Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos / Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units

Objetivos: Determinar el grado de conocimientos de las enfermeras sobre el uso de contenciones mecánicas en las unidades de críticos y los factores relacionados. Método: Estudio multicéntrico, observacional, en 12 unidades de críticos de 8 hospitales en España (n = 354 enfermeras). Se elaboró una encuesta ad-hoc de conocimientos cuyo contenido fue validado por expertos. La encuesta obtuvo una estabilidad test-retest de CCI = 0,71 (IC 95%: 0,57-0,81) en un estudio piloto previo. El instrumento final quedó conformado por 8 ítems. Se recogieron datos sociodemográficos y profesionales de los participantes, así como variables estructurales y clínicas de las unidades a estudio. Se llevó a cabo un análisis descriptivo y de asociación entre variables. Se consideró estadísticamente significativo un valor de p < 0,05. Resultados: Respondieron 250 enfermeras (70,62%), con una edad media de 36,8 (DE 9,54) años y una media de 10,75 (DE 8,38) años de experiencia profesional en unidades de críticos. El 73,6% no había recibido formación previa sobre contenciones mecánicas. La media de conocimientos fue de 4,21 (DE 1,39) (rango 0-8). El grado de conocimientos se asoció al hospital de referencia (p < 0,001). Las enfermeras con mayor grado de conocimientos es más probable que trabajen en unidades con consentimiento informado para el uso de contenciones mecánicas (p < 0,001); visita familiar flexible (p < 0,001); y que dispongan de protocolo de analgosedación (p = 0,011), o que la enfermera tenga autonomía en el manejo de la analgosedación (p < 0,001). Ningún dato sociodemográfico ni profesional individual se asoció al grado de conocimientos. Conclusiones: Es necesaria una mayor formación de las enfermeras sobre el uso de contenciones mecánicas. El entorno de trabajo donde se desarrollan los cuidados tiene una gran influencia en el grado de conocimientos de las enfermeras sobre esta intervención

Objectives: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. Method: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n = 354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. Results: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p < .001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p < .001); flexible family visiting (p < .001); analgo-sedation protocol (p = .011), and units in which nurses had autonomy to manage analgo-sedation (p < .001). Individual sociodemographic and professional data was not associated with knowledge level. Conclusions: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention

Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units. / Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos.

OBJECTIVES: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. METHOD: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n=354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. RESULTS: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p<.001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p<.001); flexible family visiting (p<.001); analgo-sedation protocol (p=.011), and units in which nurses had autonomy to manage analgo-sedation (p<.001). Individual sociodemographic and professional data was not associated with knowledge level. CONCLUSIONS: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention.

Descanso nocturno en el paciente urológico hospitalizado / No disponible

No disponible

Abordaje integral de un caso complejo de continuidad de cuidados a un paciente cistectomizado / No disponible

El manejo inefectivo del régimen terapéutico es uno de los diagnósticos que con más frecuencia se le presenta al profesional enfermero durante su desarrollo profesional. Es fundamental que el enfermero desarrolle un plan de cuidados de forma óptima para que el paciente adquiera una correcta adhesión al tratamiento terapéutico y mejore su calidad de vida, así como prevenir las posibles complicaciones ante el no cumplimiento de tal tratamiento. Atendimos en nuestra unidad a un paciente de 56 años con diagnóstico de carcinoma infiltrante de vejiga que iba a ser intervenido de cistectomía. Controla su diabetes sin seguir con el plan terapéutico de su médico de familia, tampoco ha conseguido dejar su hábito tabáquico. Esto nos pone alerta de los posibles problemas posquirúrgicos y al alta

Nursing staff is exposed to ineffective management of therapeutic regimen during their professional development. It is essential for the nursing staff to develop an optimum self-care plan so that the patient can adhere to treatment and improve his quality of life. This will help the patient to anticipate possible complications related to non-compliance for treatment of the disease. A 56 years old patient with an infiltrating bladder cancer was admitted to our unit. The patient poorly controls diabetes, does not follow an appropriate treatment plan and has not stopped smoking. This is putting the patient at great danger due to post-operative complications and problems as a result of discharge from hospital

Exon-focused genome-wide association study of obsessive-compulsive disorder and shared polygenic risk with schizophrenia.

Common single-nucleotide polymorphisms (SNPs) account for a large proportion of the heritability of obsessive-compulsive disorder (OCD). Co-ocurrence of OCD and schizophrenia is commoner than expected based on their respective prevalences, complicating the clinical management of patients. This study addresses two main objectives: to identify particular genes associated with OCD by SNP-based and gene-based tests; and to test the existence of a polygenic risk shared with schizophrenia. The primary analysis was an exon-focused genome-wide association study of 370 OCD cases and 443 controls from Spain. A polygenic risk model based on the Psychiatric Genetics Consortium schizophrenia data set (PGC-SCZ2) was tested in our OCD data. A polygenic risk model based on our OCD data was tested on previous data of schizophrenia from our group. The most significant association at the gene-based test was found at DNM3 (P=7.9 × 10(-5)), a gene involved in synaptic vesicle endocytosis. The polygenic risk model from PGC-SCZ2 data was strongly associated with disease status in our OCD sample, reaching its most significant value after removal of the major histocompatibility complex region (lowest P=2.3 × 10(-6), explaining 3.7% of the variance). The shared polygenic risk was confirmed in our schizophrenia data. In conclusion, DNM3 may be involved in risk to OCD. The shared polygenic risk between schizophrenia and OCD may be partially responsible for the frequent comorbidity of both disorders, explaining epidemiological data on cross-disorder risk. This common etiology may have clinical implications.

Plan de cuidados de cistectomía: variaciones y adaptación a la Unidad de Cirugía/Especialidades / No disponible

No disponible

Bernoulli, Poiseuille, Pascal y la energética de la circulación sanguínea / Bernoulli, Poiseuille, Pascal and the energetics of the circulation

La sangre fluye desde un sitio de mayor energía a otro de menor energía y no necesariamente desde un sitio de mayor presión a otro de menor presión como frecuentemente se asevera. Existen varios ejemplos en la circulación sanguínea que demuestran esta aseveración, pero su comprensión requiere del conocimiento básico de las ecuaciones de Bernoulli, Poiseuille y Pascal lo cual se intenta entregar en este artículo. La ecuación de Bernoulli es la ecuación básica que describe los componentes de energía que la contracción ventricular imparte a la sangre durante la eyección y en que la energía de presión es sólo uno de esos componentes, además de la energía cinética y de la energía potencial gravitacional. La ecuación de Poiseuille aporta a lo anterior el componente de viscosidad, el cual induce resistencia al flujo y pérdida de energía de presión para mantener el flujo. Finalmente el principio de Pascal explica la aparente paradoja de la dirección del flujo en contra de un gradiente de presión con los cambios posturales.

Blood flows from a site of high energy to a site of low energy and not necessarily from a site of high pressure to a site of low pressure as usually asserted. Several examples in the circulation support this view, however its understanding requires a basic knowledge of Bernoulli, Poiseuille and Pascal equations which is the purpose of this report. Bernoulli equation is the basic equation that describes the different energy components that the ventricular contraction imparts to the blood and of which pressure is just one of them besides kinetic and potential gravitational energies. Poiseuille equation supplies the viscous component that induces resistance to flow and dissipates pressure energy to maintain flow. Finally, Pascal principle provides the explanation for the direction of flow against a pressure gradient in the erect position.

[Cefditoren pivoxil: A new oral cephalosporin for skin, soft tissue and respiratory tract infections]. / Cefditoren pivoxilo: una nueva cefalosporina oral para infecciones de vias respiratorias y de piel y tejidos blandos.

Cefditoren pivoxil, a new-third generation cephalosporin antibiotic that has recently been granted approval in Spain, shows important activity over a large part of the pathogens causing skin, soft tissue and respiratory tract infections, including Gram-negative and Gram-positive bacteria. Cefditoren has also been shown to be stable against hydrolysis by many common beta-lactamases. Data from in vitro studies and clinical trials show this antibiotic as an oral formulation with an intrinsic activity against Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae equivalent to that of other third-generation cephalosporins administered via parenteral, like cefotaxime or ceftriaxone, thereby placing its maximal benefits mainly in the treatment of ambulatory infections. This paper reviews the main characteristics of cefditoren pivoxil (spectrum of activity, chemical structure, mechanism of action, pharmacokinetics, adverse effects and clinical efficacy) and attempts to find its place in current antibiotic therapeutics.

Cefditoren pivoxilo: una nueva cefalosporina oral para infecciones de vías respiratorias y de piel y tejidos blandos / Cefditoren pivoxil: A new oral cephalosporin for skin, soft tissue and respiratory tract infections

Recientemente se ha aprobado en España cefditoren pivoxilo, una nueva cefalosporina oral de tercera generación con importante actividadsobre gran parte de los patógenos causantes de infecciones de vías respiratorias, de piel y tejidos blandos, entre ellos bacterias grampositivasy gramnegativas, y que además es estable frente a la hidrólisis por muchas de las betalactamasas habituales. Teniendo en cuenta los datosin vitro y la eficacia mostrada en los ensayos clínicos, parece ser una alternativa equivalente a la cefotaxima o la ceftriaxona, pero de administraciónoral, por su actividad intrínseca equiparable frente a Haemophilus influenzae, Moraxella catarrhalis y Streptococcus pneumoniae,y cuyo lugar principal se sitúa fundamentalmente en el ámbito extrahospitalario. El objetivo de este trabajo es realizar una revisión delas principales características de cefditoren pivoxilo (espectro de actividad, estructura, mecanismo de acción, farmacocinética, reacciones adversasy eficacia clínica) con objeto de orientar su lugar en la terapéutica antimicrobiana

Cefditoren pivoxil, a new-third generation cephalosporin antibiotic that has recently been granted approval in Spain, shows important activityover a large part of the pathogens causing skin, soft tissue and respiratory tract infections, including Gram-negative and Gram-positivebacteria. Cefditoren has also been shown to be stable against hydrolysis by many common beta-lactamases. Data from in vitro studiesand clinical trials show this antibiotic as an oral formulation with an intrinsic activity against Haemophilus influenzae, Moraxella catarrhalisand Streptococcus pneumoniae equivalent to that of other third-generation cephalosporins administered via parenteral, like cefotaxime orceftriaxone, thereby placing its maximal benefits mainly in the treatment of ambulatory infections. This paper reviews the main characteristicsof cefditoren pivoxil (spectrum of activity, chemical structure, mechanism of action, pharmacokinetics, adverse effects and clinical efficacy)and attempts to find its place in current antibiotic therapeutics

[Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy]. / Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía.

We documented the frequency of nephritic colic in patients with primary hyperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism.

Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía / Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy

Se documentó la frecuencia de cólicos nefríticos en pacientes con hiperparatiroidismo primario, y se determinó su modificación tras la paratiroidectomía; así mismo se estudiaron parámetros de laboratorio tales como calcio, fósforo y parathormona en suero, y excreción de calcio en orina de 24h previos y posteriores a la intervención. A la vista de los resultados se puede concluir que la paratiroidectomía es útil en el tratamiento de la enfermedad calculosa renal producida por el hiperparatiroidismo primario (AU)

We documented the frequency of nephritic colic in patients with primary hiperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism (AU)

[Bacterial tracheitis due to Haemophilus influenzae]. / Traqueítits bacteriana por Haemophilus influenzae.

We present a case of bacterial tracheitis in a 6.5 year old girl. Clinical signs and symptoms consisted of severe croup with high grade fever, which were preceded by upper respiratory tract prodrome. Initial treatment with steroids and nebulized epinephrine was unsuccessful. The patient was intubated a few hours after admission. Thick purulent secretions emerging from the trachea and the normal appearance of the epiglottis suggested the diagnosis of bacterial tracheitis, which was confirmed by isolation of Haemophilus influenzae in the culture of the tracheal secretions. The patient was administered a 14 day course of endovenous ceftriaxone and was kept on mechanical ventilation for 7 days. Fever and purulent tracheal secretions continued for the next 5 days. After 48 hours without these signs, laryngotracheobronchoscopy ruled out residual obstruction. Extubation was successfully performed. Fourteen days later physical examination showed no abnormalities and the patient was discharged. No complications were found during followup. The clinical, diagnostic and therapeutic aspects of this potentially life threatening entity that should taken into account in the differential diagnosis of severe croup are discussed.

Traqueítits bacteriana por Haemophilus influenzae / Bacterial tracheitis due to haemophilus influenzae

Se presenta un caso de traqueítis bacteriana en una niña de 6 años y medio. La forma clínica de presentación fue la de un crup intenso con fiebre alta y pródromos catarrales en los días previos, que no respondió al tratamiento inicial con adrenalina inhalada y corticoides y precisó intubación orotraqueal a las pocas horas del ingreso. La visualización de secreciones purulentas fluyendo de la tráquea en el momento de la intubación, con epiglotis de aspecto normal, orientó el diagnóstico de traqueítis bacteriana, que fue confirmado por el crecimiento de Haemophilus influenzae en el cultivo de dichas secreciones. Se administró tratamiento con ceftriaxona por vía intravenosa durante 14 días y ventilación mecánica durante 7 días. La fiebre alta y las secreciones traqueales purulentas persistieron durante los 5 primeros días de tratamiento. A los 2 días de desaparición de dichos signos, y previa laringotraqueobroncoscopia normal, se extubó con éxito. Tras 2 semanas de ingreso fue dada de alta con exploración física normal, y no se han observado complicaciones posteriores. Se revisan aspectos clínicos, diagnósticos y terapéuticos de una enfermedad que puede conllevar un compromiso vital y que debe considerarse en el diagnóstico diferencial de todo crup grave (AU)

Childhood history of abuse and child abuse potential in adolescent mothers: a longitudinal study.

OBJECTIVES: The purpose of this research was to determine whether adolescent mothers of newborns are at higher risk for child abuse than adult mothers of newborns and to examine whether adolescent mothers with memories of child maltreatment have a higher risk for child abuse. METHOD: Two groups (adolescents and adults) of pregnant mothers were followed for 20 months beginning between the 5th and the 7th month of pregnancy until the child was 18 months old. Adolescent (N = 24) and adult (N = 24) mothers were matched on sociodemographic variables. During pregnancy, memories of child maltreatment were evaluated. When child was 1, 6, 12, and 18 months old, risk for child abuse was evaluated. RESULTS: Adolescent and adult mothers showed no differences in memories of childhood physical or emotional abuse. Nevertheless, adolescent mothers showed higher child abuse potential and depression scores than adult mothers. Mothers with memories of severe physical punishment showed higher child abuse potential scores and mothers with memories of physical punishment producing physical damage showed higher child abuse potential and depression scores. A statistically significant age of the mother by physical punishment producing physical damage interaction was found for depression. CONCLUSIONS: The results of this longitudinal study indicated that the potential for abuse was significantly greater in adolescent mothers than in adult mothers, and in mothers who had been victims of physical abuse than in those who had not. It also appeared that, among adolescent mothers, those who had been victims of childhood physical abuse constitute a higher risk group for child physical abuse.

El endotelio y la circulación coronaria / The endothelium and the coronary circulation

In the last few years, so many different substances produced by the endothelium have been discovered that this structure is considered today a parafcrine organ. Among these substances, there are at least three with marked vascular effects: prostacyclin (PGI-2) and the endothelium-derived relaxing factor (EDRF) are vasodilators, platelet stabilizers and anti-atherogenic. On the other hand, endothelin-1 (ET-1) is a potent vasoconstrictor and probably pro-atherogenic. There are many agents that stimulate the liberation of these substances by the endothelium and most of then stimulate simultaneously the production of the three substances. even thought it is not possible yet to define the exact participation of the endothelium in the normal regulation of coronary blood flow it is highly probably that a disfunction of this structure secondary to hypercolesterolemia, hypertension, atheromatosis, diabetes and smoking may decrease the coronary reserve, induce coronary spasm and facilitates the development of atheroma

Prolapso de válvula mitral / Mitral valve prolapse

El prolapso valvular mitral (PVM) es un desplazamiento sistólico excesivo de uno o ambos velos mitrálicos hacia la aurícula. La principal etiología es una degeneración mixomatosa de la cuerdas tendíneas, velos y anillo mitral. Puede ocurrir como una alteración aislada (primaria) o asociada a discolagenosis sistémicas. Un desplazamiento acentuado de velos mitrílicos normales puede ocurrir secundario a una disminución de tamaño del ventrículo izquierdo. La prevalencia del PVM primario varía entre 1% y 8%. La mayor parte de los pacientes son asintómaticos. De las muchas manifestaciones adscritas al PVM, aquellas que muestran la mejor asociación con ella son: bajo peso y presión arterial, alteraciones óseas torácicas, palpitaciones y tendencia a la hipotensión ortostática y al síncope. La expresión característica es la auscultación de uno o más ruidos de eyección meso o telessistólicos y un soplo telesistólico claros y reproducibles de mayor intensidad en la punta y movibles con intervenciones físicas. El mejor standar de referencia para apoyar el diagnóstico es la ecocardiografía siempre que se use con prudencia. Debido a la geometría del anillo mitrálico la visión apical de cuatro cámaras produce muchos falsos positivos y el diagnóstico no debe basarse sólo en esta visión. Mientras no se conozca la topografía de los velos mitrálicos y su rango normal muchas observaciones quedarán indefinidas y no deberán ser catalogadas como PVM. Las principales complicaciones del PVM son la insuficiencia mital aguda y la crónica. Otras complicaciones como endocarditis infecciosa, arritmias ventriculares, muerte súbita y tromboembolismo cerebral tienen un riesgo no superior al observado en la población general salvo en presencia de insuficiencia mitral y aún así su prevalencia es muy baja

Slow ventricular tachycardia complicating acute myocardial infarction.

Among 200 consecutive cases of acute myocardial infarction (AMI) treated in a CCU, 117 episodes of slow ventricular tachycardia were observed in 72 patients. This figure represents a 36% rate of incidence. It is a relatively high figure because of the close monitoring to which the patient is submitted and because of the early admission to the unit. There were no significant differences of age, sex, or localization of the myocardial necrosis between patients with SVT and those without it. The different mechanisms of production described support an active origin in most of the patients for the following reasons: (1) coexistence of SVT and PVT in 51.3% of the patients; (2) identical QRS morphology in both rhythms; (3) onset of the SVT after a nonprolonged diastole in 70% of the tracings; (4) inhibition of the SVT after increase of the sinus discharge in only 14 occasions; and (5) irregular SVT rhythm in 76.9% of the recordings and ectopic mechanisms with different degrees of exit block. Because of the potential hazard of the SVT, especially if it is assumed to be of an active origin, we recommend lidocaine for patients with a sinus rate faster than 60 per minute or coexisting PVT. Atropine should be used when the sinus rate is slower than 60 per minute assuming a possible escape or passive origin.