[SAFETY IN THE ELDERLY: HOME ACCIDENTS]. / Seguridad en personas mayores: accidentes en el hogar.

Home accidents are more common in the elderly and they can have serious consequences to the injured person's health. At home, chances to suffer accidents of any type are higher, because it's the place where old people spend most of their daily time. It is important to point out that a high percentage of domestic accidents could be easily avoided by taking some simple cautions. The main aim of this paper is to know how we can prevent most common domestic accidents in the aged population: falls, burnings, poisonings and fire prevention.

[What do we need to know about the burn injuries? Pathophysiology, aetiology and effects]. / ¿Que necestamos saber sobre las quemaduras? Fisiopatología, etiología y repercusiones.

Burn injuries are a major public health problem worldwide, because they are very common. They are usually produced in domestic or work environments, although it is not unusual that they might be caused by traffic accidents or intentionally (self-injured or assaults on the people). These injuries do not attract much attention but if they are not treated properly, they can lead to serious systemic complications which can sometimes cause the death of the patient. In the last few years, the therapeutic approach of the burned patient has significantly improved due to an early correct initial valuation, which is used to design an effective nursing care plan and it determines the prescription of a suitable medical treatment according to the characteristics and the severity of the burn. The aim of this chapter is to explain some general aspects about the aetiology and pathology of burn injuries and their systemic effects, because the medical and nursing staff should know these aspects to make an adequate initial valuation. They should recognize the aetiology of the burn, its depth and area, its severity and its systemic complications to act properly in the initial phase of the treatment, because these preliminary actions are essential in the prognosis and evolution of the burns.

[Local nursing care in burn injuries]. / Cuidados de enfermería locales en las quemaduras.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can be seriously compromised. An estimate 300 people for every 100,000 inhabitants are treated for burn injuries every year in hospitals or social-sanitary centers. In this chapter we aim at clarifying the nursing care for the affected area, once patient's life risk is stabilized and controlled.This care will be based on an adequate approach to local handling of burn injuries, after severity and prognosis have been stated.

[Therapeutic guide to local care of burn injuries]. / Guía terapéutica en el cuidado local de las quemaduras.

There is a large variety of topical application substances in the market for burnt areas treatment. This fact, far from being an advantage, turns into a serious problem when nursing staff has to choose the most adequate for each case. We think that, apart from a thorough knowledge of aspects such as indications and contraindications, application methods, combination with other substances and possible interactions, the formulation of a series of practical criteria can be of great help in order to select the right topical substance for the objectives pursued. This is the goal of this article.

[Therapeutic guide to critical burn patients]. / Guía terapéutica en el paciente quemado crítico.

Burn injuries are defined as the destruction of skin tissue under the effects of a thermal, electrical, chemical or radioactive agent. They can cause local injuries, with no systemic effect, but in certain cases, considered as "critical burn patients", they can produce severe and immediate systemic injuries, thus making it necessary to address care from a comprehensive perspective in order to achieve a satisfactory evolution. With this in mind, as nursing staff we must consider the need to review the treatments and nursing care we are applying to critical burn patients, in order to prevent the onset of complications that might lead to unwanted consequences or even the death of the patient, and eventually unifying criteria of nursing care. The main goal of this guide is to provide an efficient and easy to use working tool that is suitable for adult burn patients, thus making it easier for nurses to update knowledge and decision making.

[Sequelae in patients with severe burns]. / Secuelas en los pacientes con quemaduras graves.

Nowadays, the main aim with severe burned patients is the prevention and treatment of the complications associated to burn injuries, because the mortality caused by them has significantly declined due to the improvements in the treatments used. This fact has changed the focus of the care from a biomedical model which pay attention to the physical aspects, to other based on the holistic care of the patient in which physical, psychological and social aspects are considered. To minimize the development of these adverse complications and to prevent their severity in long term, it is essential to initiate an early rehabilitation at hospital and follow these patients by the Primary Care team when they return home. The adverse effects of the burns can invalidate the patient and they can affect several spheres of his life: physical, psychological and social. The goals of this article are to determine the most common complications in severe burns, describe the treatments more effective to combat them and explain the role of nurses in the prevention and rehabilitation of these injured.

Caffeine challenge in insomniac patients after total sleep deprivation.

BACKGROUND AND PURPOSE: This study compared the effects of caffeine in patients with primary insomnia and normal volunteers. The main goal was to determine the differences in sensitivity to caffeine between the groups. We investigated the effects on daytime sleep of placebo or caffeine after a night of total sleep deprivation (SD). We hypothesized that insomniacs would be more affected by caffeine, which would suggest a change in adenosine receptor (number or sensitivity) in primary insomniacs. PATIENTS AND METHODS: Six primary insomnia patients (Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) and six normal volunteers with no sleep complaints participated in a double-blind study with caffeine or placebo administered under a cross-over design with each subject serving as his or her own control. The participants did not have a history of drinking coffee or caffeinated beverages. Data from all-night polysomnography and multiple sleep latency test (MSLT) were collected in the sleep research laboratory of National Institute of Medical Sciences and Nutrition Salvador Zubirán. RESULTS: During the baseline night, patients with insomnia had significantly less delta sleep and less total sleep time than the normal volunteers. Mean sleep latency under basal MSLT did not differ between the groups. However, insomnia patients had significantly less total sleep during each nap compared to normal volunteers. After one night of total SD and under caffeine administration, the insomniacs had significantly longer sleep latency and less total sleep time in MSLT compared to normal volunteers. After SD, healthy volunteers reduced sleep latencies in MSLT with or without caffeine. CONCLUSIONS: Patients with insomnia had a higher sensitivity to the diurnal awakening effect of caffeine even after one night of SD. This suggests that changes in the adenosine receptors could, in part, be responsible for the hyperarousal state that has been reported in primary insomnia.