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Epidural electrical epinal cord stimulation (ESCS) is an established therapeutic option in various chronic pain conditions. In the last decade, proof-of-concept studies have demonstrated that ESCS in combination with task-oriented rehabilitative interventions can partially restore motor function and neurological recovery after spinal cord injury (SCI). In addition to the ESCS applications for improvement of upper and lower extremity function, ESCS has been investigated for treatment of autonomic dysfunction after SCI such as orthostatic hypotension. The aim of this overview is to present the background of ESCS, emerging concepts and its readiness to become a routine therapy in SCI beyond treatment of chronic pain conditions.
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Fundamento: el desarrollo de habilidades sociales adquiridas mediante indagación científica en procesos de gestión para la salud por parte de los estudiantes que se desempeñan como docentes de Educación Física, así como su evaluación en línea son aspectos fundamentales, en la formación integral del personal, la mejora de la gestión por procesos y en la imagen corporativa de la institución. Objetivo: evaluar el estado de las actividades físicas para la formación de docentes de la entidad educativa. Métodos: se realizó una investigación no experimental con un diseño transeccional. Se efectuó un diagnóstico basado en la observación y la recogida de datos mediante la encuesta. La muestra estuvo constituida por el grupo de alumnos que se desempeñan como docentes. Se evaluaron dos variables en una de las cuatro dimensiones de la imagen corporativa. Resultados: la institución educativa carece de una imagen corporativa sólida, sin promoción de competencias digitales y habilidades sociales de los docentes. El 76 % de los encuestados calificó las habilidades sociales para el aprendizaje en la dimensión servicios ofrecidos al usuario con un nivel medio, el 14 % bajo y el 10 % alto. El 55 % calificó la gestión por procesos para la salud del usuario en un nivel medio, el 8 % bajo y el 10 % alto. La mayoría no percibió que la institución ofreciera variedad de servicios. Conclusiones: existe la necesidad de desarrollar las habilidades sociales adquiridas como una herramienta poderosa para ayudar a los estudiantes a gestionar sus necesidades y el cuidado de la salud.
Foundation: the development of social skills acquired through scientific inquiry in health management processes by students who work as physical education teachers, as well as their online evaluation are fundamental aspects, both in the comprehensive training of staff, the improvement of process management, and the corporate image of the institution. Objective: evaluate the state of physical activities for the training of teachers of the educational entity. Methods: the research was non-experimental with a transectional design. A diagnosis was made based on observation and data collection through the survey. The sample was the group of students who work as teachers. Two variables were evaluated in one of the four dimensions of corporate image. Results: the educational institution lacks a solid corporate image, without promoting digital competencies and social skills of teachers. 76 % of those surveyed rated the social skills for learning in the services offered to the user dimension with a medium level, 14 % low and 10 % high. 55 % rated process management for user health at a medium level, 8 % low and 10 % high. The majority did not perceive that the institution offered a variety of services. Conclusions: it's necessary to develop acquired social skills as a powerful tool to help students manage their needs and health care.
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Resumen: Introducción: en años recientes con el renacimiento de la anestesia regional a causa de los avances técnicos en equipamiento como el ultrasonido, estos han permitido llevar a cabo bloqueos de plexo braquial con varias técnicas de abordaje, alta eficacia de éxito y disminución de complicaciones. Objetivo: conocer la eficacia y seguridad del bloqueo de plexo braquial con ultrasonido, en anestesiólogos con especialidad en anestesia regional. Material y métodos: se realizó el estudio observacional, descriptivo y retrospectivo de la práctica clínica habitual en 283 pacientes de 0 a 15 años, programados para cirugía electiva de ortopedia y traumatología, de extremidad superior (húmero tercio distal, codo, antebrazo y mano), con manejo anestésico: sedación más bloqueo de plexo braquial con ultrasonido abordaje supraclavicular o infraclavicular. Durante dos años, de enero de 2018 a diciembre de 2019. Resultados: los bloqueos fueron realizados por 11 anestesiólogos con especialidad en anestesia regional. Se evaluó la eficacia con 99.65% de éxito. En cuanto a la seguridad no se registraron complicaciones. Conclusiones: el uso de ultrasonido en bloqueo de plexo braquial con abordaje supraclavicular e infraclavicular es una técnica con éxito alto y sin complicaciones; sin embargo, es necesario tener capacitación y experiencia.
Abstract: Introduction: in recent years with the revival of regional anesthesia due to technical advances in equipment such as ultrasound, have allowed to carry out brachial plexus blocks with several approach techniques with high efficiency of success and reduction of complications. Objective: to know the efficacy and safety of brachial plexus block with ultrasound, in anesthesiologists with a specialty in regional anesthesia. Material and methods: the observational, descriptive, retrospective study of the usual clinical practice was carried out in 283 patients from 0 to 15 years old, scheduled for elective orthopedic surgery and traumatology, of the upper extremity (distal third humerus, elbow, forearm and hand), with anesthetic management: sedation plus brachial plexus block with ultrasound supraclavicular or infraclavicular approach. For two years from January 2018 to December 2019. Results: the blocks were performed by 11 anesthesiologists specializing in regional anesthesia. Efficacy was evaluated with 99.65% success. In terms of safety, there were no complications. Conclusions: the use of ultrasound in brachial plexus block with supraclavicular and infraclavicular approach is a technique with high success and without complications however it is necessary to have training and experience.
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Objetivo principal: Determinar las principales acciones de Teletriaje/teleorientación de enfermería pediátrica durante la pandemia por Covid-19. Metodología: Estudio exploratorio, longitudinal, documental, con 349 fichas de registro, en un instituto especializado de Lima, Perú, durante los meses de mayo a julio del 2020. Resultados principales: 28,4% de los atendidos fueron lactantes; 54,4% de sexo masculino; 47,3% con Seguro Integral de Salud; 89,1% procedentes de la capital; 66,9% se conectaron por llamada telefónica; 20,9% presentó problemas dérmicos. El principal diagnóstico de enfermería identificado fue seguridad y protección (38,1%); 87,4% fueron derivados a especialidades médicas y 100% de usuarios manifestaron su conformidad. Conclusión principal: El Teletriaje/teleorientación de enfermería pediátrica es un eficiente procedimiento asistencial que inicia la consulta externa virtual o presencial, seleccionando especialidades pediátricas y brindando consejería. Este procedimiento alcanzó reconocimiento social.(AU)
Primary Objective: Determine the principal actions of Teletriage /teleorientation of pediatric nursing during the Covid-19 pandemic. Method: Exploratory, longitudinal, documentary study, with 349 registration cards, in a specialized institute from Lima, Peru, during the months of May to July in the year 2020. Principal results: 28.4% of the patients attended were breastfeeding; 54.4% were male; 47.3% with Insurance (Seguro Integral de Salud); 89.1% were from the capital; 66.9% were connected through a phone call; 20.9% presented skin problems. The primary identified diagnostic of nursing was Safety and Protection (38.1%); 87.4% were referred to medical specialties and 100 % of users expressed their agreement. Main conclusion: Pediatric nursing teletriage/teleorientation, efficient assistance procedure that initiates virtual or face-to-face outpatient consultation, selecting pediatric specialties and providing counseling. This procedure achieved social recognition.(AU)
Subject(s)
Humans , Male , Female , Infant , Teleorientation , Telescreening, Medical , Pediatric Nursing , Pandemics , Coronavirus Infections , Severe acute respiratory syndrome-related coronavirus , Betacoronavirus , Child Health , Adolescent Health , Nursing , Peru , Longitudinal Studies , Telemedicine , TelephoneABSTRACT
BACKGROUND: In order to decrease the rate of adverse effects, we aimed to identify the lowest analgesic dose of epidural morphine administered to patients undergoing hip surgery. METHODS: Forty-five ASA I-II children undergoing surgical correction of hip dysplasia under caudal or epidural anesthesia with bupivacaine were randomized to receive epidural morphine 11.2, 15 or 20 microg.kg(-1) (groups 1, 2 and 3, respectively; 15 patients per group) immediately after completion of surgery. Postoperative pain control, sedation, motor block, urinary retention, pruritus and vomiting were evaluated. RESULTS: In the recovery room, 46.7% of patients from group 1, 33.3% from group 2, and 93.3% from group 3 were sleeping but were easy to arouse (x(2) = 12.2; P < 0.005). The rest of the patients from each respective group were completely asleep. The cardiovascular and respiratory parameters were within normal limits. The ability to move the legs returned approximately 1 h after surgery in all three groups. Seven patients (46.7%) from group 1, nine (60%) from group 2, and 13 patients (86.7%) from group 3 vomited (x(2) = 5.4; P = 0.06). One patient receiving 20 microg.kg(-1) morphine experienced urinary retention. One patient receiving 15 microg.kg(-1) morphine suffered from pruritus. The duration of analgesia was similar, 12-14 h, in all three groups. CONCLUSIONS: In patients undergoing hip surgery under regional anesthesia with bupivacaine, epidural morphine at a dose of 11.2 microg.kg(-1) administered immediately after completion of the procedure resulted in adequate pain relief for more than 12 h. Explanation of the high rate of patients vomiting (>45%) remains to be elucidated.