Actuación de enfermería en el tratamiento del tumor vesical con láser ambulante con anestesia local / No disponible

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Who safeguards mothers?

While routine screening for group B streptococcus is not recommended in the UK, women are sometimes coincidentally found to be carrying these bacteria during investigations of symptoms in pregnancy. If such women decide to decline intravenous antibiotics for themselves in labour, they can seek support from midwives in appropriate roles. But once the woman's baby is born, the situation changes somewhat, as the legal context changes and the issue of safeguarding may be raised. This article considers the issues that arise in such scenarios and raises questions about who is there to support women who experience pressure to consent to their healthy newborn baby having prophylactic intravenous antibiotics.

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations.

OBJECTIVE: To describe factors senior critical care nurses identify as being important to address when introducing selective digestive tract decontamination (SDD) in the clinical setting. BACKGROUND: Critically ill patients are at risk of developing ventilator-associated pneumonia (VAP). SDD is one strategy shown to prevent VAP and possibly improve survival in the critically ill. METHODS: We performed a secondary analysis of qualitative data obtained from 20 interviews. An inductive thematic analysis approach was applied to data obtained from senior critical care nurses during phase two of a multi-methods study. RESULTS: There were four primary considerations identified that should be addressed or considered prior to implementation of SDD. These considerations included education of health care professionals, patient comfort, compatibility of SDD with existing practices, and cost. CONCLUSIONS: Despite a lack of experience with, or knowledge of SDD, nurses were able to articulate factors that may influence its implementation and delivery. Organizations or researchers considering implementation of SDD should include nurses as key members of the implementation team.

The microbiota battle.

Antibiotic prophylaxis for laboring women with the intent of protecting newborns from group B strep (GBS) infection carries substantial risks and ethical shortcomings. GBS has been proven to be developing resistance to erythromycin and clindamycin. We are now seeing evidence of its resistance to penicillin, the recommended drug used in the prophylactic protocol. Bacterial resistance to antibiotics is linked to increased virulence of the bacteria. Considering the fact that robust bacterial flora throughout the body is essential to the health and well-being of new mothers and the bacterial colonization of their babies, perhaps the prophylactic use of antibiotics needs to be reconsidered.

¿Qué dicen las guías sobre la anticoagulación en la fibrilación auricular no valvular? / Anticoagulation in nonvalvular atrial fibrillation: what do the clinical practice guidelines say?

El desarrollo de los nuevos anticoagulantes ha modificado el tratamiento antitrombótico en la fibrilación auricular no valvular. Como consecuencia, las principales guías de práctica clínica han recogido e incorporado las nuevas evidencias. Para establecer la decisión terapéutica más adecuada, es imprescindible realizar una estratificación correcta del riesgo de ictus y de hemorragia. Las escalas CHADS2 y HAS-BLED son las más recomendadas. El auténtico papel de los nuevos anticoagulantes en la profilaxis tromboembólica está aún por definir. En el momento actual se deben considerar como una opción más junto a los antagonistas de la vitamina K, si bien para algunas sociedades científicas podrían ser de elección (AU)

The development of new anticoagulants has modified antithrombotic therapy in nonvalvular atrial fibrillation. As a result, the main clinical practice guidelines have incorporated the new evidence. To reach the most appropriate therapeutic decision, it is essential to accurately identify the risks of stroke and hemorrhage. The most widely recommended scales for risk stratification are CHADS2 and HAS-BLED. The definitive role of the new anticoagulants in thromboembolic prophylaxis remains to be established. Currently, these drugs should be considered as one more option, together with vitamin K antagonists, although some scientific societies consider them to be the drug of choice (AU)

Estudio descriptivo de profilaxis antibiótica. Infección neonatal / Descriptive study of intrapartum antibiotic prophilaxis of neonatal infection by group b streptococcus in Txagorritxu

Introducción. El SGB (Streptococcus grupo B) es una de las causas más importantes de sepsis neonatal por transmisión vertical (1-2% de las portadoras). La infección puede comportar la muerte del recién nacido o complicaciones severas. El cultivo vagino-rectal del SGB es una prueba de detección que se realiza a todas las embarazadas entre las semanas 35-37 de gestación. Si es positivo se prescribe penicilina intraparto. Si es negativo o desconocido, el antibiótico se protocoliza según factores de riesgo: rotura de membranas mayor de 18 horas, fiebre intraparto o prematuridad. El objetivo del estudio es cuantificar las mujeres que reciben antibiótico intraparto en relación con el cultivo positivo y el cumplimiento de la recomendación de la SEGO (Sociedad Española de Ginecología y Obstetricia). Material y métodos. Se describe una muestra de 261 mujeres del hospital de Txagorritxu, que han parido durante el turno de trabajo de los investigadores, excluyendo las cesáreas. Variables: resultado de cultivo, administración de antibiótico. Los datos fueron recogidos por revisión de historia clínica y analizados con el programa SPSS 17.0. Resultados. De las 261 mujeres, 69 (26,4%) recibieron la administración antibiótico. De las 69, 46 (66,67%) tenían un cultivo positivo. Recibieron antibioterapia según factores de riesgo 26 (37,68%), aunque sus cultivos fueran negativo o desconocido. Discusión. Los resultados apuntan a una aplicación correcta de la recomendación de la SEGO. Las mujeres portadoras sin factores de riesgo no habrían recibido antibioterapia sin screening(AU)

Introduction. GBS is one of the most important causes of neonatal sepsis of vertical transmission (1-2% of the carriers). The infection may involve newborn's death or severe complications. The culture of vaginal and rectal GBS is a screening test and it is performed to all pregnant women between 35-37 weeks of gestation. If it is positive, intrapartum penicillin is prescribed. If it is negative or unknown, the antibiotic per protocol is given according to risk factors: rupture of membranes more than 18 hours, intrapartum temperature, or prematurity. The aim of this study is to quantify women who receive intrapartum antibiotic in relation to the positive culture and achievement with the SEGO's recommendation. Material and methods. It describes a sample of 261 women of the Txagorritxu Hospital who have given birth during the work shift of researchers, excluding cesarean sections. Variables: results of culture, antibiotic administration. Data were collected by reviewing and analyzed medical records using SPSS 17.0. Results. From 261 women, 69 (26.4%) received antibiotic administration. From 69, 46 (66.67%) had a positive culture. 26 (37.68%) received antibiotics according to risk factors, although their cultures were negative or unknown. Discussion. The results suggest there is a correct application of the SEGO's recommendation. Carrier women with no risk factors would not have received antibiotic therapy without screening(AU)

Cirugía Bariátrica. Profilaxis tromboembólica / Thromboembolic prophylaxis in Bariatric Surgery. A multidisciplinary protocol

La obesidad mórbida es una de las epidemias del siglo xxi. La cirugía ha demostrado ser el tratamiento más importante y coste-efectivo, por esto, la cirugía bariátrica está siendo cada vez más común en nuestros Hospitales. Los eventos tromboembólicos, como la trombosis venosa profunda (TVP) la embolia pulmonar (EP) son la causa médica de mortalidad más frecuente tras estos procedimientos. La incidencia de EP puede llegar al 3% y su mortalidad es de hasta un 75%. Los protocolos de profilaxis tromboembólica en cirugía bariátrica aún no están claramente definidos. Estos protocolos deben considerar que se está tratando pacientes diferentes por su obesidad; por la diversidad de procedimientos que se pueden realizar, la mayoría laparoscópicos; así como por las comorbilidades de los pacientes. Por otro lado, al igual que el tratamiento de la obesidad mórbida, el abordaje debe ser multidisciplinario. En este trabajo presentamos el protocolo que se ha iniciado en nuestro Centro. Tras una larga y dilatada experiencia en cirugía de la obesidad mórbida, hemos diseñado un protocolo multidisciplinar y para la profilaxis de eventos tromboembólicos, donde enfermería y los cirujanos tienen un papel principal. La combinación de medidas físicas, farmacéuticas y educacionales son la calve de la adecuada prevención en estos pacientes(AU)

Severe or morbid obesity is one of the 21st century epidemics. Surgery is the most important and cost-effective treatment. Bariatric procedures are becoming very common in our Hospitals. Thromboembolic events such us deep venous thrombosis or pulmonary embolism (PE) are the most common medical cause of death after these procedures. Incidence of PE may arise to 3% after surgery and its mortality is about 75%. Prophylactic protocols have not been clearly defined until now. These protocols have to consider special patients, such as morbid obese ones; different kind of procedures, most of the laparoscopic; and patients’ comorbidities. By the other hand, treatment for morbid obesity has to be considered by a multidisciplinary approach. Here we present the protocol that has been initiated at our Institution. After a long and high experience in bariatric procedures, we have defined a multidisciplinary protocol to prevent thomboembolic events after surgery, where nurses and surgeons play a leading role. The combination of physical, pharmaceutical and educational measeures all together are the key for the adequate prevention in these patients(AU)

A systematic review of prophylactic antimicrobials in PEG placement.

AIM: To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. BACKGROUND: Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. DESIGN: Systematic review. METHODS: We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. RESULTS: Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22-0.44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5.8 patients to prevent one infection - NNT. CONCLUSIONS: Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. RELEVANCE TO CLINICAL PRACTICE: The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.

Profilaxis de la hepatitis B después de trasplante hepático y tratamiento de la recidiva / Hepatitis B prophylaxis following liver transplantation and treatment of recurrence

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Prótesis y paliación / Stents and palliation

El drenaje endoscópico de las neoplasias malignas de la vía biliar es el tratamiento paliativo de elección, con una baja morbilidad y mortalidad. Claramente se benefician del uso de prótesis metálicas auto-expansibles, aquellos pacientes que tienen una sobrevida estimada mayor a 6 meses, en especial quienes tienen obstrucciones distales y cuando existe una colangitis asociada a la obstrucción biliar inicial. En las obstrucciones proximales, hay que utilizar el medio de contraste mínimo y con baja presión de inyección, drenando en lo posible ambos lóbulos, siempre y cuando para lograr esto último, no se requiera de una manipulación excesiva, evitando así, la colangitis segmentaria. La complicación más frecuente es la colangitis aguda, en especial en pacientes con obstrucciones proximales. Se recomienda el uso de antibióticos profilácticos en todos los pacientes, ya que desconocemos en cuáles no vamos a lograr nuestro objetivo.

Naúseas y vómitos postoperatorios en cirugía ambulatoria / Post-operative nause and vomiting in Ambulatory Surgery

Las náuseas y vómitos postoperatorios se incluyen entre las experiencias más desagradables que puede presentar un paciente, y constituyen uno de los motivos con mayor impacto negativo en la satisfacción global dentro del conjunto de la experiencia (..) (AU)

Post-operative nausea and vomiting are amongst the most disagreeable symptoms patients can experience and are one of the main negative reasons for patient's discontent with the surgical procedure. Despite the advances (..) (AU)