Evaluación de la tecnología sanitaria. Apósitos basados en la cura en ambiente húmedo para heridas crónicas / Evaluation of Sanitary Technology. Dressings based on humid environment cure for chronic wounds

El bombardeo constante en producción, diferenciación e idoneidad de tipos deapósitos al que se ha sometido en las dos últimas décadas el mundo de las heridaspor parte de la industria hace necesario y obligatorio por parte del personalde la salud un conocimiento exhaustivo de la tecnología que tiene en sus manos.Los informes de Tecnología Sanitaria se han convertido en una buena herramientapara cubrir tanto la evaluación de los apósitos basados en cura enambiente húmedo, como la precisión de sus indicaciones. En el presente trabajoanalizamos la estructura de un Informe de Evaluación de Tecnología Sanitariadesde su marco general hasta su particularidad en el campo de los apósitos parael cuidado de heridas, las características básicas y estándar solicitadas por el profesionaly el enfermo, manteniendo en todo momento unas visión integral desdeel cuidado enfermero. Proponemos, al final, un informe ideal para hospital ocentro de salud imaginario, que se ajuste a todas las premisas de calidad, las realidadesde cada ámbito de salud y las posibilidades de cada sistema sanitario(AU)

In the last two decades the wounds sector has been subjected by the industry to aconstant shelling in production, differentiation and suitability of types of dressings that requires necessarily and by imperative from the health staff an exhaustiveknowledge of the technology that they have in their hands.The Sanitary Technology reports have become a good tool for covering both theevaluation of the dressings based on humid environment cure and their indicationsprecision. In the present work we analyze the structure of a Sanitary TechnologyEvaluation report, from its general context to its special features in the fieldof dressings for wounds care, and the basic and standard characteristics requestedby professionals and patients, always keeping an integral vision from the nursecare perspective. Finally, we propose an ideal report for a fictitious hospital or healthcenter, that adapts itself to all the premises of quality, the realities of every healthfield and the possibilities of each sanitary system(AU)

Visión de la enfermería de urgencias hospitalaria ante la herramienta de triage / The Hospital Emergency Clinic Nurses´ view of the triage tool

Objetivos: Analizar la actitud enfermera ante el triage, como instrumento de valoración en la unidad de urgencias. Métodos: Realizamos un análisis descriptivo, para los enfermeros/as estables en plantilla de Urgencias, del 1-01-01 al 1-10-01, período para el cual identificaron el triage como función asistencial y para ello elaboramos encuesta estructurada por consenso, registrando perfil profesional, así como actitudes de formación, idoneidad, auto capacitación y satisfacción. Resultados: Encuestamos a 39 enfermeros, de los cuales 14 realizaron al menos una vez el triage. Media de edad 37,6, con 14,6 años de profesión y media de estancia en el servicio de 7 años. No están de acuerdo con el triage el 37 por ciento, rechazan el modelo actual el 86,5 por ciento, aunque lo consideran beneficioso para el usuario (74,4 por ciento). Un 76,4 por ciento se angustia ante el desempeño de éste; un 92,9 por ciento identifica carencia de formación y el 57,1 por ciento intuye beneficios en el turno laboral por realizarlo. Referente al respaldo en triage, un 50 por ciento se considera arropado por los enfermeros, 21,4 por ciento por los facultativos, 7,1 por ciento por la dirección y el 42,9 por ciento por nadie. Los encuestados elaboraron el siguiente perfil de idoneidad: más de 1 año de experiencia en urgencias, formación específica, incluyendo habilidades en priorización de procesos urgentes, comunicación y trabajo en equipo. Al analizar la asistencia al usuario, problemas centrados en seguimiento, comunicación, información y relaciones interpersonales fueron considerados como más relevantes. Los aspectos más valorados por los enfermeros de triage fueron: autonomía, turno y comunicación paciente/familiar, siendo la falta de apoyo, respaldo del equipo y carencia de recursos los más negativos. Conclusiones: Aunque se considera útil para el enfermo, el triage es rechazado por el personal de enfermería. Quizás un enfoque multidisciplinar y una formación específica sean necesarios para incrementar tanto la calidad del proceso asistencial al enfermo que acude a urgencias, como la satisfacción del profesional que realiza el triage (AU)

Hot sand burns on the sole of a patient with diabetes.

A patient with diabetes who burnt his feet by walking on hot sand was treated with an amorphous hydrogel, which resulted in full wound healing within four weeks. These patients should avoid walking barefoot on sand whenever possible.

A novel alveolar type I cell-specific biochemical marker of human acute lung injury.

Currently there is no recognized biochemical or molecular marker for human parenchymal lung injury analogous to markers for acute myocardial injury. Injury to the alveolar epithelial barrier is of central importance in the pathogenesis of and recovery from acute lung injury. In animal models, an alveolar type I cell-specific protein, RTI(40), has been shown to be an accurate marker of alveolar epithelial damage. We now report that HTI(56), a novel apical plasma membrane protein specific to the human type I cell, is a biochemical marker for lung injury. Using a sensitive, quantitative, light-based ELISA, we measured HTI(56) in pulmonary edema fluid from 15 patients with a clinical diagnosis of acute lung injury and 12 control patients with hydrostatic (cardiogenic) pulmonary edema. HTI(56) was also measured in plasma from these two groups and from 11 normal volunteers. The amount of HTI(56) was 4. 3-fold higher (p < 0.0001) in alveolar edema fluid and 1.4-fold higher (p < 0.05) in plasma from the patients with acute lung injury, compared with patients with hydrostatic pulmonary edema. To our knowledge, this study is the first to utilize a specific marker of alveolar epithelial damage in human disease and demonstrates the feasibility of using a blood test to detect lung parenchymal damage.

HTI56, an integral membrane protein specific to human alveolar type I cells.

The alveolar epithelium is composed of two morphologically distinct types of cells, Type I and Type II cells. The thin cytoplasmic extensions of Type I cells cover more than 95% of the internal surface area of the lungs. Type I cells provide the very short diffusion pathway essential for gas exchange. Because there were no biochemical markers specific for human Type I cells, we developed a strategy to produce a monoclonal antibody (MAb) specific for human Type I cells. Isolated human lung cells were used as immunogens; >5000 clones from seven fusions were screened to identify an MAb specific for a 56-kD protein of Type I cells, HTI56. By Western blotting, HTI56 is unique to the lung. By immunoelectron microscopy, it is localized to the Type I cell apical plasma membrane. The pI of HTI56 is 2.5-3.5. HTI56 is glycosylated and has the biochemical characteristics of an integral membrane protein. HTI56 is detectable by Week 20 of gestation and its expression increases in fetal lung explant culture. HTI56 should be useful as a marker for human Type I cells both morphologically and biochemically. It may also be useful in studies of disease and as a marker for lung injury.

Mechanical distension modulates pulmonary alveolar epithelial phenotypic expression in vitro.

The pulmonary alveolar epithelium is composed of two distinct types of cells, type I and type II cells, both of which are critical for normal lung function. On the basis of experiments of both nature and in vivo studies, it has been hypothesized that expression of the type I or type II phenotype is influenced by mechanical factors. We have investigated the effects of mechanical distension on the expression of specific markers for the type I and type II cell phenotypes in cultured alveolar type II cells. Rat alveolar type II cells were tonically mechanically distended in culture. Cells were analyzed for a marker for the type I phenotype (rTI40, an integral membrane protein specific for type I cells) and for markers for the type II phenotype [surfactant protein (SP) A, SP-B, and SP-C] as well as for glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Mechanical distension caused a 68 +/- 25% (n = 3) increase in mRNA content of rTI40 relative to undistended controls. In contrast, mechanical distension resulted in a decrease in mRNA content of SP-B to 35 +/- 19% (n = 3) and of SP-C to 20 +/- 6.7% (n = 3) of undistended controls. There was no effect on mRNA content of SP-A or GAPDH. The differences in mRNA content of SP-B and SP-C were found to be primarily due to changes at the transcriptional level by nuclear run-on assays. The effects on rTI40 appear to be due to posttranscriptional events. These data show that mechanical distension influences alveolar epithelial phenotypic expression in vitro, at least in part, at the transcriptional level.

Purification and analysis of RTI40, a type I alveolar epithelial cell apical membrane protein.

RTI40 is a 40-42 kDa protein that, within the lung, is specific to the apical plasma membrane of the rat alveolar type I cell. Type I cells cover greater than 95% of the internal surface area of the lung. In this report, we describe some of the physical properties of RTI40, and its purification to homogeneity. By liquid phase isoelectric focusing, the pI of the protein is 3.0+/-0.5. In two-dimensional immunoblots, there is a 1.0 pH unit charge train, suggesting post-translational modification of the protein. We have purified the protein to homogeneity by the following method. A membrane preparation from perfused rat lungs was extracted with detergent and applied to an ion-exchange column. Immunoreactive fractions from the column were pooled, dialyzed and further fractionated by reverse phase high performance liquid chromatography (HPLC). Essentially all the antigenicity was recovered in one protein peak that was homogeneous both by spectral analysis and silver-stained polyacrylamide gels. Because the purified protein was N terminus blocked, we cleaved the protein with CNBr and fractionated peptide fragments by reverse phase HPLC. Fractions were pooled and concentrated. Direct amino acid sequencing of the major peptide fragment yielded a 15 amino acid peptide homologous to a mouse osteoblast protein, OTS-8. Analysis of purified RTI40 shows that the protein contains glycan, some of which is sialic acid. Characterization of RTI40 should facilitate future studies of the functional properties of RTI40.

The role of calcium in the secretion of surfactant by rat alveolar type II cells.

Beta adrenergic agonists, tetradecanoylphorbol acetate, and the ionophore A23187 all stimulate surfactant secretion in type II cells isolated from rats. We found that combinations of these agonists cause augmented secretion, suggesting that the agonists may effect different steps in the secretory process. Previous studies have shown that cAMP is likely to be an intracellular 'second messenger' in type II cells. A23187, which has been reported to increase cAMP in some cell systems, did not increase the cAMP content of type II cells. We investigated the possible role of Ca2+ as another 'second messenger' by studying cellular 45Ca fluxes and the effect of extracellular calcium depletion on secretion. Depletion of extracellular calcium for as long as 3 h did not alter stimulated secretion, although basal secretion was increased. Secretagogues did not stimulate 45Ca influx from extracellular sources. A23187 and, to a lesser extent, terbutaline caused an acceleration of 45Ca efflux from type II cells. The addition of terbutaline or tetradecanoylphorbol acetate to A23187 further accelerated 45Ca efflux, suggesting that these agonists may act on separate calcium pools or by different mechanisms on the same calcium pool. Although secretion from type II cells is not inhibited by extracellular calcium depletion, the studies on 45Ca efflux suggest that Ca2+ plays a role in the regulation of surfactant secretion from isolated type II cells.