Multimodal imaging assessment of a "micro" optic disk melanocytoma: A case report.

An optic disk melanocytoma is a benign pigmented neoplasm of the optic disk measuring 2.00 mm of diameter in average. Smaller optic disk melanocytomas are rare and have not been studied with multiple imaging studies. A case of a "micro" optic disk melanocytoma measuring 0.71 mm in diameter was studied by multiple imaging modalities, including fundus autofluorescence, ultrasound, visual fields, optical coherence tomography (OCT) and OCT angiography. While clinical appreciation and fundus autofluorescence reveal changes compatible with previously reported cases, OCT, OCT angiography and ultrasound reveal specific changes that could be useful for follow up.

Resolver problemas y tomar decisiones, esencia de práctica reflexiva en enfermería. Análisis de la literatura / Problem-solving and decision-making, essence of reflexive practice in nursing: A literature review / Resolver problemas e tomar decisões, essência de prática reflexiva em enfermagem. Análise da literatura

Dada la importancia de la formación de profesionales reflexivos, y en el marco de la búsqueda de una nueva epistemología de la práctica de enfermería, este artículo de revisión analiza diversas fuentes teóricas que representan evidencias científicas relativas a la resolución de problemas, toma de decisiones clínicas y su relación con las características de los recién egresados del pregrado, quienes al realizar servicio social (residencias), vivencian un proceso de transición: dejar de ser estudiante, pero a la vez enfrentarse a situaciones de ejercicio profesional que requieren habilidades para resolver problemas y tomar decisiones en situaciones inciertas y complejas. La revisión implicó búsquedas sistemáticas en bases de datos como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden y Redalyc, que permitieron localizar: 3 revisiones sistemáticas, 11 estudios con enfoque cuantitativo, 11 con enfoque cualitativo y 2 mixto, 14 artículos de revisión y 5 libros, publicados en los últimos 15 años. Aunque las publicaciones analizadas proceden de todos los continentes, predominan las de América en un 50%, seguidas por las europeas en un 22%. Se concluye que existen modelos que pueden apoyar el desarrollo de habilidades para los procesos cognitivos referidos, lo que coadyuvaría a un ejercicio profesional reflexivo y autónomo, en lugar de la adhesión a prácticas asistenciales rutinarias. También que las escuelas de Enfermería tienen el compromiso para incorporar en el currículo diversas estrategias deliberadas y progresivas que apoyen el desarrollo de dichas habilidades, así como de generar ambientes de aprendizaje áulicos y clínicos que las promuevan.

Considering the importance of forming reflexive professionals, and also within the frame of a new epistemology of nursing practice, this review explores diverse theoretical sources which represent scientific evidence related to problem-solving and clinical decision-making skills, and also to the characteristics of newly nursing graduates who, during their social service (residency), experience a process of transition facing professional realities which require them to use those skills within complex and uncertain situations. The review included systematic searches in databases such as Medline, CINHAL, Scielo, Lilacs, Cochrane, Cuiden, and Redalyc, and yielded: 3 systematic reviews, 11 studies with quantitative approaches, 11 studies with qualitative ones, 2 with mixed ones, 14 review articles, and 5 books published in the last 15 years. The analyzed publications came from all continents, but there was a higher prevalence of those from America (50%) and Europe (22%). This review suggested that there are models which can support the development of these important skills and thus help consolidate a professional performance which is autonomous-reflexive rather than repetitive. Moreover, the schools of nursing can consider incorporating these models into their curricula and also generate school and clinical environments which further support the development of these skills.

Dada a importância da formação de profissionais reflexivos e no quadro da busca de uma nova epistemologia da prática de enfermagem, este artigo de revisão, analisa diversas fontes teóricas que representam evidencias científicas relativas à resolução de problemas, toma de decisões clínicas e a sua relação com as caraterísticas dos recém-formados da pre-graduação, os quais ao fazer o estágio (residências), vivenciam um processo de transição: deixar de ser estudante, mas ao mesmo tempo confrontar-se a situações de exercício profissional, eles requerem habilidades para resolver problemas e tomar decisões em situações incertas e complexas. A revisão envolveu buscas sistemáticas em bases de dados como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden e Redalyc, que permitiram localizar 3 revisões sistemáticas, 11 estudos com abordagem quantitativa, 11 com abordagem qualitativa e 2 mista, 14 artigos de revisão e 5 livros, publicados nos últimos 15 anos. Ainda que as publicações analisadas procedam de todos os continentes, predominam as da América em um cinquenta por cento, seguidas pelas europeias em vente e dois por cento. Conclui-se que existem modelos que podem apoiar o desenvolvimento de habilidades para os processos cognitivos referidos, o qual contribuiria a um exercício profissional reflexivo e autônomo, em vez da adesão de práticas assistenciais rotineiras. Também que as escolas de Enfermagem têm o compromisso para incorporar no currículo diversas estratégias intencionais e progressivas que apoiem o desenvolvimento de tais habilidades, assim como para gerar ambientes de aprendizagem escolares e clínicos que as promovam.

Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome.

PURPOSE: The main objective of this study is to describe the prevalence, degree and risk of corneal involvement, and visual impact in a pediatric population with blepharokeratoconjunctivitis (BKC). METHODS: Retrospective, observational, case-control study. Clinical records of patients ≤16 years old with BKC seen between 2006 and 2012 were reviewed. The prevalence and relative risk of corneal involvement was evaluated between patients with and without corneal affection through a univariate and multivariate analysis with logistic regression. Visual acuity at presentation and at last follow-up visit was also analyzed. RESULTS: One hundred and fourteen children with BKC, with a male-to-female ratio of 1 : 1 and a mean age at diagnosis of 9.13 years. The mean follow-up time was 26.4 (±25) months. Corneal involvement was present in 39.5% of patients, varying from superficial punctate keratitis to perforation. Corneal changes were not seen in children under 4 years old. The risk of corneal affection was greater in patients with photophobia, hordeolum, female gender and asymmetric disease (OR of 2.69, 11.6, 2.35 and 2.77, respectively). The mean best-corrected visual acuity at presentation was 0.20 (corneal affected group), compared to 0.11 (unaffected group; P=0.02). CONCLUSIONS: Our study showed an older age at time of diagnosis and a worse visual outcome in patients with BKC and corneal disease compared with previous reports. Early diagnosis and detection of risk factors for corneal involvement, as well as adequate treatment, is mandatory to prevent serious long-term visual repercussions in children with BKC.

[Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit]. / Riesgo de pie diabético en pacientes con diabetes mellitus tipo2 en una unidad de medicina de familia.

OBJECTIVE: To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. METHODS: The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. RESULTS: We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income <236 euros (OR 2.0; 95%CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95%CI: 1.5-5.0). CONCLUSIONS: It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot.