Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española / Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population

Introducción: En España el ictus es la sexta causa de discapacidad. Sus secuelas producen alteraciones motoras, sensoriales y cognitivas, que pueden minimizarse con una actuación terapéutica temprana. Por ello se necesitan instrumentos de evaluación rápida que detecten déficits en estas áreas. El Oxford Cognitive Screen Test (OCS) es un test breve diseñado para la valoración de funciones cognitivas en pacientes con ictus. Nuestro objetivo fue generar una versión española (OCS-E) realizando una adaptación lingüística y cultural.Material y métodosDiseño de validación lingüística con doble traducción y 10 reuniones de consenso del equipo investigador multidisciplinar. Tres estudios piloto administrando el test respectivamente a 5 usuarios potenciales, 23 personas sanas y 23 diagnosticadas de ictus isquémico (61%) o hemorrágico, con edades entre 31-88 años.ResultadosEl OCS-E mantiene las 10 tareas originales, la codificación de respuestas y el sistema de puntuación. Se modificaron y ampliaron las instrucciones de administración, lo que asegura la fiabilidad del contenido y de su aplicación. En 5 tareas se han modificado imágenes, números y frases. La tarea praxia se amplió para evaluar ambos miembros superiores. Los estudios piloto confirmaron que las personas de la población diana comprendían de forma adecuada las tareas, con independencia de la existencia de problemas cognitivos.ConclusionesLa adaptación cultural ha generado una versión lingüística y conceptualmente equivalente, permitiendo su estudio psicométrico y posterior aplicación en población española. El OCS-E puede ser un instrumento de cribado útil para evaluación rápida de funciones cognitivas postictus. (AU)

Introduction: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S).Material and methodsThe linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years.ResultsThe OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems.ConclusionsThe OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke. (AU)

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSION: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in internal medicine.

OBJECTIVE: To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS: We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS: We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (p < .001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (p < .001), and the rate for transparent dressing was 2.1 and 11.5 (p < .001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS: Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Estudio de cohortes prospectivo sobre el manejo y las complicaciones del catéter venoso periférico en pacientes ingresados en Medicina Interna / Prospective cohort study on the management and complications of peripheral venous catheter in patients hospitalised in Internal Medicine

Objetivo Analizar la adherencia a las recomendaciones de inserción-mantenimiento del catéter venoso periférico (CVP) y la incidencia de complicaciones según el servicio asistencial de inserción. Pacientes y métodos Estudio de cohortes prospectivo de seguimiento del CVP desde su inserción en Urgencias o Medicina Interna (MI) hasta su retirada. Resultados Se monitorizaron 590 CVP: 274 de Urgencias y 316 de MI. Entre la adherencia a indicadores de proceso destaca la tasa de canalización en fosa antecubital de 3,5 vs. 1,6 por 100 catéteres-día (p <0,001) en Urgencias y MI, respectivamente. La tasa de fijación estéril fue 1,6 vs. 12,4 (p <0,001) y el apósito transparente de 2,1 vs. 11,5 (p <0,001) por 100 catéteres-día en Urgencias y MI, respectivamente. Las tasas de complicaciones no mostraron diferencias entre los servicios. La más frecuente fue la flebitis 95 (16,1%). Conclusiones La adherencia a las recomendaciones de inserción-mantenimiento del CVP mostró diferencias entre servicios; sin embargo, la incidencia de complicaciones fue similar (AU)

Objective To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheter (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. Patients and methods We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. Results We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). Conclusions Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar (AU)

Percepción de la calidad de vida en pacientes con diverticulitis aguda recidivante / Perception of quality of life in patients with acute recurrent diverticulitis

Introducción: los episodios recurrentes de diverticulitis aguda no complicada pueden provocar dolor y disminución en la calidad de vida. Los tratamientos médico y quirúrgico además de evitar estos episodios buscan ofrecer una mejoría de esta. El objetivo principal consiste en comparar la percepción que los pacientes afectados por diverticulitis aguda recidivante tienen de su calidad de vida según el tratamiento recibido, médico o quirúrgico. Material y método: se analizaron respuestas sobre calidad de vida y proporción de sentimientos positivos. Para ello se aplicó metodología mixta. Se realizaron entrevistas y análisis cualitativo de las respuestas y los sentimientos expresados, y análisis cuantitativo de las características demográficas. Resultados: los pacientes que recibieron tratamiento quirúrgico presentaron una mayor percepción de mejora de su calidad de vida, mientras que los pacientes que recibieron tratamiento médico presentaron resultados variables. El grupo que recibió tratamiento quirúrgico presentó más sentimientos positivos. Conclusiones: el tratamiento quirúrgico puede ofrecer una mayor percepción de calidad de vida y mayor proporción de sentimientos positivos. (AU)

Introduction: recurrent episodes of uncomplicated acute diverticulitis can cause pain and decrease quality of life. Medical and surgical treatments, besides to avoid these episodes, seek to offer an improvement in it. The main objective is to contrast the perception that patients affected by recurrent acute diverticulitis have of their quality of life according to the medical or surgical treatment received. Material and methods: responses about quality of life and proportion of positive feelings were analyzed. For this, mixed methods were applied. Interviews and qualitative analysis of the responses and feelings expressed, and quantitative analysis of demographic characteristics were carried out. Results: patients who received surgical treatment presented a greater perception of improvement in their quality of life, while patients who received medical treatment presented variable results. The group that received surgical treatment presented more positive feelings. Conclusions: surgical treatment can offer a greater perception of quality of life and a greater proportion of positive feelings. (AU)

Osseointegration around dental implants biofunctionalized with TGFß-1 inhibitor peptides: an in vivo study in beagle dogs.

The aim of this study was to evaluate the effect of biofunctionalization with two TGF-ß1 inhibitor peptides, P17 and P144, on osseointegration of CP-Ti dental implants. A total of 36 implants (VEGA, Klockner®) with 3.5 × 8 mm internal connection were used in this study, divided in three groups: (1) control group (n = 12), (2) implants which surfaces were biofunctionalized with P17 peptide inhibitor (n = 12), (3) implants with surfaces biofunctionalized by P144 peptide (n = 12). Three implants, one from each group, were inserted in both hemimandibles of 6 beagle dogs, 2 months after tooth extraction. Two animals were sacrificed at 2, 4 and 8 weeks post implant insertion, respectively. The samples were analyzed by Backscattering Scanning Electron Microscopy (BS-SEM) and histological analysis. Histomorphometric analysis of bone to implant contact (BIC), peri-implant bone fraction (BF) and interthread bone (IB) were carried out. Bone formation around implants measured by quantitative analysis, BS-SEM, was significantly higher in the P17-biofunctionalized implants, 4 and 8 weeks after the implantation. Histomorphometric analysis of BIC, BF and IB showed higher values in the P17-biofunctionalized group at initial stages of healing (2 weeks) and early osseointegration both at 4 and 8 weeks. For P144 biofunctionalized implants, the histomorphometric values obtained are also higher than control group. Accordingly, better results in the experimental groups were proven both by the quantitative and the qualitative analysis. Surface biofunctionalization with TGF-ß1 inhibitor peptides, P17 and P144, resulted in better quantitative and qualitative parameters relative to implant osseointegration.

Prospective cohort study on the management and complications of peripheral venous catheters in patients hospitalised in Internal Medicine. / Estudio de cohortes prospectivo sobre el manejo y las complicaciones del catéter venoso periférico en pacientes ingresados en Medicina Interna.

OBJECTIVE: To analyse compliance with the recommendations on the insertion-maintenance of peripheral venous catheters (PVC) and the incidence of complications according to the healthcare department that inserted the PVCs. PATIENTS AND METHODS: We conducted a prospective cohort follow-up study of PVCs, from their insertion in the emergency or internal medicine (IM) department until their withdrawal. RESULTS: We monitored 590 PVCs, 274 from the emergency department and 316 from IM. In terms of compliance with the process indicators, there was a cannulation rate in the antecubital fossa of 3.5 and 1.6 per 100 catheters-day (P<.001) in the emergency and IM departments, respectively. The sterile placement rates were 1.6 and 12.4 (P<.001), and the rate for transparent dressing was 2.1 and 11.5 (P<.001) per 100 catheters-day in the emergency and IM departments, respectively. The complications rates showed no differences between the departments. The most common complication was phlebitis (95 cases, 16.1%). CONCLUSIONS: Compliance with the insertion-maintenance recommendations for PVC showed differences between the departments; however, the incidence of complications was similar.

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population. / Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). MATERIAL AND METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSIONS: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus.

PURPOSE: The anterior tibiofibular ligament (ATiFL) and its distal fascicle have been the subject of numerous studies, mainly due to the involvement of this ligament in anterolateral soft-tissue impingement of the ankle. There is currently no firm evidence related to the incidence of the distal fascicle or the frequency with which it is in contact with the talus, or whether this is a constant anatomic finding. In addition, the terminology used to refer to this structure is not accurate and varies widely in previous studies. The purpose of this study was to perform an anatomic study on a large number of specimens to clarify the anatomy of the anterior tibiofibular ligament, and specifically its distal fascicle, and its possible role in anterior ankle impingement syndrome. METHODS: During a 7-year period (2010-2016), cadaveric ankle specimens dissected at our Anatomy Department were included in this study, accounting for a total of 154 ankles. The incidence of the distal fascicle and its contact with the talus were documented. RESULTS: One hundred and seventeen ankles were included [78 men, 39 women, with a median age of 79.3 years (range 51-100 years)]. The ATiFL was found to have a distal fascicle in 100% of ankles, contacting the anterolateral part of the talus in all cases. The contact was increased in plantarflexion and reduced in dorsiflexion and finally disappeared completely in maximum dorsiflexion. CONCLUSIONS: The ATiFL has a constant distal fascicle that is in contact with the talus in the neutral position and in plantar flexion. Contact disappears in maximum dorsiflexion.

The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments.

PURPOSE: A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. METHODS: Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. RESULTS: Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. CONCLUSION: Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.

Prevalence of potential drug-drug interactions in outpatients on treatment with parenteral antineoplastic drugs.

Background As live expectancy and cancer incidence growing, polypharmacy in oncology patients is also increasing, raising the risk of developing potential drug-drug interactions.Objective To assess the prevalence of clinically relevant potential drug-drug interactions among cancer patients who receive parenteral treatment at our outpatient clinic. Method Retrospective observational study which included randomly selected patients who had received parenteral treatment from November 1st 2016 to January 31st 2017. Interactions were checked in 3 databases, and classified as clinically relevant or not and in three categories of severity: contraindicated, consider modification or monitor. Results A total of 273 patients were included; of which seventy three (26.7%) had at least one clinically relevant potential drug-drug interaction. Amongst them, 54 (74%) had at least one classified as monitor treatment, 50 (68.5%) as contraindicated and 26 (35.6%) as consider modification. The number of chronic prescriptions was associated with a higher risk of drug interactions. Conclusion Around one in four patients on treatment with parenteral antineoplastic drugs presented a clinically relevant potential drug-drug interaction. A systematic assessment of drug-drug interactions should be implemented to reduce the risk of clinically relevant drug-drug interactions.

Equilibrio emocional, capacidad de autocuidado e integridad cutánea en la persona ostomizada / Emotional balance, self-care ability and skin integrity in ostomized persons

Objetivo: explorar la relación entre equilibrio emocional, autocuidado e integridad cutánea en personas ostomizadas mediante criterios de resultado NOC. Método: estudio observacional prospectivo. Se incluyeron pacientes ostomizados en seguimiento en "Consulta de Ostomía" a los siete días del alta, a los dos, seis y 12 meses. Se estudiaron variables sociodemográficas, clínicas y de resultado, basadas en ocho indicadores relacionados con los NOC (1101) Integridad tisular: piel y membranas mucosas, (1615) Autocuidado de la ostomía y (1204) Equilibrio emocional. Se realizó análisis descriptivo, usando frecuencias, medias y desviaciones estándar (DE). Se estudiaron las correlaciones entre los indicadores derivados de los NOC. Resultados: se incluyeron 55 pacientes. El 65,45% (n= 36) era hombre, con una edad media (DE) de 67,45 (13,4) años, siendo el 58,2% mayores de 65 años. Se restableció la continuidad intestinal en el 50,90% (n= 28) de los participantes. La integridad de la piel la consiguió el 10,90% (n= 6) (visita 1), llegando al 100% (n= 20) (visita 4). Logró un autocuidado adecuado el 18,18% (n= 10) (visita 1), llegando al 100% (n= 20) (visita 4). No consiguió equilibrio emocional ningún paciente en la visita 1, obteniéndolo el 34% (n= 17) (visita 2), el 59,5% (n= 21) (visita 3) y el 70% (n= 14) (visita 4). Las correlaciones entre variables se presentan de forma directa y positiva, con niveles de asociación moderado-bueno. Todas son estadísticamente significativas. Conclusiones: el porcentaje de pacientes con problemas en la piel periestomal mejora a lo largo del seguimiento. El autocuidado aumenta gradualmente así como el equilibrio emocional. Hay relación directa y positiva entre integridad cutánea y autocuidado, calidad del sueño, apetito, mantenimiento del arreglo e higiene personal y manifestación de un estado de ánimo sereno

Objective: to explore the relationship between emotional balance, self-care and skin integrity in ostomized persons through the NOC Outcomes Criteria. Method: a prospective observational study, including ostomized patients under follow-up in the Ostomy Unit at seven days after discharge, and at two, six and 12 months. Sociodemographical, clinical and outcome variables were studied, based on eight indicators associated with the NOC (1101) Tissue Integrity: Skin & Mucous Membranes, (1615) Ostomy Self-Care and (1204) Emotional Balance. A descriptive analysis was conducted, using frequencies, means and standard deviations (SD). Correlations between NOC-derived indicators were studied. Results: the study included 55 patients; 65.45% (n= 36) were male, with 67.45 (13.4) years as mean age (SD), and 58.2% were >65-year-old. Intestinal continuity was restored in 50.90% (n= 28) of the participants; 10.90% (n= 6) achieved skin integrity (visit 1), reaching 100% (n= 20) (visit 4). An adequate self-care was achieved by 18.18% (n= 10) (visit 1), reaching 100% (n= 20) (visit 4). No patient achieved emotional balance at Visit 1; 34% (n= 17) had achieved it at Visit 2, 59.5% (n= 21) at Visit 3, and 70% (n= 14) at Visit 4. Correlations between variables were presented in a direct and positive manner, with Moderate-Good association levels; all of them were statistically significant. Conclusions: the proportion of patients with problems in peristomal skin improved throughout follow-up. Self-care was gradually increased, as well as emotional balance. There was a direct and positive relationship between skin integrity and self-care, quality of sleep, appetite, maintaining personal hygiene and care, and reporting a serene mood

The Incidence of Dental Needs During Isolated Missions Compared to Non-isolated Missions: A Systematic Review and Implications for Future Prevention Strategies.

INTRODUCTION: Dental emergencies in isolated groups have always been difficult to treat. Especially in people or groups who cannot be evacuated and who need urgent dental assistance: long-term submarine missions, long-term spaceship trips, military or non-governmental organizations deployments in conflict areas, military maneuvers, etc. The dental and evacuation problems could put the success of the mission at risk, with relevant associated economic and strategic costs. Our study summarizes current evidence about dental problems in isolated personnel (submarines and Antarctic missions) compared to other non-isolation conditions (military deployment in conflict area, military maneuvers) with the objective to assess the need for specific dental equipment in special long-term isolation conditions. MATERIALS AND METHODS: We searched Medline, Cochrane Library, and Dentalgate between 1960 and 2017 for studies reporting dental disease in long-term isolation conditions (minimum 1 month) versus non-isolation conditions. We conducted the systematic review with all studies fitting the inclusion criteria. The comparison of the incidence rate was performed fitting a Poisson regression model to see the effect of the individual's condition on the incidence of dental event. RESULTS: Thirty-eight studies were included in the systematic review. Antarctic missions showed a higher dental incidence rate compared to non-isolation conditions, but submarine missions showed the lowest dental incidence rate. In the sub-analysis of acute dental events, those with great impact on unit effectiveness, the incidence rates were higher. Caries and secondary decay events were the most prevalent dental problem in all conditions, followed by periodontal pathology and fractures of teeth or tooth problems not due to tooth decay in isolation conditions, and then by molar problems and endodontic problems in non-isolation conditions. The most common acute dental events were third molar problems and endodontic problems in all conditions. CONCLUSION: This systematic review shows that the incidence of dental pathology in long-term isolation conditions may seem relatively infrequent but it exists and is relevant. Dental events are unpredictable, unrelated to trauma, and caused mainly by poor dental status. Preventive measures considerably reduce dental prevalence.

Enfermedad de Parkinson: abordaje enfermero desde atención primaria / Parkinson's disease: Nursing approach from primary health care

Introducción: La enfermedad de Parkinson es un trastorno crónico neurodegenerativo de inicio insidioso y de curso prolongado. Tiene una mayor incidencia en las personas de edad avanzada; la edad media de inicio es de 57 años. Los cuidados que reciben los pacientes influyen en su calidad de vida. Se ha realizado una revisión bibliográfica de los datos publicados hasta el momento sobre qué necesidades tienen los enfermos de párkinson en fases iniciales y qué cuidados requieren. El objetivo principal del estudio ha sido determinar los cuidados de enfermería en los pacientes de párkinson recién diagnosticados en atención primaria. Resultados: Las necesidades más demandadas en la fase inicial de la enfermedad se relacionan con la movilidad, la eliminación y el sueño/reposo. Las intervenciones se programan según la necesidad de cada paciente. Conclusiones: La detención precoz del diagnóstico de la enfermedad de Parkinson mejorará la eficacia de la intervención y dará lugar a un enlentecimiento del progreso de la enfermedad. La importancia de informar y educar al paciente sobre los aspectos fundamentales y el pronóstico evolutivo de la enfermedad de Parkinson son fundamentales para mejorar la capacidad de afrontamiento del individuo

Introduction: Parkinson's disease is a chronic neurodegenerative disorder with insidious beginning and prolonged course. It has a higher impact in elderly people; the average age of onset is 57 years. The care that patients receive affect their quality of life. A literature review of the published data so far has been made to know which kind of needs the Parkinson's patients have in the early stages and which type of care they require. The main objective of this study has been to establish the nursing care for newly diagnosed Parkinson's patients at primary health care. Results: The most requested needs in the early stage of Parkinson's disease are related to mobility, elimination and sleep/rest. The interventions are programmed according to the needs of each patient. Conclusions: The early diagnosis of Parkinson's disease will improve the efficiency of the intervention and it will result in a slower progression of the disease. The importance of informing and educating the patient about the fundamental aspects and the evolution of the prognosis of Parkinson's disease are fundamental to improve the individual's ability of coping

Characterization of a bipartite medial cuneiform: micro-CT and anatomical study / Caracterización de un cuneiforme medial bipartito: micro-CT y estudio anatómico

A bipartite medial cuneiform is an anatomical variant consisting in a horizontal division of the bone. Previous descriptions of the joint type, obtained from archaeological material or clinical reports, are unclear. This study was conducted in a fresh-frozen left foot, which allowed studying the morphology of the ligaments after anatomical dissection. In addition a Micro-CT analysis was performed to elucidate the osseous structure supporting the articular surfaces. A complex ligamentous system was found between the two halves of the bipartite medial cuneiform. Two articular surfaces were observed between the two components. Hyaline cartilage was observed at the posterior surface, while fibrous tissue was found at the anterior surface. Micro-CT analysis revealed different osseous structures for each articular surface, thus proving the existence of two joint types. The finding of a bipartite medial cuneiform in a fresh-frozen specimen allowed us to perform an analysis of the soft-tissues and articular surfaces that shows the presence of hyaline cartilage and articular ligaments in the diarthrodial joint as well as the fibrous component of the synfibrosis. Micro-CT analysis further reinforces our morphological findings. Our results prove that two different joint types exist, which could help explaining the disparity of descriptions in the literature.

El cuneiforme medial bipartito es una variación anatómica que consiste en una división horizontal del hueso. Las descripciones previas del tipo de articulación entre los dos fragmentos, obtenidas de material arqueológico o de reportes clínicos, son heterogéneas. Este estudio se llevó a cabo en un pie izquierdo disecado en fresco, lo que permitió analizar la morfología de los ligamentos. Adicionalmente se llevó a cabo un análisis con Micro-CT a fin de aclarar la estructura ósea de soporte de las superficies articulares. Un sistema ligamentoso complejo une las dos mitades del cuneiforme medial bipartito. Se observaron dos superficies articulares uniendo ambos componentes. En la superficie posterior se encontró cartílago hialino, en tanto que la superficie anterior presentaba tejido fibroso uniendo las superficies articulares. El análisis por Micro-CT mostró que la estructura ósea de soporte de cada una de las superficies articulares es diferente, confirmando la existencia de dos articulaciones distintas. El hallazgo de un cuneiforme medial bipartito en un espécimen fresco ha permitido el estudio de las partes blandas y superficies articulares, demostrando la presencia simultánea del cartílago hialino y los ligamentos propios de una diartrosis y del tejido fibroso propio de una sinfibrosis, lo que ha sido posteriormente corroborado por el análisis por Micro-CT. Nuestros resultados demuestran por tanto que se trata de dos articulaciones distintas, lo cual explica la disparidad de las descripciones en la literatura.

Aplicación de la terapia de vacío en el tratamiento de la dehiscencia completa de inserción mucocutánea del estoma / Vacuum-assited closure (vac) therapy in the treatment of the complete dehiscence of the mucocutaneous junction of the stoma

La aplicación de la terapia de vacío en la dehiscencia completa de la inserción mucocutánea de un estoma es algo novedoso, ya que hasta ahora, en el manejo de las complicaciones del estoma se limitaba su uso a dehiscencias parciales del mismo. Aunque es una complicación poco frecuente, tiene gran relevancia, ya que dificulta la adaptación de los dispositivos de ostomía, enlentece la cicatrización de la cavidad dehiscente, requiere el consumo de gran cantidad de recursos humanos y materiales e impacta directamente en la calidad de vida del paciente. El abordaje de este caso se realizó de manera multidisciplinar (Cirugía, Enfermería y Nutrición) implantando una dieta de absorción alta para reducir el débito del estoma, asociando el uso de la terapia de presión negativa en la cavidad dehiscente y dispositivos de ostomía adecuados para la situación

The use of vaccum-assisted therapy in the complete dehiscence of the mucocutaneous junction of the stoma is a new alternative since, to manage stoma complications, its use has been limited to partial dehiscence of the stoma during the last years. It is an uncommon complication, but it has a great relevance, because it complicates the stoma devices adaptation, it slows the healing of the wound, it requires spending more human and material resources and it has a direct impact over the quality of life of the patient. The approach to every case must be carried out in a multidisciplinary way (Surgery, Nursing and Nutrition) giving to the patient a special diet to reduce the stoma debit, associating the use of vaccum-assisted therapy in the dehiscent wound and employing suitable stoma devices for each situation

Los enfermos de Alzheimer y sus cuidadores: intervenciones de enfermería / Alzheimer's patients and their caregivers: nursing interventions

Introducción: La enfermedad de Alzheimer es una demencia que afecta a un número cada vez mayor de personas. Estos pacientes precisan de una atención continua, prestada habitualmente por sus familiares. El cuidador informal es la persona encargada de realizar el cuidado no profesional de los pacientes dependientes, lo que puede conllevar en ellos repercusiones físicas, sociales y psíquicas, susceptibles de intervención profesional. El objetivo es analizar las necesidades más demandadas por familiares de pacientes de Alzheimer, estudiar los recursos sociosanitarios ofertados y concretar las competencias enfermeras en el abordaje del paciente y su familia. Material y métodos: Revisión bibliográfica en Cuiden, Elsevier, Dialnet, SciELO y Google Academic, de aquellos trabajos que analizan las necesidades, recursos sociosanitarios y competencias de enfermería sobre la enfermedad de Alzheimer. En total se analizaron 40 artículos. Resultados: Las necesidades más demandadas por los cuidadores son las de información, formación, ayuda física, atención al duelo y apoyo social. Los recursos sociosanitarios disponibles para facilitar la atención de estos son la atención a domicilio y diurna de no internamiento entre otros. Los cuidadores perciben que no se utilizan todos los recursos sociosanitarios disponibles. Los enfermeros aportan apoyo y cuidado, y destacan sobre todo las intervenciones de tipo psicoeducativo. Conclusión: Las necesidades de los cuidadores abarcan las dimensiones física, psíquica y social. Los recursos sociosanitarios a disposición de los cuidadores se encuentran infrautilizados y las intervenciones enfermeras más valoradas son las estrategias de educación sanitaria. Es preciso seguir investigando para ampliar los conocimientos que permitan ofrecer cuidados de calidad

Introduction: Alzheimer disease is a dementia which affects an increasing number of people. Those patients require continued assistance which is usually given by their relatives. The informal carer is the person in charge of the non-professional care of the dependent patients. This can imply physical, social and psychic repercussions, susceptible to professional intervention. The goal is analysing the most demanding necessities by the relatives of Alzheimer’s patients, studying the offered socio-health resources and concreting the nursing competencies in the approach of the patient and his family. Material and methods: Bibliographic revision in Cuiden, Elsevier, Dialnet, SciELO and Google Academic, of those works which analyse the necessities, sociohealth resources and nursing competences about Alzheimer disease. Overall forty articles were analysed. Results: The most demanding necessities by the cares are related with the information, formation, physical help, grief attention and social support. The available socio-health resources to ease their attention are for instance, the home care and the daytime and non-hospitalized attention. The cares observe that the available socio-health resources are not completely used. The nurses give support and care, especially in the psychoeducational interventions. Conclusion: The necessities of the cares cover physical, psychic and social dimensions. Their available socio-health resources are untapped and the most valued nursing interventions are the health education strategies. It is necessary to carry out more research in order to broaden the knowledge which allows us to provide good quality cares

X-shaped inferior extensor retinaculum and its doubtful use in the Bröstrom-Gould procedure.

PURPOSE: The inferior extensor retinaculum (IER) is an aponeurotic structure located in the anterior aspect of the ankle. According to the literature, it can be used to reinforce a repair of the anterior talofibular ligament in ankle instability. Despite its usual description as an Y-shaped structure, it is still unclear which part of the retinaculum is used for this purpose, or if it is instead the crural fascia that is being used. The purpose of this study is to define the anatomical characteristics of the IER to better understand its role in the Broström-Gould procedure. METHODS: Twenty-one ankles were dissected. The morphology of the IER and its relationship with neighbouring structures were recorded. RESULTS: Seventeen (81%) of the IER in this study had an X-shaped morphology, with the presence of an additional oblique superolateral band. This band, by far the thinnest of the retinaculum, is supposed to be used to reinforce the repair of the anterior talofibular ligament. The intermediate dorsal cutaneous nerve (lateral branch of the superficial peroneal nerve) was found to cross the retinaculum in all cases. CONCLUSIONS: The IER is most commonly seen as an X-shaped structure, but the fact that the oblique superolateral band is a thin band of tissue probably indicates that it may not add significant strength to ankle stability. Furthermore, the close relationship of the retinaculum with the superficial peroneal nerve is another factor to consider before deciding to perform a Broström-Gould procedure. These anatomical findings advise against the use of the Gould augmentation.

Is coracohumeral distance associated with pain-function, and shoulder range of movement, in chronic anterior shoulder pain?

BACKGROUND: The aim of this study was twofold: (i) to assess the intrarater reliability of coracohumeral distance; (ii) to investigate the level of association between coracohumeral distance measured by ultrasonography, and pain-disability and shoulder range of movement, in patients suffering from chronic anterior shoulder pain. METHODS: An observational, cross sectional study was carried out. A convenience sample comprised of 87 patients with chronic anterior shoulder pain was assessed from 3 primary care centres. Main outcomes as pain and function were measured through the shoulder pain and disability index. Furthermore, shoulder range of movement-free of pain in shoulder elevation, as well as coracohumeral distance at both 0 and 60 degrees, were collected. RESULTS: Absence of any correlation was found between coracohumeral distance and shoulder pain and disability index at both 0 and 60 degrees of shoulder elevation. Furthermore, absence of any correlation was found between coracohumeral distance measurements and active shoulder range of movement -free of pain. CONCLUSIONS: There was poor association between coracohumeral distance and shoulder pain and function, as well as with shoulder range of movement, in patients with chronic anterior shoulder pain. Hence, clinicians should consider, not only increasing this space, but also other possibilities in their therapies, when patients with anterior shoulder pain are treated. TRIAL REGISTRATION: ACTRN12614000144617 . Registered: 1st March 2014.

Asociación de familiares de enfermos de Alzheimer cubriendo un vacío / Association of relatives of Alzheimer patients filling a gap

Introducción: Existe una alta prevalencia de adultos mayores diagnosticados de demencia que generan una importante demanda de cuidados y recursos sociosanitarios. Los centros de día atienden a las personas en situaciones de dependencia y facilitan la integración familiar. Nuestras preguntas iniciales son acerca de las asociaciones de enfermos y familiares. ¿Cómo surgen y se organizan? ¿Qué servicios ofrecen? ¿Qué competencias desarrollan los profesionales de enfermería? Objetivo: Analizar la percepción que tienen los miembros del equipo de una asociación de familiares de enfermos de Alzheimer y otras demencias sobre el funcionamiento y el servicio que ofrecen a la sociedad. Material y métodos: Estudio cualitativo descriptivo, realizado en una asociación de familiares de enfermos de Alzheimer. Se realizan tres entrevistas semiestructuradas respetando las consideraciones éticas establecidas para los trabajos de investigación con personas. Resultados: Surgen tres categorías en el análisis de los relatos, la historia de la asociación, la estructura y organización del equipo interdisciplinar, destacando las competencias del profesional de enfermería y la oferta de servicios que ha desarrollado. Conclusiones: La asociación surge ante las necesidades de atención sentidas por parte de las familias y que no obtienen respuesta en otras instituciones. Se ha consolidado como un recurso imprescindible cuyo objetivo es mantener a la persona dependiente en su medio habitual y proporcionar apoyo a sus cuidadores. Atiende desde un equipo interdisciplinar que contribuye al desarrollo de unos fines comunes, donde la enfermería desarrolla las competencias propias de la profesión

Introduction: There is a high prevalence of elderly diagnosed of dementia that generates an important demand of well-taken care of and socio-sanitary resources. The day care centers take care of the people in dependency situations and facilitate familiar integration. Our initial questions are about the Associations of patients and relatives. How arises and how they are organized? What services do they offer? What competences develop the nurse professionals? Aim: To analyze the perception which the members of the equipment have of an Alzheimer´s patients relatives Association and other dementias on the operation and the service that offer to the society. Material and methods: Descriptive qualitative study, made in an Alzheimer´s Relatives Association. Three semi structured interviews are made respecting the established ethical considerations for the investigation works with people. Results: Three categories in the analysis arise from the stories, the history of the Association, the structure and organization of the multidisciplinary equipment, emphasizing the competitions of the nurse professional and the supply of services that it has developed. Conclusions: The Association arises from the needs of heartfelt attention from families and that do not obtain answer in other institutions. It has established as an essential resource whose aim is to maintain to the disabled person in its usual means and to provide support to its caretakers. It takes care of from a multidisciplinary equipment that contributes to the development of common aims, where nursing develops the own competitions of the profession