Eficacia de la hidroterapia frente al tratamiento en gimnasio en prótesis total primaria de rodilla por osteoartritis: ensayo controlado y aleatorizado / Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: a randomized controlled trial

Fundamento: La fisioterapia se postula como un tratamiento eficaz tras la intervención de prótesis total derodilla (PTR) por osteoartritis. El objetivo fue valorarla eficacia de la hidroterapia frente a la cinesiterapia engimnasio durante la segunda fase de la rehabilitación depacientes intervenidos de PTR en relación a la mejora deltest de la marcha, el dolor, la rigidez, el balance articular,la fuerza muscular y la inflamación. Método: Se realizó un ensayo controlado y aleatorizado.Los pacientes intervenidos de PTR recibieron una primerafase rehabilitadora (15 sesiones de 60 minutos) en el gimnasio. En la segunda fase (15 sesiones de 40 minutos), ungrupo realizó fisioterapia en gimnasio y otro en piscina.Se valoraron (basal, tras 15 y tras 30 sesiones): capacidadfuncional, dolor y rigidez con índice WOMAC, balance articular con goniómetro, fuerza muscular con escala Lovett,y test de la marcha de 6 minutos. Resultados: Participaron 115 pacientes, 59 (51,3 %) en grupo sala y 56 (48,7 %) en grupo piscina. Tras la segunda fasede rehabilitación se observaron mejoras clínicas superiores en el grupo piscina, siendo las diferencias estadísticamente significativas respecto al dolor (p = 0,005), rigidez(p = 0,010), balance articular flexión (p = 0,027) y fuerzamuscular (p = 0,049) en la rodilla intervenida, y en el testde la marcha de 6 minutos (p = 0,002). Conclusiones: En pacientes intervenidos de PTR, la hidroterapia durante la segunda fase del tratamiento rehabilitador fue más eficaz que la fisioterapia en gimnasio enrelación a la mejora del dolor, rigidez, balance articular,fuerza muscular y resultado del test de la marcha.(AU)

Background: Physiotherapy is postulated as an effective treatment after total knee arthroplasty (TKA) due toosteoarthritis. The aim was to assess the efficacy of hydrotherapy versus gym kinesitherapy during the secondphase of treatment in TKA patients, with regard to theimproved gait test, pain, stiffness, joint balance, musclestrength and inflammation. Methods: A controlled and randomized trial was carriedout. TKA patients received a first rehabilitative phase (1560-minutes sessions) at the gym. In the second phase (1540-minute sessions), one group performed physiotherapyin a gym and another in a swimming pool. Different variables were assessed (basal, after 15 and after 30 sessions):functional capacity, pain and stiffness with WOMAC index, joint balance with goniometer; muscle strength withLovett scale, and result of 6-minute gait test. Results: A total of 115 patients participated, 59 (51.3%)in the gym group and 56 (48.7 %) in the pool group. After the second phase of rehabilitation, higher clinical improvements were observed in the pool group, with statistically significant differences in pain (p = 0.005), stiffness(p = 0.010), joint balance (p = 0.027) and muscle strength(p = 0.049) in the operated knee, and in the result of the6-minute gait test (p = 0.002). Conclusions: In TKA patients, hydrotherapy during thesecond phase of rehabilitative treatment was more effective than gym physiotherapy in terms of improved pain,stiffness, joint balance, muscle strength and gait testing.(AU)

Perspectives of intensive care nurses on open visits in an ICU.

OBJECTIVE: To determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. METHOD: A cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. RESULTS: 101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. CONCLUSIONS: Most of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

[Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: a randomized controlled trial].

BACKGROUND: Physiotherapy is postulated as an effective treatment after total knee arthroplasty (TKA). The objective of the study was to assess the efficacy of hydrotherapy versus gym kinesitherapy during the second phase of treatment in TKA patients, with regard to the improved gait test, pain, stiffness, joint balance, muscle strength and inflammation. METHODS: A controlled and randomized trial was carried out. TKA patients received a first rehabilitative phase (15 60-minutes sessions) at the gym. In the second phase (15 40-minute sessions), one group performed physiotherapy in a gym and another in a swimming pool. Different variables were assessed (basal, after 15 and after 30 ses-sions): functional capacity, pain and stiffness with WOMAC index, joint balance with goniometer; muscle strength with Lovett scale, and result of 6-minute gait test. RESULTS: A total of 115 patients participated, 59 (51.3%) in the gym group and 56 (48.7?%) in the pool group. After the second phase of re-habilitation, higher clinical improvements were observed in the pool group, with statistically significant differences in pain (p?=?0.005), stiffness (p?=?0.010), joint balance (p?=?0.027) and muscle strength (p?=?0.049) in the operated knee, and in the result of the 6-minute gait test (p?=?0.002). CONCLUSIONS: In TKA patients, hydrotherapy during the second phase of rehabilitative treatment was more effective than gym physiother-apy in terms of improved pain, stiffness, joint balance, muscle strength and gait testing.

Perspectivas de los profesionales de enfermería de cuidados intensivos sobre las visitas abiertas en una UCI / Perspectives of intensive care nurses on open visits in an ICU

Objetivo Conocer la opinión de los profesionales de enfermería de una Unidad de Cuidados Intensivos Polivalente (UCI) respecto a los efectos de la visita abierta en el paciente, en la familia y en la actividad diaria de los profesionales, así como sus aportaciones a la actual política de visitas abiertas. Método Estudio transversal, descriptivo, mediante muestreo discrecional no probabilístico. La muestra estuvo formada por profesionales de enfermería de la citada Unidad. Se les entregó un cuestionario con 26 ítems, desarrollado y adaptado por Marco et al., además de una pregunta abierta. Resultados La tasa de participación fue del 84% de los profesionales de la unidad (101/120). El 75,2% manifestó que el equipo de enfermería tiene que posponer o modificar su trabajo debido a la presencia de la familia y el 89,9% que su presencia produce una carga física y psíquica al personal. El 80% pensaba que la visita agota a la familia y el 84,2% que la familia se siente obligada a permanecer con el paciente. El 94% opinó que el efecto de la presencia de la familia depende del paciente y de la familia. Conclusiones La mayoría de los profesionales han tenido una opinión negativa hacia la política de visitas abiertas, mostrando cierta reticencia a la hora de flexibilizar los horarios de visita; aunque admitieron que un horario sin restricciones en este tipo de unidades supone cierto grado de beneficio para el paciente y la familia. (AU)

Objective To determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. Method A cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. Results 101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. Conclusions Most of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family. (AU)

Perspectives of intensive care nurses on open visits in an ICU. / Perspectivas de los profesionales de enfermería de cuidados intensivos sobre las visitas abiertas en una UCI.

OBJECTIVE: To determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. METHOD: A cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. RESULTS: 101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. CONCLUSIONS: Most of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos / Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit

Introducción: La traqueotomía es una técnica habitual en las Unidades de Cuidados Intensivos (UCI). Es sabido que los cuidados enfermeros durante y posteriores al procedimiento están directamente relacionados con el éxito del mismo, minimizando el riesgo de aparición de complicaciones como la infección del estoma y favoreciendo la adecuada evolución del paciente crítico. Objetivos: Comparar la incidencia de infección en las traqueotomías realizadas en UCI según el antiséptico empleado: cura con polihexanida (PLX) y cura con suero fisiológico + povidona yodada (PY). Material y método: Ensayo experimental, aleatorizado y abierto, realizado en una UCI polivalente de 32 camas durante 2 años. El estudio fue aprobado por el Comité Ético de Investigación del Principado de Asturias. Resultados: La tasa observada de infecciones por 100 pacientes-día de traqueotomía fue de 1,34 (IC del 95%, 0,81-2,01): 1,46 en PLX y 1,21 PY (p valor 0,685). Conclusiones: A pesar de que el tratamiento experimental (PLX) ha mostrado su eficacia en otro tipo de heridas, en nuestro estudio no se encontraron diferencias significativas entre esta técnica y la estándar. Dado que no existe un registro nacional de incidencia de infección asociada a traqueotomías, no se puede saber si la observada está dentro de los parámetros habituales

Introduction: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. Objectives: To compare the use of polyhexanide (PLX) versus saline + povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. Material and method: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. Results: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). Conclusions: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters

[Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit]. / Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos.

INTRODUCTION: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. OBJECTIVES: To compare the use of polyhexanide (PLX) versus saline+povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. MATERIAL AND METHOD: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. RESULTS: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). CONCLUSIONS: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters.

[Indications for BCG in surface tumors of the bladder]. / Indicaciones de la BCG en los tumores superficiales de vejiga.

Overall view of Bacille de Calmette-Guerin (BCG) immunotherapy in the prophylaxis and treatment of surface cancer of the bladder. A series of issues, on some of which a consensus has been reached while controversy is still frequent in others are discussed. Intravesical instillation of BCG as the single route has been considered to best mode of administration. With regard to the BCG strain to be used, there is still no consensus after the analysis of the data provided by the studies conducted. Relative to the treatment schedule, it appears clear that maintenance therapy is superior to an exclusively induction regime. No consensus has been reached about optimal dosage or the possibility to reduce toxicity. Although some studies support the belief that intravesical immunotherapy with BCG is superior to chemotherapy, further data is required to confirm such assumption. In conclusion, although treatment with BCG has proven to be effective in patients with surface tumours of the bladder, it should not be considered a panacea to be indiscriminately used in any patient with this malignancy.