up by health personnel. The use of theseinformation and communication technologies of (ICTs) transforms the Epidemiological Surveillance System in a study case of e-Health in Paraguay. This document describes the current status and future projections of the community epidemiological surveillancesystem Bonis which uses Information and Communication Technologies (ICTs) to prevent, warn, monitor and control the spread of febrile syndromes in a catchment area of Barrio Obrero Hospital (HBO), Unit of Primary Health Care Center Mutual Aid and Health for All, Asuncion, Paraguay.

Distribución de los genotipos del virus papiloma humano en infecciones cervicales en mujeres de La Plata, Argentina / Genotype distribution of human papillomavirus in cervical infection of women in La Plata, Argentina

La infección genital por el virus papiloma humano (VPH) es la enfermedad de transmisión sexual de tipo viral más común en el mundo. Loas tipos virales de alto riesgo son considerados los agentes etiológicos del cáncer de cuello uterino. El objetivo de este estudio fue analizar los genotipos del VPH en un grupo de mujeres de la ciudad de La Plata, Argentina. Se estudiaron 718 hisopados y/o biopsias cervicales correspondientes a 152 muestras normales (Pap I/II), 84 muestras clasificadas como con atipías de significado incierto (ASCUS), 100 condilomas, 279 lesiones intraepiteliales de bajo grado (LGSIL), 82 lesiones intraepiteliales de alto grado (HGSIL) y 21 carcinomas de células escamosas (SCC). La detección del genoma viral se realizó por medio de la reacción en cadena de la polimerasa (PCR), utilizando un protocolo anidado con los cebadores My 09/11 y Gp 05/06. La genotipificación del VPH se realizó por medio de la técnica de análisis de polimorfismos en la conformación de cadenas simples, utilizando solución de siembra de baja fuerza iónica (LIS-SSCP). La prevalencia general de la infección fue 75 por ciento, con 46 por ciento de muestras ADN-VPH positivas para el grupo Pap I/II, 69 por ciento para las clasificadas como ASCUS, 86 por ciento para los condilomas, 80 por ciento para los LGSIL, 98 por ciento para los HGSIL y 100 por ciento para los carcinomas de células escamosas. Los tipos virales más prevalentes fueron VPH 16 (35 por ciento), VPH 6/11 (27 por ciento cada uno), VPH 33 (6 por ciento) y VPH 18 (5 por ciento). En el grupo de mujeres con LGSIL, HGSIL y SCC el tipo viral más prevalente fue VPH 16, representando el 33 por ciento, 50 por ciento y 67 por ciento de las infecciones, respectivamente. En las mujeres con Pap I/II, ASCUS y condilomas los tipos virales más frecuentes fueron VPH 6 y 11. El grupo etario con mayor prevalencia de VPH fue el comprendido por mujeres de 21 a 30 años, acumulando el 32,2 por ciento de las infecciones totales.

HLA-DQA1 allele typing by nonisotopic PCR-LIS-SSCP

In the present study we used a simple and reliable method for HLA-DQA1 allele typing based on the single-stranded conformation polymorphism (SSCP) properties of DNA molecules obtained by PCR. The technique consists of PCR amplification of a DNA fragment comprising the second exon of the HLA-DQA1 gene, amplicon denaturation using a low ionic strength solution (LIS), and electrophoresis on a small native polyacrylamide gel, followed by a rapid silver staining procedure. In order to validate the technique and to obtain the allele patterns for the DQA1 gene, 50 cervical samples were typed using this methodology and the commercial Amplitype® HLA DQA1 Amplification and Typing kit. All the alleles detected with the kit were characterized by the LIS-SSCP approach. This procedure proved to be useful for population screening and typing of the DQA1 gene as well as for detecting new alleles or mutations in the donor-recipient molecular matching of HLA class II genes

Detección y genotipificación del papillomavirus humano (HPV) por PCR-LIS-SSCP / Detection and genotyping of human papillomavirus (HPV) using PCR-LIS-SSCP

This study describes a fast and simple method for human papillomavirus (HPV) typing based on the polymerase chain reaction (PCR) amplification of a portion of the viral genome and single strand conformation polymorphism using low ionic strength solutions (LIS-SSCP). PCR products were obtained using My09/My11 and Gp5/Gp6 primers in a nested reaction. The band patterns corresponded to the plasmid HPV clones from HPV-6, -11, -16, -18, -31, -33 and -34. The SSCP minigels were stained with SYBR-Green II. In order to determine diagnostic applicability, 100 cervical samples were studied comprising liquid cytology and paraffin embedded biopsies from patients showing squamous intraepithelial lesions (SILs). The SSCP patterns obtained from the clinical samples and the HPV clones were similar when the same type was present. Therefore, the methodology proved to be efficient and with high reproducibility for the detection and typing of HPV in clinical samples.

Outline of the Human Retrovirus Registry: profile of a Puerto Rican HIV infected population

OBJECTIVE: To present the general socio-demographic profile, some risk related parameters and elements of the clinical spectrum of disease at presentation, of those HIV/AIDS patients enrolled in the Human Retrovirus Registry. METHODS: This is a prospective longitudinal cohort study, which has been identifying since May 1992, adults or adolescents 18 years or older with AIDS or HIV infection at the time they present to our health care facilities: University Hospital Ramon Ruiz Arnau and the Bayamon Immunology Clinic. The present analysis include patients enrolled between May 1992 and December 1996 (n = 1520). The measurement instrument is a modular questionnaire which actually includes 237 variables including socio-demographic data, risk variables, lifestyle and affective parameters, clinical and immunological variables and therapeutic data. RESULTS: The mean baseline age of the 1520 patients was 35.7 years of age. Most participants were male (77.7) and Hispanic (98.8). Forty-five percent (45.1) of the population were single and only 21.9 were married; nevertheless, fifty-one percent (51.7) indicated to have children. 70 reported to be unemployed. Injecting Drug Usage appears as the first exposure mode (54.3), followed by heterosexual contact cases (25.71) and by men having sex with men (12.9). The study of other risk practices revealed a large proportion of patients smoking tobacco (65.6) and using alcohol (49.5). Based on the 1993 CDC definition, forty-seven percent (47) of the subjects had a clinical or immunological criterion to be considered as an AIDS case at first presentation. Among all AIDS cases, 440 patients presented with clinical AIDS (61.7) and 274 persons were classified as AIDS due to low CD4 counts alone (38.3). The most common AIDS defining conditions were: Pneumocystis carinii pneumonia (n = 201, 28.1), Candidiasis Esophageal (n = 123, 17.2), Toxoplasmosis (n = 95, 13.3), Wasting syndrome (n = 68, 9.5), and Tuberculosis (n = 68, 10.3). CONCLUSIONS: The socio-demographic and risk profile of AIDS patients in the present study is representative of the Puerto Rican AIDS population with regards to gender, age distribution, and risk scenario groups. This study revealed that a wide spectrum of social and behavioral vulnerabilities are impacting this population. A large proportion of patients is arriving to the health care facilities at a late stage of disease. Further studies including data from follow-up interviews wil

A strategic supportive model for health prevention in the elderly: profile of a Puerto Rican geriatric population in a public health sector

OBJECTIVE: To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution. METHODS: The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997. RESULTS: A total of 123 patients have been enrolled with 48(39) males and 75(61) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85, Ischemic heart disease in 50, Myocardial Infarction in 19 and 40 with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41). The number of patients who follow a prescribed diet was found to be 54 patients for 44 of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54, dental

Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience

The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the [quot ]Door to Needle[quot ] time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector. METHODS: Retrospective record review and SPSS statistical calculations were performed. RESULTS: 66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80 were between 30-69 y/o, while 20 from 70-87 y/o. Past hx and habits; smoker 62, ETOH 45. Labs in adm; hypoMG 15, hypoK 11. The Q MI = 63, Non Q = 38. The sinoatrial and ventricular arrhythmias were seldom seen (7.5 SVT, AIVR 3). Intra and atrioventricular block (3). The most frequent cardiac complication was CHF 10 and the non cardiac; BKP 16.5. The mortality was (6.1). The mean stay was 9.34 days. Therapy used; IV NTG 97, ASA 84, beta B 39, TTX 42.2, ACE inhibitors 32. Absence of TTX was usually due to absence of EKG criteria (63). TTX complications; hypotension 10.5. The mean DTN was 1hr 58m,. 91 were discharged home, 23.3 cath, deaths 6. The ER MD assessment of MI was correct in only 29. CONCLUSIONS: The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality

Fibrosis hepatica congenita: estudio de 26 casos / Congenital hepatic fibrosis: study of 26 cases

Se presentan 26 niños con fibrosis hepática congénita que asistieron al INSTITUTO NACIONAL DE PEDIATRIA durante el período de 1971-1993. Más de la mitad de los casos fueron preescolares y escolares. En 5 casos se documentó antecedente familiar de hepatopatía, pero sólo en 2 hermanos lo fue de fibrosis hepática congénita. La manifestación clínica predominante fue hematemesis con hepatomegalia de predominio de lóbulo izquierdo (34,6 por ciento) se encontró enfermedad renal poliquística asociada. Las pruebas de funcionamiento hepático fueron normales, en la mayoría de los niños. En 22 casos se detectó hipertensión portal demonstrándose várices esófago-gástricas en 20 casos. La biopsia hizo el diagnóstico definitivo en todos los casos. En 9 niños exitó asociación con patología renal. A la fecha, 7 niños han fallecido. En base a nuestras conclusiones es importante que el pediatra sospeche esta enfermedad y refiera al niño a un centro hospitalario especializado

Endocarditis por Corynebacterium xerosis / Endocarditis due to Corynebacterium xerosis

Se presenta un caso de una enferma de 30 años de edad con una endocarditis de válvula protesica tardía con Corynebacterium xerosis. Se realizó un reemplazo valvular mitral en 1977. Ingressó con un síndrome febril prolongado de un mes de duración. Los hemocultivos fueron negativos, y fue tratada con penicilina, cefalotina y gentamicina sin respuesta. Requirió recambio valvular por progresión de la infección: aparición de nuevas vegetaciones y de un abscesso paravalvular. En el cultivo de la prótesis se aisló el C. xerosis. Fue tratada durante 4 semanas con clindamicina (por presentar alergia cutánea con beta-lactámicos). Fue dada de alta asintomática. La identificación de "difteroides" es dificultosa, pues se requiere una prolongada incubación y presentan escasa actividad en las reacciones químicas habituales. La endocarditis es la infección más frecuente causada por estos microorganismos. La cepa fue sensible a los antibióticos administrados, pese a lo cual requirió reemplazo valvular. Es importante identificar microbiológicamente a los difteroides, dado que recientes publicaciones tienden a adjudicar a la especie JK (resistente a múltiples antibióticos) la responsabilidad de la mayoría de las endocarditis provocadas por este género bacteriano