Professional profile and work conditions of nurses working in intensive care units: A multicentre study.

AIM: To determine the professional profile and the work conditions of nurses working in intensive care units (ICU) in Colombia, Argentina, Peru and Brazil. BACKGROUND: ICUs require a differentiated professional profile to provide quality care, and appropriate working conditions, leading to a transformation of care and management practices. DESIGN: Descriptive multicentre cross-sectional observational study. METHODS: An online survey was applied to identify both the characteristics of the professional profile and the working conditions. 1,427 ICU nursing professionals were included. RStudio statistical software was used for the analysis of the information. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross-sectional studies was used in this study. RESULTS: Only 33.6% of the professionals had a specialisation degree in intensive care. The skills that were most frequently put into practice were communication (68.5%) and care management (78.5%). The most predominant nurse-to-patient ratios were 1:2, and greater than 1:6. 59.1% of the nurses had an indefinite term contract, 38.8% worked 48 hours per week and 49.8% had rotating shifts. Only 50.4% of them received incentives. The average salary ranged between 348 and 1,500 USD. 64.5% of the participants were satisfied with their job. CONCLUSION: It is necessary to strengthen nurses' professional profile by promoting both postgraduate education and the development of troubleshooting and teamwork skills. It is necessary to standardise the nurse-to-patient ratio, improve wages and increase incentives to achieve greater job satisfaction. RELEVANCE TO PRACTICE: The knowledge and the improvement of both the professional profile and the work conditions of nurses working in intensive care units will improve the quality of the care given to critical patients and, therefore, the quality of health outcomes.

Comparison of long-term clinical evolution in highly myopic eyes with vertical oval-shaped dome with or without untreated serous retinal detachment.

BACKGROUND: To compare the long-term clinical evolution of highly myopic eyes with vertical oval-shaped dome associated with or without untreated serous retinal detachment. METHODS: Twenty-eight patients with high myopia (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmological examinations, including optical coherence tomography at baseline every 6 months for 2 years. Fluorescein angiographies were performed in cases with serous retinal detachment to rule out choroidal neovascularisation. RESULTS: There were no statistical differences in baseline age, sex, spherical equivalence or axial length between the two groups. Serous retinal detachment always occurred at the top of the inward macular incurvation. Moreover, no statistically significant differences in mean best-corrected visual acuity were observed during the 24-month follow-up period in the study and control groups and between the two groups at all time points. The mean central foveal thickness was significantly higher in the study group at each visit (p=0.001, in all cases). At the final follow-up visit, complete resolution of the serous retinal detachment was achieved in 1 of the 11 study group's eyes. CONCLUSIONS: Serous retinal detachment is a complication associated with vertical oval-shaped domes that seems to remain stable in terms of visual function over time without treatment.

Análisis de las diferencias cuantitativas en el grosor de la capa de fibras nerviosas retiniana entre la tomografía de coherencia óptica de dominio-tiempo y de dominio-espectral en pacientes con esclerosis múltiple remitente recurrente / Analysis of the quantitative differences in the thickness of the retinal nerve fibre layer between time-domain and spectral-domain optical coherence tomography in patients with relapsing-remitting multiple sclerosis

Introducción. La tomografía de coherencia óptica (OCT) es una herramienta cada vez más extendida en el estudio de las enfermedades neurodegenerativas. Objetivos. Analizar y correlacionar el grosor de la capa de fibras nerviosas retiniana (CFNR) mediante OCT de dominio-tiempo y dominio-espectral en pacientes con esclerosis múltiple (EM) remitente recurrente, con y sin antecedente de neuritis óptica (NO). Sujetos y métodos. Estudio transversal del grosor medio y por cuadrantes de la CFNR en 15 sujetos libres de enfermedad, 28 con EM sin historia previa de NO y 18 con antecedentes de NO. La exploración oftalmológica completa incluía la medición de la CFNR mediante tomógrafos de dominio-tiempo y dominio-espectral. Resultados. Existen diferencias estadísticamente significativas entre ambos tomógrafos al comparar el grosor medio de la CFNR en el grupo control (p = 0,000), el grupo con antecedentes de NO (p = 0,000) y el grupo sin NO (p = 0,000). Hemos obtenido una fuerte correlación, estadísticamente significativa y directamente proporcional entre el grosor medio de la CFNR medido con ambos tomógrafos en el grupo control (rho = 0,842; p = 0,000), y los grupos de ojos sin NO (rho = 0,91; p = 0,000) y con NO (rho = 0,902; p = 0,000). Conclusiones. Existe una fuerte correlación en la medición del grosor de la CFNR entre ambos tomógrafos en pacientes con EM, con y sin antecedente de NO. La OCT de dominio-tiempo cuantifica grosores mayores, por lo que ambos tomógrafos se demuestran eficaces en el estudio de la EM, aunque los resultados no son intercambiables ni extrapolables (AU)

Introduction. Optical coherence tomography (OCT) is a tool that is increasingly more commonly used in the study of neurodegenerative diseases. Aims. To analyse and correlate the thickness of the retinal nerve fibre layer (RNFL) by means of time-domain and spectraldomain OCT in patients with relapsing-remitting multiple sclerosis (MS), with and without a history of optic neuritis (ON). Subjects and methods. We conducted a cross-sectional study of the thickness (mean and by quadrants) of the RNFL of 15 disease-free subjects, 28 with MS with no prior history of ON and 18 with a history of ON. The full ophthalmologic examination included measurement of the RNFL by means of time-domain and spectral-domain tomography. Results. Statistically significant differences are found between the two tomography scans on comparing the mean thickness of the RNFL of the control group (p = 0.000), the group with a history of ON (p = 0.000) and the group without ON (p = 0.000). We obtained a strong, statistically significant and directly proportional correlation between the mean thickness of the RNFL measured with the two types of tomography in the control group (rho = 0.842; p = 0.000), and the groups of eyes without ON (rho = 0.91; p = 0.000) and with ON (rho = 0.902; p = 0.000). Conclusions. There is a strong correlation between the two tomography scans in the measurement of the thickness of the RNFL in patients with MS, with and without a history of ON. Time-domain OCT quantifies greater thicknesses, and therefore both types of tomography have proven to be effective in the study of MS, although the results cannot be interchanged or extrapolated (AU)

Two- and three-dimensional topographic analysis of pathologically myopic eyes with dome-shaped macula and inferior staphyloma by spectral domain optical coherence tomography.

PURPOSE: To investigate the posterior anatomical structure of pathologically myopic eyes with dome-shaped macula and inferior staphyloma using spectral domain optical coherence tomography (SD-OCT). METHODS: Our database of 260 pathologically myopic eyes was analyzed retrospectively to identify patients with dome-shaped macula and inferior staphyloma. All patients underwent vertical and horizontal SD-OCT scans across the central fovea, with three-dimensional macular map reconstruction. Best-corrected visual acuity, axial length, and choroidal thickness measurements were recorded. The macular bulge height was also analyzed in eyes with dome-shaped macula. In the three-dimensional images, the symmetry and orientation of the main plane of the inward incurvation of the macula were examined. RESULTS: Twenty-eight (10.7%) of the 260 pathologically myopic eyes had dome-shaped macula of one of three different types: a round radially symmetrical dome (eight eyes, 28.5%), a horizontal axially symmetrical oval-shaped dome (15 eyes, 53.5%), or a vertical axially symmetrical oval-shaped dome (five eyes, 17.8%). The macular bulge height was significantly greater in horizontal oval-shaped dome eyes (p = 0.01, for each comparison). Inferior posterior staphylomas were observed in ten (3.8%) of the 260 pathologically myopic eyes with asymmetrical macular bends. CONCLUSIONS: Vertical and horizontal OCT sectional scanning in combination with three-dimensional macular map reconstruction provides important information for understanding the posterior anatomical structure of dome-shaped macula and inferior staphyloma in pathologically myopic eyes.

Comodidad de los pacientes hospitalizados en unidades de cuidado intensivo e intermedio / Comfort of hospitalized patients in intermediate and intensive care units

Objetivo: Asociar los factores sociodemográficos a las dimensiones de la comodidad (físico, social, psicoespiritual y ambiental) de los pacientes hospitalizados en las Unidades de Cuidado Intensivo e Intermedio. Metodología: Estudio analítico transversal, realizado a 160 pacientes hospitalizados en las Unidades de Cuidado Intensivo e intermedio de cuatro instituciones de la ciudad de Cartagena, durante los meses de Julio a Septiembre del 2014. Se utilizaron dos instrumentos, la encuesta sociodemográfica y el cuestionario general de comodidad de Kolcaba. Se utilizaron la estadística descriptiva y una prueba de regresión logística para el manejo de los datos. Resultado: El 57,5% de los participantes fueron mujeres con 51,7 años como edad promedio, con pareja estable el 76.9%, secundaria (incompleta y completa) el 43.4%. Predominó en los participantes, el tipo de confort trascendencia en las dimensiones social, psicoespiritual y física y en la dimensión ambiental el tipo de confort alcanzado fue la tranquilidad. Se encontró asociación entre las dimensiones física, social y ambiental con ser de un estrato socioeconómico mayor que 2 y contar con estudios de secundaria o superiores. La dimensión psicoespiritual no presentó asociación con los factores sociodemográficos. Conclusiones: Los pacientes hospitalizados en la UCI o en la UCIN con un mayor estrato socioeconómico presentaron menor probabilidad de sentir comodidad durante su hospitalización; en la dimensión social, los pacientes con mayor educación tuvieron mayor probabilidad de sentirse cómodo. El pertenecer a un estrato socioeconómico mayor que 2, reduce la probabilidad de que el paciente hospitalizado se sienta cómodo en las dimensiones ambiental y física (AU)

Objective: Associate the sociodemographic factors to the contexts of comfort (physical, social, psycho-spiritual and environmental) of hospitalized patients in the Intermediate and Intensive Care Unit. Methodology: Analytical cross-sectional study, performed to 160 hospitalized patients in Intermediate and Intensive Care Units of four institutions in the city of Cartagena, during the months of July to September of 2014. Two instruments were used, the socio-demographic survey and the general comfort questionnaire developed by Kolcaba. Descriptive and logistic regression statistics were used for data management. Result: 57.5% of participants were women with average age of 51.7 years, with 76.9% with a steady partner, secondary (incomplete and complete) 43.4%. Transcendence was the kind of comfort that was prevailed on participants for social, psycho-spiritual and physical dimensions; for environmental dimension, tranquility was the kind of comfort achieved. It was found an association between physical, social and environmental dimensions for patients with a socioeconomic stratum higher than 2 and with secondary level educational or higher. The psycho-spiritual dimension did not showed an association with socio-demographic factors. Conclusions: Patients hospitalized in the ICU or NICU with high socioeconomic status were less likely to feel comfort during hospitalization; in the social dimension, patients with high educational level were more likely to feel comfortable. To belong to a socioeconomic status higher than 2, reduce the likelihood that the hospitalized patient feel comfortable in the environmental and physical dimensions (AU)

Dellen and corneal perforation after bilateral pterygium excision in a patient with no risk factors.

Corneal perforation associated with dellen is a rare but serious complication of a primary pterygium excision. In this case report, we describe a 60-year-old man who underwent a corneal perforation in the centre of corneal dellen in his right eye and corneal dellen in his left eye after the surgical treatment of a bilateral pterygium with a bare sclera technique without adjunctive therapy. He was successfully treated with lamellar keratoplasty in his right eye and a conservative approach in his left eye, consisting of the use of artificial tears, antibiotic ointment and a patch. The clinical evidence from this brief interventional case report indicates that topical lubricants are proper therapy for corneal dellen. However, if corneal perforation is observed, lamellar keratoplasty is a good option.

Leptospirosis en el entorno actual / Leptospirosis in present environment

La leptospirosis constituye un grupo de infecciones que se caracterizan por manifestaciones variables como fiebre, cefalea, escalofríos, malestar intenso, vómitos, dolores musculares y conjuntivitis. Su distribución es a nivel mundial, aunque tiene mayor incidencia en las zonas tropicales, asociado también a la expansión poblacional, sobre todo en países en vías de desarrollo. Se considera una enfermedad endémica, epidémica y reemergente. Se realizó una revisión bibliográfica, utilizando los recursos disponibles en la red Infomed, con el objetivo de actualizar conocimientos sobre sus causas, diagnóstico y tratamiento. Se consultaron diferentes bases de datos especializadas como: Medline, Mediclatina, PubMed, Hinari y Scielo. El diagnóstico de la leptospirosis comprende aspectos de lo clínico, bacteriológico, molecular y serológico, requiriendo de un diagnóstico integral. El tratamiento de elección sigue siendo la penicilina. Además de la quimioterapia específica son necesarias las medidas sintomáticas, la corrección de las alteraciones hemodinámicas, del equilibrio hidroelectrolítico, la asistencia renal y otras medidas de soporte vital (AU)

Leptospirosis is a group of infections that are characterized by diverse manifestations, such as fever, headache, chills, severe malaise, vomiting, muscle pain and conjunctivitis. It is spread all over the world, although it has a higher incidence in the tropical regions, also associated to the population expansion, especially in developing countries. It is considered an endemic, epidemic and reemerging disease. A bibliographical revision, using the resources available in Infomed network, was carried out with the objective to update knowledge about its causes, diagnosis and treatment. Different specialized data base, such as Medline, Mediclatina, PubMed, Hinari and Scielo were consulted. The diagnosis of leptospirosis covers clinical, bacteriologic, molecular and serologic aspects, requiring an integral diagnosis. Penicillin is still the choice treatment. Besides the specific chemotherapy, the symptomatic measures, the correction of hemodynamic alterations, the hydro-electrolyte balance, the renal care and other life support are necessary (AU)