Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease.

The objective was to evaluate the Modified Early Warning Score in patients hospitalized for COVID-19 plus chronic disease. METHODS: Retrospective observational study, 430 hospitalized patients with COVID-19 and chronic disease. Instrument, Modified Early Warning Score (MEWS). Data analysis, with Cox and logistic regression, to predict survival and risk. RESULTS: Of 430 patients, 58.6% survived, and 41.4% did not. The risk was: low 53.5%, medium 23.7%, and high 22.8%. The MEWS score was similar between survivors 3.02, p 0.373 (95% CI: -0.225-0.597) and non-survivors 3.20 (95% CI: -0.224-0.597). There is a linear relationship between MEWS and mortality risk R 0.920, ANOVA 0.000, constant 4.713, and coefficient 4.406. The Cox Regression p 0.011, with a risk of deterioration of 0.325, with a positive coefficient, the higher the risk, the higher the mortality, while the invasive mechanical ventilation coefficient was negative -0.757. By providing oxygen and ventilation, mortality is lower. CONCLUSIONS: The predictive value of the modified early warning score in patients hospitalized for COVID-19 and chronic disease is not predictive with the MEWS scale. Additional assessment is required to prevent complications, especially when patients are assessed as low-risk.

Ocular Surface Characteristics and Colonization in a Burn Center: A Prospective Cohort Study.

We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an 8-mo period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell's phenomenon, Schirmer's test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell's phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with a periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms on the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of a persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.

Cuidados de enfermería ante la necesidad de oxigenación en adultos con enfermedad por COVID-19: revisión integrativa / Nursing Cares due to Oxygenation Requirements in Adults with COVID-19 Disease: Integrative Review / Cuidado de enfermagem à necessidade de oxigenação em adultos com doença COVID-19: revisão integrativa

Introducción: la enfermedad por COVID-19 genera el síndrome de distrés respiratorio agudo, afecta la necesidad de oxigenación y demanda cuidados de enfermería para mantener la estabilidad hemodinámica y prevenir complicaciones respiratorias. Objetivo: analizar la evidencia científica sobre los cuidados de enfermería ante la necesidad de oxigenación en adultos hospitalizados con enfermedad por COVID-19. Métodos: revisión integrativa con un universo de 518 artículos científicos de 2020 y 2021 de las bases de datos: PubMed, Ebsco, Cuiden y ScienceDirect. Se analizaron seis (n= 6) estudios que abordan: ¿cuáles son los cuidados de enfermería ante la necesidad de oxigenación en adultos con enfermedad por COVID-19? Resultados: los cuidados de enfermería incluyen estrategias de oxigenoterapia, recomendaciones sobre el cuidado en la primera línea de atención, uso de oxígeno de alto flujo, posicionamiento prono despierto temprano, y control de saturación y de signos vitales mediante un proceso de atención en enfermería. Conclusión: los cuidados de enfermería satisfacen la necesidad de oxigenación mediante intervenciones de oxigenoterapia, control de comorbilidades y prevención de riesgos hospitalarios.

Introduction: COVID-19 disease generates acute respiratory distress syndrome, affects the need for oxygenation and demands nursing care to maintain hemodynamic stability and to prevent respiratory complications. Objective: To analyze the scientific evidence on nursing care facing the need for oxygenation in hospitalized adults with COVID-19 disease. Methods: Integrative review of a universe of 518 scientific articles published from 2020 to 2021 in the following databases: PubMed, EBSCO, CUIDEN and ScienceDirect. N=6 studies were analyzed. These address what the nursing care implies facing the need for oxygenation in adults with COVID-19. Results: Nursing care includes oxygen therapy strategies, recommendations on care in the first line of care, use of high-flow oxygen, early awake prone positioning, control of saturation and vital signs, through a nursing care process. Conclusion: Nursing care satisfies the need for oxygenation through oxygen therapy interventions, control of comorbidities and prevention of hospital risks.

Introdução: a doença Covid-19 gera síndrome do desconforto respiratório agudo, afeta a necessidade de oxigenação e demanda cuidados de enfermagem para manter a estabilidade hemodinâmica e prevenir complicações respiratórias. Objetivo: analisar as evidências científicas sobre o cuidado de enfermagem diante da necessidade de oxigenação em adultos hospitalizados com doença Covid-19. Métodos: revisão integrativa; universo 518 artigos científicos de 2020-21, nas bases de dados: PubMed, Ebsco, Cuiden e ScienceDirect. Foram analisados N=6 estudos que abordam quais são os cuidados de enfermagem diante da necessidade de oxigenação em adultos com Covid-19? Resultados: a assistência de enfermagem inclui estratégias de oxigenoterapia, recomendações sobre cuidados na primeira linha de cuidado, uso de oxigênio de alto fluxo, posicionamento prono acordado precocemente, controle da saturação e dos sinais vitais, por meio de um processo de cuidado de enfermagem. Conclusão: a assistência de enfermagem satisfaz a necessidade de oxigenação, por meio de intervenções de oxigenoterapia, controle de comorbidades e prevenção de riscos hospitalares.

Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City.

Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.

Necesidades de salud: experiencia de mujeres mayores de un centro de día / Health needs: experience of older women in a day center / Necessidades de saúde: experiência de mulheres idosas num centro de dia

Marco contextual: La población de adultas mayores es vulnerable a mostrar afectaciones en su salud, por las condiciones sociales, económicas, culturales o políticas en las que se desarrollan. Objetivo: Describir las necesidades de salud de las mujeres mayores que asisten a un centro de día. Metodología: Estudio mixto, con una población de 490 mujeres y muestra de 177. Se aplicó el cuestionario de 11 patrones funcionales de Marjory Gordon con 60 ítems y una confiabilidad de 0,735; así como una entrevista en profundidad en 10 sujetos clave. Los datos se analizaron con medidas de tendencia central y análisis de contenido. Resultados: Las necesidades de las mujeres mayores se analizaron de forma integral (física, social, emocional y espiritual). La mayoría padecen diabetes mellitus tipo 2 o hipertensión arterial. Casi la mitad tiene problemas de sobrepeso, estreñimiento y distención abdominal. No hay seguimiento de acciones de salud preventivas, solo curativas. Conclusión: Las necesidades detectadas son orientación nutricional, prevenir y superar malestares físicos, mantenerse en movimiento, disminución de estrés y ansiedad.

Background: Older adults are more susceptible to manifest the effects of their social, economic, cultural, or political environment on their health. Objective: To describe the health needs of older women in a day care center. Methodology: Mixed study, with a population of 490 women and a sample of 177. The 60-item Gordon's 11 Functional Health Patterns Assessment questionnaire was applied, obtaining a 0.735 reliability, as well as an in-depth interview in 10 key topics. The data were analyzed with central tendency and content analysis measurements. Results: The needs of older women were submitted to a full analysis (physical, social, emotional, and spiritual). The majority has type-2 diabetes mellitus or high blood pressure. Almost half of them has overweight, constipation, and abdominal distention problems. There is no follow-up of preventive health actions, only curative ones. Conclusion: The needs detected are nutritional guidance, preventing and recovering from physical ailments, keeping moving, reducing stress and anxiety.

Enquadramento: A população de idosos é vulnerável a mostrar efeitos sobre as suas condições de saúde, sociais, económicas, culturais ou políticas em que se desenvolvem. Objetivo: Descrever as necessidades de saúde das mulheres idosas que frequentam um centro de dia. Metodologia: Estudo misto, com uma população de 490 mulheres e amostra de 177. Aplicou-se o questionário de 11 padrões funcionais de Marjory Gordon com 60 itens e uma confiabilidade de 0,735; bem como uma entrevista em profundidade em 10 participantes. Os dados foram analisados com medidas de tendência central e análise de conteúdo. Resultados: As necessidades das mulheres idosas foram analisadas de forma integral (física, social, emocional e espiritual). A maioria sofre de diabetes mellitus tipo 2 ou hipertensão. Quase metade tem problemas com excesso de peso, prisão de ventre e inchaço. Não há acompanhamento de ações preventivas em saúde, apenas curativas. Conclusão: As necessidades identificadas são: orientação nutricional, prevenir e superar desconfortos físicos, continuar em movimento, reduzir o stress e ansiedade.

Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery.

BACKGROUND: Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk. METHODS: This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups. RESULTS: The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11). CONCLUSION: The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.

Deterioro cognitivo y riesgo de caída en adultos mayores institucionalizados en el estado de Colima, México / Cognitive impairment and risk of falling in institutionalized older adults in the state of Colima, Mexico

Introducción: el envejecimiento es un proceso que marca la pérdida gradual de las capacidades motrices y cognitivas, lo que puede favorecer el riesgo de caída en el adulto mayor. Objetivo: analizar el grado de deterioro cognitivo y su asociación con el riesgo de caída en adultos mayores institucionalizados. Metodología: estudio descriptivo correlacional, en una muestra de 59 adultos mayores institucionalizados de cuatro casas hogar del estado de Colima, en México. Se evaluó el grado de deterioro cognitivo con la Escala de Pfeiffer SPMSQ, y la marcha y equilibrio para determinar el riesgo de caída con la Escala de Tinetti. El análisis fue descriptivo e inferencial con el coeficiente de correlación de Spearman p (rho). Resultados: la edad promedio fue de 80.03 ± 9.28 años, el 51% presentó deterioro cognitivo moderado y severo; el riesgo de caída fue alto en el 44% de ellos. El análisis de la interacción entre deterioro cognitivo y riesgo de caída, demostró un comportamiento directamente proporcional con un valor de r = -0.3616 y p = 0.0049. Conclusión: la correlación encontrada sugiere que a menor deterioro cognitivo, menor será el riesgo de caída en la población estudiada.

Introduction: Aging is a process that marks the gradual loss of motor and cognitive abilities that may favor the risk of falling in the elderly. Objective: To analyze the degree of cognitive deterioration and its association with the risk of falling in institutionalized older adults. Methods: Descriptive correlational study, in a sample of 59 institutionalized older adults from four homes in the State of Colima, Mexico. The degree of cognitive impairment was evaluated with the Pfeiffer Scale SPMSQ and the gait and balance to determine the risk of falling with the Tinetti Scale. The analysis was descriptive and inferential with the Spearman correlation coefficient p (rho). Results: Average age was 80.03 ± 9.28 years old, 51% presented moderate and severe cognitive deterioration; the risk of falling was high at 44%. The analysis of the interaction between cognitive deterioration and fall risk showed a directly proportional behavior with a value of r = -0.3616 and p = 0.0049. Conclusion: The correlation found suggests that the lower the cognitive deterioration, the lower the risk of falling in the studied population.

Significado de salud: la vivencia del adulto mayor / Meaning of Health: The Experience of the Elderly / Significado de saúde: a vivência do idoso

RESUMEN Durante la vejez, el significado de salud se basa en alcanzar un estado de bienestar; por ello, es importante comprender los factores que benefician o afectan el logro de este propósito. Objetivo: analizar los significados de salud que los adultos mayores construyen a partir de sus vivencias y experiencias. Materiales y métodos: investigación cualitativa con técnica de análisis de contenido y entrevista semiestructurada. Participaron veinte adultos mayores, que acudieron a un centro de atención geriátrica, seleccionados de manera intencionada y determinada por índice de saturación. Resultados: el significado de salud se manifiesta en la capacidad de poder hacer cosas; así, la salud se concibe como un medio útil para obtener un beneficio, ya sea material, moral o físico. Los vínculos familiares son importantes, incluso los comparan con la salud; también, identifican la salud con la ausencia de dolor y enfermedad. Conclusión: la salud del adulto mayor es vivida en contexto familiar; el bienestar es percibido como la capacidad de hacer cosas, aunque el dolor y la enfermedad estén presentes.

ABSTRACT The meaning of health during old age is based on achieving a state of well-being. Therefore, it is important to understand the factors that benefit or affect accomplishing that goal. Objective: Analyze what health means to older adults, based on their experiences. Materials and methods: This is a qualitative study based on content analysis and semi-structured interviews. Twenty elderly adults who frequented a geriatric care center were selected intentionally and determined by means of a saturation index. Results: The meaning of health is manifest in the ability to do things. Accordingly, health is conceived as a useful means to obtain a benefit, be it material, moral or physical. Family ties are important and were even compared to health. The participants also equated health with the absence of pain and disease. Conclusion: Health is experienced by the elderly in a family context. Well-being is perceived as the ability to do things, even if pain and illness are present.

RESUMO Durante a velhice, o significado de saúde está baseado em atingir um estado de bem-estar; por isso, é importante compreender os fatores que beneficiam ou afetam conquistar esse propósito. Objetivo: analisar os significados de saúde que os idosos constroem a partir de suas vivências e experiências. Materiais e método: pesquisa qualitativa com técnica de análise de conteúdo e entrevista semiestruturada. Participaram vinte idosos que foram a um centro de atenção geriátrica, selecionados de maneira intencionada e determinada por índice de saturação. Resultados: o significado de saúde se manifesta na capacidade de poder fazer coisas; assim, a saúde é concebida como um meio útil para obter um benefício - material, moral ou físico. Os vínculos familiares são importantes, inclusive os comparam com a saúde; também identificam a saúde com a ausência de dor e doença. Conclusões: a saúde do idoso é vivida em contexto familiar; o bem-estar é percebido como a capacidade de fazer coisas, embora a dor e a doença estejam presentes.

Formación de enfermeras mexicanas en el período revolucionario / Formation of Mexican Nurses in the Revolutionary Period

Resumen

El surgimiento de las escuelas de enfermería en México ocurrió por la necesidad de satisfacer las demandas de atención de los enfermos. El período de fundación fue a principios del siglo XX cuando fueron traídas las reformas de Florence Nightingale. En sus inicios las enfermeras estudiaban periodos de uno a dos años y el método de enseñanza era a través de prácticas clínicas bajo la tutela y supervisión de una enfermera graduada con experiencia. Esta formación fue influenciada por la tradición religiosa, la herencia simbólica femenina, así como el origen militar de la profesión, que ha dejado como característica, una disciplina para lograr la productividad en el cuidado. La enfermería inició un proceso de profesionalización cuando enfermeras seglares tituladas fueron ocupando los puestos que las religiosas iban dejando. Las enfermeras en nuestro país han transitado por un proceso empírico teórico; lo que significa que enfermería surgió como una actividad social que se ha ido profesionalizando. Los “conocimientos formales” que adquirieron tuvieron dos enfoques: a) teórico biologicista y b) basados fundamentalmente en el método del aprendiz. A cien años del surgimiento de la disciplina, ésta ha crecido y se ha desarrollado, tanto en la educación como en la práctica profesional, y ha buscado transformar algunos elementos histórico-delegados, por factores que la empoderen y favorezcan su reconocimiento profesional y social.

Summary

The school’s emerge of infirmary in Mexico happened by the necessity to satisfy the demands of attention the patients. The period of foundation was at the beginning of 20th when the reforms of Florence Nightingale were brought. At the beginning nurses studied periods of one to two years and the education method was through clinical practices under the trusteeship and supervision of a graduated experience nurse. This formation was influenced by the religious tradition, the feminine symbolic inheritance, as well as the military origin of the profession, that has left as a characteristic, a discipline to obtain productivity in care. Nursing initiated a professionalization process when titled nurses lay occupied positions that the nuns were leaving empty. Nurses in our country have journeyed by a empirical-theoretical process; that means that nursing arose like a social activity that has been professionalized. The “formal knowledge” that they acquired had two characteristics. First it was the biologicista theoretical approach and the second one talks about to the subjets, contents and times, since the insufficient planning made that each professor-the majority medical, taught to them what they considered that a nurse had to know. A hundred years after the sprouting of the discipline, it has grown and developed, as much in the actually professional education as, and has looked for the transformation of some historical- delegated elements, by factors that would center it and becoming its professional and social recognition.

Cuidados de la salud: paradigma del personal de enfermeros en México: la reconstrucción del camino / Health care: paradigm of nurses in Mexico: rebuilding the road / Cuidados de saúde: paradigma de enfermeiros no México ­ a reconstrução da estrada

Se hace un recuento histórico-sociológico sobre los antecedentes y las bases filosóficas basada en el rendimiento del personal profesional de enfermería en México, que permiten conocer y reconocer la necesidad apremiante de transitar del paradigmasalud-enfermedad al de vida-salud. Esto responde a las necesidades de la población en el ámbito de la salud, en una sociedad donde la atención es a la enfermedad y no a la salud, otorgándose aquélla en un sistema hospitalario y con costos altos. Es una investigación cuya metodología se basa en el enfoque de la sociología de las profesiones, apoyada en entrevistas a profundidad.La población de estudio fueron 10 enfermeras de un hospital público de segundo nivel de atención a la salud. Los resultados indican que mientras la atención de enfermería se otorgue en un área hospitalaria, el paradigma vida-salud tardará en instalarse en el ser y hacer de las enfermeras.

Propuesta de validación de indicadores y estándares para el manejo del dolor en el paciente / Proposal for validation of indicators and standards for pain management in the patient / Proposta de validação estandares e indicadores para o manuseio do dor em paciente

El dolor es una experiencia sensorial y emocional desagradable relacionada con daño a los tejidos. El objetivo fue validar los estándares e indicadores para el manejo del dolor. Es un estudio transversal y descriptivo. Se utilizó el modelo de estándares de A. Donavedis. El universo fueron 150 enfermeras y la muestra 109. El proceso de validación se realizó en tres etapas: En laprimera se utilizó la técnica delphi en 24 enfermeras expertas con dos rondas. En la segunda una prueba piloto en el 10% de la muestra, en donde se validó la consistencia con el alfa de Cronbach con índices de validación de exactitud mayores a 0,711. En la tercera, se midió la precisión utilizando el Modelo de Capacidad de Procesos (Icp). En conclusión el instrumento se validó contres estándares: 7 de estructura, 13 de proceso y 4 de resultado todos con un Icp máximo mayores a uno.