La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar / Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation

Objetivos: El objetivo fue explorar la experiencia de médicos y técnicos en cuidados auxiliares de enfermería (TCAE) respecto al manejo de contenciones mecánicas en unidades de cuidados críticos. Método: Estudio fenomenológico multicéntrico que incluyó 14 unidades de cuidados críticos (UCC) de Madrid (España). Las UCC fueron estratificadas en función del uso de contenciones mecánicas: «uso frecuente» versus «uso escaso». Se realizaron 3 grupos de discusión: el primero compuesto por TCAE procedentes de UCC con uso frecuente de contenciones mecánicas, el segundo grupo por TCAE de UCC de uso escaso de contenciones mecánicas y el último grupo por médicos de ambos subtipos de UCC. Método de muestreo: por propósito. Análisis de datos: análisis temático de contenido. Se alcanzó la saturación de los datos. Resultados: Emergen 4 temas principales: 1) concepto de seguridad y riesgo (seguridad del paciente versus seguridad del profesional); 2) tipos de contenciones; 3) responsabilidades profesionales (prescripción, registro y roles profesionales); y 4) paradigma «contención cero». La conceptualización sobre el uso de contenciones mecánicas muestra diferencias en algunos de los temas principales dependiendo del tipo de UCC en cuanto a políticas, uso y manejo de contenciones mecánicas (uso frecuente versus uso escaso). Conclusiones: La reducción real del uso de contenciones mecánicas en UCC debe partir de un punto clave: la aceptación de la complejidad del fenómeno. El uso de contenciones mecánicas observado en las diferentes UCC está influenciado por factores individuales, grupales y organizativos. Estos factores determinan las interpretaciones que médicos y TCAE realizan sobre seguridad y riesgo, el centro del cuidado (cuidado centrado en el paciente o en el profesional), el concepto de contención, las responsabilidades e intervenciones profesionales y las interacciones del equipo y el liderazgo

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

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

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.

Autofocus method for automated microscopy using embedded GPUs.

In this paper we present a method for autofocusing images of sputum smears taken from a microscope which combines the finding of the optimal focus distance with an algorithm for extending the depth of field (EDoF). Our multifocus fusion method produces an unique image where all the relevant objects of the analyzed scene are well focused, independently to their distance to the sensor. This process is computationally expensive which makes unfeasible its automation using traditional embedded processors. For this purpose a low-cost optimized implementation is proposed using limited resources embedded GPU integrated on cutting-edge NVIDIA system on chip. The extensive tests performed on different sputum smear image sets show the real-time capabilities of our implementation maintaining the quality of the output image.

Complicación infrecuente de cirugía de tiroides / Uncommon complication in thyroid surgery

No disponible

Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera / Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality

Objetivos: Comprender la experiencia vivida por los enfermeros respecto a la gestión de la inmovilización terapéutica en Unidades de Cuidados Críticos. Explorar similitudes y diferencias en la experiencia enfermera respecto al manejo de la inmovilización terapéutica según el medio en el que están insertos. Método: Estudio fenomenológico multicéntrico en 14 Unidades de Cuidados Críticos de la Comunidad de Madrid estratificadas según el uso de inmovilización terapéutica: frecuente/sistemático, escaso/individualizado y mixto. Recogida de datos: 5 grupos de discusión (23 participantes). Muestreo intencional por propósito. Tamaño muestral: hasta saturación de datos. Análisis crítico temático del contenido guiado por el método de Colaizzi. Resultados: Emergen 6 grandes temas: 1) significado de inmovilización terapéutica en Unidades de Cuidados Críticos, 2) seguridad (autorretirada de dispositivos de soporte vital), 3) factores favorecedores, 4) sentimientos, 5) alternativas y 6) problemas pendientes. Aunque se significan los mismos temas en los 3 tipos de unidades, se observan diferencias en el discurso (indicación, sentimientos, herramientas validadas para la medición de dolor, sedación…). Conclusiones: Para conseguir una reducción real de la inmovilización terapéutica en Unidades de Cuidados Críticos, resulta clave la comprensión profunda de su uso en el medio específico. Al identificarse como eje central la autorretirada de dispositivos de soporte vital, algunas medidas propuestas en otros ámbitos podrían no resultar pertinentes, precisándose alternativas encaminadas a pacientes críticos. Las variaciones del discurso planteadas en los distintos tipos de unidades podrían arrojar luz sobre los puntos clave que determinan las diferencias de uso y actitudes hacia la inmovilización terapéutica

Aims: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. Method: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Findings: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. Conclusions: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. / Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera.

AIMS: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.

Drenaje torácico / Thoracic drainage

La patología pleural supone un problema clínico frecuente. En algunos casos, eltratamiento incluye drenaje de la cavidad que puede efectuarse mediante toracocentesisevacuadoras, pero en ocasiones exige mantener un drenaje permanentede la cavidad pleural. El drenaje torácico consiste en la colocación de una sondaen el espacio pleural para evacuar la presencia de aire, líquido o sangre, lo cualproduce un colapso pulmonar de grado variable con repercusión clínica en funciónde la reserva ventilatoria previa de paciente y el grado de colapso. Existenvarios modelos de tubos torácicos, así como sistemas de drenaje pleural, y su lugarde inserción dependerá del tipo de patología ante la que nos encontremos.Enfermería es fundamental en todo el proceso, tanto en la preparación del paciente,inserción, y mantenimiento adecuado para el éxito del tratamiento, comodurante la extracción y posteriores cuidados. Resulta fundamental que dichos profesionalesconozcan el material utilizado así como su mantenimiento. Una buenatécnica de cura del punto-orificio de inserción prevendrá numerosas complicacionesque podrían resultar fatales para el paciente. Se crea un protocolo de actuaciónen los cuidados de enfermería de los pacientes portadores de drenaje torácicotanto en los cambios de apósito como en cura del drenaje para servir dereferente, de guía de actuación sistemática y homogénea [1-24](AU)

Pleural pathology is a frequent clinical problem. In some cases, treatment includesdraining the cavity which can be carried out by thoracentesis evacuators, but onoccasions treatment requires maintaining a drainage permanently inside the pleuralcavity. Pleural drainage consists in inserting a catheter in the pleural sack todrain the presence of air, liquid or blood which causes a variable degree of lungcollapse having a clinical consequence in function of the reserve breathing capacitythe patient previously had and the degree of collapse. There are variousmodels of thoracic tubes as well as systems to drain the pleural cavity and theirspot for insertion depends on the type of pathology being dealt with for thepatient under treatment. Nursing is fundamental in this entire process, includingin the preparation of the patient for this treatment, the insertion of the catheterand the adequate maintenance so that this procedure succeeds as well as duringthe removal of the catheter and the subsequent care required. It is fundamentalthat the nursing professionals know the materials used as well as their maintenance.A good technique to cure the punt/orifice where a catheter is inserted willprevent numerous complications which could be deadly for the patient. Theauthors create a procedural protocol for nurses to use when treating patients whohave thoracic drains; this protocol deals with changing the catheters as well as theentire process related to how to treat patients with a pleural drain. This protocolshould serve as reference material and as a guide to a systematic and homogenousworking procedure [1-24](AU)

[Prognostic value of the inmunohïstochemical expression of protein p27KIP1 in laryngeal cancer]. / Valor pronóstico de la expresión inmunohistoquímica de la proteína p27KIP1 en cáncer de laringe.

In this paper we carried out an immunohistochemical study of protein p27KIP1 expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at "Virgen de la Salud" Hospital (Toledo, Spain). In the cases with lymph node metastasis we also studied p27KIP1 expression at this level. Furthermore we have analysed the value of protein p27KIP1 expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we evaluate the relationship between p27KIP1 expression and other clinic and pathologic parameters.

Valor pronóstico de la expresión inmunohistoquímica de la proteína p27KIP1 en cáncer de laringe / Prognostic value of the inmunohïstochemical expression of protein p27KIPI in laringeal cancer

En este trabajo hemos estudiado la expresión inmunohistoquímica del alproteína p27KIp1 en una serie de 195 pacientes con cáncer de laringe que fueron diagnosticados, tratados y seguidos durante al menos 5 años en el servicio ORL del Hospita "Virgen de la Salud" (Toledo). En los casos que presentaron metástasis ganglionares analizamos también la expresión de p27KIP1 a dicho nivel. Además se ha analizado el valor pronóstico de la expresión de p27KIP1 en este tipo de tumores (desarrollo de recidivas, mortalidad por cáncer de laringe y supervivencia) y estudiamos la posible relación de dicha expresión con otros parámetros clinicopatológicos

In this paper we carried out an immunohistochemical study of protein p27KIPI expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at «Virgen de la Salud» Hospital (Toledo, Spain). In the cases with lymph node metastasis we also studied p27KIPI expression at this level. Furthermore we have analysed the value of protein p27KIPI expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we evaluate the relationship between p 27KIPI expression and other clinic and pathologic parameters

Valor pronóstico de la expresión de la proteina mdm-2 en cáncer de laringe / Pronostic value of the MDM-2 protein expression in the larynx cancer

En este trabajo hemos estudiado la expresión inmunohistoquímica de la proteína Mdm-2 (IF2) en una serie de 195 pacientes con cáncer de laringe que fueron diagnosticados, tratados y seguidos durante al menos 5 años en el servicio de ORL del Hospital "Virgen de la Salud" (Toledo). En los casos que presentaron metástasis ganglionares analizamos también la expresión de Mdm-2 a este nivel. También hemos querido investigar el valor pronóstico de la expresión de Mdm-2 en este tipo de tumores (desarrollo de recidivas, mortalidad por cancer de laringe y supervivencia) y analizamos la posible relación de dicha expresión con otros parámetros clínicopatológicos (AU)

[Pronostic value of the MDM-2 protein expression in the larynx cancer]. / Valor pronóstico de la expresión de la proteina MDM-2 en cancer de laringe.

In this paper we carried out an immunohistochemical study of Mdm-2 (IF2) expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at Virgen de la Salud Hospital (Toledo, Spain). In the cases with lymph node metastasis we also studied Mdm-2 expression at this level. We also wanted to investigate the value of Mdm-2 expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we have evaluated the relationship between Mdm-2 expression and other clinic and pathologic characteristics.

[Epidemiology and clinical manifestation of laryngeal tumors treated at the Hospital Virgen de la Salud of Toledo, Spain]. / Epidemiología y clínica de los tumores de laringe tratados en el Hospital Virgen de la Salud de Toledo.

A descriptive, retrospective study was made of 110 cases of laryngeal neoplasm diagnosed at the Hospital Virgen de la Salud of Toledo, Spain, between 1988 and 1991. Cases were studied by sex, age, alcohol use, smoking, first symptom, and time to treatment.

[Bioenergetic radiographic absorptiometry in hemodialysis]. / Absorciometría radiográfica bienergética en hemodiálisis.

UNLABELLED: In order to assess bone loss in uremic renal osteodystrophy (URO), we have measured total and regional mineral bone density (TMBD and RMBD, respectively) by using bioenergetic radiographic absorptiometry (BRA) in a population of patients on hemodialysis (HD). Thirty one patients have been evaluated, with a mean age of 55 and a mean time on hemodialysis of 31 mo. (range 2-120 mo.). Bone absorptiometry consisted of measurement of total body (TMBD) and regional analysis of head, upper limb, lower limb, ribs, pelvis and spine (RMBD). TMBD inversely correlated with alkaline phosphatase and parathyroid hormone levels; it also correlated inversely with age, but only in females. TMBD showed significantly lower values in HD patients than in chronic renal failure patients and controls. All the regional parameters correlated inversely with alkaline phosphatase levels. CONCLUSION: BRA is a non invasive method which quantifies TMBD and RMBD with a very low radiologic exposure and correlates adequately with levels of alkaline phosphatase and parathyroid hormone in URO. TMBD measures total cortical bone of the skeleton with good accuracy, RMBD allows a selective analysis of regional bone changes and a evolutive control in these patients, given the nonuniform decrease of mineral density in the skeleton.

[Our results in the surgery of otosclerosis]. / Nuestros resultados en la cirugía de la otosclerosis.

A statistical study is made of the results of 78 stapedectomies carried out during the last six years in the Virgen de la Salud Hospital of Toledo, Spain. An auditive gain of 90%, averaging 27 dBs, was found. Other parameters assessed were age, sex, prosthesis type, and failures.

Bouveret's syndrome: new cause of double-arch-shadow sign in cholecystosonography.

A case of Bouveret's syndrome which later presented as a jejunal obstruction is reported. Special reference is made to the echographic findings. Bouveret's syndrome has a double-arch-shadow image in the zone of the gallbladder bed on ultrasound examination. So far, this sign has been considered specific for gallstones inside the gallbladder.