Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device.

Introduction: Tracheostomy is one of the most common surgical strategies in intensive care units (ICU) and provides relevant clinical benefit for multiple indications. However, the complications associated with its use range from 5 to 40% according to different series. The risk of these complications could be reduced if fixation strategies and alignment of the tracheostomy tube with respect to the tracheal axis are improved. Aim: To build a functional device of technological innovation in respiratory medicine for the fixation and alignment of tracheostomy cannula (acronym DYNAtraq) and to evaluate its feasibility and safety in a pilot study in mechanically ventilated patients. Methods: Study carried out in four phases: (1) design engineering and functional prototyping of the device; (2) study of cytotoxicity and tolerance to the force of traction and push; (3) pilot study of feasibility and safety of its use in tracheostomized and mechanically ventilated patients; and (4) health workers satisfaction study. Results: The design of the innovative DYNAtraq device included, on the one hand, a connector with very little additional dead space to be inserted between the cannula and the ventilation tubes, and, on the other hand, a shaft with two supports for adhesion to the skin of the thorax with very high tolerance (several kilograms) to pull and push. In patients, the device corrected the malpositioned tracheostomy tubes for the latero-lateral (p < 0.001) and cephalo-caudal angles (p < 0.001). Its effect was maintained throughout the follow-up time (p < 0.001). The use of DYNAtraq did not induce serious adverse events and showed a 70% protective effect for complications (RR = 0.3, p < 0.001) in patients. Conclusion: DYNAtraq is a new device for respiratory medicine that allows the stabilization, alignment and fixation of tracheostomy tubes in mechanically ventilated patients. Its use provides additional benefits to traditional forms of support as it corrects misalignment and increases tolerance to habitual or forced movements. DYNAtraq is a safe element and can reduce the complications of tracheostomy tubes.

Calidad de vida laboral en empleados de una empresa distribuidora de bebidas de Santander, Colombia / Quality of work life in employees of beverage distribution company in Santander, Colombia

Introducción: Es deber de las organizaciones preocuparse por el bienestar físico, mental y social de los trabajadores. Evaluar la calidad de vida laboral puede indicar cómo el empleo cubre las necesidades de seguridad, satisfacción, bienestar y desarrollo personal/laboral del trabajador. Método: estudio transversal en 122 trabajadores con labores de conducción de vehículos, cargue/descargue, entrega/recepción de mercancía y dinero, seleccionados a conveniencia en una empresa distribuidora de bebidas. La calidad de vida laboral se evaluó mediante CVT-GOHISALO y se exploró su relación con variables sociodemográficas y laborales. Resultados: se encontró un alto nivel de satisfacción en el soporte institucional para el trabajo y la seguridad en el trabajo, un nivel medio en la integración al puesto y el desarrollo personal, un nivel bajo en la satisfacción a través del trabajo y un nivel de satisfacción en riesgo en el bienestar logrado y la administración del tiempo libre. La calidad de vida laboral se relacionó con el número de horas y días trabajados, también con la antigüedad en las dimensiones de integración al puesto y seguridad en el trabajo; el nivel educativo, la jornada laboral, las pausas activas y el cargo se relacionaron con todas las dimensiones excepto con soporte institucional y administración del tiempo libre. Conclusiones: La calidad de vida laboral fue valorada por cómo el empleador brinda los elementos e indicaciones necesarias para realizar el trabajo; pero con deficiencias en el bienestar y el manejo del tiempo. La calidad de vida fue más baja en trabajadores con secundaria, que laboran más días/horas y en la jornada diurna, tienen mayor antigüedad, son conductores y no realizan pausas activas. (AU)

Introduction: Organizations have to care about the physical, mental, and social well-being of their workers. The evaluation of the quality of work-life indicates how the job responds to the needs of safety, satisfaction, well-being, and personal and professional development of the worker. Method: a cross-sectional study in 122 workers with occupations of driving vehicles, loading, unloading, delivering merchandise, and receiving money, selected at convenience in a beverage distribution company. We evaluate the quality of work-life using CVT-GOHISALO and we expose its relationship with sociodemographic and work variables using Pearson’s correlation coefficient and Student’s T-test and ANOVA. Results: We found a high level of satisfaction in institutional support for work and job security, a medium level in job integration and personal development, a low level of job satisfaction, and a level of satisfaction at risk in well-being achieved and management of free time. The quality of working life was related to the number of hours and days worked, also to seniority in the dimensions of job integration and job security; educational level, working hours, active breaks, and position were related to all dimensions except institutional support and free time management. Conclusions: The quality of working life was assessed by how the employer provides the elements and indications necessary to carry out the work, but with deficiencies in well-being and time management. The quality of life was lower in workers with secondary education, who work more days/hours and during the day, have more seniority, are drivers, and do not take active breaks. (AU)

Ensayo controlado aleatorizado de un programa multicomponente para cuidadores informales de pacientes con Alzheimer / Randomized controlled trial of a multicomponent program for informal caregivers of Alzheimer's patients / Ensaio controlado randomizado de um programa multicomponente para cuidadores informais de pacientes com Alzheimer

Resumen Objetivo Evaluar la eficacia del programa multicomponente más respiro en la sobrecarga y el apoyo social de cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor tipo Alzheimer. Materiales y Método Ensayo controlado aleatorizado en paralelo en 58 cuidadores aleatorizados a uno de los tres grupos de comparación: Grupo de intervención multicomponente más respiro (n=19), grupo de sólo respiro (n=19) y grupo control (n=20), se evaluaron la sobrecarga y el apoyo social mediante las escalas de Zarit y Medical Outcomes Study, en línea de base, post intervención a 5 meses y un seguimiento a 10 meses. La evaluación del efecto se realizó mediante un modelo de efectos mixtos de covarianza no estructurada. Resultados Los cuidadores fueron en su mayoría los hijos de los pacientes (72%), mujeres (76%) con una edad media de 55.1(12) años y con educación inferior a secundaria (58%). Se encontró una reducción significativa de la sobrecarga de 13.1 (IC95% -19.3:6.9) puntos en el grupo multicomponente más respiro, con un sostenimiento del efecto a 10 meses (p<0.001). Se encontró un incremento, aunque no significativa del apoyo social post intervención de 10.8 (-1,7; 23,4) para el grupo multicomponente y respiro, sin embargo, el efecto se incrementó en el tiempo logrando un aumento a 13,2 puntos (p=0.039) a los 10 meses de seguimiento. No se observó un efecto significativo en la sobrecarga ni apoyo social para el grupo que solo recibió respiro. Conclusiones El programa multicomponente más respiro mostró tener un efecto benéfico en la sobrecarga y apoyo social de cuidadores de Alzheimer.

Abstract Objective To evaluate the efficiency of a multicomponent plus respite care program on care burden and social support for informal caregivers of patients with major neurocognitive disorders associated with Alzheimer's disease. Materials and Methods A parallel randomized controlled trial was conducted with 58 caregivers who were randomly allocated to one of the following three comparison groups: a multicomponent plus respite care group (n=19), a respite care group (n=19), and a control group (n=20). Burden and social support were assessed by using the Zarit Scale and Medical Outcomes Study at baseline with a post-intervention at 5 months and follow-up at 10 months. The assessment of effects was measured by using a mixed-effects model with an unstructured covariance matrix. Results Caregivers were mostly patients' children (72%), female (76%) having a mean age of 55.1 years (12) and less than secondary education (58%). A significant reduction of 13.1% (95%CI -19.3:6.9) in caregiver burden was found in the multicomponent plus respite care group, showing a sustained effect at 10 months (p<0.001). A non-significant increase of 10.8% (-1.7;23.4) in post-intervention social support was found in the multicomponent plus respite care group. However, the effects increased over time achieving an increase at 13.2% (p=0.039) at the 10-month follow-up. No significant effects on caregiver burden or social support were reported for the respite care group. Conclusions The multicomponent plus respite care group demonstrated beneficial effects on care burden and social support for Alzheimer's caregivers.

Resumo Objetivo Avaliar a eficácia do programa multicomponente mais alívio na sobrecarga e suporte social de cuidadores informais de pacientes com Transtorno Neurocognitivo Maior do tipo Alzheimer. Método Ensaio controlado randomizado em paralelo em 58 cuidadores randomizados para um dos três grupos de comparação: Grupo de intervenção multicomponente mais alívio (n=19), grupo apenas alívio (n=19) e grupo de controle (n=20), foram avaliados a sobrecarga e suporte social usando as escalas de Zarit e Medical Outcomes Study, linha de base, pós-intervenção em 5 meses e um acompanhamento de 10 meses. A avaliação do efeito foi realizada usando um modelo de efeitos mistos de covariância não estruturada. Resultados Os cuidadores eram, em sua maioria, filhos dos pacientes (72%), mulheres (76%) com uma de idade de média de 55,1 (12) anos e com escolaridade inferior ao ensino médio (58%). Foi encontrada uma redução significativa na sobrecarga de 13,1 (IC95% -19,3:6,9) pontos no grupo multicomponente mais alívio, com uma sustentação de efeito em 10 meses (p<0,001). Foi encontrado um aumento, embora não significativo, no suporte social pós-intervenção de 10,8 (-1,7; 23,4) para o grupo multicomponente e alívio, no entanto, o efeito aumentou ao longo do tempo, alcançando um aumento para 13,2 pontos (p=0,039) aos 10 meses de acompanhamento. Nenhum efeito significativo na sobrecarga ou suporte social foi observado para o grupo que apenas recebeu alívio. Conclusões O programa de multicomponente mais alívio mostrou ter um efeito benéfico na sobrecarga e no suporte social dos cuidadores de Alzheimer.

Ensayo controlado aleatorizado de un programa multicomponente para cuidadores informales de pacientes con Alzheimer / Randomized controlled trial of a multicomponent program for informal caregivers of Alzheimer's patients

Objetivo: Evaluar la eficacia del programa multicomponente más respiro en la sobrecarga y el apoyo social de cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor tipo Alzheimer. Materiales y Método: Ensayo controlado aleatorizado en paralelo en 58 cuidadores aleatorizados a uno de los tres grupos de comparación: Grupo de intervención multicomponente más respiro (n=19), grupo de sólo respiro (n=19) y grupo control (n=20), se evaluaron la sobrecarga y el apoyo social mediante las escalas de Zarit y Medical Outcomes Study, en línea de base, post intervención a 5 meses y un seguimiento a 10 meses. La evaluación del efecto se realizó mediante un modelo de efectos mixtos de covarianza no estructurada. Resultados: Los cuidadores fueron en su mayoría los hijos de los pacientes (72%), mujeres (76%) con una edad media de 55.1(12) años y con educación inferior a secundaria (58%). Se encontró una reducción significativa de la sobrecarga de 13.1 (IC95% -19.3:6.9) puntos en el grupo multicomponente más respiro, con un sostenimiento del efecto a 10 meses (p<0.001). Se encontró un incremento, aunque no significativa del apoyo social post intervención de 10.8 (-1.7; 23.4) para el grupo multicomponente y respiro, sin embargo, el efecto se incrementó en el tiempo logrando un aumento a 13.2 puntos (p=0.039) a los 10 meses de seguimiento. No se observó un efecto significativo en la sobrecarga ni apoyo social para el grupo que solo recibió respiro. Conclusiones: El programa multicomponente más respiro mostró tener un efecto benéfico en la sobrecarga y apoyo social de cuidadores de Alzheimer.

Objective: To evaluate the efficiency of a multicomponent plus respite care program on care burden and social support for informal caregivers of patients with major neurocognitive disorders associated with Alzheimer's disease. Materials and Methods: A parallel randomized controlled trial was conducted with 58 caregivers who were randomly allocated to one of the following three comparison groups: a multicomponent plus respite care group (n=19), a respite care group (n=19), and a control group (n=20). Burden and social support were assessed by using the Zarit Scale and Medical Outcomes Study at baseline with a post-intervention at 5 months and follow-up at 10 months. The assessment of effects was measured by using a mixed-effects model with an unstructured covariance matrix. Results: Caregivers were mostly patients' children (72%), female (76%) having a mean age of 55.1 years (12) and less than secondary education (58%). A significant reduction of 13.1% (95%CI -19.3:6.9) in caregiver burden was found in the multicomponent plus respite care group, showing a sustained effect at 10 months (p<0.001). A non-significant increase of 10.8% (-1.7;23.4) in post-intervention social support was found in the multicomponent plus respite care group. However, the effects increased over time achieving an increase at 13.2% (p=0.039) at the 10-month follow-up. No significant effects on caregiver burden or social support were reported for the respite care group. Conclusions: The multicomponent plus respite care group demonstrated beneficial effects on care burden and social support for Alzheimer's caregivers.

Objetivo: Avaliar a eficácia do programa multicomponente mais alívio na sobrecarga e suporte social de cuidadores informais de pacientes com Transtorno Neurocognitivo Maior do tipo Alzheimer. Método: Ensaio controlado randomizado em paralelo em 58 cuidadores randomizados para um dos três grupos de comparação: Grupo de intervenção multicomponente mais alívio (n=19), grupo apenas alívio (n=19) e grupo de controle (n=20), foram avaliados a sobrecarga e suporte social usando as escalas de Zarit e Medical Outcomes Study, linha de base, pós-intervenção em 5 meses e um acompanhamento de 10 meses. A avaliação do efeito foi realizada usando um modelo de efeitos mistos de covariância não estruturada. Resultados: Os cuidadores eram, em sua maioria, filhos dos pacientes (72%), mulheres (76%) com uma de idade de média de 55.1 (12) anos e com escolaridade inferior ao ensino médio (58%). Foi encontrada uma redução significativa na sobrecarga de 13.1 (IC95% -19.3:6.9) pontos no grupo multicomponente mais alívio, com uma sustentação de efeito em 10 meses (p<0,001). Foi encontrado um aumento, embora não significativo, no suporte social pós-intervenção de 10,8 (-1.7; 23.4) para o grupo multicomponente e alívio, no entanto, o efeito aumentou ao longo do tempo, alcançando um aumento para 13,2 pontos (p=0.039) aos 10 meses de acompanhamento. Nenhum efeito significativo na sobrecarga ou suporte social foi observado para o grupo que apenas recebeu alívio. Conclusões: O programa de multicomponente mais alívio mostrou ter um efeito benéfico na sobrecarga e no suporte social dos cuidadores de Alzheimer.

Calidad de vida en cuidadores informales de pacientes con Alzheimer tras implementación de programa multicomponente / Quality of life in informal caregivers of Alzheimer's patients after implementation of a multi-component program

INTRODUCCIÓN: el cuidado de un paciente dependiente tiene mayores implicaciones si el diagnóstico es la enfermedad de Alzheimer, su calidad de vida se ve afectada de manera considerable en los aspectos relacionados con la salud. OBJETIVO: evaluar el efecto de una intervención multicomponente y transdisciplinar en la calidad de vida relacionada con la salud en cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor (TNC) tipo Alzheimer. MÉTODOS: participaron 50 cuidadores informales de pacientes con Alzheimer, empleando el cuestionario SF-36, mediante un ensayo aleatorizado con tres grupos de comparación y con evaluación de la calidad al inicio, y a los 5 y 10 meses. Para encontrar el tamaño del efecto de las intervenciones en la calidad de vida, según los grupos estudiados, se usó un modelo de efectos mixtos con covarianza no estructurada. RESULTADOS: se encontró que quienes recibieron la intervención multicomponente más respiro obtuvieron un mejoramiento de la calidad de vida en todas las dimensiones y componentes excepto en la función física, con efectos sostenidos en seguimiento. CONCLUSIÓN: las intervenciones no farmacológicas multicomponente acompañadas de un relevo del cuidado tienen un efecto positivo en la percepción de calidad de vida en cuidadores.

INTRODUCTION: The care of a dependent patient has greater implication if the diagnostic is the disease of Alzheimer's, their quality of life is affected considerably in the aspects related to health. OBJECTIVE: to evaluate the effect of a multicomponent and transdisciplinary intervention on health-related quality of life in informal caregivers of patients with Alzheimer-type Major Neurocognitive Disorder (TNC). METHODS: 50 informal caregivers of Alzheimer's patients participated, using the SF-36 questionnaire, through a randomized trial with three comparison groups and quality assessment at baseline, and at 5 and 10 months. To find the effect size of the quality of life interventions, according to the groups studied, a mixed effects model with unstructured covariance was used. RESULTS: it was found that those who received the multicomponent intervention plus respite obtained an improvement in the quality of life in all dimensions and components except physical function, with sustained effects in follow-up. CONCLUSION: multicomponent non-pharmacological interventions accompanied by a change of care have a positive effect on the perception of quality of life in caregivers.

Persistence of symptoms in dengue patients: a clinical cohort study.

BACKGROUND: Dengue is commonly considered an acute illness and follows three phases: febrile, critical in some cases and recovery. However, a number of studies have described a continuation of dengue symptoms for weeks or months, extending the recovery phase. Here we evaluate this persistence of dengue symptoms during convalescence. METHODS: Our clinical cohort study included patients who sought medical services 48 to 144 h from the onset of fever at seven hospitals or ambulatory centers in Morelos, Mexico. Seventy-nine laboratory-confirmed dengue patients were followed up regularly using clinic and/or home visits and telephone calls for as long as symptoms persisted or up to 6 mo. RESULTS: In total, 55.7% of patients had dengue-related symptoms 1 mo after the onset of fever; pain and dermatological manifestations were the most common persistent symptoms. Prognostic factors for symptom persistence were: ≥4 d of fever (RR 1.72; 95% CI 1.35 to 2.19), platelet count ≤100 000/mm3 (RR 1.20; 95% CI 1.20 to 2.20), petechiae/bruises (RR 1.97; 95% CI 1.56 to 2.48) and abdominal pain/hepatomegaly (RR 1.79; 95% CI 1.41 to 2.28). CONCLUSIONS: Persistence of dengue symptoms were common in laboratory-confirmed dengue patients. Manifestations related to tissue damage were associated with persistence after 30 d; host characteristics, such as age and health status before infection, were associated with prolonged persistence (>60 d). The burden of dengue may be higher than previously estimated.

Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016-2017.

We adapted the EQ-5D-3L questionnaire and visual analog scale to assess health-related quality of life (HRQOL) and persistent symptoms in 79 patients with laboratory-confirmed dengue in Morelos, Mexico. The lowest HRQOLs were 0.53 and 38.1 (febrile phase). Patients recovered baseline HRQOL in ≈2 months.

Evaluación de las competencias clínicas en estudiantes de enfermería / Avaliação das competências clínicas em estudantes de enfermagem / Evaluation of clinical competencies in nursing students

Introducción: Los nuevos modelos apuntan a incluir la autoevaluación como un método que permite a los estudiantes conocer sus progresos y reflexionar en torno a su rendimiento. El objetivo fue evaluar el nivel de cumplimiento y el alcance de las competencias de la asignatura “Cuidado de familia, gestante y recién nacido”. Materiales y Métodos: Estudio de corte transversal, en 41 estudiantes. Se diseñó un instrumento con 19 competencias. Los estudiantes expresaban si las habían alcanzado y en qué nivel, en una escala de 1 a 5. Las notas obtenidas en las rotaciones fueron correlacionadas. Resultados: La competencia Aplica el proceso de enfermería en situaciones de bienestar y riesgo durante el puerperio a la mujer y familia en etapa de crianza, fue alcanzada en 100%, con un nivel de cumplimiento de 3,65 (0,44). La rotación de Alto Riesgo Obstétrico obtuvo un nivel de cumplimiento de 3,82 (IC 95%: 3,63-4,01). No hubo diferencias entre rotaciones (p=0,416) ni en los niveles de cumplimiento (p=0,3180). La correlación de Spearman entre el nivel de cumplimiento del estudiante y las notas otorgadas por el docente fue baja en sala de partos y muy baja alto riesgo obstétrico y puerperio, sin significancia estadística. Discusión: Los resultados de este estudio son una aproximación de cómo los estudiantes están percibiendo el logro de las competencias y una forma de retroalimentar el proceso de formación. Otros estudios también concuerdan en la importancia del punto de vista del estudiante en el alcance de competencias. Conclusiones: El cumplimiento de las competencias en Proceso de Enfermería para el IV nivel es superior a 3,7.

Introdução: Os novos modelos têm como objetivo incluir a auto-avaliação como um método que permite aos alunos ver seu progresso e ao mesmo tempo, refletir sobre o seu desempenho. Nosso objetivo foi avaliar o nível de cumprimento e o âmbito das competências da matéria "Cuidado da família, mulheres grávidas e recém-nascidos." Materiais e Métodos: Estudo transversal em 41 alunos. Um instrumento com 19 competências foi projetado. Estudantes expressavam se tinham conseguido e em que nível, numa escala de um a cinco, sendo cinco a maior pontuação possível. As notas obtidas nas rotações foram correlacionadas. Resultados: A competência aplica o processo de enfermagem em situações de bem-estar e risco durante o puerpério em mulheres e famílias em etapas de criação, foi atingida no 100% com um nível de cumprimento de 3,65 (0,44). A rotação de alto risco obstétrico obteve o maior nível de cumprimento com um valor de 3,82 (IC 95%: 3,63-4,01). Não houve diferenças entre rotações (p = 0,416) ou nos níveis de cumprimento (p = 0,3180). A correlação de Spearman entre o nível de cumprimento dada pelo aluno e as notas atribuídas pelos professores foi baixa para sala de parto e muito baixa para alto risco obstétrico e pós-parto, sem significância estatística. Discussão: Os resultados deste estudo são uma primeira aproximação de como os estudantes estão vendo a realização de competências e uma forma de avaliar o processo de formação. Outros estudos também concordam sobre a importância da perspectiva do estudante sobre o alcance das competências.Conclusões: O cumprimento das competências em processo de enfermagem para o nível IV excede 3,7.

Introduction: The new models aim to include self-evaluation as a method that allows students to know their progress and at the same time, reflect on their academic performance. The objective was to assess the level of compliance and the scope of the competences of the subject "Family Care, pregnant and newborn." Materials and Methods: Cross-sectional study, conducted in 41 students. We designed a tool to assess 19 competences. Students said if they had achieved competencies and what was the level in a score from 1 to 5, with 5 being the highest score of achievement. The grades obtained in rotations were correlated. Results: The competency: Applies nursing process in well-being and risk situations along puerperium and family in parenting stage,was achieved in 100% and the level of compliance was 3,65 (0,44). The rotation high risk obstetric obtained a compliance level of 3,82 (95% CI: 3,63 to 4,01).We found no differences between rotations (p= 0,416) or in compliance levels (p= 0,3180). Spearman correlation between the level of compliance given by the student and the grades given by teachers was low in the practice of "delivery room" and very low in the practices of "high-risk obstetrics" and "postpartum" without statistical significance. Discussion: The results of this study become a first approximation of how students are seeing the achievement of skills and a way of feeding back the process of formation. Other studies also agree on the importance of student perspective on the scope of powers. Conclusions: Compliance competence in nursing process for the IV level is greater than 3,7.

Competencias en proceso de enfermería en estudiantes de práctica clínica / Nursing process competency in clinical practice students

Introducción: El proceso de enfermería es un método que involucra conocimientos, habilidades, destrezas, capacidades, actitudes y valores adquiridos durante la formación profesional, por tanto es fundamental garantizar el logro de esta competencia en la práctica clínica. El objetivo consistió en evaluar el nivel de cumplimiento y alcance de las competencias en Proceso de Enfermería en los estudiantes de Enfermería. Materiales y Métodos: Diseño de corte transversal, cuya muestra correspondió al total de estudiantes matriculados (73 estudiantes) en IV y VI nivel de un programa de enfermería de la ciudad de Bucaramanga que rotaban por áreas clínicas y comunitarias. Resultados: Según la opinión de los estudiantes, las competencias de proceso de enfermería fueron alcanzadas entre 2.63% a un 100% y un nivel de cumplimiento de 2.7 y 4, que según la escala establecida están entre regular y muy bueno. La competencia “Brinda cuidado aplicando el proceso de enfermería” fue común entre rotaciones de IV nivel y no se encontraron diferencias en el nivel de logro percibido (p=0.3180 test ANVOVA), además evidenció una diferencia significativa entre el nivel alcanzado entre IV y VI semestre. Discusión: Aunque existen pocos estudios sobre la medición de las competencias en proceso de enfermería durante la formación universitaria, un gran número de publicaciones científicas han hecho evidente los resultados de la aplicación de este método en la práctica clínica. Conclusiones: El conocer en qué medida las competencias en proceso de Enfermería son alcanzadas y en qué nivel, facilita el ajuste de aspectos curriculares del programa del estudio.

Introduction: The nursing process is a method that involves knowledge, skills, abilities, attitudes and values acquired during training, so it is essential to ensure the achievement of this competition in clinical practice. The aim was to assess the level of compliance and scope of the Nursing Process skills in nursing students. Materials and Methods: Sectional design, with a sample being all the students’ enrolled (73 students) in IV and VI level nursing program in the city of Bucaramanga that rotated through clinical and community areas. Results: In the opinion of the students, the skills of the nursing process were reached between 2.63 % to 100 % and a level of compliance with 2.7 and 4, which according to the scale established are fair to very good. The skill "provides care using the nursing process" was common among rotations in IV level and were found no differences in the perceived level of achievement (p = 0.3180 ANVOVA test), but there were also significant differences between the level reached between IV and VI semesters. Discussion: Although there are few studies on the measurement of skills in nursing process for university level education, a large number of scientific publications have made evident the results of the application of this method in clinical practice. Conclusions: Knowing the extent to which nursing skills are being achieved and at what level, makes easy to adjust curricular aspects of the study program.

Discapacidad en dengue y su relación con severidad / Disability in dengue and its relationship to the severity

Introducción: La discapacidad en dengue ha sido poco descrita en la literatura científica. Objetivo: Determinar la frecuencia de la discapacidad en dengue y su asociación con severidad. Materiales y métodos: Estudio de cohorte en pacientes con 48-96 horas de inicio de fiebre seguidos como mínimo hasta el sexto día. Se evaluó la discapacidad relacionada con limitación de la actividad (suspensión total de actividades habituales). Resultados: Se siguieron 352 personas con dengue, de éstas 324(95,05%) manifestaron discapacidad en algún momento y 259(73,58%) durante al menos 4 días. Se clasificaron como dengue clásico 301(85,51%) personas y 51(14,49%) como severo (48 hemorrágico y 2 choque). La mediana de días de discapacidad fue 5(0–10) en dengue clásico y 7(0-4) en severos (p<0.0001). El dengue severo estuvo asociado con discapacidad ≥4 días (RR:1,92; IC95%:1,11-3,31). Se calcularon 1376,7 AVAD por 100,000 personas. Discusión: Se evidenció una frecuencia de discapacidad considerable incluso en los casos menos severos, similar a lo encontrado en Brasil, Puerto Rico y Tailandia. Conclusión: El dengue genera discapacidad en zonas endémicas y ésta se asocia con severidad.

Introduction: Disability in dengue has been poorly described in the scientific literature. Objective: We described the frequency of disability in dengue and its relationship with dengue severity. Materials and methods: A cohort study of patients with 48-96 hours of onset of fever followed at least until the sixth day. We evaluate disability related to activity limitation because of illness (total suspension of usual activities). Results: We followed 352 patients with dengue, 324(95.05%) were disabled at anytime of follow-up, 259(73.58%) patients were disabled for at least 4 days or more from the onset. Dengue cases were classified as classic in 301 (85.51%) persons and 51 (14.49%) cases as severe dengue (48 dengue haemorrhagic fever and 2 shock syndrome). The median in days of disability was 5(0-10) in classic dengue fever and 7(0-14) in severe cases (p <0.0001). The diagnosis of severe dengue was associated with a disability ≥4 days (RR: 1.92, CI95%: 1.11-3.31). Discussion: We found a considerable disability frequency even when dengue is less severe, similar to findings in Brazil, Puerto Rico and Thailand. Conclusions: The dengue disease cause disability in endemic areas and this is associated with severity.

Validez y confiabilidad de un instrumento de satisfacción del usuario con síndrome febril agudo / The validity and reliability of an instrument for measuring the satisfaction of users suffering from acute febrile syndrome

Objetivo Determinar la validez y la confiabilidad de un instrumento de satisfacción del paciente con Síndrome Febril Agudo en urgencias y consulta oportuna de la Red Pública de Bucaramanga. Métodos Estudio de evaluación de tecnologías diagnósticas en personas con Síndrome Febril Agudo entre el 2008 y 2009. Se diseñó un cuestionario telefónico a partir de 3 instrumentos en español. Se evaluó validez de contenido mediante sometimiento a expertos y a profesionales de salud y validez facial en una prueba piloto con 30 usuarios. La reproducibilidad fue realizada por dos enfermeras independientemente en 19 encuestas. Resultados Se realizaron 146 encuestas, de estas 75.3 por ciento fueron contestadas por mujeres, 33.6 por ciento por los mismos pacientes y 52.7 por ciento por las madres de estos cuando eran menores de 15 años. Se realizó análisis factorial obteniendo 3 factores: satisfacción con la atención médica, de enfermería y la organización del centro; al modelo final entraron 16 de 26 ítems. El alfa de Cronbach para cada factor fue 0,89 (IC 95 por ciento: 0,86;0,93), 0,78 (IC95 por ciento: 0.67;0.84) y 0,88 (IC95 por ciento: 0.85;0.91) respectivamente; el coeficiente de kappa fue 0.90 (IC95 por ciento: 0.77;0.97) y el coeficiente de correlación intraclase fue 0.955 (IC95 por ciento: 0.862;0.986) El promedio de las diferencias en la sumatoria de los ítems fue -1.3 (DS: 8,5) y los límites de acuerdo de Bland y Altman fueron -18.9 y 15.3. Discusión Este estudio demuestra validez y confiabilidad del instrumento de satisfacción de usuarios de los servicios de urgencias y consulta oportuna y podría aplicarse en la red pública del sistema de salud Colombiano.

Objective Determining the validity and reliability of a user satisfaction instrument applied to patients attending the emergency department and clinic who were suffering from acute febrile syndrome in Bucaramanga's Public Health Network. Methods A diagnostic technology assessment study was conducted between 2008 and 2009 on patients suffering from acute febrile syndrome. A telephone questionnaire was designed using 3 instruments. Content validity was assessed by experts and health professionals and face validity was assessed in a pilot study involving 30 users. Reproducibility was tested in questionnaires independently applied by two nurses to 19 patients. Results Data from 146 surveys was collected; 75.3 percent were answered by women, 33.6 percent were patients and 52.7 percent were their mothers when patients were under 15. Three factors were identified from factor analysis: satisfaction with medical care, nursing and medical centre organisation. The final model included 16 of the 26 items. Cronbach's Alpha for each factor was 0.89 (0.86-0.93 95 percentCI), 0.78 (0.67- 0.84 95 percentCI) and 0.88 (0.85-0.91 95 percentCI), respectively. The Kappa coefficient was 0.90 (0.77-0.97 95 percentCI) and intra-class correlation coefficient was 0.96 (0.86-0.99 95 percentCI). The average difference of the sum of all items was -1.3 (SD: 8.5) and Bland and Altman limits of agreement were -18.9 and 15.3, respectively. Discussion This study established the validity and reliability of a new instrument concerning user satisfaction used with patients suffering from acute febrile syndrome attending emergency health care which that could be applied in the Colombian Public Health System.

[The validity and reliability of an instrument for measuring the satisfaction of users suffering from acute febrile syndrome]. / Validez y confiabilidad de un instrumento de satisfacción del usuario con síndrome febril agudo.

OBJECTIVE: Determining the validity and reliability of a user satisfaction instrument applied to patients attending the emergency department and clinic who were suffering from acute febrile syndrome in Bucaramanga's Public Health Network. METHODS: A diagnostic technology assessment study was conducted between 2008 and 2009 on patients suffering from acute febrile syndrome. A telephone questionnaire was designed using 3 instruments. Content validity was assessed by experts and health professionals and face validity was assessed in a pilot study involving 30 users. Reproducibility was tested in questionnaires independently applied by two nurses to 19 patients. RESULTS: Data from 146 surveys was collected; 75.3 % were answered by women, 33.6 % were patients and 52.7 % were their mothers when patients were under 15. Three factors were identified from factor analysis: satisfaction with medical care, nursing and medical centre organisation. The final model included 16 of the 26 items. Cronbach's Alpha for each factor was 0.89 (0.86-0.93 95 %CI), 0.78 (0.67- 0.84 95 %CI) and 0.88 (0.85-0.91 95 %CI), respectively. The Kappa coefficient was 0.90 (0.77-0.97 95 %CI) and intra-class correlation coefficient was 0.96 (0.86-0.99 95 %CI). The average difference of the sum of all items was -1.3 (SD: 8.5) and Bland and Altman limits of agreement were -18.9 and 15.3, respectively. DISCUSSION: This study established the validity and reliability of a new instrument concerning user satisfaction used with patients suffering from acute febrile syndrome attending emergency health care which that could be applied in the Colombian Public Health System.