Dificultades de los enfermeros para investigar en úlceras por presión y heridas crónicas. Un estudio cualitativo / Difficulties of the nursing personnel in the investigation of pressure ulcers and chronic wounds. A qualitative study

Introducción y objetivo. Los enfermeros que se deciden a investigar han de enfrentarse a diversos obstáculos y dificultades, tanto generales como personales e institucionales. El objetivo de nuestro estudio es explorar los obstáculos y dificultades de los enfermeros y enfermeras para la investigación en úlceras por presión (UPP) y heridas crónicas a través de las opiniones / percepciones de estos profesionales. Sujetos, material y método. Metodología cualitativa a través del estudio de caso, con recogida de datos por entrevista no estructurada a 11 enfermeros con actividad investigadora en lesiones de piel compaginada con su actividad asistencial en el ámbito de la provincia de Cádiz. El análisis de los datos se realizó con la técnica del análisis cualitativo de contenido. Resultados. Dentro de las dificultades para investigar destacamos 4 temas: 1. Apoyo y reconocimiento: falta de ayuda institucional y de colaboración por los compafieros; 2. Financiación: escasez de ayudas económicas; 3. Formación en investigación: carencias en formación y falta de consenso en el tema de las UPP; 4. Vida personal: ausencia de tiempo institucional para investigar y aparición de frustración. Conclusiones. La investigación en enfermería es la principal estrategia de transformación profesional. Se hacen necesarias la promoción y puesta en práctica de las líneas y estrategias de trabajo encaminadas a favorecer y facilitar el trabajo investigador de los profesionales motivados (AU)

Valoración de úlceras por presión y heridas crónicas. Un modelo de hoja de registro en Atención Primaria / Assessment of pressure ulcers and chronic wounds. A model of record sheet in primary care

La evaluación integral a pacientes con úlceras de piel -úlceras por presión (UPP) y heridas crónicas- precisa de una valoración del paciente, del entorno de cuidados y de la lesión. Atendiendo a éste último aspecto, es necesario seguir una metodología sistemática y ordenada, por lo que han de utilizarse documentos sencillos, concretos, fáciles de manejar y rápidos de cumplimentar que aporten la información necesaria e indispensable. Con este objetivo nos planteamos la elaboración de una "Hoja de Registro de UPP y heridas crónicas" para su utilización en Atención Primaria de Salud. Presentamos en este artículo la descripción de este sistema de registro de 2 páginas de extensión, con ítems abiertos y cerrados, con claves codificadas para respuestas y formato gráfico y dinámico; este documento nos permite describir las características de la lesión y recoger la actividad preventiva y/o terapéutica en las UPP de una manera ágil, clara y concisa, ayudando a mejorar la eficacia de los cuidados de las lesiones de piel (AU)

[Cutaneous cysts, minor surgery]. / Quistes cutáneos.

For the nursing profession, the practice of minor surgery means the recovery of an activity which possesses a long historical tradition in our profession and an experience for nurses to provide a specific service in health care. The incorporation of minor surgery as one of the services offered by Primary Outpatient Clinic Care is taking place slowly but surely, especially in light of the advantages it provides. For several years now, some health professionals, nurses and doctors belonging to the Andalucian Health Services, have been actively working on the development and implementation of Minor Surgery Programs inside the Health Clinics of our community. One of our lines of work has been the development of protocols for the treatment of the most habitual lesions by means of minor surgery. Among these are cutaneous cysts whose protocol we present in this article.

Nociones básicas acerca de las úlceras por presión y su prevención: una guía para los cuidadores familiares / Basic notions about pressure ulcers and their prevention: a guide for home care workers

Las úlceras por presión (UPP) constituyen un importante problema de salud para todos los niveles asistenciales. Su aparición origina serias repercusiones en distintos ámbitos, por lo que es necesario el uso de medidas y estrategias de prevención. En Atención Primaria la familia desarrolla un papel determinante en el cuidado de la salud, incrementándose cuando hablamos de pacientes incapacitados. A través de programas de formación se pretende promover y fomentar la participación del paciente y la familia en su autocuidado, en aspectos como la higiene, nutrición, ocio y tiempo libre,... y UPP. Como parte del material complementario de estos programas, hemos desarrollado una guía para cuidadores familiares de pacientes inmovilizados en su domicilio donde se exponen las nociones básicas acerca de las UPP y las actividades tendentes a su prevención. Dicha Guia, eminentemente gráfica y caracterizada por su sencillez, brevedad y fácil comprensión, pretende facilitar la enseñanza y aprendizaje de los conceptos elementales en este tema y servir como material de apoyo a los cuidadores (AU)

[Prevention and treatment of pressure ulcers. A plan for self-care]. / Prevención y tratamiento de las úlceras por presión.

Decubitus ulcers present a real challenge to health care workers. Primary care nurses, in particular, are faced with special considerations when treating a patient in his or her home. For them, it is often necessary to adapt or design treatments to meet the particular circumstances of the patient. Within their Home Health Program, the authors have developed a self care method that is based on educating patients and the family members who will assist them. In this way the families and patients become partners in the planning and application of the proper nursing care that will allow them a greater independence and quality of life.

[Significance of apolipoproteins A and B and the remaining lipid fractions as indicators of protein-calorie malnutrition in the elderly]. / Importancia de las apolipoproteínas A y B y las restantes fracciones lipídicas como indicadoras de desnutrición proteico-calórica en el anciano.

Effects of calorie/protein malnourishment have been studied on plasma concentrations of cholesterol, triglycerides, HDL-C, LDL-C and apolipoproteins A and B, in institutionalized elderly people, 53 males and 62 females, of whom 19 females and 12 males were malnourished. In malnourished patients, total cholesterol and LDL-C were significantly lower both in males and in females, but HDL-C was lower only in females. No significant differences in plasma triglycerides were found between the control and the malnourished groups. Apolipoprotein A showed no significant changes on malnourished males, but did show a significant lowering in malnourished females. On the opposite, apolipoprotein B was lower in males than in females. The lowering in cholesterol in malnourished patients leads us to think that this could be a early predictor of nutritional risk in the elderly.

[The importance of a diet survey in the early detection of malnutrition in the elderly]. / Importancia de la encuesta dietética en la detección temprana de desnutrición en el anciano.

BACKGROUND: The elevated incidence of malnutrition in the elderly and its close relation with the prevalence and evolution of determined diseases raises the need for early identification. Despite the existence of numerous indicators, specificity, sensitivity or occasionally both are lacking. METHODS: One hundred fifteen institutionalized elderly of which 19 females and 12 males had signs of malnutrition were studied. A dietetic survey was carried out on all of those studied by means of a 24 hour recollection-interview, during which triceps fold (TF) and muscular area of the arm (MAA) were measured and serum concentrations of prealbumin (PA) protein bound to retinol (PBR), albumin (ALB), trasferrin (TNF) and complement factor 3 (C3) were determined. RESULTS: Not only caloric but also proteic intake were significantly lower in the undernourished (p less than 0.001) as with ALB (p less than 0.001), TNF (p less than 0.001) and C3 (p less than 0.02 in males and p less than 0.05 in females). However, the sensitivity demonstrated by the dietetic survey (77% in males and 73% in females) was higher to that presented by ALB (44% in males and 53% in females), TNF (33% in males and 53% in females) and C3 (0 in both sexes). CONCLUSIONS: The results obtained demonstrate that the dietetic survey is a valid method for detecting not only the risk but also the subclinical presence of malnutrition, in contrast to ALB, TNF and C3 which, to that end, were of less use.

[Thrombogenic factors in the elderly. Evaluation of the plasma concentrations of thromboxane B2 and antithrombin III]. / Factores trombogénicos en el anciano. Valoración de las concentraciones plasmáticas de tromboxano B2 y antitrombina III.

The aim of this study is to prove the existence of a major tendency of platelet aggregation in elderly patients compared to medium-aged adults and, also, to detect whether it is affected by the presence of diabetes mellitus. Plasmatic concentrations of B2 thromboxane (TXB2) and antithrombin III (AT III) were determined in 73 elderly patients of both sexes; 56 without metabolic disease known (Group a) and 17 diabetic patients, 7 type I (Group bI) and 10 of type II (Group bII); and 12 healthy adults (control group). Medium plasmatic concentration of TXB2 was significantly higher (p less than 0.001) in Group a (55 +/- 14 ng/ml) compared to the control group (37 +/- 9 ng/ml) and there was no difference between Group bI (53 +/- 19 ng/ml) and bII (57 +/- 15 ng/ml). No variations were noted in ATIII concentration between the adults (27.4 +/- 2.3 mg/dl) and elderly patients (a = 29.6 +/- 4.4, bI = 29 +/- 2.6, bII = 31.2 +/- 5.9 mg/dl). In elderly patients, there appears to be a state of platelet pro-aggregation without influence of any risk factor, such as diabetes. This could explain the thrombogenic tendency of this age group.

[Clinical remission in Cushing's disease through treatment with sodium valproate and bromocriptine]. / Remisión clínica de una enfermedad de Cushing mediante tratamiento combinado con valproato sódico y bromocriptina.

A patient suffering Cushing disease is presented in whom the administration of ciproheptadine, bromocriptine and sodium valproate in a single dose did not manage to control the clinical-biologic manifestations of the process. Combined treatment with 1.200 mg/day of sodium valproate and 15 mg/day of bromocriptine induced a complete clinical-biological remission, being arterial pressure the last parameter to normalize. The patient who has always refused to undergo surgery has stayed with this treatment for three years, maintaining remission and without appearance of side effects. On two occasions (after one and a half years and after two and half years) the transitory interruption of treatment induced in a few weeks an increase in plasma cortisol levels which again normalized after treatment was re-established. There were no clinical-biological data, pharmacological tests which permitted the prediction of these therapeutic results and therefore, the therapeutic response obtained is not indicative of any specific etiological subtype of Cushing disease.

[Changes in the hypophyseal-thyroid axis and their prognostic value in sepsis]. / Modificaciones del eje hipofisotiroideo y su valor pronóstico en el curso de la sepsis.

The alterations in serum concentration of thyroxine (T4), tri-iodine-thyronine (T3), reverse tri-iodinetiroinine (rT3), thyrotropine (TSH and free thyroxine index (IT4L), are studied in 37 patients diagnosed of sepsis who were divided into two groups according to their evolution: Group A: 22 patients who evolved favourably, and Group B: 15 patients who died, as well as in 14 healthy controls; this was carried out in order to establish, on one hand, its prognostic value, and, on the other, which of these parameters is most useful in the evaluation of thyroid function in these patients. A decrease in serum T3 levels was observed in patients from both groups (p less than 0.001) which was accompanied by an increase in rT3 levels (p less than 0.001) and a decrease in It4L (p less than 0.001); No significant modifications were observed in T4 and TSH. On follow up of 12 patients from group A and 14 from group B, an increase in mean T3 concentration was observed (p less than 0.02) only in the first patient from both groups. The greatest discriminative efficacy of thyroid hormones study with an unfavorable sepsis evolution corresponded to a T3 value below 35 ng/dl.

[The partial inhibition of the growth hormone response to growth hormone-releasing hormone after the administration of the calcium antagonist verapamil]. / Inhibición parcial de la respuesta de hormona de crecimiento a la hormona liberadora de hormona de crecimiento tras la administración del antagonista del calcio verapamil.

The changes produced by administering a calcium channel antagonist on the releasing of growth hormone (GH) induced by the growth hormone-releasing factor (GHRF), are studied. The study was performed on 7 healthy males between 25 and 35 years old, fasting and in bed. We measured the release of GH after the intravenous administration of 250 micrograms of GHRF on 2 successive occasions; one baseline and the second after 3 previous continuous days of 240 mg/day of verapamil. There were no statistically significant differences between the basal concentrations of GH before and after the administration of verapamil. However, the response of GH to GHRF, measured as maximum increase (before verapamil: 12.5 +/- 5.3; after verapamil: 9.5 +/- 3.9 ng/ml and total increase (before verapamil: 29.6 +/- 12.4; after verapamil: 21.6 +/- 11.9 ng/ml) was significantly lower after verapamil produces a partial blockade of GH release induced by GHRF.