Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study.

Introduction: Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. Methods: A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). Results: After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. Discussion: It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. Conclusion: The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.

A case report: Upper limb recovery from stroke related to SARS-CoV-2 infection during an intervention with a brain-computer interface.

COVID-19 may increase the risk of acute ischemic stroke that can cause a loss of upper limb function, even in patients with low risk factors. However, only individual cases have been reported assessing different degrees of hospitalization outcomes. Therefore, outpatient recovery profiles during rehabilitation interventions are needed to better understand neuroplasticity mechanisms required for upper limb motor recovery. Here, we report the progression of physiological and clinical outcomes during upper limb rehabilitation of a 41-year-old patient, without any stroke risk factors, which presented a stroke on the same day as being diagnosed with COVID-19. The patient, who presented hemiparesis with incomplete motor recovery after conventional treatment, participated in a clinical trial consisting of an experimental brain-computer interface (BCI) therapy focused on upper limb rehabilitation during the chronic stage of stroke. Clinical and physiological features were measured throughout the intervention, including the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), the Modified Ashworth Scale (MAS), corticospinal excitability using transcranial magnetic stimulation, cortical activity with electroencephalography, and upper limb strength. After the intervention, the patient gained 8 points and 24 points of FMA-UE and ARAT, respectively, along with a reduction of one point of MAS. In addition, grip and pinch strength doubled. Corticospinal excitability of the affected hemisphere increased while it decreased in the unaffected hemisphere. Moreover, cortical activity became more pronounced in the affected hemisphere during movement intention of the paralyzed hand. Recovery was higher compared to that reported in other BCI interventions in stroke and was due to a reengagement of the primary motor cortex of the affected hemisphere during hand motor control. This suggests that patients with stroke related to COVID-19 may benefit from a BCI intervention and highlights the possibility of a significant recovery in these patients, even in the chronic stage of stroke.

Artificial intelligence analysis of the impact of fibrosis in arrhythmogenesis and drug response.

Background: Cardiac fibrosis has been identified as a major factor in conduction alterations leading to atrial arrhythmias and modification of drug treatment response. Objective: To perform an in silico proof-of-concept study of Artificial Intelligence (AI) ability to identify susceptibility for conduction blocks in simulations on a population of models with diffused fibrotic atrial tissue and anti-arrhythmic drugs. Methods: Activity in 2D cardiac tissue planes were simulated on a population of variable electrophysiological and anatomical profiles using the Koivumaki model for the atrial cardiomyocytes and the Maleckar model for the diffused fibroblasts (0%, 5% and 10% fibrosis area). Tissue sheets were of 2 cm side and the effect of amiodarone, dofetilide and sotalol was simulated to assess the conduction of the electrical impulse across the planes. Four different AI algorithms (Quadratic Support Vector Machine, QSVM, Cubic Support Vector Machine, CSVM, decision trees, DT, and K-Nearest Neighbors, KNN) were evaluated in predicting conduction of a stimulated electrical impulse. Results: Overall, fibrosis implementation lowered conduction velocity (CV) for the conducting profiles (0% fibrosis: 67.52 ± 7.3 cm/s; 5%: 58.81 ± 14.04 cm/s; 10%: 57.56 ± 14.78 cm/s; p < 0.001) in combination with a reduced 90% action potential duration (0% fibrosis: 187.77 ± 37.62 ms; 5%: 93.29 ± 82.69 ms; 10%: 106.37 ± 85.15 ms; p < 0.001) and peak membrane potential (0% fibrosis: 89.16 ± 16.01 mV; 5%: 70.06 ± 17.08 mV; 10%: 82.21 ± 19.90 mV; p < 0.001). When the antiarrhythmic drugs were present, a total block was observed in most of the profiles. In those profiles in which electrical conduction was preserved, a decrease in CV was observed when simulations were performed in the 0% fibrosis tissue patch (Amiodarone ΔCV: -3.59 ± 1.52 cm/s; Dofetilide ΔCV: -13.43 ± 4.07 cm/s; Sotalol ΔCV: -0.023 ± 0.24 cm/s). This effect was preserved for amiodarone in the 5% fibrosis patch (Amiodarone ΔCV: -4.96 ± 2.15 cm/s; Dofetilide ΔCV: 0.14 ± 1.87 cm/s; Sotalol ΔCV: 0.30 ± 4.69 cm/s). 10% fibrosis simulations showed that part of the profiles increased CV while others showed a decrease in this variable (Amiodarone ΔCV: 0.62 ± 9.56 cm/s; Dofetilide ΔCV: 0.05 ± 1.16 cm/s; Sotalol ΔCV: 0.22 ± 1.39 cm/s). Finally, when the AI algorithms were tested for predicting conduction on input of variables from the population of modelled, Cubic SVM showed the best performance with AUC = 0.95. Conclusion: In silico proof-of-concept study demonstrates that fibrosis can alter the expected behavior of antiarrhythmic drugs in a minority of atrial population models and AI can assist in revealing the profiles that will respond differently.

Combined atrial fibrillation ablation and balloon mitral commissurotomy in patients with rheumatic mitral stenosis.

INTRODUCTION: Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC). METHODS: We prospectively included 22 patients with severe RMS to undergo a combined PBMC + AF ablation procedure. Noninvasive mapping of the atria was also performed. A historical sample of propensity-scored matched patients who underwent PBMC alone was used as controls. The primary endpoint was freedom from AF/AT at 1-year. Multivariate analysis evaluated sinus rhythm (SR) predictors. RESULTS: Successful pulmonary vein isolation and electrocardiographic imaging-based drivers ablation was performed in 20 patients following PBMC. At 1-year, 75% of the patients in the combined group were in SR compared to 40% in the propensity-score matched group (p = 0.004). The composite of AF recurrence, need for mitral surgery and all-cause mortality was also more frequent in the control group (65% vs. 30%; p = 0.005). Catheter ablation (odds ratio [OR] 1.58; 95% confidence interval [CI] [1.17-17.37]; p = 0.04) and AF type (OR 1.46; 95% CI [1.05-82.64]; p < 0.001) were the only independent predictors of SR at 1-year. Noninvasive mapping in the combined group showed that the number of simultaneous rotors (OR 2.10; 95% CI [1.41-10.2]; p = 0.04) was the only independent predictor of AF. CONCLUSION: A combined procedure of AF ablation and PBMC significantly increased the proportion of patients in sinus rhythm at 1-year. Noninvasive mapping may help to improve AF characterization and guide personalized AF treatment.

Fabrication of human myocardium using multidimensional modelling of engineered tissues.

Biofabrication of human tissues has seen a meteoric growth triggered by recent technical advancements such as human induced pluripotent stem cells (hiPSCs) and additive manufacturing. However, generation of cardiac tissue is still hampered by lack of adequate mechanical properties and crucially by the often unpredictable post-fabrication evolution of biological components. In this study we employ melt electrowriting (MEW) and hiPSC-derived cardiac cells to generate fibre-reinforced human cardiac minitissues. These are thoroughly characterized in order to build computational models and simulations able to predict their post-fabrication evolution. Our results show that MEW-based human minitissues display advanced maturation 28 post-generation, with a significant increase in the expression of cardiac genes such as MYL2, GJA5, SCN5A and the MYH7/MYH6 and MYL2/MYL7 ratios. Human iPSC-cardiomyocytes are significantly more aligned within the MEW-based 3D tissues, as compared to conventional 2D controls, and also display greater expression of C×43. These are also correlated with a more mature functionality in the form of faster conduction velocity. We used these data to develop simulations capable of accurately reproducing the experimental performance. In-depth gauging of the structural disposition (cellular alignment) and intercellular connectivity (C×43) allowed us to develop an improved computational model able to predict the relationship between cardiac cell alignment and functional performance. This study lays down the path for advancing in the development ofin silicotools to predict cardiac biofabricated tissue evolution after generation, and maps the route towards more accurate and biomimetic tissue manufacture.

Cardiovascular Diseases in the Digital Health Era: A Translational Approach from the Lab to the Clinic.

Translational science has been introduced as the nexus among the scientific and the clinical field, which allows researchers to provide and demonstrate that the evidence-based research can connect the gaps present between basic and clinical levels. This type of research has played a major role in the field of cardiovascular diseases, where the main objective has been to identify and transfer potential treatments identified at preclinical stages into clinical practice. This transfer has been enhanced by the intromission of digital health solutions into both basic research and clinical scenarios. This review aimed to identify and summarize the most important translational advances in the last years in the cardiovascular field together with the potential challenges that still remain in basic research, clinical scenarios, and regulatory agencies.

Artificial Intelligence-Driven Algorithm for Drug Effect Prediction on Atrial Fibrillation: An in silico Population of Models Approach.

Background: Antiarrhythmic drugs are the first-line treatment for atrial fibrillation (AF), but their effect is highly dependent on the characteristics of the patient. Moreover, anatomical variability, and specifically atrial size, have also a strong influence on AF recurrence. Objective: We performed a proof-of-concept study using artificial intelligence (AI) that enabled us to identify proarrhythmic profiles based on pattern identification from in silico simulations. Methods: A population of models consisting of 127 electrophysiological profiles with a variation of nine electrophysiological variables (G Na , I NaK , G K1, G CaL , G Kur , I KCa , [Na] ext , and [K] ext and diffusion) was simulated using the Koivumaki atrial model on square planes corresponding to a normal (16 cm2) and dilated (22.5 cm2) atrium. The simple pore channel equation was used for drug implementation including three drugs (isoproterenol, flecainide, and verapamil). We analyzed the effect of every ionic channel combination to evaluate arrhythmia induction. A Random Forest algorithm was trained using the population of models and AF inducibility as input and output, respectively. The algorithm was trained with 80% of the data (N = 832) and 20% of the data was used for testing with a k-fold cross-validation (k = 5). Results: We found two electrophysiological patterns derived from the AI algorithm that was associated with proarrhythmic behavior in most of the profiles, where G K1 was identified as the most important current for classifying the proarrhythmicity of a given profile. Additionally, we found different effects of the drugs depending on the electrophysiological profile and a higher tendency of the dilated tissue to fibrillate (Small tissue: 80 profiles vs Dilated tissue: 87 profiles). Conclusion: Artificial intelligence algorithms appear as a novel tool for electrophysiological pattern identification and analysis of the effect of antiarrhythmic drugs on a heterogeneous population of patients with AF.

Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study.

Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.

The Essential Need for a Validated Potency Assay for Cell-Based Therapies in Cardiac Regenerative and Reparative Medicine. A Practical Approach to Test Development.

Biological treatments are one of the medical breakthroughs in the twenty-first century. The initial enthusiasm pushed the field towards indiscriminatory use of cell therapy regardless of the pathophysiological particularities of underlying conditions. In the reparative and regenerative cardiovascular field, the results of the over two decades of research in cell-based therapies, although promising still could not be translated into clinical scenario. Now, when we identified possible deficiencies and try to rebuild its foundations rigorously on scientific evidence, development of potency assays for the potential therapeutic product is one of the steps which will bring our goal of clinical translation closer. Although, highly challenging, the potency tests for cell products are considered as a priority by the regulatory agencies. In this paper we describe the main characteristics and challenges for a cell therapy potency test focusing on the cardiovascular field. Moreover, we discuss different steps and types of assays that should be taken into consideration for an eventual potency test development by tying together two fundamental concepts: target disease and expected mechanism of action. Development of potency assays for cell-based products consists in understanding the pathophysiology of the disease, identifying potential mechanisms of action (MoA) to counteract it and finding the most suitable cell-based product that exhibits these MoA. When applied, the potency assay needs to correlate bioactivity of the product, via a measurement related to the MoA, with treatment efficacy. However, in the cardiovascular field, the process faces several challenges and high requirements.

Artificial intelligence for a personalized diagnosis and treatment of atrial fibrillation.

Although atrial fibrillation (AF) is the most common cardiac arrhythmia, its early identification, diagnosis, and treatment is still challenging. Due to its heterogeneous mechanisms and risk factors, targeting an individualized treatment of AF demands a large amount of patient data to identify specific patterns. Artificial intelligence (AI) algorithms are particularly well suited for treating high-dimensional data, predicting outcomes, and eventually, optimizing strategies for patient management. The analysis of large patient samples combining different sources of information such as blood biomarkers, electrical signals, and medical images opens a new paradigm for improving diagnostic algorithms. In this review, we summarize suitable AI techniques for this purpose. In particular, we describe potential applications for understanding the structural and functional bases of the disease, as well as for improving early noninvasive diagnosis, developing more efficient therapies, and predicting long-term clinical outcomes of patients with AF.

Generation of NKX2.5GFP Reporter Human iPSCs and Differentiation Into Functional Cardiac Fibroblasts.

Direct cardiac reprogramming has emerged as an interesting approach for the treatment and regeneration of damaged hearts through the direct conversion of fibroblasts into cardiomyocytes or cardiovascular progenitors. However, in studies with human cells, the lack of reporter fibroblasts has hindered the screening of factors and consequently, the development of robust direct cardiac reprogramming protocols.In this study, we have generated functional human NKX2.5GFP reporter cardiac fibroblasts. We first established a new NKX2.5GFP reporter human induced pluripotent stem cell (hiPSC) line using a CRISPR-Cas9-based knock-in approach in order to preserve function which could alter the biology of the cells. The reporter was found to faithfully track NKX2.5 expressing cells in differentiated NKX2.5GFP hiPSC and the potential of NKX2.5-GFP + cells to give rise to the expected cardiac lineages, including functional ventricular- and atrial-like cardiomyocytes, was demonstrated. Then NKX2.5GFP cardiac fibroblasts were obtained through directed differentiation, and these showed typical fibroblast-like morphology, a specific marker expression profile and, more importantly, functionality similar to patient-derived cardiac fibroblasts. The advantage of using this approach is that it offers an unlimited supply of cellular models for research in cardiac reprogramming, and since NKX2.5 is expressed not only in cardiomyocytes but also in cardiovascular precursors, the detection of both induced cell types would be possible. These reporter lines will be useful tools for human direct cardiac reprogramming research and progress in this field.

Pharmacological Regulation in the USA and Pharmacokinetics Parameters of Firocoxib, a Highly Selective Cox-2, by Pain Management in Horses.

The objective of the study was to conduct a review of the pharmacological regulation and pharmacokinetic parameters of firocoxib when administered orally or intravenously in horses. A search for literature was done in SCOPUS and PubMed for studies that had to evaluate the pharmacological regulation as well as the pharmacokinetic parameters of firocoxib when administered in horses. The nonsteroidal anti-inflammatory drugs have analgesic, anti-inflammatory, antipyretics, and antiendotoxic effects. The newly developed is selective to COX2 characterized by less adverse effects in veterinary patients when administered at the recommended doses and do not exceed the established prescribed time. Firocoxib is authorized by the Food and Drug Administration for the treatment of pain in horses, whereas for humans, there is still no approval. Controversy has arisen because the administration of the same pharmaceutical presentation in horses and dogs has pharmacokinetic differences between animal species. However, special attention must be paid to pharmacokinetic differences between species like in horses and dogs. In the case of the horse, the dosage is 0.1 mg/kg in single dose or up to 14 days in oral paste formulation and can keep maintained on the same concentration for a period of 7-14 days in oral tablet formulation. Thorough knowledge of pharmacological regulations and pharmacokinetic parameters, it allows the posology and effective application of firocoxib in pathologies associated with chronic pain, avoiding the indiscriminate use by owners and in some cases veterinarians, thus reducing the negative impacts on horse's health.

Three-Dimensional Printing for Craniofacial Surgery: A Single Institution's 5-Year Experience.

BACKGROUND: As 3-dimensional (3D) printers and models become more widely available and increasingly affordable, surgeons may consider investing in a printer for their own cleft or craniofacial center. To inform surgeons considering adoption of this evolving technology, this study describes one multi-surgeon center's 5-year experience using a 3D printer. METHODS: This study included 3D models printed between October 2012 and October 2017. A 3D Systems ZPrinter 650 was used to create all models. Models were subclassified by type (craniofacial vs noncraniofacial) and diagnosis, and the cost of consumable materials was recorded. A survey was distributed to craniofacial team members who used the printed models. Likert scales and free texts were used for responses about lessons learned and the usefulness of the printer for different craniofacial indications. RESULTS: A total of 106 models were printed at this institution during the 5-year time period. Printing times were 7.4 ± 1.9 hours for complete skulls and 6.0 ± 1.7 hours for maxillofacial prints. The average cost for a complete skull was about US$60 in material cost alone. The 3D printer was most frequently used for complex craniosynostosis, hemifacial microsomia syndrome, and fibrous dysplasia cases. The surgeons found the printer to be most useful for planning complex facial orthognathic cases and least useful for routine single-suture synostosis. CONCLUSION: Three-dimensional printing was found to be helpful for all 4 craniofacial surgeons, who would all invest again in a 3D printer. For lower volume centers, commercially printed models may be a more cost-effective alternative.

Correcting B0 Field Distortions in MRI Caused by Stainless Steel Orthodontic Appliances at 1.5 T Using Permanent Magnets - A Head Phantom Study.

Susceptibility artifacts caused by stainless steel orthodontic appliances (braces) pose significant challenges in clinical brain MRI examinations. We introduced field correction device (FCD) utilizing permanent magnets to cancel the induced B0 inhomogeneity and mitigate geometric distortions in MRI. We evaluated a prototype FCD using a 3D-printed head phantom in this proof of concept study. The phantom was compartmented into anterior frontal lobe, temporal lobe, fronto-parieto-occipital lobe, basal ganglia and thalami, brain stem, and cerebellum and had built-in orthogonal gridlines to facilitate the quantification of geometric distortions and volume obliterations. Stainless steel braces were mounted on dental models of three different sizes with total induced magnetic moment 0.15 to 0.17 A·m2. With braces B0 standard deviation (SD) ranged from 2.8 to 3.7 ppm in the temporal and anterior frontal lobes vs. 0.2 to 0.3 ppm without braces. The volume of brain regions in diffusion weighted imaging was obliterated by 32-38% with braces vs. 0% without braces in the cerebellum. With the FCD the SD of B0 ranged from 0.3 to 1.2 ppm, and obliterated volume ranged from 0 to 6% in the corresponding brain areas. These results showed that FCD can effectively decrease susceptibility artifacts from orthodontic appliances.

El sistema de información administrativa, instrumento indispensable para la toma de decisiones / Administrative information system, essential tool for decision making

Resumen:

Introducción: el estudio de los sistemas de información se produjo como una sub-disciplina de las ciencias de la computación en un intento por entender y racionalizar la administración de la tecnología dentro de las organizaciones, sin embargo, constituye una herramienta tecnológica útil en la toma de decisiones.

Desarrollo: el Sistema de Información Administrativa de los Recursos Humanos de Enfermería (SIARHE) es uno de los proyectos más ambiciosos de la Comisión Permanente de Enfermería, mediante el cual se pretende contar con información confiable, oportuna y completa para detectar y atender con oportunidad las necesidades de recursos de enfermería y su mejor distribución a nivel nacional e institucional y en consecuencia, lograr el equilibrio entre la oferta y la demanda de estos recursos. Conclusiones: la información reportada por el SIARHE, está enfocada a lograr la caracterización del personal de enfermería desde el punto de vista académico, laboral y profesional para coadyuvar en la formulación de políticas que permitan conformar la fuerza de trabajo de enfermería suficiente y calificada, para responder de manera efectiva a las demandas de salud del país. Los avances al momento son significativos gracias a la contribución de las instituciones que conforman el sistema nacional de salud, en la consolidación del SIARHE, recurso administrativo necesario para asegurar la continuidad en la operación del sistema.

Abstract:

Introduction: the study of information systems occurred as a sub-discipline of computer science in an attempt to understand and rationalize the administration of technology within organizations; however, it is a useful technological tool in decision making.

Development: management Information System of Nursing Human Resources (Abbreviated in Spanish as SIARHE) is one of the most ambitious projects of the Standing Nursing Committee, through which it aims to have reliable, timely and complete information to detect and respond to the needs of nursing resources and for a better distribution to national and institutional level, thus achieving balance between supply and demand for these resources.

Conclusions: the information reported by the SIARHE, is focused on achieving nursing characterization from the academic, professional and work-setting standpoint to assist in the formulation of policies that will shape the skilled and enough nursing workforce to effectively respond to the health needs of the country. Progress to date are significant due to the contribution of the institutions of the national health system in the consolidation of SIARHE, administrative device necessary to ensure the continued operation of the system.

Validación de una cédula para evaluación integral de los servicios de enfermería / A certificate validation for the evaluation of nursing services

Introducción: el reto de la supervisión de los servicios de enfermería, es la obtención de la calidad en los procesos realizados, observar de manera tangible y verídica la situación real en busca del mejoramiento, corrección, o identificación de causales que estén impidiendo otorgar servicios de calidad. Objetivo: validar un instrumento para la evaluación integral de los procesos de los servicios de enfermería. Metodología: se integran los criterios de evaluación en tres grupos; los que corresponden a: Gestión del cuidado enfermero, Gestión de recursos materiales y Gestión del proceso gerencial. Se somete a ronda de expertos, se analiza y se aplican correcciones relacionadas a presentación, contenido, suficiencia, selección y pertinencia del criterio, y se diseña el instructivo de operación. Se realiza prueba de campo de la cédula en los servicios de hospitalización. Resultados: se encuentran recomendaciones en nueve criterios (75%) de los 12 que componen la cédula y del total de 72 componentes se reciben observaciones en 44, representando 61.1 %. Al comparar las dos muestras se observó diferencia estadística significativa (p = 0.045). Conclusiones: de acuerdo al análisis de los resultados que se obtuvieron posterior a la prueba de campo y a las modificaciones realizadas de apariencia, constructo y contenido así como la utilización de un instructivo operacional diseñado específicamente para su implementación, la cédula demostró su utilidad como instrumento de evaluación, proporcionó resultados objetivos que permiten sistematizar la evaluación para mejorar el nivel de las acciones que la gestión de los procesos de enfermería requieren.

Background: the supervision challenge in the nursing Services is to obtain quality in the performed process and the tangible and factual observation of the real situation about the search of improvement, corrections or causes of misidentification. Objective: to validate an instrument for the integral evaluation of the nursing Services procedures. Methodology: evaluations were integrated in three groups; management of nursing care, management of material resources and management of administrative processes. The certificate is submit-ted to a group of certificated experts, and the corrections related to the content, presentation, sufficient selection and adequate criteria were measured. The instructive of operation was designed. A field test was conducted. Results: nine criteria were recommended (75 %) of twelve items in the certificate; and of the 72 total components; 44 received observations (61 %). When comparing the two samples an important statistical difference was obtained (p = 0.045). Conclusions: according to the results, the certificate demonstrated that it is a useful as an evaluation tool. It improved the actions in the management of nursing requirements.

Biopsia de carina principal de apariencia normal: su valoración en el cáncer de pulmón / Biopsy of main carina with normal appearence: its value in lung cancer

Valorar la biopsia de la carina principal de apariencia normal en el cáncer de pulmón. Se incluyeron 50 pacientes con sospecha diagnóstica de cáncer de pulmón a quienes se les practicó broncoscopia flexible más toma de biopsia de carina principal, en un período de dos años, entre junio de 2000 y junio de 2002. La edad promedio de los pacientes fue 60,04 años. El sexo masculino predominó (86 por ciento). La biopsia de carina reportó hiperplasia en 44 por ciento de los casos, displasia en 10 por ciento, metaplasia en 10 por ciento, neoplasia en 8 por ciento y ausencia de alteraciones en el 24 por ciento restante. El hábito tabáquico acentuado se relacionó con hallazgos patológicos en la biopsia de carina. La visualización de tumor mediante broncoscopia se relacionó con un reporte de neoplasia en la biopsia carinal. En 33 casos (66 por ciento) el tumor estaba localizado en pulmón derecho, con 21 casos en lóbulo superior (63,63 por ciento). De los 17 casos en pulmón izquierdo, 10 (58,82 por ciento) estaban en lóbulo superior. La localización en los lóbulos superiores presentó mayor número de biopsias de carina patológicas. Las variedades histológicas con neoplasia en la biopsia de carina fueron: carcinoma de células pequeñas, carcinoma anaplásico, carcinoma bronquiolo-alveolar y leiomiosarcoma endobronquial. La biopsia de la carina principal de apariencia normal es útil en el estudio y estadificación del cáncer pulmonar

Empatia e grupanálise: uma abordagem integradora / Empathy and group analysis: an integrative approach

Com ajuda das mais recentes investigações neurocientíficas e psicológicas a autora propõe uma abordagem integradora de empatia. Utilizando este referencial explora o modo característico como, em grupanálise, a empatia é um agente de investigação e, como tal, abre uma via de acesso muito especial à vida intrapsíquica dos analisandos. Propõe ainda, partindo de dados neurocientíficos muito recentes (2000/2004), que este instrumento de investigação está amplificado no contexto da grupanálise e psicoterapia de grupo. Em seguida a autora reflecte ainda sobre o modo como, em grupanálise, a empatia é também integrada no próprio processo terapêutico.