Intensidad de colaboración interprofesional entre enfermeras de cuidados intensivos de un hospital de tercer nivel / Intensity of interprofessional collaboration among intensive care nurses at a tertiary hospital

Objetivos: Medir la intensidad de colaboración interprofesional (ICP) en enfermeras de una unidad de cuidados intensivos (UCI) de un hospital de tercer nivel; comprobar diferencias entre las dimensiones de la escala Intensidad de la Colaboración Interprofesional (ICP), e identificar la influencia de variables personales en la ICP. Método: Estudio descriptivo transversal realizado con 63 enfermeras de cuidados intensivos seleccionadas mediante muestreo aleatorio simple. Variables explicativas: edad, sexo, años de experiencia en enfermería, años de experiencia en cuidados críticos, jornada laboral y turno de trabajo; variable resultado: ICP. La ICP se midió mediante el cuestionario «Intensidad de la Colaboración Interprofesional». Se realizó análisis estadístico descriptivo y bivariante (ICP y sus dimensiones con variables explicativas). Resultados: El 73,8% fueron mujeres, con una edad media de 46,54 (± 6,076) años. La media de años de experiencia en enfermería y en cuidados críticos fue de 23,03 (± 6,24) y de 14,25 (± 8,532), respectivamente. El 77% tenían una jornada completa y el 95,1%, turno rotatorio. El 62,3% tuvieron valores de ICP media. Se encontró asociación estadísticamente significativa (p < 0,05) entre ICP (puntuación global) y apreciación global con años de experiencia en cuidados críticos. Conclusiones: El estudio muestra niveles medios de ICP; las enfermeras con menos experiencia en cuidados críticos son las que puntúan más alto la ICP global y su dimensión de apreciación global

Objectives: To measure the intensity of interprofessional collaboration (IPC) in nurses of an intensive care unit (ICU) at a tertiary hospital, to check differences between the dimensions of the Intensity of Interprofessional Collaboration Questionnaire, and to identify the influence of personal variables. Method: A cross-sectional descriptive study was conducted with 63 intensive care nurses selected by simple random sampling. Explanatory variables: age, sex, years of experience in nursing, years of experience in critical care, workday type and work shift type; variable of outcome: IPC. The IPC was measured by: Intensity of Interprofessional Collaboration Questionnaire. Descriptive and bivariate statistical analysis (IPC and its dimensions with explanatory variables). Results: 73.8% were women, with a mean age of 46.54 (± 6.076) years. The average years' experience in nursing and critical care was 23.03 (± 6.24) and 14.25 (± 8.532), respectively. 77% had a full time and 95.1% had a rotating shift. 62.3% obtained average IPC values. Statistically significant differences were found (P < .05) between IPC (overall score) and overall assessment with years of experience in critical care. Conclusions: This study shows average levels of IPC; the nurses with less experience in critical care obtained higher IPC and overall assessment scores

Intensity of interprofessional collaboration among intensive care nurses at a tertiary hospital. / Intensidad de colaboración interprofesional entre enfermeras de cuidados intensivos de un hospital de tercer nivel.

OBJECTIVES: To measure the intensity of interprofessional collaboration (IPC) in nurses of an intensive care unit (ICU) at a tertiary hospital, to check differences between the dimensions of the Intensity of Interprofessional Collaboration Questionnaire, and to identify the influence of personal variables. METHOD: A cross-sectional descriptive study was conducted with 63 intensive care nurses selected by simple random sampling. Explanatory variables: age, sex, years of experience in nursing, years of experience in critical care, workday type and work shift type; variable of outcome: IPC. The IPC was measured by: Intensity of Interprofessional Collaboration Questionnaire. Descriptive and bivariate statistical analysis (IPC and its dimensions with explanatory variables). RESULTS: 73.8% were women, with a mean age of 46.54 (±6.076) years. The average years experience in nursing and critical care was 23.03 (±6.24) and 14.25 (±8.532), respectively. 77% had a full time and 95.1% had a rotating shift. 62.3% obtained average IPC values. Statistically significant differences were found (P<.05) between IPC (overall score) and overall assessment with years of experience in critical care. CONCLUSIONS: This study shows average levels of IPC; the nurses with less experience in critical care obtained higher IPC and overall assessment scores.

Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block.

BACKGROUND: Peripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3-0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes. METHODS: Preoperative evaluation included a neurological exam and electroneurography. During ultrasound-guided popliteal sciatic nerve block, we measured the current required to produce motor activity for the tibial and common peroneal nerve in diabetic and non-diabetic patients. Proximity to the nerve was evaluated post-hoc using ultrasound imaging. RESULTS: Average stimulation currents did not differ between diabetic (n=55) and non-diabetic patients (n=52). Although the planned number of patients was not reached, the power goal for the mean stimulation current was met. Subjects with diminished pressure perception showed increased thresholds for the common peroneal nerve (median 1.30 vs. 0.57 mA in subjects with normal perception, P=0.042), as did subjects with decreased pain sensation (1.60 vs. 0.50 mA in subjects with normal sensation, P=0.038). Slowed ulnar nerve conduction velocity predicted elevated mean stimulation current (r=-0.35, P=0.002). Finally, 15 diabetic patients required more than 0.5 mA to evoke a motor response, despite intraneural needle placement (n=4), or required currents ≥2 mA despite needle-nerve contact, vs three such patients (1 intraneural, 2 with ≥2 mA) among non-diabetic patients (P=0.003). CONCLUSIONS: These findings suggest that stimulation thresholds of 0.3-0.5 mA may not reliably determine close needle-nerve contact during popliteal sciatic nerve block, particularly in patients with diabetic neuropathy. CLINICAL TRIAL REGISTRATION: NCT01488474.

Retraso mental de causa genética. Estudio observacional en una zona de salud / Intelectual disability of genetic cause. Observational study in an urban primary health care center

Introducción: se realiza una revisión del número de trastornos del neurodesarrollo en la población pediátrica de un centro de Atención Primaria de la ciudad de Zaragoza (España), con el objetivo de conocer la prevalencia y la importancia creciente del diagnóstico genético. Material y métodos: se realiza una búsqueda de casos en el programa de historia clínica informatizada OMI6 con los siguientes términos: 'retraso mental', 'retraso del desarrollo', 'trastorno del desarrollo', 'autismo'. Resultados: se han obtenido 76 casos de trastornos del neurodesarrollo, que son el 2,19% de la población. Los diagnósticos principales fueron: 23 trastornos del lenguaje, 17 trastornos del aprendizaje, 11 de retraso mental, 10 casos de trastorno del espectro autista (TEA), 8 de retraso del desarrollo, 5 casos de dislexia, un caso de síndrome de Asperger y un caso de dispraxia motora. Se solicitó estudio genético en 21 casos, el 27,63% de los niños, siendo mucho más frecuente su realización en casos de retraso mental o TEA. Las pruebas genéticas proporcionaron el diagnóstico en 12 pacientes de los estudiados, un 57,14% de los casos. En general, se encuentra una causa genética en el 75% de los casos con diagnóstico establecido. Conclusiones: este estudio muestra que los trastornos del neurodesarrollo aparecen en nuestra población con una frecuencia similar a la descrita en la bibliografía médica. Los estudios genéticos permiten cada vez más un diagnóstico etiológico preciso (AU)

Introduction: we review the number of neurodevelopmental disorders in the pediatric population of a primary care center in Zaragoza, in order to determine the prevalence and the growing importance of genetic diagnosis. Material and methods: the research was carried out in the computerized medical record programme OMI6 with the following terms: 'mental retardation', 'development delay', 'development disorders' and 'autism spectrum disorders'. Results: 76 cases of neurodevelopment disorders have been got, which mean 2.19% of the population of study. The main diagnoses were: 23 language disorders, 17 learning disorders, 11 mental retardation, 10 cases of autism, 8 development delay, 5 cases of dyslexia, 1 case of Asperger´s syndrome and 1 case of dyspraxia. A genetic study was requested in 21 cases, which supposed the 27.63% of children, being more frequent implementation in cases of mental retardation or autism. Genetic test provided diagnosis in 12 patients of the study, which means the 57.14% of the cases. A genetic cause was found in the 75% of the cases with an established diagnosis. Conclusion: this study shows that neurodevelopmental disorders appear in our population with a similar frequency described in the literature. Genetic studies increasingly allow precise etiological diagnosis (AU)

Medición prehospitalaria del exceso de base arterial y su posible papel en la predicción del desenlace tras una parada cardiaca extrahospitalaria / Prehospital measurement of arterial base excess and its role as a possible predictor

Objetivo: La parada cardiorrespiratoria (PCR) conduce a un estado de acidosis mixtametabólica y respiratoria. Incluso tras una ventilación adecuada y la recuperación del pulso espontáneo (ROSC) la acidosis metabólica se refleja en un exceso de bases (EB).El objetivo del estudio es comprobar que el EB arterial se correlaciona con la mortalidad en el ámbito prehospitalario. Método: Se revisaron de forma retrospectiva las hojas de registro de los pacientes en PCR desde el 1 de enero de 2003 hasta 31 de diciembre de 2010. Se incluyeron 126pacientes con PCR no traumáticas en los que se obtuvo una gasometría en el curso de la reanimación cardiopulmonar (RCP). Se recogieron las siguientes variables: edad, sexo, tiempo hasta el inicio de la reanimación, causa de la PCR, ritmo inicial, duración de la reanimación, uso de trombolítico, adrenalina, bicarbonato, hipotermia terapéutica (..) (AU)

Objective: Cardiac arrest leads to a state of mixed respiratory and metabolic acidosis. Even after adequate ventilation and restoration of spontaneous circulation, metabolic acidosis as reflected by a negative base excess (BE) persists. We hypothesized that arterial BE measured in out-of-hospital cardiac arrest would be significantly associated with prehospital mortality. Methods: We retrospectively reviewed all protocol sheets of emergency medical responses to cardiac arrest in the period from January 1, 2003 to December 31, 2010. One hundred twenty-six adult non traumatic cardiac arrest patients in whom cardiopulmonary resuscitation (CPR) was attempted and an arterial blood gas sample was obtained during ongoing CPR were included for further analysis. The following data were collected: age, sex, delay, bystander or emergency medical technician CPR, cause of cardiac arrest, initial rhythm, CPR duration; use of thrombolytic therapy, epinephrine, sodium bicarbonate, and for a cooling device and blood gas sample parameters. The univariate association (..) (AU)

ATP-sensitive potassium currents in rat primary afferent neurons: biophysical, pharmacological properties, and alterations by painful nerve injury.

ATP-sensitive potassium (K(ATP)) channels may be linked to mechanisms of pain after nerve injury, but remain under-investigated in primary afferents so far. We therefore characterized these channels in dorsal root ganglion (DRG) neurons, and tested whether they contribute to hyperalgesia after spinal nerve ligation (SNL). We compared K(ATP) channel properties between DRG somata classified by diameter into small or large, and by injury status into neurons from rats that either did or did not become hyperalgesic after SNL, or neurons from control animals. In cell-attached patches, we recorded basal K(ATP) channel opening in all neuronal subpopulations. However, higher open probabilities and longer open times were observed in large compared to small neurons. Following SNL, this channel activity was suppressed only in large neurons from hyperalgesic rats, but not from animals that did not develop hyperalgesia. In contrast, no alterations of channel activity developed in small neurons after axotomy. On the other hand, cell-free recordings showed similar ATP sensitivity, inward rectification and unitary conductance (70-80 pS) between neurons classified by size or injury status. Likewise, pharmacological sensitivity to the K(ATP) channel opener diazoxide, and to the selective blockers glibenclamide and tolbutamide, did not differ between groups. In large neurons, selective inhibition of whole-cell ATP-sensitive potassium channel current (I(K(ATP))) by glibenclamide depolarized resting membrane potential (RMP). The contribution of this current to RMP was also attenuated after painful axotomy. Using specific antibodies, we identified SUR1, SUR2, and Kir6.2 but not Kir6.1 subunits in DRGs. These findings indicate that functional K(ATP) channels are present in normal DRG neurons, wherein they regulate RMP. Alterations of these channels may be involved in the pathogenesis of neuropathic pain following peripheral nerve injury. Their biophysical and pharmacological properties are preserved even after axotomy, suggesting that K(ATP) channels in primary afferents remain available for therapeutic targeting against established neuropathic pain.

Prehospital fiberoptic intubation.

We present a case of a patient with severe multiple trauma who was treated at the scene by a physician-staffed trauma life support team. Due to a complete tracheal transection, a "cannot ventilate, cannot intubate"-situation occurred. The patient was then intubated using a fiberoptic bronchoscope in the prehospital setting. The current literature concerning fiberoptic intubation in emergencies is discussed.

[Strategies for quality assessment of emergency helicopter rescue systems. The Graz model]. / Strategien zur Optimierung notärztlicher Kompetenz in der Flugrettung. Das Modell Graz.

PURPOSE: Preclinical emergency medical treatment necessitates a comprehensive interdisciplinary knowledge by the emergency physician as well as a high level of manual dexterity. The quality of treatment therefore depends on the level of education and continuous training in emergency medical techniques. Based on an evaluation of the frequency of life-saving interventions by a physician-staffed rescue helicopter system, strategies for in-hospital training of relevant skills are suggested. MATERIAL AND METHODS: At the outset, 10 important areas of treatment (e.g. intubation, chest tube etc.) and their frequency in emergency medical services were defined as the standard to be attained by emergency physicians within 1 year. The selection of the areas of treatment was based to some extent on international recommendations. The actual frequencies of the prehospital interventions were compared to the required minimum numbers by retrospective analysis of the helicopter rescue database (NACA-X). RESULTS: During the observation period of 1 year, 20 emergency physicians responded to 956 prehospital emergency calls. A life-threatening condition requiring an on-site intervention occurred in only 521 (54.5%) patients, so that the majority of physicians did not perform the required minimum number of interventions. In order to maintain their level of skill, the emergency physicians were required to undertake additional training at the local university hospital. CONCLUSION: The frequency of on-site life-saving interventions in emergency medicine is insufficient to fulfill the quota necessary to maintain adequate training of emergency physicians. Only a link-up program at a hospital for primary care can ensure an adequate training level.

The acute coronary syndrome--pre-hospital diagnostic quality.

BACKGROUND AND OBJECTIVE: In the Austrian emergency medical service (EMS), emergency medical technician-staffed and physician-staffed vehicles are in operation. Patients with suspected acute coronary syndromes (ACS) are treated in the pre-hospital phase and transported to the hospital by an emergency physician (EP). This study evaluates the diagnostic performance of EPs in ACS and the impact of this emergency system on the outcome of ACS in an urban area. DESIGN: Retrospective case control study. METHODS: All protocol sheets from the emergency physicians were searched for the diagnosis of ACS. The database of the emergency department (ED) was searched for patients with ACS as an admission diagnosis or ACS as discharge diagnosis. For patients admitted to an intensive care unit (ICU), the medical history from the ICU was reviewed. According to the diagnosis and the aggressiveness of therapy, patients were divided in five categories of severity at each stage of care (pre-hospital category, ED category, ICU category). RESULTS: A total of 3585 patients was analysed. Only 17.8% of the patients with ACS as the admission diagnosis and 20.3% of the patients with ACS as the discharge diagnosis were transported by an EP. 46.8% of the ACS diagnosis by EPs were confirmed in hospital. Patients transported by EPs showed a higher all-cause mortality in hospital (1.6% vs. 0.6%; p=0.011). There was no significant correlation between the pre-hospital category of patients treated by EPs and the ED category. When a 12-lead-electrocardiogram was recorded, the correlation improved slightly (rho: 0.139; p=0.006). CONCLUSIONS: The percentage of ACS patients transported to hospital by an EP is very low, and EPs seem to be "over-aware" in the diagnosis of ACS.