Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar / Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCCIÓN: La hidrocefalia infantil en países de bajo y mediano ingreso, representa uno de los problemas éticos y sanitarios más conflictivos con los que se enfrenta el desarrollo de la salud a nivel internacional. Las estimaciones más optimistas señalan que 200.000 nacidos anualmente desarrollarán una hidrocefalia o nacerán con un defecto del tubo neural en África oriental, central y sur de África (ECSA). Se calcula que menos del 10% de estos niños serán operados mediante derivaciones ventriculoperitoneales y, en general, en condiciones de mala calidad o con un índice de complicaciones muy elevado. OBJETIVO: Describir las características generales, la epidemiología y los datos demográficos de la hidrocefalia infantil de los pacientes atendidos en el Instituto NED en el archipiélago de Zanzíbar y valorar los detalles clínicos y los resultados a medio plazo del impacto de los cuidados de enfermería implantados. MATERIAL Y MÉTODOS: Se trata de un estudio observacional descriptivo y analítico de carácter retrospectivo, en pacientes diagnosticados y tratados de hidrocefalia infantil, en el período comprendido entre septiembre del 2016 y septiembre del 2018. Con la implantación de una serie de protocolos perioperatorios de enfermería en dichos pacientes, se describieron y analizaron los resultados obtenidos. RESULTADOS: Un total de 96 pacientes fueron atendidos de hidrocefalia infantil. Un 51% (n = 49) de estos pacientes eran varones, con una media de edad de 9,25 meses. Todas las madres de los pacientes fueron controladas durante el embarazo, pero solamente un 8% de ellas fueron tratadas con ácido fólico durante su gestación. El 81% de los niños nacieron mediante parto vaginal o parto espontáneo no complicado. Con respecto a la etiología, el 27,1% de la hidrocefalia tratada estaba asociada a una causa infecciosa y un 35,4% a una causa desconocida. Se realizaron 67 cirugías de derivación ventriculoperitoneal y 15 ventriculostomías endoscópicas. La tasa de complicaciones fue del 23,17%. CONCLUSIONES: Los resultados de esta investigación indican que la hidrocefalia infantil en Zanzíbar tiene una etiología, una evolución y unas complicaciones similares o menores que las descritas hasta la fecha en el África oriental. El hecho de implantar una serie de protocolos perioperatorios y cuidados estandarizados de enfermería influyen positivamente en los resultados obtenidos. En la actualidad, el Mnazi Mmoja Surgical NED Institute es uno de los escasos centros en África del Este con un registro exhaustivo de la actividad asistencial y el primer centro sanitario que oferta una formación continuada al personal de enfermería

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n = 49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses

[Significance of Existence and Future Prospects of Nurse Practitioners in Neurosurgical Teams].

Recently, hospitals and medical facilities have been experiencing a shortage of doctors along with heavy workload. The role of a mid-level provider may be important as a potential solution to these problems. A nurse practitioner(NP)is the most famous mid-level provider, and in our institution, the neurosurgery department has 3 NPs. Contrary to America, in Japan, the job of an NP is not an occupation independent from doctors or nurses. NPs perform 38 specific procedures according to doctors' instructions. Their activities include assisting with operations, writing prescriptions, participation in neurosurgical rounds and conferences, transportation of patients by helicopter, etc. The safe transportation of patients to isolated islands by a helicopter is especially a representative activity in our institution. Inclusion of NPs in clinical settings may bring forth medical improvements and superior work efficiency. According to regional characteristics, the job profile of a NP presents a potential scope for added capabilities.

Benefits of the epilepsy specialist nurses (ESN) role, standardized practices and education around the world.

Epilepsy, often considered as a stigmatizing disease, affects 65 million people worldwide and is frequently associated with comorbidities that increase both direct and indirect costs. The degree of impact on quality of life and the cost of care differs depending on the social and health care organizations in place, political, medico-economic and/or socio-cultural contexts. Across the globe, healthcare is provided by nurses in primary care, urgent or emergency care, and within specialized domains of practice. In Epilepsy the global care could be enhanced by developing standardized nursing education in close collaboration with other caregivers. The impact of epilepsy nursing care has been documented in some developed countries, but the diversity of nursing practices and professional education of nurses raise difficulties in generalizing these findings. Specialized education in epilepsy will improve access, treatment and ultimately the quality of life of patients.

[Glioblastoma and nursing care in neurosurgery]. / Glioblastome et soins infirmiers en neurochirurgie.

Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis.

A socio-technical systems approach to studying interruptions: understanding the interrupter's perspective.

The purpose of this study was to understand the cognitive processes underlying nurses' decision to interrupt other nurses. The Institute of Medicine (2000) reported that interruptions are likely contributors to medical errors. Unfortunately, the research to date has been quite homogenous, focusing only on the healthcare provider being interrupted, ignoring the true complexities of interruptions. This study took a socio-technical approach being the first to examine interruptions from the viewpoint of the interrupting nurse. Over 15 h of observations and 10 open-ended interviews with expert nurses in a Neuroscience Surgical Intensive Care Unit were conducted. It was found that nurses conduct a quick cost-benefit assessment to determine the interruptibility of other nurses and whether an interruption is value-added vs. non-value added. To complete the assessment, nurses consider several conditional factors related to the interruptee, the interrupter, and the nature of the interruption content, and different potential consequences of the interruption.

[Observational study on interruptions during nurses work in two surgical wards of a hospital in Liguria]. / Work interruption: indagine in due reparti chirurgici di un ospedale ligure sulle interruzioni a cui gli infermieri sono sottoposti durante le attività assistenziali.

INTRODUCTION: Interrumption that occur during nursing practice are hazardous for patient safety, resulting in a heavy cognitive load for the health care professionals and increases the risk of making mistakes. METHODS: An observational study was carried out in UU.OO operation of Neurosurgery and Vascular Surgery at a hospital in Liguria. The observation lasted one months, from July 1st, 2012 to August 1st, 2012. For data collection were used three form, one for each work shift, in which each health care professional had to report what activity was interrupted and why. RESULTS: A total of 7744 interruptium (in 5676 in Neurosurgery and 2068 Vascular Surgery). The major source of interruption was the bell, followed by the phone and relatives' questions. In general, activities interrupted were mainly made beds / hygiene care, administration and preparation of medication, handover and completion of the nursing documentation CONCLUSIONS: Interrumption will be an inevitable part of nursing practice, because of its very nature. It is therefore necessary to intervene on interruptions deemed avoidable and organizational variables that generate them, in order to increase patient safety and improve care activities.

Catéter central de inserción periférica. Complicaciones en pacientes neurológicos / Complications of the picc in neurologic patients of the hospital Ramon y Cajal

Se abordan, a través de un estudio descriptivo, las complicaciones derivadas del uso del PICC (Peripherally Inserted Central Catheter / catéter central de inserción periférica) en una muestra de pacientes ingresados en la Unidad de Neurocirugía del Hospital Ramón y Cajal. Tras recopilar y analizar la información acerca del sexo y edad de los pacientes, indicación de implantación del PICC, grosor del mismo, días de permanencia hospitalaria, complicaciones encontradas, causa de retirada del catéter, y fecha de implantación y retirada del mismo, no se han encontrado complicaciones significativas derivadas de su uso. Este hecho demuestra que el PICC es un sistema seguro y viable para la administración de tratamiento intravenoso de larga duración y para cuyo uso cada vez está más capacitado el personal de enfermería. Estas circunstancias permiten la administración de un tratamiento intravenoso preservando la anatomía vascular del paciente, cumpliendo, de este modo, con la finalidad de todo catéter de larga duración(AU)

Descriptive study focused on the complications arising from the use of the PICC (peripherally inserted central catheter) in a sample of patients admitted to the neurology unit of the «Hospital Ramón y Cajal».After collecting and analyzing the information about the sex and age of the patients, indication of implantation of the PICC, thickness of the same, days of permanence, complications found, cause of withdrawal of the catheter, and date of introduction and removal of the same, we not found significant complications arising from the use of the same. PICC is a safe and viable system for the administration of intravenous treatment of long duration and nursing personnel is more qualified for which. This allows the administration of intravenous treatment while preserving the vascular anatomy of the patient, that is the purpose of all long-term catheters (AU)

Establishing the position of neurosurgery nurse coordinator as a catalyst for advancing quality of care in a tertiary hospital in Israel.

BACKGROUND: The role of neurosurgery nurse coordinator is unique in Israel and was developed to provide a comprehensive response to the needs of patients undergoing cranial surgery to remove various types of tumors. The creation of the neurosurgery nurse coordinator role was based on patient and staff needs assessment and focused on two major areas: (1) the patient and his or her family-creating personal and empathic communication with the goal of offering emotional support, providing support to assist in relieving symptoms, coordinating between the patient and/or the patient's family and the physicians and consultants, and assisting with bureaucratic processes and with familiarization with the hospital's medical environment; and (2) establishing departmental processes related to improving patient care within a multidisciplinary team. OBJECTIVE: The aim of this study was to investigate the needs and level of satisfaction of patients and their families, hospitalized in the neurosurgery department for the surgical removal of cranial tumors. METHODS: Satisfaction survey is composed of 47 questions. SAMPLE: A convenience sample of 67 patients completed a satisfaction survey related to various aspects of their hospitalization. FINDINGS: The study results reflect patient needs for emotional support, information, and additional education. These findings emphasize the great importance of the position of nurse coordinator in the neurosurgery department.

Nurse practitioner-based sign-out system to facilitate patient communication on a neurosurgical service: a pilot study with recommendations.

Failure to communicate important patient information between physicians causes medical errors and adverse patient events. On-call neurosurgery physicians at the Toronto Western Hospital do not know the medical details of all the patients that they are covering at night because they do not care for the entire service of patients during the day. Because there is no formal handover system to transfer patient information to the on-call physician, a nurse practitioner-based sign-out system was recently introduced. Its effectiveness for communication was evaluated with preintervention-postintervention questionnaires and by recording daily logins. There was a statistically significant decrease in number of logins after 8 weeks of use (p = .05, Fisher's exact test), and the tool was abandoned after 16 weeks. Modifications identified to improve the system include the ability to sort by attending physician and to automatically populate the list with new patients. Effective communication is important for reducing medical errors, and perhaps these modifications will facilitate this important endeavor.

Ethical decision making in neurosurgery: a case study.

Neurosurgical patients often challenge their caregivers with moral issues that arise during their care. As the population ages, end-of-life decision making and flexible planning need to be stressed so patients can be included in their care decisions and better communicate with the healthcare team. This case study illustrates how one team of nurses used an ethical decision-making model and a caring perspective to help a patient successfully navigate a complex healthcare system as they advocated for her increased involvement in her care.

Cuidados em neurocirurgia como indutores de sentimentos da enfermagem: o que os cuidadores sentem e como seus corpos reagem

O estudo abordou como os corpos dos cuidadores da neurocirurgia reagem e sentem ao cuidar. A investigação foi desenvolvida em um hospital universitário do município do Rio de Janeiro e abrangeu um grupo de enfermeiras (os) e auxiliares de enfermagem. Os objetivos foram identificar os sentimentos da equipe acerca de seu cuidado; descrever os fatores causais dos sentimentos manifestados; e analisar as implicações destes sentimentos nos corpos da equipe quando cuidam dos clientes. Possui natureza quanti-qualitativa como metodologia, sendo empregado o tipo de entrevista semi-estruturada, que foi escolhida por melhor se adequar ao projeto. Das entrevistas analisadas, surgiram os dados, que foram trabalhados e divididos em duas categorias, apresentando os resultados da pesquisa. Os resultados revelam as condições e o espaço onde a enfermagem e seus clientes se encontram. Esta pesquisa nos colocou diante da realidade de um grupo de pessoas da enfermagem num micro espaço social e que podem, como parte de um todo, refletir os problemas desse todo. Concluímos que o cuidado em neurocirurgia, que contempla o ambiente em todas as suas condições, merece continuar sendo investigado, pois, assim compreenderemos como adoecemos em nossos ambientes de trabalho.

Using clinical performance information to improve the quality of care in a specialist NHS trust.

This article offers a case study of how an National Health Service trust specializing in neurology and neurosurgery used clinical performance information to underpin its quality improvement strategy. This involved developing a clinical effectiveness framework and identifying trust-specific clinical indicators, an exercise which involved both staff and patients. Writing from personal experience as clinical effectiveness manager, the author argues that clinical indicators can be powerful tools for monitoring the quality and effectiveness of health care at a system-wide level. In the case of nursing care, the use of appropriate, nursing-sensitive indicators can provide a valuable complement to the qualitative information generated by the benchmarking approach used in 'Essence of Care'. The article contains details of the sort of problems encountered along the way--such as resistance from clinicians and general managers, and difficulties with the existing information technology infrastructure--and suggests how other trusts might approach them.

Influencia de factores de riesgo en las infecciones neuroquirugicas en el periodo enero 2001 diciembre 2003 / The influence of risk factors in the neurosurgery infections

El objetivo del trabajo es determinar los factores de riesgo asociados a infecciones posquirurgicas en neurocirugia y lograr jerarquizarlos en orden de potencia de asociacion (AU)

The perioperative role of the neurosurgical service coordinator.

At one institution, the development of a position of Neurosurgical Service Coordinator was implemented to expedite the neurosurgical procedures in the operating room. The position required a registered nurse experienced in the field of neurosurgical nursing, who could schedule surgical cases, train personnel, manage budgetary requests, and coordinate a department of 10 neurosurgeons performing 1,500 cases annually.