Surgical management of middle cranial fossa bone defects: meningoencephalic herniation and cerebrospinal fluid leaks.

Along the medical practice of an Otologist he/she will face middle cranial fossa (MCF) bone defects. The purpose of this study is to contribute to the understanding of this possible life threatening condition, and to share and discuss our management approach. A literature review is also presented. STUDY DESIGN: Retrospective case series at García-Ibáñez Otology and Skull base private center referral. METHODS: This study is based on the analysis of data collected from 19 cases of temporal bone meningoencephalic herniations surgically treated from 2006 to 2018. The follow-up ranged from 18 to 162 months with a mean average of 44.5 months. MAIN FINDINGS: Meningoencephalic herniations were divided into four etiologic groups: spontaneous (24.8%), secondary to chronic otitis media (21.8%), iatrogenic (45.9%), and posttraumatic (7.5%). Different surgical techniques were used as treatment: transmastoid (TM) approach (27.8%), MCF approach (27.8%), combined technique (transmastoid plus minicraniotomy, 3%), and middle ear obliteration with blind sac closure of the external auditory canal (41.4%). CONCLUSIONS: Variables like bilateral hearing level, size and location of the bone defect and existence of CSF leak should be analyzed to select the safest and most effective closing surgical approach.

Development of a safe drug administration assessment instrument for nursing students.

OBJECTIVE: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. METHOD: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. RESULTS: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. CONCLUSION: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Adaptación transcultural de instrumentos de evaluación en salud: historia y reflexiones del por qué, cómo y cuándo / Cross-cultural adaptation of evaluation instruments in health: history and reflections of why, how and when

En la actualidad se enfatiza el enfoque universal para abordar situaciones de interés mundial en ámbitos tales como educación, economía y salud. Esto requiere indicadores transversales que posibiliten comparaciones adecuadas. En el área de la salud esto es especialmente relevante para comprender, conocer y responder problemas sanitarios que trascienden las fronteras. La mayoría de los instrumentos de evaluación en salud han sido desarrollados en idioma anglosajón, lo que requiere de un proceso de Adaptación Transcultural (AT) para ser utilizados en países de habla hispana. La AT va más allá de la mera traducción; tiene etapas y requiere componentes específicos para asegurar la validez y confiabilidad del instrumento al ser aplicado en poblaciones con diferente cultura y/o idioma. El presente artículo tiene por objetivo revisar la relevancia de la adaptación transcultural de instrumentos en salud, los componentes y recomendaciones generales del proceso, así como también algunos conceptos claves como la equivalencia, el rol del comité de expertos y la prueba piloto del instrumento adaptado. Se describe el desarrollo histórico de este proceso, evidencia de su uso y desafíos actuales. Finalmente se insta a la revisión de los documentos referenciados para quienes deseen ahondar en los recursos disponibles que lo guían.

Nowadays the use of a universal approach is emphasized to address issues of world level interest in the areas of education, economy and health, among others. This requires cross-sectional indicators that allow adequate comparisons. In the health area this is especially relevant to gain knowledge, understanding and responses of health problems that transcend borders. Most health assessment instruments have been developed in Anglo-Saxon cultures and languages, which require a process of Transcultural Adaptation (TA) to be used in Spanish-speaking countries. TA means not only translation; it has steps and requires specific components to ensure the validity and reliability of the instrument when applied to populations with different culture and/or languages. The objective of this article is to review the relevance of cross-cultural adaptation of health instruments, the components and general recommendations of the process as well as some key concepts such as equivalence, the role of the expert committee and the pilot testing of the adapted instrument. It describes the historical development of this process, evidence of its use and current challenges. Finally, the reviewing of the referenced documents is recommended for those who wish to gain more knowledge in the available resources that guide this process.

Development of a safe drug administration assessment instrument for nursing students / Elaboração de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem / Elaboración de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería

Objective: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. Method: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. Results: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. Conclusion: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Objetivo: determinar a validade de face e conteúdo de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem. Método: estudo quantitativo, descritivo. Analisou-se a literatura relativa a erros de medicação em estudantes e elaborou-se um roteiro utilizando a metodologia Arquitetura Integrada de Sistema de Informação e a Estrutura de Decomposição do Trabalho. Analisou-se a validade de face utilizando a técnica nominal com especialistas em educação, gestão, pesquisa e/ou prática clínica. Resultados: nove especialistas participaram de todo o processo de validação, do qual se obteve um roteiro com 8 subprocessos e 58 itens, ajustados ao ambiente de simulação e prática clínica. Conclusão: o roteiro se encontra em condições de ser testado na avaliação da administração segura de medicamentos em estudantes de enfermagem, principalmente em ambiente de simulação.

Objetivo: determinar la validez de aspecto y contenido de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería. Método: estudio cuantitativo, descriptivo. Se analizó la literatura respecto a errores de medicación en estudiantes y se creó una pauta utilizando la metodología Arquitectura Integrada de Sistema de Información y la Estructura de Descomposición del Trabajo. Se analizó la validez de aspecto utilizando la técnica nominal con personas expertas en educación, gestión, investigación y/o práctica clínica. Resultados: Nueve personas expertas participaron durante todo el proceso de validación, se obtuvo una pauta con 8 subprocesos y 58 ítems, ajustados al ambiente de simulación y práctica clínica. Conclusión: La pauta se encuentra en condiciones de ser probada en la evaluación de la administración segura de medicamentos en estudiantes de enfermería, especialmente en el ambiente de simulación.

The anthropologic-ethic views of nursing students.

Philosophic anthropology, as a philosophic study of human beings, has as objective to create unity around men, from all the disciplines, and constitutes the way of teaching ethics. "being a person" is something unique of human beings. It recognizes a special dignity and a dialogic character where men is only an "I" facing a "you" (Buber, 1981). Given extreme situations humans have faced, men has been recognized as unitary a priori, his knowledge cannot be defined in an analytic way with out destroying it.

[Cardiovascular prevention and attitude of people towards behavior changes: state of the art]. / Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo: un análisis crítico del estado actual.

In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.