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Aims and objectives: This study analyzes, in nurses, the influence of openness to experience and hardiness (assessed at baseline and one year after the COVID-19 pandemic respectively) on the development of optimism (assessed two years after the COVID-19 pandemic). Concerns about self-contagion were included as a moderating variable, given their relevance as a risk factor. Background: Nurses have been among the healthcare professionals most affected by the COVID-19 pandemic. Most previous studies have focused on the variables contributing to psychological symptoms, whilst the attention given to the variables adding to the well-being of these professionals has been much scarcer. Design: A prospective study was carried out. Methods: This study was carried out using three data collection periods: Period 1 (From May to June 2020), Period 2 (From January 2021 to April 2021), and Period 3 (From April 2022 to July 2022), with the participation of 151 Spanish nurses, using online self-reporting questionnaires. The study followed the STROBE statement. Results: The results showed that the proposed model was statistically significant. There was a positive effect of openness to experience (year 2020) on hardiness assessed one year later (year 2021). Similarly, hardiness had a positive effect on optimism assessed another year on (year 2022). Conclusions: Concerns about self-contagion behaved as a moderator in the relationship between openness to experience and hardiness (the relationship between openness and hardiness was statistically significant when contagion concern was higher). Relevance to clinical practice: In-depth understanding of the psychological processes that trigger psychological strengths (i.e. optimism) as a result of adverse situations (i.e. COVID-19 pandemic) is essential in promoting the mental health of healthcare professionals. Interventions targeting resilient personality traits and cognitive flexibility are key to this goal. No Patient or Public Contribution: The participants contributed exclusively to the collection of the sample.
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The aim of this research is to analyze the role that children play between fear of contagion and distress in intensive care unit (ICU) nurses during the COVID-19 pandemic, taking into account possible work stressors. Cross-sectional study using an online survey. The selection of the sample was carried out by means of a non-probabilistic sampling for convenience, sending the link to professionals of the Spanish healthcare system who had been in contact with COVID-19 patients. Social networks were also used. Data was collected from May to July 2020. Mothers were selected from among the female nurses for participation in this study. The sample was composed of 283 female nurses working in critical care during the COVID-19 pandemic. Distress levels were significantly lower (F = 2.372, p = .048) in women with children over the age of 16 (M = 8.26, SD = 4.44) than in those without them (M = 10.30;DT = 3.75) (cohabitants). No differences were observed in worries about contagion between nurses with children (either under or over 16 years of age) and without children at home. The regression analysis found significant direct positive contributions of worries about contagion (p = .025) and the presence of children living at home (p = .033) on distress levels. We found a moderating effect of having children over 16 years old living at home in this relationship (ß = 2.198, t = 2.422, p = .016, 95 percentCI = .406-3.992). Our results suggest higher levels of distress in ICU nurses who are working-mothers during COVID-19 pandemic. Living at home with children over 16 years of age has a moderating effect. Our study results point to the need to create action protocols that prepare the health system for outbreaks including early care actions with special emphasis on higher risk groups.
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COVID-19 , Adolescente , COVID-19/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Unidades de Cuidados Intensivos , Pandemias , Encuestas y CuestionariosAsunto(s)
COVID-19 , Enfermeras y Enfermeros , Femenino , Humanos , Unidades de Cuidados Intensivos , PandemiasRESUMEN
Objetivo: Estimar la incidencia de caídas y conocer sus características en cuanto a localización, temporalidad y lesiones producidas, y analizar las características sociodemográficas y clínicas de los pacientes que sufren caídas. Método: Se llevó a cabo un estudio observacional de cohortes retrospectivo, en un hospital de nivel 2 del Servicio Madrileño de Salud. Se estudiaron las caídas de pacientes hospitalizados entre el 1 de julio de 2018 y el 30 de junio de 2019. Se estimó la tasa de incidencia de caídas por 1.000 días de estancia considerando una distribución de Poisson. Se describen las características de las caídas: temporalidad, lesiones producidas, localización de las lesiones y pauta de fármacos. Se registraron características sociodemográficas y clínicas de los pacientes que sufrieron una caída. Se realizó un análisis univariante para comparar los resultados por sexos. Todos los datos se han obtenido de registros de la historia clínica electrónica. Resultados: Se estudiaron 132 caídas, que suponen una tasa de 1,61 caídas por 1.000 días de estancia. Hombres, edad avanzada e ingreso a cargo de una especialidad médica presentaron una tasa de caída significativamente mayor. Los pacientes que sufrieron una caída tienen una edad media de 77,5 años (DE 11,7), y tuvieron pautados una mediana de 12,5 fármacos (RIC 9,25-15). El 63,6% de las caídas no presentan lesión alguna. Solo se encontró diferencia en cuanto al género en la situación en la que se produce la caída. Conclusiones: Nuestros datos notifican una incidencia de caídas similar a la de centros de nuestro entorno. El perfil del paciente que sufre una caída es el de un hombre mayor, ingresado a cargo de una especialidad médica, con estancias hospitalarias más largas, con alguna comorbilidad y polimedicado, sin una asociación temporal evidente.(AU)
Objective: To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. Methodology: A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1,000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. Results: One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. Conclusions: Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.(AU)
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Hospitales , Pacientes Internos , Seguridad del Paciente , Accidentes por Caídas , Estudios Retrospectivos , Estudios de Cohortes , EspañaRESUMEN
OBJECTIVE: To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. METHODOLOGY: A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. RESULTS: One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. CONCLUSIONS: Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.
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Pacientes Internos , Anciano , Estudios de Cohortes , Humanos , Incidencia , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. METHODS: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). RESULTS: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. CONCLUSIONS: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.
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INTRODUCTION: Computed tomography (CT) scanning of the brain continues to be the basic imaging mode in the acute phase of stroke. The hyperdense posterior cerebral artery sign is an early and infrequent radiological finding with topographic and prognostic value that must be taken into account in the initial CT scans. CASE REPORT: We report the case of a 79-year-old woman who suddenly presented with severe left homonymous hemianopsia, mild lower left facial paresis, 3/5 left hemiparesis and severe left hypaesthesia. In the initial brain CT scan, calcium hyper-density of the P1 segment is observed in the right posterior cerebral artery. Intravenous fibrinolytic therapy is administered. The patient shows clinical improvement, and in the follow-up brain CT scan at 24 hours after fibrinolysis, hyperdensity of the P3 segment is observed in the right posterior cerebral artery. CONCLUSIONS: Evidence of posterior cerebral artery hyperdensity is a rare radiological finding associated with an increased volume of ischaemic stroke. A computed tomography scan of the head in the acute phase is essential to try to clarify its causation. Calcium emboli are an under-diagnosed cause of stroke and occur spontaneously in a large proportion of cases. If calcium embolism is suspected, a study must be conducted in search of a carotid, valvular or aortic arch pathology. Migration of the arterial hyperdensity towards distal is associated with a better prognosis. This case presented good progress in contrast to the poor prognosis described in the literature in cases of arterial hyperdensity as an early marker of stroke in the acute phase.
TITLE: Signo de la arteria cerebral posterior hiperdensa migratoria tras trombólisis intravenosa.Introducción. La tomografía computarizada cerebral sigue siendo la modalidad de imagen básica en la fase aguda del ictus. El signo de la arteria cerebral posterior hiperdensa es un hallazgo radiológico precoz e infrecuente con valor topográfico y pronóstico que hay que tener en cuenta en las tomografías computarizadas iniciales. Caso clínico. Mujer de 79 años, que presenta de forma brusca una hemianopsia homónima izquierda, leve paresia facial inferior izquierda, hemiparesia izquierda 3/5 y grave hipoestesia izquierda. En la tomografía computarizada cerebral inicial se objetiva hiperdensidad cálcica del segmento P1 de la arteria cerebral posterior derecha. Se administra fibrinolítico intravenoso. Presenta mejoría clínica, y en la tomografía computarizada cerebral de control 24 horas después de la fibrinólisis se observa hiperdensidad del segmento P3 de la arteria cerebral posterior derecha. Conclusiones. La evidencia de una hiperdensidad de la arteria cerebral posterior es un hallazgo radiológico infrecuente asociado a un mayor volumen de infarto isquémico. La tomografía computarizada cerebral en fase aguda resulta fundamental para tratar de dilucidar su etiología. Los émbolos cálcicos son una causa infradiagnosticada de ictus y ocurren de forma espontánea en una gran proporción. Ante la sospecha de embolismo cálcico, es necesario realizar un estudio en busca de una patología carotídea, valvular o del arco aórtico. La migración de la hiperdensidad arterial hacia distal en la tomografía computarizada se relaciona con un mejor pronóstico. Este caso presentó una buena evolución frente al mal pronóstico descrito en la bibliografía en casos de hiperdensidad arterial como marcador precoz de ictus en fase aguda.
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Arteria Cerebral Posterior/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Anciano , Femenino , Humanos , Terapia Trombolítica/métodos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.
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Actitud del Personal de Salud , Cuidados Críticos/normas , Unidades de Cuidados Intensivos , Cuerpo Médico de Hospitales/psicología , Personal de Enfermería en Hospital/psicología , Restricción Física/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
TITLE: Neuralgia glosofaringea asociada a sincopes y secundaria a carcinoma de cuello.
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Enfermedades del Nervio Glosofaríngeo/etiología , Neoplasias Faríngeas/complicaciones , Síncope/etiología , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the efficacy of topical tranexamic acid topical in cementless total hip arthroplasty from the point of view of bleeding, transfusion requirements and length of stay, and describe the complications of use compared to a control group. MATERIAL AND METHODS: A prospective, randomised, double-blinded and controlled study including all patients undergoing cementless total hip arthroplasty in our centre between June 2014 and July 2015. Blood loss was estimated using the formula described by Nadler and Good. RESULTS: The final analysis included 119 patients. The decrease in haemoglobin after surgery was lower in the tranexamic acid group (3.28±1.13g/dL) than in the controls (4.03±1.27g/dL, P=.001) and estimated blood loss (1,216.75±410.46mL vs. 1,542.12±498.97mL, P<.001), the percentage of transfused patients (35.9% vs. 19.3%, P<.05) and the number of transfused red blood cell units per patient (0.37±0.77 vs. 0.98±1.77; P<.05). There were no differences between groups in the occurrence of complications or length of stay. CONCLUSIONS: The use of topical tranexamic acid in cementless total hip arthroplasty results in a decrease in bleeding and transfusion requirements without increasing the incidence of complications.
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Antifibrinolíticos/administración & dosificación , Artroplastia de Reemplazo de Cadera , Pérdida de Sangre Quirúrgica/prevención & control , Hemostasis Quirúrgica/métodos , Cuidados Intraoperatorios/métodos , Ácido Tranexámico/administración & dosificación , Administración Tópica , Anciano , Antifibrinolíticos/uso terapéutico , Artroplastia de Reemplazo de Cadera/métodos , Transfusión Sanguínea/estadística & datos numéricos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ácido Tranexámico/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECT: To assess the feasibility of measuring diffusion and perfusion fraction in vertebral bone marrow using the intravoxel incoherent motion (IVIM) approach and to compare two fitting methods, i.e., the non-negative least squares (NNLS) algorithm and the more commonly used Levenberg-Marquardt (LM) non-linear least squares algorithm, for the analysis of IVIM data. MATERIALS AND METHODS: MRI experiments were performed on fifteen healthy volunteers, with a diffusion-weighted echo-planar imaging (EPI) sequence at five different b-values (0, 50, 100, 200, 600 s/mm2), in combination with an STIR module to suppress the lipid signal. Diffusion signal decays in the first lumbar vertebra (L1) were fitted to a bi-exponential function using the LM algorithm and further analyzed with the NNLS algorithm to calculate the values of the apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (D*) and perfusion fraction. RESULTS: The NNLS analysis revealed two diffusion components only in seven out of fifteen volunteers, with ADC=0.60±0.09 (10(-3) mm(2)/s), D*=28±9 (10(-3) mm2/s) and perfusion fraction=14%±6%. The values obtained by the LM bi-exponential fit were: ADC=0.45±0.27 (10(-3) mm2/s), D*=63±145 (10(-3) mm2/s) and perfusion fraction=27%±17%. Furthermore, the LM algorithm yielded values of perfusion fraction in cases where the decay was not bi-exponential, as assessed by NNLS analysis. CONCLUSION: The IVIM approach allows for measuring diffusion and perfusion fraction in vertebral bone marrow; its reliability can be improved by using the NNLS, which identifies the diffusion decays that display a bi-exponential behavior.
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Médula Ósea/anatomía & histología , Imagen de Difusión por Resonancia Magnética/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Adolescente , Adulto , Algoritmos , Imagen Eco-Planar/métodos , Estudios de Factibilidad , Femenino , Humanos , Análisis de los Mínimos Cuadrados , Masculino , Reproducibilidad de los Resultados , Columna Vertebral , Adulto JovenRESUMEN
Objetivo valorar la eficacia y seguridad de un sistema de control de la glucemia guiada por objetivo en una UCI. Metodología estudio descriptivo prospectivo de 13 meses. Se recogieron diariamente los valores de todas las determinaciones de glucemia en los pacientes con perfusión continua de insulina. Resultados se recogieron 12.677 glucemias realizadas a 69 pacientes en tratamiento con insulina intravenosa; el 57,9% se encontraron en el rango objetivo (100-140mg/dl); no hubo ninguna glucemia menor de 40mg/dl y tan solo el 0,2% de ellas se encontraron entre 40-60mg/dl. Conclusiones para un adecuado control de las cifras de glucemia mediante el empleo de terapia con insulina intravenosa es esencial el manejo individualizado de la perfusión de insulina, ajustándose a las características de cada paciente individual. El método guiado por objetivos que planteamos ha permitido obtener mejores resultados que los de otros estudios (AU)
Objective to evaluate the effectiveness and safety of a nurse-led blood glucose control protocol in a medical ICU. Method a descriptive, prospective study was carried out for a period of 13 months. All blood glucose values from patients on insulin therapy for intensive glycemic control were recorded daily. Results A total of 12,677 blood glucose determinations were performed on the 69 patients under glycemic control; 57.9% of the determinations had predetermined study target values for blood glucose (100-140mg/dl) and 68.8% of the determinations had physiological blood glucose values (80-140mg/dl); no values under 40mg/dl were obtained, and only 0.2% were between 40-60mg/dl. Conclusions For an adequate blood glucose control using intensive insulin therapy, individual management of insulin infusion regimen is essential, adjusted to the characteristics of each patient. A nurse-led intervention has allowed better results to be obtained in comparison with other studies in which different protocols for insulin infusion are used (AU)
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Humanos , Cuidados Críticos/métodos , Monitoreo Fisiológico/métodos , Hiperglucemia/prevención & control , Índice Glucémico , Sistemas de Infusión de Insulina , Hospitalización/estadística & datos numéricosRESUMEN
OBJECTIVE: to evaluate the effectiveness and safety of a nurse-led blood glucose control protocol in a medical ICU. METHOD: a descriptive, prospective study was carried out for a period of 13 months. All blood glucose values from patients on insulin therapy for intensive glycemic control were recorded daily. RESULTS: A total of 12,677 blood glucose determinations were performed on the 69 patients under glycemic control; 57.9% of the determinations had predetermined study target values for blood glucose (100-140 mg/dl) and 68.8% of the determinations had physiological blood glucose values (80-140 mg/dl); no values under 40 mg/dl were obtained, and only 0.2% were between 40-60 mg/dl. CONCLUSIONS: For an adequate blood glucose control using intensive insulin therapy, individual management of insulin infusion regimen is essential, adjusted to the characteristics of each patient. A nurse-led intervention has allowed better results to be obtained in comparison with other studies in which different protocols for insulin infusion are used.
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Glucemia/análisis , Hiperglucemia/sangre , Hiperglucemia/enfermería , Planificación de Atención al Paciente , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Measuring von Willebrand factor (VWF) activity is essential to the diagnosis of von Willebrand disease (VWD). The VWF activity is usually assessed based on measurement of the ristocetin cofactor (VWF:RCo). However, that test is technically challenging and has high intra- and inter-assay variabilities. The HemosIL VWF activity (VWF:AC) is a fully automated assay, recently proposed as a good alternative to VWF:RCo for VWD diagnosis. This study was undertaken to assess this new method. First, the analytical performance of VWF:AC on an automated coagulo-meter (ACLTop) was determined, and then this new method was compared with VWF:RCo and the platelet function analyzer (PFA100) for 160 patients referred for VWD screening. The VWF:AC achieved acceptable precision with within-run and between-run coefficients of variation ranging from 2.3% to 14.1%, and linearity from 10% to 100%. Despite some marked differences between VWF:AC and VWF:RCo for 10 plasmas tested, their agreement for VWD diagnosis was good. The VWF:AC had sensitivity similar to that of PFA100 (close to 100%), but better specificity (97.7% vs. 66% or 60%, depending on the cartridge used). The good analytical performance, and the sensitivity and specificity of VWF:AC to detect VWF deficiency renders it a suitable method for VWD screening. Our findings support VWF:AC use for the diagnostic work-up of VWD, paying close attention to concomitant clinical signs and bleeding score, as recommended for VWD.
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Pruebas de Coagulación Sanguínea/normas , Enfermedades de von Willebrand/diagnóstico , Factor de von Willebrand/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Automatización , Pruebas de Coagulación Sanguínea/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Curva ROC , Sensibilidad y Especificidad , Adulto JovenRESUMEN
La canulación arterial es el segundo procedimiento más frecuentemente empleado en las unidades de cuidados intensivos. Estos dispositivos van a ser esenciales para el manejo de determinados tipos de pacientes (hemodinámicamente inestables o en los que la valoración de los parámetros gasométricos se deba realizar de manera regular). Las complicaciones derivadas del empleo de estos dispositivos son relativamente escasas y poco frecuentes; sin embargo, no contamos con indicadores fiables para predecir la posibilidad de aparición de oclusión de la arteria radial o de lesiones isquémicas en la mano tras la realización de una canulación radial. La inserción de catéteres guiada mediante ultrasonidos es una práctica cada vez más empleada en servicios de cuidados intensivos, aunque su empleo fundamental se ha destinado a la inserción de catéteres venosos centrales. En el presente trabajo se realiza una descripción de la técnica de canalización arterial mediante ultrasonidos, a la vez que se realiza un resumen de los trabajos realizados hasta el momento y que han evaluado la seguridad y eficacia de la técnica (AU)
Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population (AU)
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Humanos , Cateterismo/métodos , Ultrasonografía , Arteria Radial , Cirugía Asistida por Computador , Cuidados Críticos/métodos , Atención de Enfermería/métodosRESUMEN
Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population.
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Cateterismo/métodos , Arteria Radial/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , HumanosRESUMEN
Fluorescence polarization assay (FPA) is a homogeneous technique which was applied to the serological diagnosis of bovine brucellosis. Because of its simplicity and because it may be performed very rapidly, it was an ideal test to adapt to field use. The FPA was used to test cattle on six dairy farms in Baja California, Mexico. Anticoagulated blood, serum, and milk were collected from each animal. The anticoagulated blood was tested immediately on the farm while serum and milk were tested subsequently in the laboratory. Cattle on one farm (n = 140) were thought not to be infected with Brucella abortus and the other farms were thought to have high prevalence of the infection. The whole blood FPA (FPA(bld)) did not detect antibody in any of the cattle on the first premise. This finding was confirmed using a number of other serological tests, including the buffered antigen plate agglutination test, the complement fixation test, the indirect and competitive enzyme immunoassays, and the FPA using serum and milk. Cattle on the other premises (n = 1122) were tested in a similar fashion. The sensitivity of the FPA(bld), relative to the serum FPA (considered the definitive test), was 99.1% and the relative specificity of the FPA(bld) was 99.6%. These results compared favourably with those obtained using the other serological tests.
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Brucelosis Bovina/diagnóstico , Inmunoensayo de Polarización Fluorescente/veterinaria , Animales , Anticuerpos Antivirales/sangre , Brucella abortus/inmunología , Bovinos , Reacciones Falso Positivas , Inmunoensayo de Polarización Fluorescente/normas , Leche/microbiología , Sensibilidad y EspecificidadRESUMEN
Objetivos. Estimar la prevalencia de psicomorbilidad y de ansiedad ante la muerte en población consultante. Observar la asociación de estas variables con la presencia de enfermedad crónica, consumo de psicofármacos y frecuentación. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro semiurbanode atención primaria. Pacientes. Propuesta del estudio a 281 sujetos, aceptando 226 mayores de 18 años, seleccionados sistemáticamente entre 1.829 personas que consultaron de mayo a julio de 1999. Estimamos una prevalencia de psicomorbilidad del 30 por ciento. Mediciones y resultados principales.Entrevistas personales y cuestionarios usando las escalas de Ansiedad y Depresión de Goldbergy la de Ansiedad ante la Muerte de Templer. Responde un 63,7 por ciento de mujeres y el 36,3 por ciento de varones; media, 52,2 años (DE, 16,2). Escala de Ansiedad y Depresión positiva (prevalencia de psicomorbilidad), 55,3 por ciento; mujeres, 61,8 por ciento, y varones, 43,9 por ciento (p = 0,009). Puntuación media de la escala de Ansiedad ante la Muerte 6,08 (DE, 3,15); mujeres, 6,66 (DE, 2,67), y varones, 5,05 (DE, 2,67) (p < 0,0005). En los hiperfrecuentadores la ansiedad ante la muerte es de 6,61 (DE, 3,23) y de 5,81 (DE, 3,10) en los que no lo son (p = 0,074). El grupo con psicomorbilidad tiene una media de visitas de 38,4 (DE, 27,28) frente a las 35,5 (DE, 22,59) de los que no tienen (NS). En pacientes con psicomorbilidad, la media de la escala de Ansiedad ante la Muerte es de 7,51 (DE, 3,33), y de 5,33 (2,65) en los pacientes sin ella (p < 0,0005). Conclusiones. Alta prevalencia de psicomorbilidad. La mayoría son mujeres y tienen un valor medio de ansiedad ante la muertesuperior a los varones. No hallamos asociación entre ansiedad ante la muertee hiperfrecuentación. Los pacientes con psicomorbilidad tienen más ansiedad ante la muerte. La enfermedad crónica, la edad y el consumo de psicofármacos se asocian a una mayor utilización de la consulta. Sólo en mayores de 70 años encontramos relación entre psicomorbilidad y una más alta demanda de visitas (AU)
Asunto(s)
Persona de Mediana Edad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Masculino , Femenino , Humanos , Actitud Frente a la Muerte , Prevalencia , Ansiedad , Trastornos Mentales , Estudios TransversalesRESUMEN
Plasma levels of prothrombin fragment 1+2 (Fl+2), thrombin-antithrombin complexes (TAT) and D-dimers were measured in 15 patients with pulmonary embolism during heparin therapy, oral anticoagulation, and after cessation of warfarin therapy. Each patient had a favorable outcome during anticoagulant therapy (3 months), but late venous thromboembolism occurred in six cases. The mean levels of the three markers were significantly increased on day 4 after the thrombotic event, and normalized during warfarin therapy. Nine months after the initial pulmonary embolism, mean levels of the three markers, as compared with a control population, were significantly higher in the patients with late recurrences, whereas only TAT were slightly higher in patients without recurrences as compared with controls. Only TAT levels were significantly higher in the patients with late recurrences than in those without late recurrences. Thus, the levels of the three markers 9 months after pulmonary embolism seem to be interesting to identify patients with high risk of recurrence and who might require longer anticoagulant treatment.
Asunto(s)
Anticoagulantes/administración & dosificación , Antitrombina III/metabolismo , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hemostasis , Péptido Hidrolasas/metabolismo , Protrombina/metabolismo , Embolia Pulmonar/sangre , Embolia Pulmonar/tratamiento farmacológico , Adulto , Anciano , Biomarcadores , Humanos , Persona de Mediana Edad , Fragmentos de Péptidos/metabolismo , Embolia Pulmonar/fisiopatologíaRESUMEN
OBJECTIVES: To calculate the prevalence of psychological morbidity and anxiety about death among patients. To observe the association of these variables with the presence of chronic illness, consumption of psychiatric drugs and frequency of attendance. DESIGN: Cross-sectional, descriptive study. SETTING: Semi-urban primary care centre. PATIENTS: The study was proposed to 281 patients and accepted by 226 over 18 years old, selected systematically from among 1829 people who attended for consultation between May and July 1999. We calculated 30% prevalence of psychological morbidity. MEASUREMENTS AND MAIN RESULTS: Face-to-face Interviews and questionnaires using the Goldberg Anxiety and Depression scales and Templer's scale of Anxiety about death. 63.7% women and 36.3% men responded, with an average age of 52.2 (SD 16.2). Positive Anxiety and Depression scale (prevalence of psychological morbidity) 55.3%; 61.8% in women and 43.9% in men (p = 0.009). Mean score on scale of anxiety about death 6.08 (SD 3.15); 6.66 in women (SD 2.67) and 5.05 in men (SD 2.67) (p < 0.0005). In over-attenders, anxiety about death was 6.61 (SD 3.23); and in those who are not, 5.81 (SD 3.10) (p = 0.074). The group with psychiatric morbidity had 38.4 mean visits (SD 27.28) against 35.5 (SD 22.59) for those without psychiatric morbidity (NS). In patients with psychiatric morbidity, the mean on the scale of anxiety about death was 7.51 (SD 3.33); and 5.33 (2.65) in patients without it (p < 0.0005). CONCLUSIONS: High prevalence of psychiatric morbidity. The majority are women, who have a mean value of anxiety about death which is greater than men's. We found no association between anxiety about death and over-attendance. The patients with psychiatric morbidity are more anxious about death. Chronic illness, age and consumption of psychiatric drugs are linked to a greater use of the clinic. We only found a relationship between psychiatric morbidity and a greater demand for health-care among the over-70s.