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Comunicación de las enfermeras con los pacientes. Validación de la escala "Interpersonal Communication Assessment Scale" (ICAS) / Communication of nurses with patients. Validation the "interpersonal communication assessment scale" (ICAS)

OBJETIVO: Adaptar culturalmente la escala "Interpersonal Communication Assessment Scale" en el contexto español de la práctica enfermera. METODOLOGÍA: Estudio trasversal con metodología de traducción directa e inversa, para obtener la adaptación lingüística-cultural. Participaron enfermeras de hospital general universitario. Para analizar las propiedades psicométricas, se valoró fiabilidad analizando la consistencia interna y validez mediante análisis de la estructura factorial. RESULTADOS: Participaron 188 enfermeras, el coeficiente alfa de Cronbach para el cuestionario total fue de 0,881 con coeficientes entre 0,816 y 0,622 en las subescalas. El test KMO mostró índice de 0,850, la prueba de esfericidad de Barlett con Chi cuadrado de 1208,714 con p = 0,000 y análisis factorial con 4 factores que explicaban el 49,268% de la varianza total. CONCLUSIÓN: El cuestionario obtenido comprende todos los aspectos necesarios para evaluar competencias en comunicación de estos profesionales con sus pacientes, con suficiente evidencia y características psicométricas para su utilización en población española

OBJECTIVE: The adaptation of ICAS in the Spanish context of nursing practice. METHODS: A cross-sectional study was carried, using the bidirectional translation method for linguistic-cultural adaptation. It was applied to the nursing staff in a universitary hospital. Reliability, internal consistence and construct validity were calculated to evaluate the psychometrics properties of the Spanish version. RESULTS: Participation was of 188 nurses. Cronbach's alpha coefficient for the total scale was 0,881, with coefficients between 0,816 and 0,622 in the subscales. Exploratory factor analysis resulted in four factors, which explained 49,268% of total variance, and Kaiser-Meyer-Olkin measure was 0,850. CONCLUSIONS: The Spanish version showed high internal consistency and psychometrics characteristics like appropriate tool for assessing interpersonal communications skills between nurses and patients

Management of cirrhotic ascites in children. Review and recommendations. Part 1: Pathophysiology, diagnostic evaluation, hospitalization criteria, treatment, nutritional management. / Manejo de la ascitis secundaria a cirrosis en el paciente pediátrico. Revisión y recomendaciones. Parte 1: Fisiopatología, evaluación diagnóstica, criterios de hospitalización, tratamiento, manejo nutricional.

Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of pediatric patients with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to its diagnostic and therapeutic aspects, and preventive care.

La ascitis es una complicación grave de la cirrosis. Existen numerosos artículos y guías basadas en la evidencia para adultos, pero poco se ha publicado para niños. Ante un paciente pediátrico con ascitis secundaria a cirrosis (PPAC), se plantean las siguientes preguntas: ¿Cómo se realiza la evaluación clínica y los exámenes complementarios? ¿Cuándo se considera que la ascitis es refractaria; cómo se trata? ¿Debe infundirse plasma fresco y plaquetas antes de la paracentesis abdominal para evitar el sangrado? ¿Cuáles son los criterios de hospitalización? ¿Cuáles son los tratamientos indicados? ¿Qué complicaciones puede presentar? ¿Cuándo y cómo debe tratarse la hiponatremia? ¿Qué criterios diagnósticos tiene la peritonitis bacteriana espontánea; cómo se trata? ¿Qué es el síndrome hepatorrenal; cómo se trata? ¿Cuándo debe infundirse albúmina? ¿Cuándo debe restringirse el aporte líquido? Las recomendaciones que efectuamos, basadas en la fisiopatología, sugieren el enfoque preferido para encarar sus aspectos diagnósticos, terapéuticos y los cuidados preventivos.

Información a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos. Evaluación por parte de las enfermeras / Providing information to patient's families on the end of life process in the intensive care unit. Nursing evaluation

INTRODUCCIÓN: La información a familiares de pacientes en proceso final de vida comprende múltiples aspectos y resulta muy complejo, no solo por la noticia, sino también por el estado de confusión en el que se encuentra aquel a quien va dirigido. Por ello, es necesario que se adapte al lenguaje y a la educación del paciente y de su familia, que sea honesta y adecuada al momento.ObjetivosDescribir los aspectos de la información que se ofrece a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos (UCI) y conocer la evaluación que hacen las enfermeras de ellos. Valorar las actitudes de los profesionales en este proceso.Material y métodoEstudio observacional realizado a las enfermeras de UCI pediátricas y de adultos de hospitales de alta complejidad de la Red Sanitaria Pública de Madrid capital. Recogida de datos mediante Cuestionario sobre la evaluación de los cuidados a los niños que fallecen en UCI pediátricas.ResultadosLa mayoría de las enfermeras, el 71% (159), refieren que se informa en un cuarto a solas con el médico. El 52,4% (118) consideran que la información es suficiente/insuficiente dependiendo del día. Con respecto al comportamiento del personal en el momento del fallecimiento se encontraron diferencias significativas (p < 0,01), siendo más empáticos los profesionales de las UCI pediátricas. CONCLUSIONES: Las enfermeras de la UCI opinan que la información resulta adecuada al pronóstico y se ajusta a la situación del paciente, considerando adecuado el lugar en que se informa a los familiares y la actitud de los profesionales en el proceso final de vida

INTRODUCTION: Informing is a process that includes many aspects and when it involves a familymember at the end of life it becomes a complicated matter, not only for giving the information,but also for the mood of family members. Thus, the information should be adapted to thelanguage and education of the patient and family. That information must be proper and suitableto the moment. OBJECTIVE: To describe the aspects of information offered to relatives of patients in the endof life process in Intensive Care Units (ICU), and to determine the nursing evaluation in thisprocess. To evaluate the professionals' attitude on this subject. MATERIAL AND METHOD: An observational study conducted on nurses in pediatric and adult ICUnurses of a large public health hospital complexes in the city of Madrid. The data was collectedusing a questionnaire on the evaluation of care of children who died in pediatric ICU. RESULTS: The majority of the nurses, 71% (159), said that the information was given in a placealone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P < .01), with pediatric ICU professionals being more empathetic. CONCLUSIONS: ICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate

Evaluación de los triajes realizados en una unidad de urgencia infantil de un hospital terciario / Triage evaluation making in a pediatric emergency department of a tertiary hospital

Objetivo. Estudiar la relación del nivel de formación y la antigüedad en la unidad de los profesionales con la adecuación de los triajes realizados. Método. Estudio analítico, observacional, con recogida retrospectiva de datos de todos los triajes realizados en Urgencia Infantil de un hospital terciario de Madrid, de enero a marzo de 2012. Se incluyeron variables socioprofesionales y variables del triaje pediátrico canadiense de 5 niveles, que es la escala de triaje utilizada en la unidad. Resultados. Se analizaron 6443 triajes. Los errores encontrados en mayor proporción fueron: no reseñar el grado de dolor cuando el síntoma principal lo requiere, 1445 (22.4 %); no registrar el grado de hidratación, 377 (5.9 %); síntoma principal inadecuado, 232 (3.6 %). No reseñaron dolor 140 (5.6 %) enfermeras con formación en triaje de 12 horas; 492 (14.5 %) con asistencia a sesión de formación en la Unidad y 92 (16.3 %) sin formación en el último año (p < 0.001). Entre las enfermeras con más de 7 años de antigüedad, no reseñaron dolor 472 (12.3 %), indicaron síntoma principal inadecuado 191 (5%) y no indicaron grado de hidratación 296 (7.7 %). Conclusiones. El nivel de formación favorece una mayor adecuación en la asignación de triajes. Los fallos más frecuentes son: no registrar el grado de dolor y la hidratación cuando el síntoma principal lo precisa (AU)

Objective. Evaluation triage level assignments depending level of the professionals’ education and experience in the unit. Method. This was a retrospective and observational study to triages making from January to March 2012 in Pediatric Emergency Department of tertiary hospital in Madrid. The collection data included variables from Pediatric Canadian Triage with five levels, triage tool using in the unit. Results. 6443 triages were evaluated. The most common mistakes was: not to register pain level, 1445 (22.4 %); not to register hydration level, 377 (5.9 %); principal symptoms inappropriate, 232 (3.6 %). Didn’t indicate pain level 140 (5.6 %) nurses with 12 hours formal training on triage; 492 (14.5 %) with training in the unit, and 92 (16.3 %) without training in the last year (p < 0.001). Among the nurses working in the unit more than 7 years did not register pain level 472 (12.3 %), identified inappropriate principal symptoms 191 (5 %) and did not register hydration level 296 (7.7 %). Conclusions. The triage education favors better adaptation in the triage assignment. The most common errors are: not to register level pain and hydration when it’s needed for the principal symptoms (AU)

[Providing information to patient's families on the end of life process in the intensive care unit. Nursing evaluation]. / Información a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos. Evaluación por parte de las enfermeras.

INTRODUCTION: Informing is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment. OBJECTIVE: To describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals' attitude on this subject. MATERIAL AND METHOD: An observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU. RESULTS: The majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P<.01), with pediatric ICU professionals being more empathetic. CONCLUSIONS: ICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate.

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation (AU)

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women.

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation.

Structural evidence for ammonia tunneling across the (beta alpha)(8) barrel of the imidazole glycerol phosphate synthase bienzyme complex.

Since reactive ammonia is not available under physiological conditions, glutamine is used as a source for the incorporation of nitrogen in a number of metabolic pathway intermediates. The heterodimeric ImGP synthase that links histidine and purine biosynthesis belongs to the family of glutamine amidotransferases in which the glutaminase activity is coupled with a subsequent synthase activity specific for each member of the enzyme family. Its X-ray structure from the hyperthermophile Thermotoga maritima shows that the glutaminase subunit is associated with the N-terminal face of the (beta alpha)(8) barrel cyclase subunit. The complex reveals a putative tunnel for the transfer of ammonia over a distance of 25 A. Although ammonia tunneling has been reported for glutamine amidotransferases, the ImGP synthase has evolved a novel mechanism, which extends the known functional properties of the versatile (beta alpha)(8) barrel fold.

Infecciones nosocomiales en pacientes críticos: incidencia en el período 1988 - 1989 en el CTI del Hospital de Clínicas / Nosocomial infections in critically ill patients: incidence during the period 1988-1989 at the ICU of Hospital de Clinicas

Durante un período de nueve meses (1988-1989) realizamos en forma diaria y prospectiva, una encuesta de incidencia de infecciones nosocomiales (INOS) en todos los ingresos correlativos al Centro de Tratamiento Intensivo (CTI) del Hospital de Clínicas de Montevideo (HC). Seguimos en lo fundamental las pautas del CDC de Atlanta, USA. Encontramos que 68,6 por ciento de 205 ingresos eran portadores de una o más infecciones (nosocomial, comunitaria o ambas). Veintiocho pacientes (13,6 por ciento) ingresaron por infecciones de la comunidad, en tanto que 121 adquirieron 251 INOS. Es destacable que 95 enfermos iniciaron INOS antes de su ingreso al CTI, mientras que 69 de 205 encuestados (33,6 por ciento) desarrollaron INOS durante su estadía en el CTI. Las INOS más frecuentes fueron las bronquitis purulentas. Las neumonías constituyeron 22 por ciento de todas las INOS y 26 por ciento de las iniciadas en CTI. El riesgo mayor para adquirir neumonía nosocomial durante la ventilación mecánica (NNV) ocurrió entre los días 3 y 11 a partir del momento de la intubación. Los pacientes asistidos más de cinco días tuvieron 12 veces más INOS que sus opuestos. Los gérmenes más frecuentes en INOS de CTI fueron Pseudomas aeruginosa (28 por ciento), Enterobacter (21 por ciento) y Staphilococcus aureus MS (18 por ciento). Acinetobacter y SAMAR estuvieron presentes en muy pocas infecciones, mientras Enterococo y Cándida no ocasionaron ningún problema importante. En 38 por ciento de los 84 fallecidos una o más INOS fue causa única o asociada de fallecimiento

Factibilidad de utilización de un modelo de investigación de operaciones en planificación de salud. Informe preliminar de investigación / Feasibility of the utilization of a research model on operations in health planning. Preliminary research report

Se realiza un informe preliminar de la investigación realizada por la autora con la colaboración de los licenciados Manuel Alvarez y Ricardo de Soto. la misma está encaminada a analizar la factibilidad de utilización de un modelo de Investigación de Operaciones, desarrollado por Ortiz y Parker (1971) en Planificación de Salud. Se presentan, a grandes rasgos, las principales características de las entradas y salidas del modelo; se hace referencia a las modificaciones hechas a la formulación matemática original, y se señalan algunas restricciones en su explotación (AU)