[The nurse's role in endoscopic ultrasonography]. / Ruolo dell'infermiere in ecoendoscopia.

The role of trained nurses in endoscopic ultrasonography (EUS) examination is very relevant for the quality and results of EUS. Nurses have many tasks in EUS. To prepare the endoscopic room with the right instrument and necessary devices for examination of the upper or lower GI tract is very important. It is also crucial that the nurse gives the right information about the procedure to the patient, to relieve anxiety and to give explanations about the modality of the endoscopic procedure. During the procedure the nurse must help the endoscopist and, when indicated, the anesthesist. After the completion of the procedure, the nurse must carry-on with the reprocessing of the endoscopic instrument and of the devices. Specialized and dedicated nurses who follow courses to keep up-dated are indispensable in this field because of the constant evolution of the endoscopic instruments and techniques. Possible complications must be kept in mind to be recognized and to be treated in an early phase. The endoscopy-trained nurse must know the anatomy of the examined segments but should however integrate this knowledge with the care of the patients. Nurses should also contribute to clinical research regarding EUS.

[Endoscopic ultrasound-fine needle aspiration (EUS-FNA) for pancreatic lesions: effectiveness in clinical practice]. / Agoaspirato con ago sottile sotto guida ecoendoscopica nelle lesioni pancreatiche: efficacia nella pratica clinica.

UNLABELLED: Endoscopic ultrasound-fine needle aspiration (EUS-FNA) was shown to be a highly reliable and a very effective diagnostic technique, both based on data from clinical trials and from large clinical practice studies. EUS-FNA results are reported to be in good-to-very good agreement with the final diagnosis, and the agreement significantly exceeded the chance agreement. The overall sensitivity and specificity of EUS and of EUS-FNA are very good. EUS-FNA is an effective diagnostic technique for the evaluation of pancreatic lesions, either reported with other imaging tests or suspected on the basis of clinical and biochemical features. EUS-FNA may be performed in most cases, and the results of EUS-FNA are particularly important for their excellent positive predictive value. Nonetheless, in a few cases EUS-FNA can not be feasible, or can give false negative or inconclusive RESULTS: The main practical consequence is that before referring patients to surgeons or oncologists, EUS-FNA should be considered as the best diagnostic strategy, since tissue is still the issue' . In a prospective two-centers consecutive series from Italy, FNA did not give any false positive diagnoses of malignancy, and reduced the number of indeterminate diagnoses; moreover, FNA significantly increased the specificity of diagnosis, while sensitivity was unchanged.

[Health inequalities in Panama]. / Las desigualdades en salud en Panamá

OBJECTIVES: To document socioeconomic inequalities in health and health services in Panama and thus create a baseline for the prospective monitoring of the impact of health policies on equity. METHODS: Analysis of data from the 1997 Living Standards Measurement Survey, the 1990 National Population Census and birth registration data for 1996. The relative index of inequality and concentration coefficient were calculated for a wide range of indicators of out-of-pocket health expenditure, access, utilization and quality of health services and of health outcomes. RESULTS: Large and statistically significant socioeconomic differences in many of the variables examined were detected, almost all of which favored the rich. The inequalities identified included qualitative factors such as the type of care received as well as quantitative factors such as travelling times and utilization rates. Some of the inequalities were concentrated among a small, very poor segment of the population whilst others were the result of gradually increasing advantage with increased levels of outcome. CONCLUSIONS: The results obtained provide a valuable starting point for the Panamanian government from which it can identify the most serious inequalities in health and health service provision and develop policies to eliminate or reduce them. They also offer a baseline to monitor changes in the magnitude of these inequalities over time.

Las desigualdades en salud en Panamá / Health inequalities in Panama

Objetivos: Documentar las desigualdades socioeconómicas en la salud y en los servicios de la salud en Panamá, y así crear una línea de base para la monitorización prospectiva de la repercusión de las políticas sanitarias en la equidad. Métodos: Análisis de los datos de la Encuesta Nacional de Vida, el Censo Nacional de 1990, y el Registro Nacional de Eventos Vitales. Se calcularon los índices de desigualdad relativa y los coeficientes de concentración para un variedad amplia de indicadores de gasto (de bolsillo) en salud, acceso, utilización y calidad de los servicios de salud, así como de la morbimortalidad de la población. Resultados: Fueron detectadas grandes y estadísticamente significativas desigualdades socioeconómicas en salud, de las cuales casi todas favorecieron a los ricos. Las desigualdades identificadas incluyeron tanto factores cualitativos, como el tipo de atención recibido, como factores cuantitativos, como los tiempos de espera y las tasas de utilización. Algunas de las desigualdades fueron concentradas en un grupo pequeño de la población, mientras otras fueron el resultado de una ventaja que aumenta progresivamente con mayor ingreso. Conclusiones: Los resultados obtenidos brindan un punto de partida valioso para el gobierno panameño, a partir de los cuales puede identificar las inequidades más grandes en los servicios de salud y desarrollar políticas de salud para eliminarlas o reducirlas. También ofrece una línea basal para monitorizar los cambios en la magnitud de estas desigualdades en el transcurso del tiempo (AU)