Estado de las actividades de Enfermería en el apoyo nutricional. Resultados de un estudio piloto multicéntrico en hospitales de América Latina / On the current state of Nursing activities in nutritional support. Results of a pilot multicenter study in Latin American hospitals

Justificación: El personal de Enfermería juega varios e importantes roles dentro de los equipos multidisciplinarios de terapia nutricional (EMTN) relacionados con la implementación, administración y supervisión de la terapia nutricional (TN). Sin embargo, no se tienen documentos sobre las prácticas corrientes de Enfermería en las TN que se administran en los países de América Latina (AL). Objetivo: Documentar el estado actual de las prácticas de Enfermería comprendidas dentro de las TN conducidas en los países AL. Diseño del estudio: Transversal, descriptivo. Locación del estudio. Cincuenta hospitales de las ciudades-capitales de 8 países de AL. La encuesta se desarrolló durante el mes de Noviembre del 2019. Métodos: Mediante una encuesta anónima distribuida sobre la plataforma Survey Monkey™ (SurveyMonkey LLC, Palo Alto, California, Estados Unidos) entre los profesionales en Enfermería en los hospitales participantes se documentó la existencia de un EMTN (u otra forma de organización hospitalaria), la dedicación exclusiva de los integrantes del mismo a la provisión de la TN, la existencia de legislaciones sobre la provisión de TN, las actividades que realiza el personal de Enfermería dentro del EMTN, la existencia de protocolos propios para la evaluación nutricional del enfermo, la administración de la TN, y la educación nutricional del enfermo y los familiares al alta hospitalaria; el monitoreo de los indicadores de calidad de la TN, el gerenciamiento del riesgo relacionado con la TN; y la formación local en temas de TN. Resultados: El 95 % de las instituciones participantes cuenta con un EMTN, pero el 55 % de los encuestados se dedica en forma exclusiva a la provisión de TN. La mitad de los encuestados conocía las legislaciones nacionales existentes sobre la TN. El 65 % de los profesionales en Enfermería se ocupa de la TN como parte de la atención de pacientes críticamente enfermos, y durante la convalecencia posquirúrgica...(AU)

Rationale: Nursing personnel plays several and important roles within the nutritional therapy multidisciplinary teams (NTMT) regarding implementation, management and supervision of nutritional therapy (NT). However, current Nursing practices in nutritional therapy (NT) administered in Latin American (LA) countries are not well documented. Objective: To document the current state of Nursing practices followed with NT administered in LA countries. Study design: Cross-sectional, descriptive. Study location: Fifty hospitals in the capitol-cities of eight LA countries. The survey was conducted during the month of November 2019. Methods: By means of an anonymous survey distributed through Survey Monkey™ platform (SurveyMonkey LLC, Palo Alto, California, United States) among Nursing professionals dedicated to TN in participating hospitals existence of a NTMT (or any other form of hospital organization) dedicated to NT administration, exclusive dedication of their members to NT provision, existence of legislations on NT provision, activities performed by Nursing personnel as part of the NTMT, existence of proprietary protocols for nutritional assessment of the patient, NT administration, and nutritional education of patients and relatives upon hospital discharge; and monitoring of NT quality indicators, management of risks related with NT, and local formation in NT issues were documented. Results: Ninety-five percent of participating institutions has a NTMT, but 55 % of the respondents are dedicated to NT provision in an exclusive manner. Half of the respondents knew of nationally existent legislations on NT. Sixty-five percent of the surveyed Nursing personnel delivers NT as part of the care of critically ill patients and those convalescing after surgery. Seventy-seven percent of Nursing personnel conducts hospital NT schemes according with locally-derived protocols...(AU)

Assessing dairy goat welfare in intensive or semi-intensive farming conditions in Mexico.

We aimed to verify whether a low number of relevant animal-based indicators was able to discriminate 33 semi-intensive (grazing during the day and confinement during the night with access to an outdoor paddock; S-INT) and 8 intensive farms (permanent confinement with access to an outdoor paddock; INT) located in the Mexican semi-desert. In addition, we implemented the resource-based assessment scheme Animal Needs Index (ANI) with the identified animal-based indicators to compare the overall level of welfare in INT and S-INT. In particular, we used a protocol made up of 2 parts. The first comprised 4 evaluation sheets (locomotion, flooring, environment, management) and resource-based indicators derived from ANI, and the second one comprised a set of validated animal-based measures focusing on physical conditions and clinical signs of disease derived from the Animal Welfare Indicators scheme and reported in 2 additional sheets. The scoring system was also derived from ANI, with partial scores for each sheet to be summed to obtain the total score. A total of 1,116 dairy goats were assessed. All the observations and recordings were performed by an expert veterinarian evaluator assisted by an auxiliary, and longevity was retrieved from the farm records. The prevalence of animals displaying dirtiness, ocular discharge, abscesses, and claw overgrowth were higher in INT than in S-INT. Disbudding was routinely performed in INT only. Therefore, scurs, indicating improper disbudding, were recorded only in INT. In addition, the longevity of goats raised in S-INT was higher than in INT. Conversely, the prevalence of goats affected by anemia (i.e., FAMACHA scores >2) or lean (i.e., body condition score <2) tended to be higher in S-INT than in INT. No significant differences between the 2 groups of farms were detected for wounds, nasal discharge, integument alterations, fecal soiling, uterine prolapse, and subclinical mastitis. The results obtained using only animal-based measures were confirmed when resource-based variables were also included in the assessment, as 3 out of 6 sheets of the evaluation scheme (i.e., flooring, environment, and health-physical conditions) were scored higher in the S-INT than in the INT. As a consequence, the total score was also higher for S-INT than for INT. We conclude that the selected set of validated animal-based measures was able to discriminate between farms from different production systems. In particular, higher welfare levels were observed in S-INT farms, where the animals were allowed to spend most of the day on natural pasture, compared with INT farms, where the animals were constantly confined. Nevertheless, a certain degree of improvement should also be promoted in terms of anemia and body condition in S-INT farms.

Salud y Enfermedad Mental: Del Corpus Hippocraticum a una aproximación termodinámica / Health and Mental Illness: From Corpus Hippocraticum to a thermodynamic approach

Se establece una relación entre conceptos básicos acerca de salud y enfermedad mental en los Tratados Hipocráticos y los elementos actuales de la termodinámica y de la cibernética, enlace que se formula a través de los aportes de autores como Maturana y Valera (autopoiesis y teleonomía) o Bergson (regularidades vs indeterminsmos). Se definen y caracterizan los fenómenos anancásticos y los estocásticos, destacándose su relación complementaria. Con un enfoque termodinámico se define a la enfermedad mental como una estructura que se impone hegemónicamente sobre el resto de las actividades mentales y consume la energía que regula el metabolismo restante de la persona afectada. Se aportan evidencias clínicas de las bondades de esta óptica, presentándose, por ejemplo, la ansiedad como una crisis entrópica y la depresión como interferencia de la teleonomía , al tiempo que los trastornos obsesivo-compulsivos son descritos desde una perspectiva cibernética. A lo largo del texto se le confiere mayor relevancia a la noción de la enfermedad mental como pathos hegemónico que absorbe recursos energéticos y disminuye las posibilidades de adaptación del afectado a su medio externo y de éxito en el afrontamiento de sus propias tensiones.

A link is traced between the basic concepts on health and mental illness in the Hippocratic Treaties and the current elements of thermodynamics and cybernetics, through the contributions of authors such as Maturana and Valera (autopoiesis and teleonomy) or Bergson (regularities vs. indeterminism). Anankastic and stochastic phenomena are defined and characterized, highlighting their complementary connection. Following a thermodynamic approach, a mental illness is defined as a structure that imposes itself on the rest of the mental activities and consumes the energy that regulates the remnants of the affected person s metabolism. Clinical evidences of the benefits of this perspective are given, presenting, for instance, anxiety as entropic crisis and depression as an interference of teleonomy , while obsessive-compulsive disorders are described from the cybernetic perspective. Throughout the text, the greatest relevance is conferred to the notion of mental illness as a hegemonic pathos that absorbs energy resources and diminishes the affected individuals possibilities of adaptation to their external environment, and of successfully coping with their own tensions.

Incidence of the adjacent segment disease treated at the issemym medical center / Incidência da doença do segmento adjacente tratada no centro médico issemym / Incidencia de la enfermedad del segmento adyacente tratada en el centro médico issemym

ABSTRACT Objective: To determine the incidence and rate of disc degeneration adjacent to a lumbar fusion, as well as to analyze possible risk factors for its development. Methods: A retrospective study of a level of evidence IIB case series of 125 patients diagnosed with lumbar canal stenosis and spondylolisthesis, who underwent surgery from January 2011 to December 2016, with subsequent instrumentation and posterolateral fusion and outpatient follow-up in which the symptomatology and radiographic findings were evaluated to establish the diagnosis and management. Results: Twelve patients with adjacent segment disease were identified, with an incidence of 9.6%, higher both among female patients and in the seventh decade of life. The most frequent pathology was canal stenosis (42.4%), the most affected level was L4 / L5, and the procedure most associated with the prevalence of adjacent level degeneration was L4-L5 posterior transpedicular instrumentation. Conclusions: Sagittalization of the facet joint was a constant factor in all patients with involvement of the adjacent disc. The main clinical findings were treatment-resistant root pain and radiographic alterations characterized by spondylolisthesis, facet osteoarthritis and intervertebral disc herniation. Level of Evidence IIB; Retrospective study.

RESUMO Objetivo: Determinar a incidência e a taxa de degeneração do disco adjacente, bem como analisar possíveis fatores de risco de degeneração do disco adjacente à fusão lombar. Métodos: Foi realizado um estudo retrospectivo de série de casos com nível de evidência IIB, com uma amostra de 125 pacientes com diagnóstico de estenose de canal lombar e espondilolistese, que foram operados no período de janeiro de 2011 a dezembro de 2016, com instrumentação posterior e fusão posterolateral e acompanhamento ambulatorial, no qual se avaliou a sintomatologia e os achados radiográficos para estabelecer o diagnóstico e o tratamento. Resultados: Foram identificados 12 pacientes com doença do segmento adjacente, com incidência de 9,6%, com maior frequência no sexo feminino e na sétima década de vida. A patologia mais frequente foi estenose do canal (42,4%). O nível mais afetado foi L4/L5, e o procedimento mais relacionado com a prevalência do nível adjacente foi a instrumentação transpedicular posterior em L4/L5. Conclusões: A sagitalização das facetas articulares tem sido um fator constante em todos os pacientes, com envolvimento do disco adjacente. Os principais achados clínicos são dor radicular resistente ao tratamento e alterações radiográficas caracterizadas por espondilolistese, artrose facetária e hérnia de disco intervertebral. Nível de Evidência IIB; Estudo retrospectivo.

RESUMEN Objetivo: Determinar la incidencia y tasa de degeneración del disco adyacente, así como analizar posibles factores de riesgo de desarrollar degeneración del disco adyacente a una fusión lumbar. Métodos: Se realizó un estudio retrospectivo de serie de casos con nivel de Evidencia IIB, con una muestra de 125 pacientes con diagnósticos de canal lumbar estrecho y espondilolistesis, intervenidos quirúrgicamente en el periodo de enero del 2011 a diciembre del 2016, con instrumentación posterior y fusión posterolateral, con seguimiento en consulta externa en el cual se evaluó la sintomatología y hallazgos radiográficos para establecer el diagnóstico y manejo. Resultados: Se identificaron 12 pacientes con enfermedad del segmento adyacente. Con una incidencia de 9,6%, con mayor incidencia en el sexo femenino y mayor incidencia en la séptima década de la vida. La patología más frecuente ha sido la estenosis de canal (42,4%). El nivel de mayor afectación fue en L4/L5, y el procedimiento más relacionado con la prevalencia de nivel adyacente fue la instrumentación posterior transpedicular L4/L5. Conclusiones: La sagitalización de las facetas articulares ha sido un factor constante en todos los pacientes, con afectación del disco adyacente. Los principales hallazgos clínicos son dolor radicular resistente al tratamiento y alteraciones radiográficas caracterizadas por espondilolistesis, artrosis facetaria y hernia de disco intervertebral. Nivel de Evidencia IIB; Estudio retrospectivo.

[Vascular graft of aponeurosis with peritoneum in dogs]. / Injerto vascular de aponeurosis con peritoneo en perros.

BACKGROUND: Vascular autografts are commonly used to repair damage to blood vessels; however, they can be used only with small-caliber vessels. Although synthetic vascular grafts are good options, there may be a high likelihood of thrombus formation. METHODS: An experimental animal model was used in order to evaluate feasibility and viability of a vascular autograft. Under inhalatory anesthesia, seven mongrel dogs were operated on. A 4-cm vascular autograft was created with the posterior rectus aponeurosis with subjacent peritoneum, leaving the second one as the internal sheath. A 2-cm-long portion of the abdominal aorta was removed and the vascular autograft was inserted by end-end surgical anastomosis. Animals were observed for 7 weeks, evaluating clinical data of vascular insufficiency (intensity of pulse, temperature and trophic changes of the legs). At the end of the experiment, aortography under fluoroscopic visualization was performed. Dogs were sacrificed and autograft removed in order to evaluate permeability. RESULTS: All dogs survived until the end of the procedure. Vascular autograft was easy to create. During surgery, no evidence of bleeding of the anastomosis or the graft suture was noted. At the end of the procedure, no clinical signs of vascular insufficiency were noted; radiographic evaluation of the autograft showed no dye leakage at any level. Autografts were removed and no signs of thrombus formation were noticed. CONCLUSIONS: Feasibility of the vascular autograft was demonstrated with good permeability and no thrombogenicity.

Morbi-mortalidad en dialisis peritoneal continua ambulatoria. Experiencia con el uso de doble bolsa estudio multicentrico ISSSTE / Morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD). Experience with double bag. multicenter study (ISSSTE)

En el ISSSTE, el 80 por ciento de los pacientes con tratamiento sustitutivo de la función renal se encuentran en el Programa de Diálisis Peritoneal Continua Ambulatoria (DPCA). En el presente trabajo se analizan las causas más frecuentes de morbi-mortalidad de los pacientes del área metropolitana, Guadalajara y Monterrey, tratados con DPCA. De enero a Diciembre de 1999 se trataron 1021 pacientes. Al 31 de diciembre del mismo año sólo 661 permanecían dentro del programa. Los 360 restantes egresaron por causas diversas y de estas 259 fueron por fallecimiento, lo que representó el 25.1 por ciento del total. Durante el año 2000 se trataron 1439 pacientes de los cuales 344 fallecieron durante el año. Las complicaciones cardiovasculares constituyeron la mayor causa de morbi-mortalidad, promedio 50.1 por ciento durante los dos años, seguidas por las infecciones 14.2 por ciento y las metabólicas 9.6 por ciento. El índice de peritonitis observado fue de un episodio cada 26 meses paciente. Los problemas cardiovasculares son las causas más frecuentes de morbi-mortalidad en pacientes manejados con DPCA, dentro del ISSSTE.

Comunidades terapéuticas: métodos de evaluación / Therapheutics communities: methods of evaluation

Se realiza un análisis del papel de las comunidades terapéuticas dentro de las diversas modalidades de tratamiento en el campo del abuso y/o dependencia del alcohol y otras drogas. Se describen las pautas de trabajo en dicho modelo. Se presenta un recuerdo histórico del mismo y, como aspecto central del artículo, se analizan los criterios de evaluación y estudios sobre su eficacia, se presentan los indicadores actuales de evaluación y se le concede especial importancia al cuestionario sobre indicadores de calidad en comunidades terapéuticas (ERIT) y al inventario para la evaluación de normas de atención en el tratamiento de la farmacodependencia de la Organización Mundial de la Salud