Programa de atención de enfermería, pilar de la atención de pacientes con enfermedad renal crónica / Nursing care program, pillar of caring for patients with chronic kidney disease

La insuficiencia renal crónica es una enfermedad no trasmisible que se caracteriza por una disfunción renal que causa complicaciones y alteraciones metabólicas, las cuales disminuyen la capacidad funcional y la percepción de la calidad de vida relacionada con la salud de los pacientes. La atención de los pacientes con esta enfermedad demanda de cuidados integrales; entre los cuales los cuidados de enfermería ocupan un papel fundamental. El proceso de atención de enfermería es una herramienta necesaria para ofrecer el máximo nivel de calidad en los cuidados que recibe el paciente con enfermedad renal crónica en tratamiento de hemodiálisis. El objetivo de la presente investigación es exponer las particularidades del programa de atención de enfermería incluidas en el proceso de atención de enfermería de pacientes con insuficiencia renal crónica sometidos a tratamiento de hemodiálisis(AU)

Chronic kidney failure is a non-communicable disease in which there is kidney dysfunction that generates a significant number of complications and metabolic disorders, these decrease the functional capacity and the perception of quality of life related to the health of patients. The care of patients with this disease demands comprehensive care; within which nursing care plays a fundamental role. The nursing care process is a necessary tool to offer the highest level of quality in the care received by patients with chronic kidney disease undergoing hemodialysis. The objective of the present investigation is to contribute the elements from the pedagogical teaching point of view that guarantee an adequate knowledge of the actions to be carry out during the nursing care of patients with chronic kidney disease(AU)

The potential of machine learning to predict postoperative pancreatic fistula based on preoperative, non-contrast-enhanced CT: A proof-of-principle study.

BACKGROUND: Postoperative pancreatic fistula remains an unsolved challenge after pancreatoduodenectomy. Important in this regard is the presence of a soft pancreatic texture which is a major risk factor. Advances in machine learning and texture analysis of medical images allow identification of features of parenchyma that are invisible to the human eye. The aim of this study was to investigate the potential of machine learning to predict postoperative pancreatic fistula based on preoperative, non-contrast-enhanced computed tomography. METHODS: We screened a prospectively assessed database including all patients undergoing pancreatoduodenectomy at a tertiary center from 2008 until 2018 for patients based on the occurrence of postoperative pancreatic fistula. In total, 110 patients were included, consisting of 55 patients who developed a postoperative pancreatic fistula and 55 without postoperative pancreatic fistula. For machine learning-based texture analysis preoperative, non-contrast-enhanced computed tomography axial images were used. Machine learning results were tested using 10-fold cross validation. Previously validated clinical fistula risk scores (original and alternative fistula risk scores) served as reference tests. RESULTS: Both the original and the alternative fistula risk scores showed good discrimination between patients without and with postoperative pancreatic fistula (area under the curve 0.76 and 0.72, respectively). Machine learning-based texture analysis showed potential to detect histologic fibrosis (area under the curve 0.84, sensitivity 75%; specificity 92%), histologic lipomatosis (area under the curve 0.82, sensitivity 78%; specificity 89%), and intraoperative pancreatic hardness (area under the curve 0.70, sensitivity 78%; specificity 74%). The features of the machine learning-based texture analysis were most accurate in predicting the occurrence of postoperative pancreatic fistula (area under the curve 0.95, sensitivity of 96%; specificity 98%) after pancreatoduodenectomy. CONCLUSION: This proof-of-principle study suggests the ability of machine learning in recognizing important features of pancreatic texture associated with an increased risk of postoperative pancreatic fistula based on preoperative computed tomography.

Areas of work-life in Spanish hostelry professionals: explanatory power on burnout dimensions.

BACKGROUND: Researchers have studied for decades workplace stress and burnout to identify their relationship to health and wellness. This research has focused on stress levels in people, as well as on environmental and personal factors that contribute to experiencing stress or burnout. In addition to the burnout measurement questionnaires (MBI-GS), Leiter and Maslach designed a model to evaluate the areas of work environment that relate to this construct (Areas of Worklife Scale-AWLS). The goal of the present research was to analyze the psychometric properties of a Spanish translation of the MBI (GS) and the AWLS with a Spanish-speaking population. This work makes a substantial contribution by addressing the need to use validated measures and methods when exploring the positive and negative aspects of organizations. These conditions provide a means to accurately evaluate the impact of interventions aimed to address stress and burnout. METHOD: Cross-sectional study with self-report measures. The sample was comprised of 452 managers and employees (hotels, restaurants, catering) of Aragón (Spain). There were approximately equal numbers of women and men (45,4% vs. 54,6%). The average age of participants was 36.6 years (SD = 10.03). A battery of questionnaires was used: Socio-demographic and work characteristics, Scale of stress and health symptoms, Maslach Burnout Inventory-General Survey (MBI-GS), Areas of Worklife Scale (AWLS). RESULTS: The results showed optimal psychometric properties in both questionnaires, especially in terms of the predictive capacity of the AWLS in each of the MBI-GS dimensions. CONCLUSIONS: The best explained dimension is that of emotional exhaustion. The manageable load variable is the one that most contributes to predicting burnout levels. For future interventions, the results confirm the need to verify the levels of each area of work, in order to focus on the most deteriorated ones.

Enfermedad de Kawasaki en un hospital pediátrico en México / Kawasaki disease at a pediatric hospital in Mexico

Resumen: Introducción: La enfermedad de Kawasaki (EK) es una de las vasculitis sistémicas más comunes en niños menores de 5 años de edad. La epidemiología de la enfermedad no está bien establecida en México. El objetivo de este trabajo fue describir la epidemiología, características clínicas y tratamiento de los pacientes con EK atendidos en el Hospital Infantil de México Federico Gómez (HIMFG). Métodos: Se realizó un estudio retrospectivo, descriptivo y analítico de pacientes diagnosticados con EK en el HIMFG en el periodo comprendido entre enero de 2004 y diciembre de 2014. Resultados: Se analizaron 204 casos, la mayoría de sexo masculino (55%), con mediana de edad de 32.5 meses (6-120) y una tasa de hospitalización del 96%. El 20% de los pacientes presentó EK incompleto. No se reportaron diferencias en la somatometría ni signos vitales. La sintomatología más frecuente fue fiebre, conjuntivitis (89%), cambios orales (84%), faringitis (88%) y lengua en fresa (83%). Se encontraron reactantes de fase aguda más elevados en las presentaciones clásicas. Se reportaron alteraciones ecocardiográficas en 60 pacientes (29%), de las cuales el 12% fueron ectasia y el 11% aneurismas coronarios. Por otro lado, 169 pacientes (83%) recibieron inmunoglobulina intravenosa (IGIV), 18 (9%) resistencia a IGIV, 6 (3%) requirieron corticosteroides y 2 (1%) infliximab; todos recibieron ácido acetilsalicílico. Conclusiones: No se encontraron diferencias importantes entre las presentaciones clásicas e incompletas. La incidencia de alteraciones cardiacas es menor a la reportada previamente en México, pero similar a la de otros países.

Abstract: Background: Kawasaki disease (KD) is one of the most common systemic vasculitis in children under 5 years of age. The epidemiology of the disease is not well established in Mexico. The objective of this study was to describe the epidemiology, clinical features and treatment of patients with KD at the Hospital Infantil de Mexico Federico Gomez (HIMFG). Methods: We conducted a retrospective, descriptive and analytical study of patients diagnosed from January 2004 to December 2014 with KD in the HIMFG. Results: We analyzed 204 cases from which 55% were male, with a median age of 32.5 months (6-120) and a rate of hospitalization of 96%. Twenty percent of patients presented incomplete KD. No differences in the somatometric measurements or vitals were reported. The most frequent symptoms were fever, conjunctivitis (89%), oral changes (84%), pharyngitis (88%) and strawberry tongue (83%). We found higher acute phase reactants in the classic presentation. Echocardiographic alterations in 60 patients (29%), of which 12% were ectasia and 11% reported coronary aneurysms. On the other hand, 169 (83%) patients received intravenous immunoglobulin (IVIG), 18 (9%) presented resistance to IVIG, 6 (3%) required corticosteroids, and 2 (1%) infliximab; all received acetylsalicylic acid. Conclusions: There were no important differences between classic and incomplete presentations. The incidence of cardiac alterations is less than previously reported in Mexico, but similar to that of other countries.

[Kawasaki disease at a pediatric hospital in Mexico]. / Enfermedad de Kawasaki en un hospital pediátrico en México.

BACKGROUND: Kawasaki disease (KD) is one of the most common systemic vasculitis in children under 5 years of age. The epidemiology of the disease is not well established in Mexico. The objective of this study was to describe the epidemiology, clinical features and treatment of patients with KD at the Hospital Infantil de Mexico Federico Gomez (HIMFG). METHODS: We conducted a retrospective, descriptive and analytical study of patients diagnosed from January 2004 to December 2014 with KD in the HIMFG. RESULTS: We analyzed 204 cases from which 55% were male, with a median age of 32.5 months (6-120) and a rate of hospitalization of 96%. Twenty percent of patients presented incomplete KD. No differences in the somatometric measurements or vitals were reported. The most frequent symptoms were fever, conjunctivitis (89%), oral changes (84%), pharyngitis (88%) and strawberry tongue (83%). We found higher acute phase reactants in the classic presentation. Echocardiographic alterations in 60 patients (29%), of which 12% were ectasia and 11% reported coronary aneurysms. On the other hand, 169 (83%) patients received intravenous immunoglobulin (IVIG), 18 (9%) presented resistance to IVIG, 6 (3%) required corticosteroids, and 2 (1%) infliximab; all received acetylsalicylic acid. CONCLUSIONS: There were no important differences between classic and incomplete presentations. The incidence of cardiac alterations is less than previously reported in Mexico, but similar to that of other countries.

Drug-eluting stents vs. bare metal stents in patients with cardiogenic shock: a comparison by propensity score analysis.

BACKGROUND: In patients with cardiogenic shock, data on the comparative safety and efficacy of drug-eluting stents (DESs) vs. bare metal stents (BMSs) are lacking. We sought to assess the performance of DESs compared with BMSs among patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI). METHODS: Out of 236 patients with acute coronary syndromes complicated by cardiogenic shock, 203 were included in the final analysis. The primary endpoint included death, and the secondary endpoint of major adverse cardiac and cerebrovascular events (MACCEs) included the composite of death, myocardial infarction, any repeat revascularization and stroke. Patients were followed for a minimum of 30 days and up to 4 years. As stent assignment was not random, we performed a propensity score analysis to minimize potential bias. RESULTS: Among patients treated with DESs, there was a lower risk of the primary and secondary endpoints compared with BMSs at 30 days (29 vs. 56%, P < 0.001; 34 vs. 58%, P = 0.001, respectively) and during long-term follow-up [hazard ratio 0.43, 95% confidence interval (CI) 0.29-0.65, P < 0.001; hazard ratio 0.49, 95% CI 0.34-0.71, P < 0.001, respectively]. After propensity score adjustment, all-cause mortality was reduced among patients treated with DESs compared with BMSs both at 30 days [adjusted odds ratio (OR) 0.26, 95% CI 0.11-0.62; P = 0.002] and during long-term follow-up (adjusted hazard ratio 0.40, 95% CI 0.22-0.72; P = 0.002). The rate of MACCE was lower among patients treated with DESs compared with those treated with BMSs at 30 days (adjusted OR 0.42, 95% CI 0.19-0.95; P = 0.036). The difference in MACCEs between devices approached significance during long-term follow-up (adjusted hazard ratio 0.60, 95% CI 0.34-1.01; P = 0.052). CONCLUSION: DESs appear to be associated with improved clinical outcomes, including a reduction in all-cause mortality compared with BMSs among patients undergoing PCI for cardiogenic shock, possibly because of a pacification of the infarct-related artery by anti-inflammatory drug. The results of this observational study require confirmation in an appropriately powered randomized trial.

Deserción al programa de seguimiento de prematuros en el Hospital Materno Infantil Ramón Sardá de Buenos Aires (2004-2006) / Lost to follow up of very low weight preterm infants born between 2004 2006 in HMIR Sardá

Objetivo: Identificar factores asociados a la deserción del programa de seguimiento de recién nacidos prematuros menores de 1500 g al año y dos años de edad corregida. Material y método: Trabajo descriptivo, prospectivo y analítico. Se incluyeron todos los recién nacidos menores de 1500 g egresados de la unidad de terapia intensiva neonatal, nacidos entre el 01/01/2004 al 31/12/2006. Se excluyeron: niños con malformaciones congénitas mayores, infecciones intrauterinas confirmadas, derivados por patología quirúrgica, o domiciliados a más de 100 km de distancia. Se definió deserción al año de vida cuando no se cumplieron cuatro controles y a los dos años cuando no se cumplieron dos controles entre los doce y veinticuatro meses de vida. Resultados: De 207 prematuros, al año concurrieron 165 (79,5 por ciento) y desertaron 42 (20,5 por ciento), a los 2 años concurrieron 124 (75,2 por ciento) y desertaron 42 (25,4 por ciento). Los factores estadísticamente significativos al año de vida fueron: gemelaridad (p= 0,03) y familias monoparentales (p= 0,05). Conclusiones: Es necesario recrear estrategias para mejorar la adherencia de las familias de grupos vulnerables al programa de seguimiento por la implicancia que tiene ésta en el neurodesarrollo, la salud y educación a futuro.

Objectives: To identify factors related to patients withdrawing from a VLBW (=1500 g) preterm’s follow up program. Methods and subjects: very low birth weight (less or equal to 1500 g) preterm babies born between 01/01/2004 to 31/12/2006. Those with major congenital malformations, intrauterine infections or requiring surgical interventions or living more than 100 km from the hospital were excluded. Failure to show up 50 per cent of the citations or more during the first year of corrected age, and between 12 to 24 months of corrected age was considered a withdrawing patient. Factors studied were: gestational age, birth weight, days staying in NICU, bronchopulmonary dysplasia, preterm rethinopathy, intracranial hemorrhage (grade = 3), nationality, living zone, mother´s years of schooling, family type (double parent or single parent), number of children (= 4), job, health insurance, type of pregnancy (single vs. multiple) and non-satisfied basic needs. Results: 42 (20.5 per cent) of 207 preterm babies withdrew during the first year of corrected age, and 42 (25.4 per cent) between 12 to 24 months of corrected age of 165 babies attending during the first year. Factors statistically significant related to withdrawal were: twin birth (p<0.03) and single-parent family type p<0.05). Conclusions: Strategies to help families with preterm babies to attend to follow up programs are needed since these are paramount for the preterm’s health, neurodevelopment, and learning skills in the future.

Precisión diagnóstica de diferentes técnicas para hallar la vena yugular interna en niños de 6 meses a 16 años / Diagnostic precision of different technologies(skills) to find the jugular internal vein in children from 6 months to 16

Describir la técnica transmuscular modificada por Reyes (TMMR) y realizar una comparación de la efectividad y seguridad de esta y de las técnicas anterior, media y palpatoria. Métodos. Estudio observacional prospectivo de cohorte. En 32 pacientes pediátricos, sin patología cervical que asistieron al servicio de radiología u hospitalizados en los servicios de pediatría o cuidados intensivos de la Fundación Hospital de la Misericordia, se comparó la efectividad de las técnicas mencionadas para ubicar anatómicamente la vena yugular interna (VYI) usando como estándar de oro la ecografía. Adicionalmente se evaluó la seguridad estudiando la distancia del sitio hipotético de punción predicho por cada técnica al borde de la carótida (distancia pcb). Resultados. Las tasas de efectividad para las diferentes técnicas fueron 96,9 por cien, 90,3, 93,8 y 93,8 por cien para la anterior, media, palpatoria y TMMR respectivamente. La distancia de la punción hipotética al centro de la yugular, fue menor para la palpatoria y la TMMR con promedios de 1,78 y 1,98 mm respectivamente (IC95 1,2 - 2,35 y 1,32 - 2,64), comparado con las técnicas anterior y media, con 2,65 y 2,78 mm respectivamente (IC95 2,01 - 3,29 y 1,91 - 3,65). La comparación de la distancia pbc y de la piel a la VYI no mostraron diferencias significativas. Conclusiones. En la población pediátrica, las técnicas TMMR y la palpatoria son tan seguras como las demás evaluadas y tan o más efectiva que las técnicas anterior y media. Las 4 técnicas mostraron ser igual de seguras en cuanto la probabilidad de punción carotídea.