Renal Transplant Artery Stenosis and Kinking: An Unusual Association.

Renal artery stenosis of the kidney allograft associated with kinking is not a frequent finding. As a correctable cause of graft dysfunction, it is important to diagnose it as soon as possible to avoid further graft damage and improve graft and patient survival. As pulsed wave Doppler ultrasound mapping of the graft's renal arteries is essential to diagnose possible alterations, point of care ultrasound (POCUS) is a highly useful tool for early diagnosis. We present a case in which nephrologists performed this examination promptly allowing a timely diagnosis and treatment plan.

Factores relacionados con la cesación de tabaco en un programa de atención integral del tabaquismo en Bogotá / Factors related to smoking cessation in a comprehensive tobacco care program in Bogotá

Introducción. Los programas interdisciplinarios queincluyen tratamiento farmacológico y técnicas cognitivo-conductuales son efectivos en lograr la abstinenciatabáquica. Hay factores que condicionan el proceso de cesación. No hay estudios en Colombia de cesación tabáquica y los factores asociados. Pacientes y métodos.Pacientes consecutivos del programa de atención integral de cesación de tabaco de laFundación Neumológica Colombiana (EXFUMAIRE)de 2015-2019. Se definió cesación como la abstinencia al cigarrillo >12 meses. Diferencias entre grupos de cesación y no cesación con pruebas T, U de Mann-Whitney y χ2. Análisis multivariado para evaluar factores asociadosa la cesación.Resultados.Se incluyeron 170 sujetos de 55,8 ± 12,8años, el 50,6% mujeres. Hubo cesación en 113(66,5%). No hubo diferencias demográficas, historiade tabaquismo, comorbilidades o tratamiento farmacológico entre los grupos de cesación y no cesación. El 64,1% de los pacientes recibió terapia cognitivo-conductual y el 88,2% tratamiento farmacológico. La razón de no recibir terapia cognitivo-conductual fue la noaceptación del paciente, y la de no recibir tratamientofarmacológico la no disponibilidad del medicamento ono aceptación del paciente. El único factor asociado acesación en el análisis multivariado fue la motivaciónpor la escala Richmond (OR 0,81; p = 0,038).Conclusiones.La tasa de cesación de tabaquismo del66,5% fue alta. El único factor asociado con cesaciónfue la mayor motivación para cesar el tabaquismo. Lasbarreras para recibir el tratamiento farmacológico opsico-conductual son la no aceptación del paciente ola disponibilidad del medicamento. (AU)

Introduction. Interdisciplinary programs that include pharmacological treatment and cognitive behavioraltechniques are effective in achieving smoking abstinence. There are factors that condition the cessationprocess. There are no studies in Colombia on smokingcessation and the associated factors.Patients and methods.Consecutive patients of thecomprehensive smoking cessation care program of the Colombian Pneumological Foundation (EXFUMAIRE)from 2015-2019. Cessation was defined as abstinence from cigarettes >12 months. Differences between cessation and non-cessation groups with T-tests, Mann-Whitney U Test and χ2. Multivariate analysis to evaluatefactors associated with cessation.Results.A total of 170 subjects aged 55.8 ± 12.8years, 50.6% women were included. Cessation occurredin 113 (66.5%). There were no differences in the demographics, smoking history, comorbidities, or drug treatment between the cessation and non-cessation groups.A total of 64.1% of the patients received cognitivebehavioral therapy and 88.2% pharmacological treatment. The reason that cognitive behavioral therapy wasnot received was the non-acceptance of the patient and that of not receiving pharmacological treatment wasthe non-availability of the medication or non-acceptance of the patient. The only factor associated with smoking cessation in the multivariate analysis was the Richmond’ motivation scale (OR 0.81; p = 0.038).Conclusions.The smoking cessation rate of 66.5%was high. The only factor associated with cessation was the increased motivation to quit smoking. Barriers toreceive pharmacological or psycho-behavioral treatment are the non-acceptance of the patient or lack ofavailability of the medication. (AU)

Peritoneal dialysis (PD) technique training: what features influence learning time?

BACKGROUND: Within peritoneal dialysis (PD) complications, peritonitis remains a primary challenge for the long-term success of the technique. Proper technique training is essential, since it reduces peritonitis rates, but the adequacy of training has not been standardized. Furthermore, factors influencing training duration have not been well identified. METHODS: We retrospectively analyzed all consecutive training sessions of incident PD patients in our Unit from January 2001 to December 2018. RESULTS: Our analysis included 135 patients, 25.9% were diabetic and median Charlson index (CCI) was 4 (IQR 2-6). Above 13 sessions was chosen as the cut off between usual and prolonged training, as it was our cohort's 75th percentile: 23% (31) had an extended training duration as per our study definition and 77% (104) had a usual training duration. The number of training sessions required increased with age (Spearman Rho 0.404; p = 0.000001), diabetic status (p = 0.001), unemployment status (p = 0.046) and CCI (Spearman Rho 0.369; p = 0.00001). Neither gender, cohabitation status, scheduled PD start, education level nor referral origin, were significant factors impacting training duration. Requiring longer training (> 13 sessions) was a significant risk factor for higher peritonitis risk, but extended training was not related to a shorter technique survival. CONCLUSION: Number of PD training sessions depends on the patient's age and comorbidities, but is not related to social, educational or employment status. Prolonged training duration was a statistically significant predictor of higher peritonitis risk, but it was not related to shorter permanence in PD in our series. Identifying these patients since the training period would be useful to adapt training schedule as an early prevention strategy to minimize the risk of peritonitis and plan a preemptive retraining.

Early career nurses with fewer supportive peers for safe patient handling are likely to quit.

This prospective study observed turnover during 1 year at a community hospital in Oregon (n = 39). The study tested whether nurses who at baseline nominated fewer peers as sources of safe patient handling support were more likely to quit than nurses with more supportive peers. Six nurses with tenure under 2 years left their positions. Nurses who quit reported half as many co-workers as sources of support relative to nurses who remained employed, and each additional peer nomination reduced the risk of turnover by 15%. Further research should establish the contribution of peer safety support reducing turnover among recent hires.

Guía en DVD en la Cirugía Mayor Ambulatoria. Análisis de los resultados iniciales / Ambulatory surgery DVD guide. Analysis of the initial results

Introducción: Con la intención de mejorar la calidad asistencial se ha producido colateralmente una mayor complejidad en los circuitos peroperatorios. Así, en nuestro centro hemos asistido en los últimos años a un incremento de los pasos que deben realizar los pacientes desde que son derivados al cirujano para ser valorado un posible tratamiento quirúrgico hasta la fecha de la operación. Todo ello puede ocasionar confusión y angustia al paciente, a pesar del soporte y de la información oral y escrita que recibe de los diferentes profesionales sanitarios que visita. Objetivos: Para paliar esta situación se realizó un DVD que es entregado al paciente en la primera visita del especialista. Dicho DVD da a conocer una visión general del circuito de la CMA de nuestro centro y detalla cada paso que deberá realizar. De esta forma, el paciente puede verlo en su domicilio todas las veces que considere oportunas. Su observación familiariza al paciente con nuestras instalaciones y el ambiente hospitalario, complementa las explicaciones orales y escritas entregadas para clarificar las dudas que todavía pudieran persistir y creemos ayuda a disminuir la ansiedad del enfermo ante este acontecimiento. Material y método: Voluntariamente, el paciente realiza na encuesta de satisfacción que es remitida varias semanas tras el alta. Los resultados se comparan con los de un grupo de control que han visualizado el DVD. Resultados: Actualmente el estudio no está finalizado. Se han recibido 35 encuestas de las entregadas a los pacientes de cirugía general, de las cuales solo a 13 pacientes se le había entregado el DVD. El 31% de los pacientes a los que se entregó el DVD no tuvieron interés en verlo, los que lo consultaron refieren que la información fue útil en el 100% de los casos. Comparando los que reciben DVD de los que no, referente a sus preferencias de ingreso, el 11% hubieran preferido ingresar en comparación al 14% del grupo a los que no se les entregó. El grado de satisfacción fue elevado en ambos grupos, 8,8 puntos sobre 10. Conclusiones: La información perioperatoria puede ser mejorada con la entrega de material audiovisual complementario. Esta herramienta sintetiza y aclara todas las etapas que debe realizar el paciente. Incrementa el grado de satisfacción y la calidad asistencial percibida del paciente de la CMA realizada en nuestro hospital (AU)

Introduction: Nowadays there is more complexity in the per-operative circuits as a collateral consequence of trying to improve the health care quality. In the last years, we have seen an increase in steps that patients should be at our hospital since they are derived to the surgeon to be valued a possible surgical treatment until the date of the operation. All this can cause confusion and distress to the patient, despite the support and the oral and written information received from different specialists visited. Objective: A DVD was made to remedy this situation that is delivered to the patient in the first surgeon's visit. This DVD gives a general vision of the circuit of the ambulatory surgery of our center and details of each step. In this way the patient can see it at his home every time he deems appropriate. Its observation familiarizes him with our facilities and the hospitable atmosphere, clarifies the doubts that could still persist and we believe helps to decrease his anxiety before this event. Material and method: The patient performs a satisfaction questionnaire and he returns it several weeks after discharge from hospital. The results are compared with those of a control group that not viewed the DVD. Results: Currently the study is not complete. There have been 35 surveys delivered to the general surgery patients, of which only 13 patients had been given the DVD. 31% of patients who gave the DVD had no interest in seeing it, those who report that looked at the information was useful in 100% of cases. Comparing those who received the DVD not concerning their preferences for income, 11% would have preferred to enter compared to 14% of the group to which they were not given. The degree of satisfaction was high in both groups, 8.8 ut of 10. Conclusions: The preoperative information can be improved with the delivery of additional audiovisual material. This tool summarizes and clarifies all the stages that the patient should perform, increases the degree of satisfaction and the perceived quality in the care of ambulatory surgery patient in our hospital (AU)

Racial disparities in job strain among American and immigrant long-term care workers.

BACKGROUND: Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect. AIM: This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237). METHODS: Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155). RESULTS: Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders. CONCLUSION: Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.

["Medical Deputies": clinics and politics in the dispute for public resources in Buenos Aires (1906-1917)]. / Los <>: clínica y política en la disputa por los recursos públicos en Buenos Aires (1906-1917).

In June 1906, the conservative deputy and doctor Eliseo Cantón submitted in the Argentinian Parliament the project of a <>, which would take up four blocks, would be located in front of the Faculty of Medicine of the University of Buenos Aires and would be made up by 20 institutes with a capacity for 80 beds each. The dispute over this huge project, which lasted until 1917, placed in the middle of the scene, a group of "medical deputies" who used the political platform as a space to define the main aspects of the hospital system. The controversy went beyond the Parliament reaching the public sphere. The lavishness of the project on the eve of the Centenary public festivities or the opulence of a Buenos Aires which inspired to be like Paris were related, in a symbolic view, to the progress of local medicine and its aspirations to be included in the international medical arena. The analysed case helps understand how an essentially political controversy - which led to economical, ethical and cognitive discussions - intervened in the process of building up a socio-professional space of the hospital medical practice.

Hospitals' investment and return from volunteer departments and auxiliaries: evidence from one community.

In addition to their nonpecuniary outputs, volunteer and auxiliary programs can make a significant financial contribution to the hospital. Evidence from one community suggests a direct correspondence between a hospital's investment and return from these programs. Hospitals appear to invest little in these activities, however.