Prospective, multi-centric, international, single-arm, cohort study to assess a synthetic polyamide suture material in oral surgery to close the mucosa - MUCODA study.

OBJECTIVES: The aim was to collect different clinical parameters systematically and proactively regarding safety, effectiveness, and performance of a nylon monofilament suture under routine clinical practice for oral surgery. METHODS: The study design was prospective, bicentric, international, single-armed, and observational. A non-absorbable suture was applied to close the mucosa after different dental surgical interventions. Main objective was the incidence of combined postoperative complications until suture removal. The 95 % Confidence Interval (Agresti-Coull method) was used to prove the non-inferiority with a pre-specified upper margin of 21.9 %. Secondary variables were intraoperative suture handling, patient pain and satisfaction, wound healing, aesthetic appearance, and bacterial contamination. RESULTS: 105 patients were enrolled. Complication rate was low (1.9 %), 2 swellings occurred. Pain was present for 1.61 days ± 1.42 after various dental interventions with an average pain level of 20.98 ± 22.60 (VAS). Patients with impacted third molar extraction showed the longest pain duration (6 days) combined with the highest mean pain level of 35.33 ± 30.45 (VAS). Intraoperative suture handling was very good to excellent. Suture removal was done after an average duration of 7.56 ± 2.09 days. Patient's satisfaction was high, and an excellent wound healing was reported by the dentists. Aesthetic appearance only performed in implant patients was rated by oral surgeons with an average of 96.19 ± 3.79 points [min. 80 - max. 100] at 5 months postoperatively. Thread bacterial analysis showed that F. nucleatum was the most present species. CONCLUSIONS: Our findings indicate that the non-absorbable, nylon-based monofilament suture used is safe and quite suitable for oral mucosal closure after various dental surgical interventions such as tooth extraction, implant placement and impacted third molar extraction. CLINICAL SIGNIFICANCE: This study showed the safe use of a non-absorbable, nylon-based monofilament suture for different oral surgical interventions under daily routine clinical practice.

Long-term efficacy of a new 6-session cognitive behavioral therapy for adults with attention-deficit/hyperactivity disorder: A randomized, controlled clinical trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 2.8 % of the adult population. Cognitive behavioral therapy (CBT) has been demonstrated to be the most effective psychological intervention for ADHD. The aim of this study was to explore the efficacy of a new 6-session CBT program in comparison with a 12-session CBT program for adults with ADHD at short- and long-term. METHODS: 81 adults with ADHD (58 % males; mean age = 41.27±9.26 years old) were randomly assigned to each treatment condition (6- or 12-session CBT). Validated instruments were used to assess ADHD symptoms, comorbidities (anxiety and depression), and functional impairments at post treatment, and at 3- and 6-month follow-up. RESULTS: A significant improvement in ADHD severity, comorbidities (anxiety and depression) and functional impairments were found in both CBT programs after treatment. Furthermore, this improvement was also reported at 3- and 6-month follow-up. CONCLUSION: The current study highlights that a 6-session CBT program is as effective as a 12-session CBT program for ADHD improvement at post treatment and follow-up. The newly developed 6-session CBT program can be used to treat a larger number of patients, reducing the financial cost.

Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva / Prone positioning in Covid-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation

Objetivos: Identificar eventos adversos secundarios al decúbito prono (DP) en pacientes con COVID-19 con síndrome de distrés respiratorio agudo (SDRA) moderado/severo, analizar los factores de riesgo para el desarrollo de úlceras por presión (UPP) en DP y describir la evolución oximétrica de estos pacientes durante el DP. Método: Estudio descriptivo retrospectivo realizado sobre 63 pacientes ingresados en la UCI de un hospital de segundo nivel, con neumonía por SARS-CoV-2, SDRA moderado/severo, ventilación mecánica invasiva, que precisaron maniobras de DP, durante marzo y abril de 2020. Se usó un muestreo no probabilístico consecutivo y se analizaron las variables seleccionadas a través de una regresión logística. Resultados: Se realizaron un total de 139 sesiones de pronación. La mediana de sesiones fue de 2 [1-3] y la duración de 22 h [15-24] por sesión. La aparición de eventos adversos ocurrió en 84,9% de los casos, siendo los fisiológicos (por ejemplo, hiper/hipotensión) los más frecuentes. Al comparar pacientes pronados que mantuvieron la integridad cutánea (34 de 63 pacientes, 54%) vs. los que desarrollaron UPP (29 de 63, 46%), estos últimos presentaron los siguientes factores de riesgo: mayor edad, ser hipertensos, prealbúmina < 21 mg/dL, mayor número de sesiones de prono y mayor gravedad al ingreso. Se observó un incremento significativo entre la PaO2/FiO2 previa al DP y en los diferentes cortes temporales durante el prono, además de una caída significativa tras despronar. Conclusiones: Existe una alta incidencia de eventos adversos debidos al DP, siendo los de tipo fisiológico los más frecuentes. La identificación de varios factores de riesgo para el desarrollo de UPP ayudará a prevenir la aparición de estas lesiones durante la pronación. La terapia de DP en pacientes COVID-19 con SDRA moderado/severo ha demostrado una mejora en los parámetros de oxigenación.(AU)

Objective: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. Methods: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22 hours [15-24]. The prevalence of adverse events this population was 84.9%, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin < 21 mg/dL, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. Conclusions: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.(AU)

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation.

OBJECTIVE: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. METHODS: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22h [15-24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. CONCLUSIONS: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

[Prone positioning in Covid-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation]. / Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva.

Objective: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. Methods: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22 hours [15-24]. The prevalence of adverse events this population was 84.9%, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin < 21 mg/dL, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. Conclusions: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Volumetric changes in alveolar ridge preservation with a compromised buccal wall: a systematic review and meta-analysis.

BACKGROUND: Many studies have addressed socket preservation, though fewer publications considering buccal wall loss can be found, since the literature typically considers sockets with four walls. A systematic review was made on the influence of type II buccal bone defects, according to Elian's Classification, in socket grafting materials upon volumetric changes in width and height. MATERIAL AND METHODS: An electronic and manual literature search was conducted in accordance to PRISMA statement. The search strategy was restricted to randomized controlled trials (RCTs) and controlled clinical trials (CCTs) describing post-extraction sockets with loss of buccal wall in which alveolar ridge preservation (ARP) was carried out in the test group and spontaneous healing of the socket (SH) was considered in the control group. RESULTS: The search strategy yielded 7 studies. The meta-analysis showed an additional bone loss of 2.37 mm in width (p > 0.001) and of 1.10 mm in height (p > 0.001) in the absence of ARP. The reconstruction of the vestibular wall was not evaluated in any study. The results also showed moderate to great heterogeneity among the included studies in terms of the changes in width and height. CONCLUSIONS: Despite the heterogeneity of the included studies, the results indicate a benefit of ARP versus SH. Further studies are needed to determine the volumetric changes that occur when performing ARP in the presence of a buccal bone wall defect.

La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar / Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation

Objetivos: El objetivo fue explorar la experiencia de médicos y técnicos en cuidados auxiliares de enfermería (TCAE) respecto al manejo de contenciones mecánicas en unidades de cuidados críticos. Método: Estudio fenomenológico multicéntrico que incluyó 14 unidades de cuidados críticos (UCC) de Madrid (España). Las UCC fueron estratificadas en función del uso de contenciones mecánicas: «uso frecuente» versus «uso escaso». Se realizaron 3 grupos de discusión: el primero compuesto por TCAE procedentes de UCC con uso frecuente de contenciones mecánicas, el segundo grupo por TCAE de UCC de uso escaso de contenciones mecánicas y el último grupo por médicos de ambos subtipos de UCC. Método de muestreo: por propósito. Análisis de datos: análisis temático de contenido. Se alcanzó la saturación de los datos. Resultados: Emergen 4 temas principales: 1) concepto de seguridad y riesgo (seguridad del paciente versus seguridad del profesional); 2) tipos de contenciones; 3) responsabilidades profesionales (prescripción, registro y roles profesionales); y 4) paradigma «contención cero». La conceptualización sobre el uso de contenciones mecánicas muestra diferencias en algunos de los temas principales dependiendo del tipo de UCC en cuanto a políticas, uso y manejo de contenciones mecánicas (uso frecuente versus uso escaso). Conclusiones: La reducción real del uso de contenciones mecánicas en UCC debe partir de un punto clave: la aceptación de la complejidad del fenómeno. El uso de contenciones mecánicas observado en las diferentes UCC está influenciado por factores individuales, grupales y organizativos. Estos factores determinan las interpretaciones que médicos y TCAE realizan sobre seguridad y riesgo, el centro del cuidado (cuidado centrado en el paciente o en el profesional), el concepto de contención, las responsabilidades e intervenciones profesionales y las interacciones del equipo y el liderazgo

Objectives: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. Method; A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. Data analysis: thematic content analysis. Data saturation was achieved. Results: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). Conclusions; The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.

Efecto de una acción formativa en cuidados intensivos sobre la tasa de contaminación de hemocultivos / Effect of a training programme on blood culture contamination rate in critical care

La contaminación de hemocultivos puede ocurrir desde la extracción al procesamiento, y su tasa no debería exceder del 3%. Objetivo: Evaluar el impacto de una acción formativa sobre la tasa de hemocultivos contaminados tras la instauración de recomendaciones de extracción de muestras basadas en la mejor evidencia. Método: Estudio prospectivo antes-después en una unidad de cuidados intensivos polivalente de 18 camas. Se establecieron dos fases (enero-junio 2012, octubre 2012-octubre 2015) con un período formativo entre ellas. Principales recomendaciones: técnica estéril, mascarilla quirúrgica, doble desinfección de piel (alcohol 70° y clorhexidina alcohólica 2%), desinfección con alcohol 70° de tapones de frascos de cultivo e inyección de muestras sin cambiar aguja. Incluidos todos los hemocultivos de pacientes con solicitud facultativa de extracción. Variables: demográficas, gravedad, patología, motivo de ingreso, estancia y resultados de hemocultivos (negativo, positivo y contaminado). Estadística descriptiva básica: media (desviación estándar), mediana (rango intercuartílico) o porcentaje (intervalo de confianza del 95%). Calculadas tasas de contaminación por 100 hemocultivos extraídos. Análisis bivariado entre períodos. Resultados: Incluidos 458 pacientes. Extraídos 841 hemocultivos, 33 de ellos contaminados. En las variables demográficas, gravedad, diagnóstico y estancia en pacientes con contaminación de la muestra, no se observaron diferencias con no contaminados. Tasas de contaminación pre-formación vs post-formación: 14 vs 5,6 por 100 hemocultivos extraídos (p = 0,00003). Conclusión: Una acción formativa basada en la evidencia ha reducido la contaminación de las muestras. Es necesario seguir trabajando en la planificación de actividades y cuidados para mejorar la detección de contaminantes y prevenir la contaminación de las mismas

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. Objective: To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. Method: Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. Variables: demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. Results: Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P = .00003). Conclusion: An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples

Effect of a training programme on blood culture contamination rate in critical care. / Efecto de una acción formativa en cuidados intensivos sobre la tasa de contaminación de hemocultivos.

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. OBJECTIVE: To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. METHOD: Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. VARIABLES: demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. RESULTS: Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003). CONCLUSION: An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.

Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera / Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality

Objetivos: Comprender la experiencia vivida por los enfermeros respecto a la gestión de la inmovilización terapéutica en Unidades de Cuidados Críticos. Explorar similitudes y diferencias en la experiencia enfermera respecto al manejo de la inmovilización terapéutica según el medio en el que están insertos. Método: Estudio fenomenológico multicéntrico en 14 Unidades de Cuidados Críticos de la Comunidad de Madrid estratificadas según el uso de inmovilización terapéutica: frecuente/sistemático, escaso/individualizado y mixto. Recogida de datos: 5 grupos de discusión (23 participantes). Muestreo intencional por propósito. Tamaño muestral: hasta saturación de datos. Análisis crítico temático del contenido guiado por el método de Colaizzi. Resultados: Emergen 6 grandes temas: 1) significado de inmovilización terapéutica en Unidades de Cuidados Críticos, 2) seguridad (autorretirada de dispositivos de soporte vital), 3) factores favorecedores, 4) sentimientos, 5) alternativas y 6) problemas pendientes. Aunque se significan los mismos temas en los 3 tipos de unidades, se observan diferencias en el discurso (indicación, sentimientos, herramientas validadas para la medición de dolor, sedación…). Conclusiones: Para conseguir una reducción real de la inmovilización terapéutica en Unidades de Cuidados Críticos, resulta clave la comprensión profunda de su uso en el medio específico. Al identificarse como eje central la autorretirada de dispositivos de soporte vital, algunas medidas propuestas en otros ámbitos podrían no resultar pertinentes, precisándose alternativas encaminadas a pacientes críticos. Las variaciones del discurso planteadas en los distintos tipos de unidades podrían arrojar luz sobre los puntos clave que determinan las diferencias de uso y actitudes hacia la inmovilización terapéutica

Aims: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. Method: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Findings: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. Conclusions: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. / Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera.

AIMS: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.

Evaluación de un programa de educación sexual sobre conocimientos y conductas sexuales en embarazadas / Evaluation of a sexual education program on knowledge and sexual behaviour in pregnant

Objetivo: Evaluar el nivel de conocimientos de la sexualidad en la gestación previos y posteriores a un programa formativo implementado por un grupo de gestantes en el segundo y tercer trimestre. Material y método: diseño cuasi-experimental pre-post test de un único grupo. Participaron 40 mujeres grávidas de bajo riesgo que se encontraban en su segundo y tercer trimestre de gestación. Todas eran de raza blanca. El 85% de las gestantes comprendían una edad entre 20 y 35 años, un 60% eran primigestas. Resultados: al 60% de las mujeres del estudio les ha afectado el embarazo a su vida sexual. El trimestre que ellas creen que pueden disfrutar más del sexo, en un primer cuestionario el 62.5% contestaron que en el segundo, después de implantar el programa, el 95% dieron esa respuesta. Entre las diferentes técnicas sexuales que existen, el 87.5% la conocían en un principio, después de realizar nuestro programa el porcentaje aumentó a un 97.4%. En cuanto a los beneficios de los ejercicios de Kegel, en un primer cuestionario tan sólo el 25% sabían la respuesta correcta, mientras que más tarde aumentó a un 85% y su práctica era realizada un 12.5% antes de la intervención, y después un 40%. Discusión-Conclusión: después de aplicar nuestro programa específico se notaron algunas mejoras en el nivel de conocimientos y actitudes sexuales aunque debido probablemente a la pequeña muestra utilizada no se han encontrado resultados estadísticamente significativos salvo en una variable (práctica de Kegel) (AU)

Objective: Evaluate the level of knowledge of sexuality in pregnancy before and after a training program implemented by a group of pregnant women in the second and third trimesters. Materials and methods: A quasi-experimental pre-post test single group. A total of 40 pregnant women at low risk who were in their second and third trimester were included. Regarding the ethnical group all women were white. The 85% of pregnant women included had an age between 20 and 35 years and for the 60% it was their first pregnancy. Results: 60% of women have altered her sex life. The initially believed that the most suitable month to enjoy sex live more was on the second trimester, as shown on the first questionnaire (62.5%). After implementing the program, these results increased up to the 95%. Regarding the different sexual techniques, 87.5% knew them at first, after participating in our program this percentage increased to 97.4%. In relation to the benefits of Kegel exercises, in the first questionnaire only 25% knew the correct answer, while after the program increased to 85%. Its practice increased to 12.5% before the intervention, and then a 40% of pregnant women said they knew it and practiced it. Discussion-Conclusion: after applying our specific program noted some improvements in the level of knowledge and sexual attitudes but probably due to the small sample used was not found statistically significant results except for one variable (practice Kegel) (AU)

Consideraciones generales en la atención de urgencia a la paciente obstétrica politraumatizada / General considerations emergency care in the obstetric patient polytrauma

El presente artículo tiene como objetivo principal que los sanitarios conozcan las modificaciones fisiológicas que se producen en la mujer embarazada y que precisan consideraciones especiales en la atención de urgencias prehospitalaria para conseguir mejores resultados materno-fetales. Para su elaboración se ha procedido a una búsqueda sistemática de las principales bases de datos: Cinahl, Pubmed, Cuiden, Cochrane, Google académico y Revista Matronas Profesión con las palabras clave: Politraumatismo y Embarazo. La búsqueda obtuvo un resultado de 55 artículos de los cuales se eliminaron 33 por su falta de validez en la metodología o no estar relacionados con el objeto de estudio. Como conclusión podemos decir que el aumento de la actividad laboral de la mujer, la persistencia en su trabajo hasta el final de su gestación y el mayor uso del automóvil han incrementado las tasas de traumatismos obstétricos y de la morbi-mortalidad de la mujer en los países industrializados (1) siendo la consecuencia más importante la muerte fetal (2), es necesario conocer las modificaciones fisiológicas propias del embarazo y su repercusión en la compensación orgánica para proporcionar la mejor atención posible y mejorar los resultados maternos así como garantizar el mayor bienestar fetal (AU)

This article's main objective is that the toilets are aware of the physiological changes that occur in pregnant women who require special considerations in prehospital emergency care for better maternal and fetal outcomes. Its production has made a systematic search of major databases: Cinahl, Pubmed, Take care, Cochrane, Google Scholar and Midwifery Profession Magazine with keywords: trauma and pregnancy. The search yielded a score of 55 articles of which 33 were eliminated for lack of validity in the methodology or may not be related to the subject matter. In conclusion we can say that the increase in female labor activity, persistence in his work until the end of gestation and greater car use have increased rates of obstetric trauma and morbidity and mortality of women in the industrialized countries (1) being the most important consequence of fetal death (2), it is necessary to understand the physiological changes of pregnancy and their own impact on the organic compensation to provide the best care possible and to improve maternal outcomes and ensure the greater good fetal (AU)

Assessment of Fenton's reagent and ozonation as pre-treatments for increasing the biodegradability of aqueous diethanolamine solutions from an oil refinery gas sweetening process.

The aim of this work was to evaluate the efficiency of three chemical oxidation processes for increasing the biodegradability of aqueous diethanolamine solutions (aqueous DEA solutions), to be used as pre-treatments before a biological process. The raw aqueous DEA solution, sourced from a sour gas sweetening plant at a Mexican oil refinery, was first characterized by standardized physico-chemical methods. Then experiments were conducted on diluted aqueous DEA solutions to test the effects of Fenton's reagent, ozone and ozone-hydrogen peroxide on the removal of some physicochemical parameters of these solutions. Lastly, biodegradability tests based on Dissolved Organic Carbon Die Away OECD301-A, were carried out on a dilution of the raw aqueous DEA solution and on the treated aqueous DEA solutions, produced by applying the best experimental conditions determined during the aforementioned oxidation tests. Experimental results showed that for aqueous DEA solutions treated with Fenton's reagent, the best degradation rate (70%) was obtained at pH 2.8, with Fe(2+) and H(2)O(2) at doses of 1000 and 10,000 mg/L respectively. In the ozone process, the best degradation (60%) was observed in aqueous DEA solution (100 mg COD/L), using 100 mg O(3)/L at pH 5. In the ozone-hydrogen peroxide process, no COD or DOC removals were observed. The diluted spent diethanolamine solution showed its greatest increase in biodegradability after a reaction period of 28 days when treated with Fenton's reagent, but after only 15 days in the case of ozonation.

[Terminal ileitis due to Yersinia enterocolitica in infants]. / Ileítis terminal por Yersinia enterocolitica en lactantes.

Yersinia enterocolitica infection presents a wide clinical spectrum; in infants and young children it usually presents as uncomplicated acute diarrhea, while in older children and adolescents it more frequently presents as terminal ileitis and/or mesenteric adenitis. We describe two infants who developed terminal ileitis complicating Y. enterocolitica infection, which is exceptionally rare. The clinical, laboratory and radiologic findings are described and ultrasound study is emphasized as a simple and reliable tool for investigation of terminal ileitis.

Ileítis terminal por Yersinia enterocolitica en lactantes / Terminal ileitis due to Yersinia enterocolitica in infants

Dentro del amplio espectro clínico de la infección por Yersinia enterocolitica, en los lactantes y niños pequeños la manifestación más frecuente es la diarrea aguda que cursa sin complicaciones. En los niños mayores y adolescentes suele presentarse con más frecuencia como una ileítis terminal y/o adenitis mesentérica. Se presentan dos casos de ileítis terminal durante una infección por Y. enterocolitica en lactantes, hecho excepcional en la literatura médica, y se describen los datos clínicos y exámenes complementarios más relevantes, entre los que destaca la ecografía, prueba fiable y sencilla, que nos documenta dicha afectación

Yersinia enterocolitica infection presents a wide clinical spectrum; in infants and young children it usually presents as uncomplicated acute diarrhea, while in older children and adolescents it more frequently presents as terminal ileitis and/or mesenteric adenitis. We describe two infants who developed terminal ileitis complicating Y. enterocolitica infection, which is exceptionally rare. The clinical, laboratory and radiologic findings are described and ultrasound study is emphasized as a simple and reliable tool for investigation of terminal ileitis

Demanda y asistencia en un servicio de urgencias hospitalario / Patient demand and management in a hospital pediatric emergency setting

Objetivo: Estudiar la demanda y la asistencia en una Unidad de Urgencias de Pediatría hospitalaria. Pacientes y método: Se analiza la evolución del número de episodios registrados en Urgencias de Pediatría entre 1995 y 2002 y se realiza un estudio retrospectivo aleatorio de 540 episodios correspondientes a niños menores de 14 años entre el 1 de octubre de 2001 y el 30 de septiembre de 2002. Se recogen datos sociodemográficos y del episodio, hallazgos exploratorios, pruebas complementarias, tratamiento administrado, destino de los pacientes y reconsulta. Resultados: Entre el 1 de enero de 1995 y el 31 de diciembre de 2002, se registraron 337.842 episodios en la Unidad de Urgencias, precisando ingreso en planta o Unidad de Cuidados Intensivos Pediátricos (UCIP) 11.767 (3,48 por ciento). El número de episodios/año registrados pasó de 38.659 en 1995 a 51.933 en 2002 (Delta= 34,3 por ciento). La edad media de la muestra estudiada (n= 540) fue 3,5+/- 3,2 años (54,6 por ciento menores de 3 años), que se distribuyeron en 306 (56 por ciento) varones. Cerca de un tercio consultó por cuadros de menos de 6 h de evolución. Los motivos de consulta más frecuentes fueron fiebre en 160 (29,6 por ciento), dificultad respiratoria en 78 (14,4 por ciento) y vómitos-diarrea en 65 (12 por ciento). Se practicaron pruebas a 176 (32,6 por ciento), fundamentalmente radiológicas (115; 21,2 por ciento). Recibieron tratamiento en urgencias 153 casos (28,3 por ciento), sobre todo antitérmicos y broncodilatadores. El 65 por ciento permaneció menos de 1 h en Urgencias. Los diagnósticos principales fueron síndrome febril en 66 (12,2 por ciento), diarrea/gastroenteritis aguda en 40 (7,4 por ciento), asma en 35 (6,5 por ciento), laringitis en 27 (5 por ciento). Ingresaron en planta 16 niños (3 por ciento) y 3 (0,6 por ciento) en la UCIP. Se recomendó tratamiento farmacológico domiciliario a 359 (71,8 por ciento). Reconsultaron 59 pacientes (10,9 por ciento), e ingresaron 5 casos. Conclusiones: El número de pacientes atendidos entre 1995 y 2002 en la Unidad de Urgencias de Pediatría ha crecido de manera paulatina por lo general por niños pequeños con cuadros febriles recortados o dificultad respiratoria. En la mitad de los casos una correcta anamnesis y exploración física fueron suficientes para manejar a estos niños. La corta evolución de muchos procesos hacen de la observación continuada, ya domiciliaria o intrahospitalaria, una herramienta importante en el correcto seguimiento de nuestros pacientes (AU)