[Validating the Spanish version of the Nursing Activities Score]. / Validación de la versión en castellano del Nursing Activities Score.

INTRODUCTION: Validating workload scores ensures that they are appropriate for the purpose for which they were developed. OBJECTIVE: To validate the Nursing Activities Score (NAS) Spanish version. METHODOLOGY: Observational and prospective study. 1,045 patients who were admitted to a medical-surgical unit and a serious burns unit in 2006 were included. The nurse in charge assessed patient workloads by Nine Equivalent of Nursing Manpower use Score and NAS. To assess the internal consistency of the measurements of NAS, item-test correlations, Cronbach's α and Cronbach's α corrected by omitting each of the items were calculated. The intraobserver and interobserver reliability were assessed with the intraclass correlation coefficient by viewing recordings and Kappa (interobserver reliability) was estimated. For the analysis of internal validity, a factorial principal components analysis was performed. Convergent validity was assessed using the Spearman correlation coefficient values obtained from the Nine Equivalent of Nursing Manpower use Score and Spanish-NAS scales. RESULTS: For internal consistency, 164 questionnaires were analysed and a Cronbach's α of 0.373 was calculated. The intraclass correlation coefficient for intraobserver reliability estimate was 0.837 (95% IC: 0.466-0.950) and 0.662 (95% IC: 0.033-0.882) for interobserver reliability. The estimated kappa was 0.371. For internal validity, exploratory factor analysis showed that the first item explained 58.9% of the variance of the questionnaire. For convergent validity 1006 questionnaires were included and a Spearman correlation coefficient of 0.746 was observed. CONCLUSIONS: The psychometric properties of Spanish-NAS are acceptable.

[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease]. / Fiabilidad interobservador de la escala del coma de Glasgow en pacientes críticos con enfermedad neurológica o neuroquirúrgica.

INTRODUCTION: The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. OBJECTIVE: To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. METHODS: Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. RESULTS: The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). CONCLUSION: In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.

[Transcultural adaptation into Spanish of the nursing activities score]. / Adaptación transcultural al castellano del nursing activities score.

INTRODUCTION: Assessment of nursing workload is a common practice in the daily work of nursing care. This is usually done using scales that were not designed for Spanish-speaking countries, which may not take into account the characteristics of the environments that differ from one country to another. The Nursing Activities Score (NAS) has been described as being a useful tool for measuring nursing workload among the instruments used for this measurement in intensive care units. OBJECTIVE: It was aimed to adapt the NAS into Spanish for its use in Spanish intensive care units. MATERIAL AND METHODS: The NAS was adapted using translation-back translation method with the participation of both native English speakers who were bilingual in Spanish, and Spanish translators with a high level of English. All of the translators worked individually. A single Spanish version of the scale was obtained, after which a pilot test was made in an Intensive Care Major Burns Unit of the University Hospital of Getafe (Madrid, Spain) with 30 patients and 30 nurses during their regular work shift. We also consulted the primary author of the original description of the NAS regarding items that caused some kind of conflict. RESULTS: Between the original scale and the result of the back-translations to English, we obtained agreement ratings of good in 73%, and appropriate in the remaining 27%. No item was considered to have bad correspondence. CONCLUSION: We have developed a Spanish translation of the NAS that appears well matched to the original English version.

Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient. / Formación de equimosis y/o hematoma tras la administración profiláctica de enoxaparina subcutánea en abdomen o brazo en pacientes críticos.

INTRODUCTION: Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. OBJECTIVE: To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. METHODOLOGY: A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72hours. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families. RESULTS: 301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n(%): 66(44) vs 72(51), P=.25] [haematoma abdomen vs arm, n(%): 9(6) vs 14(10), P=.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm2) abdomen vs arm, median (IQR): 2(1-5.25) vs 20(5.25-156), P=.027]. CONCLUSIONS: In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72hours, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving anti-platelet agents present a higher risk of injury. No relationship was observed in relation to BMI.

Investigating Serum Uric Acid as a Risk Factor in the Development of Delayed Renal Recovery in Living Kidney Donors.

BACKGROUND: Hyperuricemia has been associated with kidney disease and remains controversial with regard to its gender-specific differences and impact in living kidney donation. METHODS: Between 2006 and 2015, charts of live kidney donors who underwent nephrectomy and had a minimum follow-up of 1 year were reviewed. A total of 291 donors were included and divided based on gender-specific pre-donation serum uric acid (SUA) tertiles. Renal functional outcomes included were estimated glomerular filtration rate (eGFR) at 6-month and 1-year follow-up and percentage of donors with a 1-year eGFR <60 mL/min/1.72 m2. Logistic regression analysis was done. RESULTS: Mean SUA tertiles were 5.8 ± 1.1 mg/dL in males and 4.1 ± 1 mg/dL in females. Females in the highest tertile (SUA >4.5 mg/dL) had lower 6-month (59.9 ± 10.3 vs 66.9 ± 14.1 vs 67.3 ± 12.1; P = .018) and 1-year (60.8 ± 10.6 vs 67.6 ± 10.8 vs 67.8 ± 11.8; P = .021) eGFR and a higher percentage of donors with 1-year eGFR <60 mL/min/1.73 m2 (59.5% vs 31.6% vs 23%; P = .002) compared with donors in the lower SUA tertiles (≤4.5 mg/dL). In males, there were similar eGFRs among SUA tertiles at 6-month and 1-year follow-up. In multivariate analysis, SUA was shown to be a significant predictor of developing stage 3 CKD (eGFR <60 mL/min/1.72 m2), 1 year after donation in females but not in males. CONCLUSIONS: Predonation SUA level is associated with the development of delayed renal recovery (GFR <60 mL/min/1.72 m2) 1 year after donation in females but not in males.

Phospholipid metabolism of dog liver under hypoxic conditions induced by ligation of the hepatic artery.

Ischemic hypoxic liver was induced in dogs by ligation of the hepatic artery. About 67% of the dogs died of liver necrosis within 1 or 2 days (severe cases), and the rest survived (mild cases). In the severe cases, the decreases in the contents of total lipids, phospholipids and proteins of the liver after 24 h were 24, 46 and 12%, respectively, of the original values. The marked decrease in phospholipids was due to decreases in the microsomal and mitochondrial fractions. In the mild cases, similar but smaller decreases occurred and decrease of phospholipids occurred only in the microsomal fraction. The main phospholipids were choline and ethanolamine glycerophospholipids, and their molecular species were analyzed. In the severe cases, ligation resulted in relative increases in mono- and diene species and a decrease in polyene species. No increase in phospholipase activity was found at various times after ligation of the hepatic artery. Penicillin-treated dogs all survived and showed little decrease in liver phospholipids.

Enhancement of chemotherapeutic effects with focused shock waves: extracorporeal shock wave chemotherapy (ESWC).

The effects of shock waves in combination with various anti-cancer agents i.e. Bleomycin (BLM), Cisplatin (CDDP) and 5-fluorouracil (5-FU) on tumor cells suspended in media containing these agents were examined. GCIY cells derived from human gastric cancer and LS 174T and SW480 cells derived from human colon cancers were used for in vitro experiments; GCIY and SW480 cells were also transplanted into nude mice for in vivo study. It was only with BLM that enhancement was evident in all three cell lines, with a degree of chemotherapeutic enhancement proportional to the amount of shock wave energy applied. Ladder formation of DNA in GCIY cells was observed only when treated with both BLM and shock waves in combination. When SW480 and GCIY cells transplanted into the backs of nude mice were treated with a combination of intravenously (i.v.) injected BLM and regional exposure to shock waves, a significant enhancement of chemotherapeutic effects was observed in terms of the tumor growth curve.

FDG PET evaluation of residual masses and regrowth of abdominal lymph node metastases from colon cancer compared with CT during chemotherapy.

Fluorine-18-2-deoxy-2-fluoro-D-glucose (F-18 FDG) PET may be more suitable for follow-up after cancer treatment than other morphologic approaches, because it reflects tumor viability. A patient with abdominal lymph node metastases from colon cancer was followed by CT and F-18 FDG PET during chemotherapy. F-18 FDG PET tumor images changed in accordance with the clinical progress, whereas CT findings were relatively unchanged. This case clearly shows the utility of F-18 FDG PET for follow-up during cancer chemotherapy.

[The study of occupational satisfaction and its determining factors among health professionals working in one of the areas in Madrid]. / Estudio de la satisfacción laboral y sus determinantes en los trabajadores sanitarios de un área de Madrid.

BACKGROUND: It is well known that job satisfaction influences health care services quality. The aim of this study is to evaluate sanitary workers' job satisfaction and to determine its components, in a sanitary district institutions: primary health care centres, speciality centres and district hospital. METHODS: A cross-sectional study was designed. The sample is proportional, stratified and randomized. It is composed of 947 workers, 460 of which are speciality care workers (SCW) (from a total study population of 1579 people), and 486 are primary care workers (PCW) (the whole population of PCW) from the tenth sanitary area of Madrid. We have used two questionnaires: the first one is Font-Roja's questionnaire which consists of 27 items that are evaluated through a Likert 1-5 scale. The second questionnaire consists of independent variables: socio-demographic and job variables. We have made an exploratory factorial analysis of various satisfaction components. We have evaluated the relationship between each dimension and the independent variables. RESULTS: 255 professionals of SCW (55.4% of the whole) and 357 of PCW (73.9% of the whole) answered the questionnaire. The dimensions that reached the lowest score were these factors: stress related with job and professional promotion (this factor was lowest in nurses and administrative worker). There are significant differences with respect to studied factors, professional level, and kind of job. CONCLUSIONS: We have found a half way satisfaction level in this sanitary district health care workers. Our results suggest that modifications in management and working conditions are needed, according to satisfaction dimension scores.

[Problems in clinical use of intraarterial blood gas monitoring system, Paratrend 7].

We evaluated the intraarterial blood gas monitoring system Paratrend 7 in clinical use. One hundred and sixty six sensors used for patients receiving thoracic, open heart or great vessel surgery were tested for one year, prospectively. Sensors were inserted through a 20 G intraarterial cannula into the radial artery before operation and removed when they malfunctioned or seemed to be not necessary for patient management in critical care unit. We encountered several problems such as, initial calibration failure (5/166), impossible sensor insertion (2/166), arterial pressure wave change (5/166), parameter display failure (21/166), and thrombus in the circuit (9/166). Parameter display failure after insertion tended to occur on patient's arm movement imparing the sensor. No serious accident, such as arterial thrombosis was experienced. Some troubles were due to staff's incorrect handling of the apparatus. Training of staffs is indispensable for safe and sufficient utilization of Paratrend 7.

[Anesthesia for bronchial stenosis treated by balloon catheter dilatation].

We experienced three cases of successful balloon catheter dilatation for bronchial stenosis under general anesthesia. There was no problem for two patients, but the third patient planned for stent insertion had bronchiomediastinal fistula. This procedure is generally performed under local anesthesia but more safely done under general anesthesia with muscle relaxants considering operative failure by bucking, pain of patients and prolonged procedure.

[Heparin concentration and hemostatic alterations with low systemic heparinization during CPB using heparin-coated circuits].

Extracorporeal circulation with heparin coated circuits allows reduction of systemic heparin. The authors investigated the effects of this method on the hemostatic and fibrinolytic systems and heparin concentration simultaneously. Ten patients undergoing coronary artery bypass surgery were studied. The dose of heparin was 100 IU.kg-1, and the target activated clotting time (ACT) was more than 300 seconds. Blood samples were obtained at the following times; before and after giving heparin, 10 and 40 minutes after the start of extracorporeal circulation, after cross-clamp release, and after giving protamine, and heparin concentration, ACT, thrombin-antithrombin complex (TAT), plasmin alpha 2 plasmin inhibition complex (PIC), and D-dimer were measured. ACT was kept over 300 seconds without additional heparin administration. Heparin concentration was maintained at 1.0 IU.ml-1. However, after release of the aortic cross-clamp, TAT, PIC, D-dimer increased significantly. Despite reduced systemic heparinization, heparin concentration was maintained adequately. Thrombin generation and fibrinolytic activity showed no significant increase until the release of the aortic cross-clamp.

[Anesthetic management for placement of tracheobronchial stents in patients with airway stenosis].

We report the anesthetic management for stents placement in patients with tracheobronchial stenosis. The subjects were 6 patients with lung cancer and one patient with tracheal invasion of esophageal cancer. Anesthesia was induced with propofol, fentanyl and vecuronium, and maintained with propofol and vecuronium. After intubation, tracheostomy was performed. The patients were kept apnic during insertion of stents. Three patients had dynamic stents inserted from tracheostomy site and one orally. Three patients had Dumon stents inserted orally, but the procedure in one patient was cancelled because her stent could not be placed at appropriate position. We recommend the anesthetic management through the tracheostomy site for the placement of Dumon tubes or dynamic stents.

[Prophylactic effect of nicorandil on perioperative coronary spasm].

The prophylactic effect of nicorandil on perioperative coronary spasm (CS) in CABG was examined retrospectively. The subjects were 313 patients who had undergone elective CABG. The patients were divided into two groups a control group receiving single administration of nitroglycerine (N = 196) and a nicorandil group receiving both nitroglycerine and nicorandil (4 mg.h-1-8 mg.h-1) (N = 107). The two groups were compared. The incidence of CS was 14 cases (7.1%) in the control group and 6 cases (5.6%) in the nicorandil group, demonstrating a significant difference. With the dose and the administration method employed in this study, no prophylactic effect of nicorandil on perioperative CS has been demonstrated.

[Application of continuous intra-arterial blood gas monitoring system "Paratrend 7" for pulmonary lavage of a patient with alveolar proteinosis].

We applied a continuous intra-arterial blood gas monitoring system (Paratrend 7) to a patient with pulmonary alveolar proteinosis during pulmonary lavage. Lavage was performed under general anesthesia with one lung ventilation. We inserted the sensor of Patatrend 7 through a 20 G catheter into the radial artery, and monitored pH, PaCO2 and PaO2 continuously throughout the procedure. SpO2 and EtCO2 were also monitored. Saline 1000-1500 ml was instilled and drained repeatedly by volume limited methods. PaO2 values by Paratrend 7 increased during instillation and decreased during drainage of the irrigating fluid. In contrast, PaCO2 value by Paratrend 7 decreased slightly during instillation and increased during drainage. The change of SpO2 was almost the same as that by Paratrend 7, but the response time of pulse oxymetry was a little quicker than Paratrend 7. During the lavage procedure, respiratory and circulatory condition changed very rapidly, and it is necessary to monitor blood gas change intensively. Paratrend 7 is useful as a perioperative monitoring system, but pulse oxymetry might be sufficient during pulmonary lavage considering its cost.

[p53 as a molecular target for cancer therapy].

Development of novel strategies is required for cancer treatment because most human tumors are refractory to current conventional therapy. During the past decade, a number of oncogenes and tumor suppressor genes have been cloned and the molecular mechanisms as to how mutations in such genes contribute to tumor development are going to be clarified. It is, therefore, a great challenge to develop novel strategies for tumor specific therapy based on molecular biology of cancer. p53 tumor suppressor gene is one of the most frequently mutated genes in a variety of human cancers. This review paper introduces several recent approaches related to the p53 as a molecular target of cancer treatment, including (i) p53 status and chemo-radiosensitivity, (ii) p53 gene therapy, (iii) E1B-deficient adenovirus and (iv) restoration of p53 function by synthetic polypeptides.

[Functional screening of p53 status in tumor cells using Saccharomyces cerevisiae].

We have detected both germ-line and somatic p53 mutations in lymphocytes, cell lines and tumor tissues using a functional analysis of p53 tumor suppressor gene based on yeast transcription assay. Through our screening projects of the p53 gene, a number of missense p53 mutations were identified as loss-of-function mutations. This method, previously termed FASAY, is rapid, sensitive, less-expensive and can be automated for screening both somatic and germ-line p53 mutations.

[Genetic alterations of human colorectal cancer].

Genetic alterations of several oncogenes and tumor suppressor genes are associated with human colorectal carcinogenesis. Especially in mutations, the K-ras, p53, APC and DCC gene frequently occurred, and these gene alterations seem to have important roles in colorectal carcinogenesis. We investigated 28 human colon cancer specimens obtained from surgery and five human colon cancer cell lines by PCR-SSCP assay, PCR-OSH assay, RT-PCR or sequencing method. Forty percent of cancers from surgical specimens had Ki-ras 2 (codon 12/13), p53 (Exon 5-8), APC (MCR) gene mutations, and fifty-seven percent of them had lower expression of DCC gene that of normal matched colon mucosa of the same patient. G to A transition was the most frequent in K-ras mutational spectrum in this case; 25% of patients had both k-ras and p53 gene point mutations. Form the results, we concluded that it in colorectal carcinogenesis for both K-ras and p53 gene point mutations might not necessary occur.