ABSTRACT
The nursing professional who treats critically ill children with cerebral injury is a key element within the pediatric intensive care team, since, through exhaustive assessment, plans nursing care in an integral manner aimed at the child and the family, and plays an essential role in the care of patients mainly at the hospital level (as well as at home). Therefore, the role played by nursing in the care of children with severe brain trauma is crucial. This guide offers nursing recommendations on neurocritical care, focusing on a systemic view based on nursing diagnoses according to the North American Nursing Diagnosis Association.
El profesional de enfermería que atiende a niños críticamente enfermos con lesión cerebral es un miembro clave dentro del equipo intensivista pediátrico, ya que, mediante la evaluación exhaustiva, planifica cuidados de enfermería de manera integral dirigidos al niño y a la familia. La enfermería como una profesión que entiende la salud de la persona humana desde una mirada integral cumple un rol esencial (indispensable) en el cuidado de los pacientes, principalmente, a nivel hospitalario (como domiciliario). Por ende, el rol que juega la enfermería en la atención de un niño con traumatismo encéfalocraneano grave es crucial en la gestión del cuidado infantil. Esta guía ofrece recomendaciones de enfermería sobre los cuidados neurocríticos focalizando una mirada sistémica basada en diagnósticos de enfermería según la Asociación Americana de Diagnósticos de Enfermería.
Subject(s)
Advanced Practice Nursing/standards , Brain Injuries, Traumatic/nursing , Consensus , Critical Care Nursing/standards , Advanced Practice Nursing/methods , Brain Injuries, Traumatic/etiology , Child , Critical Care/organization & administration , Critical Care Nursing/methods , Hospitalization , Humans , Intensive Care Units, PediatricABSTRACT
BACKGROUND: In familial combined hyperlipidemia (FCHL) the severity of the dyslipidemia is determined by an overproduction of VLDL (very low density lipoprotein) particles and by its abnormal lipid composition. However, few are known regarding the metabolic factors that determine these abnormalities. We investigated the impact of metabolic factors on the number of atherogenic particles (apolipoprotein B level (apoB)) and the triglyceride content of very low-density lipoproteins (VLDLs-TG). METHODS: A cross-sectional study done in FCHL subjects and gender and age-matched healthy subjects. A clinical assessment, lipid profile and plasma concentrations of insulin, apolipoprotein CIII (apo CIII), apolipoprotein AII (apo AII), high sensitive C-reactive protein (HS-CRP), adiponectin and leptin were documented in 147 FCHL patients and 147 age-matched healthy subjects. Multivariate regression models were performed to investigate the independent determinants of VLDL-TG and apo B levels adjusting for confounding factors. RESULTS: The variables that determined the VLDL-triglyceride content as a surrogate of VLDL composition were apo CIII (ß=0.365, p<0.001), insulin (ß=0.281, p<0.001), Apo AII (ß=0.145, p<0.035), and adiponectin levels (ß=-0.255, p<0.001). This model explained 34% of VLDL composition (VLDL-TG) variability. However, none of these variables were independent contributors of apo B-containing particles. CONCLUSIONS: In patients with FCHL apo CIII, apo AII and adiponectin are major novel factors determining the VLDL particle composition. However, such factors do not explain apo B-containing particles.
Subject(s)
Apolipoproteins B/blood , Biomarkers/blood , Hyperlipidemia, Familial Combined/diagnosis , Lipoproteins, VLDL/blood , Triglycerides/blood , Adult , Aged , Apolipoprotein C-III/blood , Case-Control Studies , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Hyperlipidemia, Familial Combined/blood , Male , Middle Aged , PrognosisABSTRACT
Empowerment interventions for chronic diseases are an evolving process. No agreement exists regarding the necessary components and methodologies to be applied. Systematic reviews have assessed the effect of self-management interventions. Improvements in illness beliefs, adherence to drug therapy and glucose monitoring have been reported. In the long term, no major changes have been achieved in weight, physical activity, smoking status, and depression scores. There is a need for additional studies. The CAIPaDi (Centro de Atención Integral del Paciente con Diabetes) program is an intervention designed to provide education and empowerment techniques (using simple low-cost interactive tools) over a short period of time followed by at-distance support using internet or cell phone technology. The target population consists of patients with type 2 diabetes, free of chronic complications who are non-smokers. The intervention is composed of four monthly visits followed by a continuous at-distance support system. At each visit, patients stay for six hours in the center. Information is presented in group sessions. Empowerment techniques are applied during individual exchanges with the team or during facilitated group sessions. In summary, empowerment programs are an unmet need in many healthcare services. This review also discusses relevant studies and patents in the management of type 2 diabetes.