Conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva: equipamiento e influencias contextuales / Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences

Objetivos: Evaluar el conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva en diferentes contextos: equipamiento e influencias contextuales. Método: Estudio descriptivo transversal en 4 unidades de cuidados intensivos (una quirúrgica, 3 polivalentes), una reanimación posquirúrgica, 2 áreas de urgencias y 3 salas de hospitalización, de 4 hospitales (3 universitarios y uno general) con 407 profesionales. Se administró una encuesta con 13 ítems, evaluando la validez del contenido (índice de Kappa 0,97 [95% IC: 0,965-0,975]). Resultados: Respondieron el 63,7% de las enfermeras y el 39% de los médicos. El porcentaje de respuestas correctas fue del 50%. Con una puntuación del 1 al 5, en la que a menor puntuación más conocimiento, las enfermeras puntuaron 3,27 ± 0,5 vs. 2,62 ± 0,5 los médicos (diferencia de la media 0,65 [IC 95%: 0,48-0,82; p < 0,001]). No hubo diferencias entre hospitales o unidades (p = 0,07 y p = 0,09). Un porcentaje notable de profesionales identificó como estrategia para mejorar la sincronización paciente-ventilador «tapar el puerto espiratorio» (fugas intencionadas) y apretar la máscara a la cara del paciente (fugas no intencionadas) (28,2% unidad de cuidados intensivos, 22,5% urgencias, 8,3% reanimación posquirúrgica, 61,5% hospitalización), sin diferencia entre enfermeras y médicos (27,9% vs. 23,4%, p = 0,6). El 50% de las enfermeras respondieron correctamente cómo seleccionar el tamaño adecuado de máscara y el 11,7% conocía que la máscara debe ajustarse permitiendo el paso de 2 dedos. Conclusiones: No hubo diferencias en el conocimiento por unidades entre enfermeras y médicos. La falta de conocimiento relacionada con la terapia de la ventilación mecánica no invasiva es dependiente de la formación recibida y del material disponible en la unidad. Para reducir la confusión entre fugas intencionadas y no intencionadas se recomienda usar un solo tipo de ventilador y mantener un entrenamiento regular de las enfermeras

Objectives: To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. Method: Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). Results: Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27 ±.5 vs 2.62 ±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P < .001). There were no differences between hospitals or units (P = .07 and P = .09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P = .6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. Conclusions: There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended

Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences. / Conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva: equipamiento e influencias contextuales.

OBJECTIVES: To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. METHOD: Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). RESULTS: Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. CONCLUSIONS: There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.

[Operative treatment of diabetics with vascular complications : Secondary data analysis of diagnosis-related groups statistics from 2005 to 2014 in Germany]. / Operative Versorgung von Diabetikern mit vaskulären Komplikationen : Sekundärdatenanalyse der DRG-Statistik von 2005 bis 2014 in Deutschland.

BACKGROUND: In Germany approximately 40,000 amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. OBJECTIVE: The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. MATERIAL AND METHODS: The microdata of the diagnosis-related groups (DRG) statistics of the Federal Statistical Office were analyzed over the period from 2005 to 2014. All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications (diabetic angiopathy and peripheral arterial disease) was encrypted. RESULTS: The median age of the 1,811,422 cases was 73 years and 62% were male. While the total number of amputations remained stable over time, there was a 41% reduction in knee-preserving and a 31% reduction in non-knee preserving major amputations with an 18% increase in minor amputations. Revascularization increased by 33% from 36 procedures in 2005 to 48 procedures per 100,000 inhabitants. The increase in revascularization was evident in the area of endovascular therapy alone where there was an increase of 78%. CONCLUSION: Due to the significant increase in endovascular revascularization measures, there was a significant increase in the proportion of diabetes patients with vascular pathologies in whom revascularization was carried out. As a result, improved limb preservation was achieved despite equally high amputation rates due to increasing minor amputation rates.

Necrotising colitis with perforation in diarrhoic patients treated with loperamide.

Two cases of necrotising enterocolitis with perforation occurred in patients with paralytic ileus after loperamide therapy. The possible role of loperamide in the pathogenesis of the complications is suggested.

[Chondrocostal and chondrosternal tuberculosis in 2 heroin addicts infected with the human immunodeficiency virus]. / Tuberculosis condrocostal y condroesternal en dos heroinómanos infectados por el virus de la inmunodeficiencia humana.

We report two cases of osteoarticular tuberculosis in heroin addict patients infected with human immunodeficiency virus. Both patients presented an inflammatory tumor in the anterior chest wall, with subacute onset; one patient had chondrosternal involvement and the other had chondrocostal involvement with a retrosternal pus collection. Diagnosis was established by needle aspiration of the tumor that gave raise to caseum. Ziehl-Neelsen stain was positive and Löwenstein-Jensen culture yielded Mycobacterium tuberculosis in both cases. The course was good after surgical debridement and tuberculous treatment for 6 months. We review the features of osteoarticular tuberculosis in drug addicts and patients infected with human immunodeficiency virus that in our environment mainly affects this population group. As in our geographical area, an increased incidence of both infections does exist and owing to the high prevalence of extrapulmonary and disseminated tuberculosis in those patients, it is expected that in a future time, the number of cases of tuberculosis will increase. Therefore, physicians must entertain a high degree of suspicion with the purpose of establishing an early diagnosis of these atypic presenting forms.

Embolismo por cristais de colesterol / Embolism by cholesterol crystals

Os autores apresentam um caso de embolia cutânea por cristais de colesterol. Após revisäo da literatura discutem sua paratogênese, clínica, histopatologia e prognóstico; sugerem que em caso de aparecimento súbito de livedo reticular, o diagnóstico da embolia cutânea por cristais de colesterol deve ser cogitado