Intensive care practices in brain death diagnosis and organ donation.

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

Predictors of mortality and neurological function in ICU patients recovering from cardiac arrest: A Spanish nationwide prospective cohort study.

OBJECTIVE: To identify predictors of mortality and neurological function in adult ICU patients recovering from cardiac arrest. DESIGN: A prospective cohort multicenter study was carried out. SETTING: Forty-six polyvalent ICUs. PATIENTS: A total of 595 patients recovering from out-of-hospital cardiac arrest (OHCA, n=285) or in-hospital cardiac arrest (IHCA, n=310). MAIN OUTCOME VARIABLES: Survival and recovery of neurological function. RESULTS: The mean cardiopulmonary resuscitation time was 18min (range 10-30). Moderate hypothermia was used in 197 patients, and 150 underwent percutaneous coronary intervention (PCI). Return of spontaneous circulation (ROSC) was achieved within 20min in 370 patients. Variables associated to mortality (ICU and in-hospital) were age (odds ratio [OR]=1.0, 95%CI 1.0-1.0 per year), non-cardiac origin of cardiac arrest (OR=2.16, 95%CI 1.38-3.38; P=0.001) and ROSC >20min (OR=3.07, 95%CI 1.97-4.78; P<0.001), whereas PCI and the presence of shockable rhythm exhibited a protective effect. Favorable neurological outcome was associated to shockable rhythm, ROSC <20min, and cardiac origin of arrest. Hypothermia did not affect survival or neurological outcome in the multivariate analysis. CONCLUSIONS: Age, non-cardiac origin of cardiac arrest and ROSC >20min were predictors of mortality. In contrast, cardiac arrest of cardiac origin, ROSC <20min, and defibrillable rhythms were associated to unfavorable neurological outcomes.

[Profile and professional expectations for nursing students]. / Perfil y expectativas profesionales del estudiante de enfermeriá.

The authors describe the profile corresponding to students enrolled in first, second and third year courses to become registered nurses in Catalonia, along with their professional and job expectations; the authors examine students' perceptions of the university environment. This information will be a great aid to, on the one hand, update the performances and initiatives taken by those responsible for nursing schools, and on the other hand, to obtain a preliminary view on future nursing professionals. At the same time, this information will provide useful elements for students themselves to reflect on their studies and their future as professionals.

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries.

Patients' and their significant others' education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients-NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Initial clinical evaluation of radiolabeled MX-DTPA humanized BrE-3 antibody in patients with advanced breast cancer.

To evaluate radiometal-labeled humanized BrE-3 (huBrE-3) monoclonal antibody as a radioimmunolocalization and therapeutic agent in breast cancer patients, tumor localization, pharmacokinetics, radiation dosimetry, and immunogenicity of (111)In-labeled combined 1-p-isothiocyanatobenzyl 3-methyl- and 1-p-isothiocyanatobenzyl 4-methyldiethylenetriamine pentaacetic acid (MX-DTPA) huBrE-3 were studied. Seven women with BrE-3 antigen-positive, metastatic breast carcinoma underwent (111)In huBrE-3 infusion (5 mCi; 50 mg), followed by serial gamma camera imaging and plasma sampling. Region of interest analysis of images was used to make radiation absorbed dose estimates for (111)In huBrE-3. Data were extrapolated to 90Y huBrE-3. Human anti-human antibody (HAHA) response was measured in serum samples obtained up to 3 months after infusion. Patients tolerated infusions well. Seventy-six percent of 105 known sites of disease were identified on planar and single-photon emission computed tomography scans. For six of seven patients, a biexponential model fit the plasma time-activity curve best with an average T1/2alpha=10.6+/-8.5 (SD) h and average T1/2beta=114.2+/-39.2 h. Radiation absorbed dose estimates for (111)In huBrE-3 for whole body averaged 0.53+/-.08 rads/mCi. Dose estimates for 90Y huBrE-3 for marrow averaged 8.4+/-11.9 rads/mCi, and for tumors, 70+/-31.5 rads/mCi. Liver radioactivity uptake averaged 19.7+/-8.8% injected dose at 24 h after infusion, translating into an average radiation absorbed dose 21.1+/-12 rads/90Y mCi administered. Only one of seven patients demonstrated a low level of HAHA response. Although the plasma half-lives are longer and marrow dose higher for radiolabeled huBrE-3 compared with the murine construct, the excellent tumor localization, good tumor dosimetry, and low immunogenicity support the use of 90Y-huBrE-3 antibody for radioimmunotherapy of breast cancer.

Secondary cancer prevention in the elderly.

Cancer incidence rises as the population ages. Fifty percent of all cancer diagnoses and 60% of all cancer deaths in the United States occur in people older than 65 years of age. Because the elderly are underrepresented in cancer screening activities, the identification of factors that encourage or discourage them to engage in secondary cancer prevention activities is a health care priority. The purpose of this study was to investigate the relationship between health perception (measured by Ware's HPQ) and participation in cancer screening programs (measured by PCSQ) in 323 elderly New Yorkers from a variety of backgrounds. A statistically significant (p < 0.001) moderate positive correlation between both variables (r = 0.51) was found by using the Pearson's Product Moment Correlation. The researcher's hypothesis, that there is a relationship between both variables, was supported. The results indicate that in addition to health perception, demographic factors (measured by DDQ), including education, economic status, ethnic group, and gender, are predictors of participation in cancer screening.

Coping strategies and psychological distress in patients with advanced cancer.

PURPOSE/OBJECTIVES: To examine the relationship between coping mechanisms and psychological distress in patients with advanced cancer receiving chemotherapy. DESIGN: Descriptive, correlational study. SETTING: Private and public hospitals in New York, NY. SAMPLE: 132 patients, ages 33-83, with advanced breast, ovarian, lung, colorectal, or other cancers. METHODS: Mail survey using the Ways of Coping Inventory-Cancer Version and the Profile of Mood States. MAIN RESEARCH VARIABLES: Coping strategies, psychological distress. FINDINGS: The coping strategies distancing, cognitive escape-avoidance, and behavioral escape-avoidance were related to psychological distress. Distancing was negatively related (r = -0.25) and cognitive escape-avoidance (r = 0.38) and behavioral escape-avoidance (r = 0.38) were positively related to psychological distress (p < 0.01). Collectively, the coping strategies explained 36% of the variance of psychological distress. The most important coping mechanism contributing to overall psychological distress was behavioral escape-avoidance, followed by cognitive escape-avoidance. CONCLUSIONS: Low levels of psychological distress were associated with low levels of cognitive and behavioral escape-avoidance and high levels of distancing. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions that reduce cognitive and behavioral escape-avoidance and enhance distancing should be tested, through further research, in relation to their ability to decrease psychological distress in patients with advanced cancer.

[Severe gastroesophageal lesions due to caustics: the role of nutritional support]. / Lesiones gastroesofágicas graves por cáusticos: papel del soporte nutricional.

AIM: Describe the clinical-nutritional state of patients with severe digestive lesions after the ingestion of caustic substances, as well as their nutritional support (NS). PATIENTS AND METHODS: We studied 5 patients diagnosed by means of early endoscopy, treated with artificial nutrition, 4 of whom used enteral nutrition. During the acute phase of the disease, an evaluation of the nutritional state (ENS) was done, by means of the following parameters: body mass index (BMI), creatinine/height index (CHI), visceral proteins, nitrogen content of 24 h urine, and plasma zinc level. The corrected Harris-Benedict equation was used to calculate the energy needs. RESULTS: The BMI did not experience significant changes. The CHI decreased in a large degree. The long life visceral protein did not change notably, and those of intermediate and short life increased. The losses of nitrogen were increased. We found hypozincemia in 4 of the cases. The mean Kcal provided was 2323 +/- 105. CONCLUSIONS: In the described patients, given their catabolic condition, and early ENS and NS should be done. If at all possible, the NS shall be enteral, with or without parenteral support. In our study we have found a cessation of the weight loss, a decrease of somatic protein with a short term re-filling of the visceral protein pol. The zinc levels should be monitored.

[Treatment of allergy to mushrooms]. / Tratamiento de la alergia a hongos.

The treatment of patients with respiratory allergy is based on environmental control measures, pharmacological and immunotherapy treatment. The third cause of allergic respiratory disease in our environment is mushrooms, the most frequently involved being the Alternaria class. However, due to the great difficulties in their diagnosis and specific treatment, there are few controlled studies on immunotherapy with mushroom extracts. A clinical test was carried out with a suitable, biologically standardized extract for the diagnosis and treatment of patients allergic to Alternaria. A second phase determined the maximum tolerated dosage of this extract administered through immunotherapy, in depot preparation and in conventional dosage, which was 0.1 mg/ml of Alt a I. This dosage was established as the maintenance dosage in the following phase (double blind test controlled with placebo), in which the efficacy and safety of the immunotherapy with this extract was determined, administered in immunotherapy to the mentioned maintenance dosage, to 28 patients with rhinitis and/or asthma due to allergy to Alternaria. All the patients reached the pre-established maintenance dosage of 1670 BSU. The treatment proved efficient, producing an improvement in the symptoms, respiratory function, subjective evaluation of patient and doctor, and severity of the disease. The immunological response supported the clinical efficacy, with an increase in the IgG and a fall in the IgE over the course of the study. Tolerance to the treatment was excellent, with only two light systemic reactions registered in the 711 dosages administered (0.28% reactions/dosages administered).

[Inhalation techniques in the treatment of asthma]. / Técnicas de inhalación en el tratamiento del asma.

In the pharmacological treatment of asthma, the most suitable way is by inhalation, since this enables us to achieve a greater concentration of medicine in the affected organ than systemic medication, and besides the latter's secondary effects are minimized. The suitable use of inhalers and hence their efficacy depends on very different factors. Some of those of a merely technical kind are as follows: A suitable volume of inhalation. The rhythm of inhalation. The length of the inspiratory apnea following administration of the medicine. The coordination between the inspiration of the aerosol and activation of the device, in the case of the metered dose inhaler (MDI). One of the reasons for the incorrect use of MDI aerosols is the lack of coordination between activation of the device and inspiration. This has led to the design of different devices that avoid the need for this coordination, such as: inhalation chambers and devices for inhaling dry dust. It has also been suggested in the literature that the causes of these mistakes are to be found in the health professionals not knowing, or not suitably teaching the patients how to handle the devices. In spite of being designed to facilitate correct administration, suitable knowledge of the technique of their use by the patient is required.

Crisis epiléptica no convulsiva inducida por propofol / Propofol-induced non-convulsive epileptic crisis

No disponible

Predictors of mortality and neurological function in ICU patients recovering from cardiac arrest: A Spanish nationwide prospective cohort study / Predictores de mortalidad y función neurológica en pacientes de UCI que se recuperan de una parada cardíaca: estudio prospectivo de cohortes a nivel nacional

OBJECTIVE: To identify predictors of mortality and neurological function in adult ICU patients recovering from cardiac arrest. DESIGN: A prospective cohort multicenter study was carried out. SETTINGS: Forty-six polyvalent ICUs. PATIENTS: A total of 595 patients recovering from out-of-hospital cardiac arrest (OHCA, n=285) or in-hospital cardiac arrest (IHCA, n=310). MAIN OUTCOME VARIABLES: Survival and recovery of neurological function. RESULTS: The mean cardiopulmonary resuscitation time was 18min (range 10-30). Moderate hypothermia was used in 197 patients, and 150 underwent percutaneous coronary intervention (PCI). Return of spontaneous circulation (ROSC) was achieved within 20min in 370 patients. Variables associated to mortality (ICU and in-hospital) were age (odds ratio [OR]=1.0, 95%CI 1.0-1.0 per year), non-cardiac origin of cardiac arrest (OR=2.16, 95%CI 1.38-3.38; P=0.001) and ROSC >20min (OR=3.07, 95%CI 1.97-4.78; P<0.001), whereas PCI and the presence of shockable rhythm exhibited a protective effect. Favorable neurological outcome was associated to shockable rhythm, ROSC <20min, and cardiac origin of arrest. Hypothermia did not affect survival or neurological outcome in the multivariate analysis. CONCLUSIONS: Age, non-cardiac origin of cardiac arrest and ROSC >20min were predictors of mortality. In contrast, cardiac arrest of cardiac origin, ROSC <20min, and defibrillable rhythms were associated to unfavorable neurological outcomes

OBJETIVO: Identificar predictores de mortalidad y de función neurológica en pacientes adultos ingresados en las UCI, recuperados de una parada cardíaca. DISEÑO: Estudio prospectivo de cohortes multicéntrico. ÁMBITO: Cuarenta y seis UCI polivalentes. PACIENTES: Se incluyeron 595 pacientes recuperados de una parada cardíaca extrahospitalaria (OHCA, n=285) o intrahospitalaria (IHCA, n=310). VARIABLES DE INTERÉS PRINCIPALES: Supervivencia y recuperación de la función neurológica. RESULTADOS: El tiempo medio de reanimación cardiopulmonar fue de 18min (rango: 10-30). Se usó hipotermia moderada en 197 pacientes, y 150 se sometieron a intervención coronaria percutánea (PCI). El retorno de la circulación espontánea (ROSC) se logró en 20min en 370 pacientes. Las variables asociadas con la mortalidad (UCI y en el hospital) fueron la edad (odds ratio [OR]: 1,0; IC 95%: 1,0-1,0 por año), origen no cardíaco de la parada cardíaca (OR: 2,16; IC 95%: 1,38-3,38; p = 0,001) y el ROSC>20min (OR: 3,07; IC 95%: 1,97-4,78; p < 0,001), mientras que la PCI y la presencia de ritmo desfibrilable mostraron un efecto protector. El resultado neurológico favorable se asoció con ritmo desfibrilable, ROSC<20min y origen cardíaco de la parada. En el análisis multivariable, la hipotermia no afectó a la supervivencia ni al resultado neurológico. CONCLUSIONES: La edad, el origen no cardíaco de la parada cardíaca y el ROSC>20min fueron predictores de mortalidad. Por el contrario, la parada cardíaca de origen cardíaco, el ROSC<20min, y los ritmos desfibrilables se asociaron con un resultado neurológico favorable

[Utility of vasopressin in cardiopulmonary resuscitation]. / Utilidad de la vasopresina en la resucitación cardiopulmonar.

Many vasopressants have been studied in cardiopulmonary resuscitation (CPR) to increase cerebral and coronary perfusion. Although there is a debate on the utility of epinephrine, this is the one that has been used historically, above all after verifying that other agents such as norepinephrine, metoxamine or phenylephrine, have not been shown to be more effective. Currently, due to the good experimental results, the use of vasopressin (ADH) in CPR is being evaluated. However there is little (only three studies) and debated evidence based on randomized clinical trials (norepinephrine or ADH) in humans. Once these are reviewed, it can be concluded: The results of the three randomized studies in humans obtain different results regarding the utility of ADH in cardiorespiratory arrest (CRA) secondary to ventricular fibrillation, electro-mechanical dissociation or asystole. More prospective studies are needed to know the role of ADH in prolonged CRA and in asystole, that may be the subgroups that can benefit the most from this drug. The neurological repercussion of a drug in the context of CRA should be evaluated before its inclusion in the CPR guides.