Dr Graham Steell and monaural stethoscopes: Cardiology before the ECG.

Dr Graham Steell, MB CM MD FRCP (1851-1942), an Edinburgh graduate, was a physician at the Manchester Royal Infirmary (1878-1911) and professor of medicine at the Victoria Manchester University (1907-1911). He is mainly remembered for describing the 'Graham Steel murmur', however his name is also associated with the 'Graham Steell monaural stethoscope', which he designed. His clinical examination of the cardiovascular system at the bedside was meticulous, using only his stethoscope, percussion hammer, and a sphygmograph to record the radial pulse. His work is described in his monograph, Diseases of the Heart (1906) and other numerous papers. The University of Manchester Museum of Medicine and Health has a collection of monaural stethoscopes, percussors and sphygmographs. This article explores Dr Steell's clinical techniques and contribution to cardiology in an era before chest X-rays and electrocardiography, and also discusses the use of monaural stethoscopes and percussion hammers by the wider medical profession during the Victorian and Edwardian period.

Estilos de vida de estudiantes de la Escuela Universitaria de Enfermería de la Universidad Nacional de Tucumán, Argentina

Fundamento: el estilo de vida saludable se erige como un factor protector contra el desarrollo de diversas enfermedades crónicas, y en el caso del estudiante de enfermería, su adopción incide en la eficacia de su futura práctica profesional como educador en salud, también sobre la calidad de la atención prestada. Objetivo: describir los comportamientos asociados a los estilos de vida de los estudiantes de la Escuela Universitaria de Enfermería de la Universidad Nacional de Tucumán en Argentina. Métodos: se realizó un estudio descriptivo, transversal y cuantitativo. Se encuestaron a 406 estudiantes con el cuestionario Health Promoting Life Profile II bajo el modelo de Nola Pender. El instrumento obtuvo un alfa de Cronbach de 0,93 (alta fiabilidad) en la población estudiada. Resultados: la media de edad fue de 28,63 años. Predominaron las mujeres, solteras y estudiantes de primer año. El crecimiento espiritual y el manejo del estrés fueron las dimensiones con el mayor y menor puntaje, respectivamente. La media del estilo de vida fue de 117,17 (DE: 20,10; IC 95 %: 115,21-119,14) con una caracterización de regular. Conclusión: el 3,94 % de los encuestados obtuvieron un estilo de vida evaluado como saludable, y las variables que incidieron fueron: la edad, el sexo, el estado civil y el año del plan de estudios en el que se encuentran inscritos. Se requiere del diseño e implementación de acciones que favorezcan la adopción de estilos de vida que promuevan un estado saludable en los estudiantes de enfermería para disminuir el riesgo de padecer enfermedades crónicas no transmisibles y contribuyan a formarlos como promotores de salud.

Background: the healthy lifestyle is established as a shielding factor against the development of diverse chronic illnesses, and in the case of the infirmary student, its adoption impacts in the effectiveness of its future professional practice as educator in health, also about the quality of the borrowed attention. Objective: to describe the behaviors associated to the lifestyles of the students of the University School of Infirmary of the National University of Tucumán in Argentina. Methods: a descriptive, traverse and quantitative study was carried out. 406 students were interviewed with the questionnaire Health Promoting Life Profile II under the Nola Pender pattern. The instrument obtained an alpha of Cronbach of 0,93 (high reliability) in the studied population. Results: the typical age was of 28,63 years. The feminine sex, single and students of the first year. Spiritual growth and manage of the stress were the dimensions with the adult and smaller punctuation, respectively. The average of the lifestyle was of 117,17 (OF: 20,10; IC 95 %: 115,21-119,14) with a characterization of regulating. Conclusion: 3,94 % of those interviewed obtained a lifestyle evaluated as healthy, and the variables that impacted were the age, the sex, the civil state and the year of the plan of studies in which they are inscribed. Its required of the design and implementation of actions them to favor the adoption of healthy lifestyles in the infirmary students to diminish the risk of suffering chronic not transmissible illnesses and contributes to his education on health education.

Desafíos de los servicios de la enfermería en Cuba

La enfermería se define como una profesión de servicio. Se encarga de brindar cuidados a personas de todas las edades, familias, grupos y comunidades que se encuentren sanas o enfermas. La formación, superación y especialización se desarrolla en las universidades de Ciencias Médicas distribuidas a lo largo del territorio nacional, y responde al encargo social. En la formación del personal de enfermería, es necesario aumentar sustancialmente la capacitación y contratación de este grupo de profesionales en salud, que constituye uno de los principales objetivos de la agenda 2030 para el desarrollo sostenible. Sin embargo, en la actualidad, cerca de la mitad de la población mundial carece de acceso integral a los servicios de salud. Dentro de los objetivos del desarrollo sostenible en Cuba tiene implícito desarrollar la formación vocacional, modificar los programas de formación de enfermeros desde, el nivel técnico, profesionales y especialistas, actualizar las prácticas profesionales y estimular la investigación científica en todos los niveles del sector salud.

Nursing is defined as a service profession. It is responsible for providing care to people of all ages, families, groups and communities who are healthy or sick. The training, improvement and specialization is developed in the universities of Medical Sciences distributed throughout the national territory, and responds to the social commission. In the training of nursing personnel, it is necessary to substantially increase the training and hiring of this group of health professionals, which is one of the main objectives of the 2030 agenda for sustainable development. However, today, about half of the population The world lacks comprehensive access to health services. Within the objectives of sustainable development in Cuba, it is implicit to develop vocational training, modify the training programs for nurses from the technical level, professionals and specialists, update professional practices and stimulate scientific research at all levels of the health sector.

A enfermagem é definida como uma profissão de serviço. É responsável por prestar cuidados a pessoas de todas as idades, famílias, grupos e comunidades saudáveis ou doentes. A formação, aperfeiçoamento e especialização é desenvolvida nas universidades de Ciências Médicas distribuídas por todo o território nacional, e responde à comissão social. Na formação de pessoal de enfermagem, é necessário aumentar substancialmente a capacitação e contratação desse grupo de profissionais de saúde, que é um dos principais objetivos da agenda 2030 para o desenvolvimento sustentável. No entanto, atualmente, cerca de metade da população mundial não tem acesso integral aos serviços de saúde. Dentro dos objetivos do desenvolvimento sustentável em Cuba, está implícito desenvolver a formação profissional, modificar os programas de formação de enfermeiros de nível técnico, profissionais e especialistas, atualizar as práticas profissionais e estimular a pesquisa científica em todos os níveis do setor saúde.

Initial Experience With Trans-anal Minimally Invasive Surgery (TAMIS) for Rectal Polyps and Early Colorectal Cancers at Cumberland Infirmary, Carlisle.

INTRODUCTION: Bowel cancer is the fourth most common type of cancer in the United Kingdom in 2019. Total mesorectal excision is the standard procedure for the removal of rectal tumors, however, it comes with serious side effects. Therefore, less invasive procedures and sphincter preservation techniques have been developed, like conventional trans-anal excision, and trans-anal endoscopic microsurgery (TEM). In 2010, trans-anal minimally invasive surgery (TAMIS) was introduced as an alternative to TEM, which offers the same benefits as TEM but at a lower cost and without the need for specialized instrumentation. This study aims to assess the practicability and safety of this technique and to report its findings.  Methods: Retrospective data of all patients who underwent TAMIS at Cumberland Infirmary (Carlisle, UK) from July 2017 to July 2022 for large benign rectal polyps or early rectal cancer were collected. Variables collected included patients' age, gender, number of procedures per year, perioperative outcome, and histopathology outcome. The SPSS version 21 (IBM Corp., Armonk, NY, USA) was used for both descriptive and inferential analyses of the data. RESULTS: During a five-year period, 42 patients underwent TAMIS at Cumberland Infirmary. The primary indication for TAMIS was distal rectal lesions, large rectal polyps up to 120 mm, and early rectal cancer (T1). The median age of the assessed patients at the time of surgery was 71 years with 64.29% (27) male and 35.71% (15) female. The mean operating time was 123 minutes (range 45 to 240 minutes). The surgical and pathological outcome included a mean polyp size of 6 cm (+/- 0.8 cm), a rate of specimen fragmentation at 19.04% (n=8), and a rate of positive margins at 04.76% (n=2), whereas histology of 73.81% (n=31) was tubulovillous adenoma and 11.91% (n=5) was adenocarcinoma. There was no 30-day postoperative mortality, however, the 30-day re-operation rate was 02.39% (n=1) and the recurrence rate which needed further intervention was 26.19% (n=11). CONCLUSION: Our findings suggest that TAMIS produces positive results. The size of the lesions removed, and the effect of an early learning curve are reflected in the rate of specimen fragmentation and polyp recurrence. Nonetheless, TAMIS is a safe and effective alternative to total mesorectal excision for certain types of rectal lesions and should be used for more proximal and complex rectal lesions.

La Enfermería Militar Española en la época de Florence Nightingale (1820-1910) / A Enfermagem Militar Espanhola na época de Florence Nightingale (1820-1910) / The Spanish Military Nursing at the time of Florence Nightingale (1820-1910)

En el presente artículo se refiere la trayectoria de la Enfermería Militar Española desde el siglo XV hasta inicios del XX, resaltando el auge que tuvo durante el siglo XVIII en el seno del Real Colegio de Cirugía de la Armada de Cádiz, en el que por primera vez en la historia se unificaron los estudios de Medicina y Cirugía en una misma titulación. Se continúa con las innovaciones de las ciencias médicas durante la segunda mitad del siglo XIX —en especial en las que se inspiró Florence Nightingale para iniciar su revolución en la Enfermería—, los avatares de los enfermeros militares españoles en el convulso siglo XIX y los avances normativos experimentados tras la Revolución de 1868. Se prosigue con un recuerdo a las Hijas de la Caridad de San Vicente de Paul que llegaron a los hospitales militares en 1870, en una época en la que las infecciones —en especial la tuberculosis— causaban una elevada mortalidad en la población castrense. Se ultima con un homenaje a la enfermería militar y unas conclusiones a modo de reflexiones.(AU)

This article refers to the trajectory ofthe Spanish Military Nursing from thefifteenth century to the beginning of thetwentieth century, highlighting the boomthat had during the eighteenth century withinthe Royal College of Surgery of the CadizNavy, in which for the first time in historythe studies of Medicine and Surgery wereunified in the same degree. The innovationsof the medical sciences continue during thesecond half of the nineteenth century —especially those inspired by FlorenceNightingale to start her revolution inNursing—, the avatars of Spanish militarynurses in the convulsive 19th century, andthe regulatory advances experienced afterthe 1868 Revolution. A memory continues tobe followed by the Daughters of Charity ofSt. Vincent de Paul who arrived at militaryhospitals in 1870 at a time when infections,especially tuberculosis, caused highmortality in the military population. It isfinalized with a tribute to military nursingand conclusions as reflections.(AU)

Este artigo refere-se à trajetória daEnfermagem Militar Espanhola do séculoXV ao início do século XX, destacando oboom que teve durante o século XVIIIdentro do Colégio Real de Cirurgia daMarinha de Cádiz, no qual pela primeira vezna história os estudos de Medicina e Cirurgiaforam unificados no mesmo grau. As inovações das ciências médicas continuamdurante a segunda metade do século XIX,especialmente aquelas inspiradas porFlorence Nightingale para iniciar suarevolução na Enfermagem, os avatares dasenfermeiras militares espanholas no séculoXIX convulsivo, e os avanços regulatóriosexperimentados após a Revolução de 1868.A memória continua a ser seguida pelasFilhas da Caridade de São Vicente de Paulo,que chegaram a hospitais militares em 1870,numa época em que infecções,especialmente a tuberculose, causavam altamortalidade na população castrense. Éfinalizado com uma homenagem àenfermagem militar e conclusões comoreflexões.(AU)

Lillias Hamilton: Personal physician to the Amir of Afghanistan.

Lillias Hamilton trained as a doctor in London, qualified in 1890 and practiced in Calcutta and later in Afghanistan where she was the personal physician to the Amir and the only Western doctor. After six years abroad, she returned to England but owing partly to establishment prejudice was unsuccessful in setting up a London practice and eventually became the Principal of a Women's Agricultural College. Her career illustrates the aspects of medical practice abroad in the 1890s, as well as the difficulties encountered by women doctors in England even after the route to qualification in the UK had been opened.

John Marshall Cowan: An appreciation.

John Marshall Cowan (1870-1947) descended from a long line of Glasgow medical practitioners. He was at the forefront in the great advances made in cardiology during the first quarter of the 20th century. He was a founder member of the Cardiac Club and the principal author of a major text book Diseases of the Heart, first published in 1914. He had a distinguished military career and was physician in charge of wards in the Royal Infirmary, Glasgow and Professor of Medicine at Anderson's College, Glasgow. This article outlines Cowan's life, career and publications and also provides an examination of his magnum opus, Diseases of the Heart.

Bruxismo y estrés académico en estudiantes de las ciencias médicas / Bruxism and academic stress in students of the medical sciences

RESUMEN Fundamento: Los estudiantes de las carreras de las ciencias médicas, especialmente los de nuevo ingreso, se desarrollan en un ambiente estresante, debido al desequilibrio emocional provocado por las exigencias del proceso enseñanza-aprendizaje; situación que, de no ser atendida de manera adecuada, puede desencadenar en la aparición del bruxismo. Objetivo: Describir el comportamiento del bruxismo relacionado con el estrés académico en los estudiantes del primer año de Medicina, Estomatología y Enfermería de la Universidad de Ciencias Médicas de Camagüey. Método: Se realizó un estudio descriptivo y transversal durante el período comprendido entre octubre de 2018 y marzo de 2020. El universo estuvo constituido por 748 estudiantes de primer año de las carreras mencionadas, de los cursos académicos 2018-2019 y 2019-2020. La muestra seleccionada de forma aleatoria, estuvo integrada por 90 estudiantes. Resultados: Más de la mitad de los examinados se diagnosticó como bruxópatas, con predominio del bruxismo céntrico. Los estudiantes de Medicina resultaron los de mayor afectación. Los síntomas más frecuentes fueron el dolor muscular, el apretamiento dentario referido, así como el dolor articular y los signos, la hipertrofia muscular y las facetas de desgaste parafuncional a nivel de esmalte. Discusión: Se constató el predominio de casos con niveles de estrés académico moderado seguido por niveles de estrés leve. Casi la totalidad de estos pacientes presentaron bruxismo, con prevalencia del tipo céntrico.

ABSTRACT Introduction: The students of the specialties of the medical sciences, especially those of 1st year, develop themselves in a stressful ambience, due to the emotional imbalance provoked by the requirements of the teaching - learning process; situation that, of not being attended in a suitable way, can unleash in the appearance of the bruxism. That´s why, the present work takes as objective to describe the behavior of the bruxism related to the academic stress in the students of the first year of Medicine, Dentistry and Infirmary of the University of Medical Sciences of Camagüey. Method: A descriptive and cross-sectional study was carried out during the period understood between October, 2018 and March, 2020. The universe was constituted by 748 students of the first year of the mentioned specialties, of the academic courses 2018-2019 and 2019-2020. The chosen sample of random form was integrated by 90 students. Results: More than half of the examined students were diagnosed with bruxism, with predominance of the central bruxism. The Medicine students resulted to be those of major affectation. The most frequent symptoms were the muscular pain, the above-mentioned dental grinding, as well as the pain to articulate and the signs, the muscular hypertrophy and the facets of parafunctional wear at enamel level. Discussion: The cases predominance was stated at levels of moderate academic stress continued by levels of light stress. Almost the totality of these patients presented bruxism, with predominance of the central type.

Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose.

BACKGROUND: Acetylcysteine (NAC) is effective at preventing liver injury after paracetamol overdose. The Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) Study demonstrated that a 12 h NAC regimen was associated with fewer adverse drug reactions compared with the standard 21 h regimen. Here, we describe the clinical effectiveness of the SNAP NAC regimen. METHODS: The SNAP regimen, consisting of intravenous NAC 100 mg/kg over 2 h then 200 mg/kg over 10 h, was introduced to treat all paracetamol overdose patients at the Royal Infirmary of Edinburgh, the Royal Victoria Infirmary, Newcastle and St Thomas' Hospital, London. Patient data were prospectively and systematically collected before and after the change in treatment (total patients N = 3340, 21 h N = 1488, SNAP N = 1852). Health record linkage was used to determine patient outcome after hospital discharge. FINDINGS: There was no difference in liver injury or liver synthetic dysfunction between regimens. Hepatotoxicity (peak ALT > 1000 U/L) occurred in 64 (4.3%) and 67 (3.6%) patients, respectively, in the 21 h and SNAP groups (absolute difference - 0.7%, 95% CI - 2.1 to 0.6). Multivariable logistic regression did not identify treatment regimen as an outcome-associated factor. No patients were readmitted to hospital with, or died from, liver failure within 30 days of discharge. Anti-histamine treatment (for NAC anaphylactoid drug reactions) was prescribed for 163 (11.0%) patients with the 21 h regimen and 37 (2.0%) patients with the SNAP regimen (absolute difference 9.0% (95% CI 7.3 to 10.7)). INTERPRETATION: In clinical use the SNAP regimen has similar efficacy as standard therapy for preventing liver injury and produces fewer adverse reactions.

Desarrollo socio sanitario de un asentamiento rural desde la perspectiva de las ciencias sociales / Social sanitary development of a rural establishment from the perspective of the social sciences

RESUMEN Se aplicó una intervención socio sanitaria en el asentamiento rural El León de Camagüey basada en los resultados de un estudio anterior, desde la comunicación social, educativa, así como aspectos socioculturales evaluados que permitieron la realización de este estudio. Su objetivo fue implementar una estrategia de intervención basada en acciones sociales y educativas colectadas en un manual que organizó contenidos de antropología socio cultural, psicología, sociología de la salud y trabajo social comunitario, la que fue conducida por profesionales de enfermería como prestadores, cuyo encargo social les asigna una mayor permanencia e intercambio con los pobladores, potenciándose el trabajo comunitario a partir de febrero de 2016,como etapa de sostenibilidad . La investigación constituyó un diseño mixto, con un estudio cuasi experimental sin grupo control (pre-post prueba) combinado con métodos cualitativos. La evaluación final efectuada en el periodo 2017-2018 exhibió modificaciones positivas en indicadores de las historias clínicas familiares de los pobladores, repercutiendo en el Análisis de la Situación de Salud, realizado en abril de 2018 y el entorno comunitario. Se demostró la importancia de la aplicación de la estrategia de intervención comunitaria desde las disciplinas de las ciencias sociales, por el personal de enfermería como agente de cambio de desarrollo local y protagonista de sostenibilidad.

ABSTRACT A social sanitary intervention was applied in the rural establishment El León of Camagüey, based on social and educational actions collected in a manual that organized social cultural anthropology contents, psychology, sociology of the health and community social work, which was led by infirmary professionals like lenders, whose social order assigns a major permanence and exchange of them with the settlers. The investigation constituted a mixed design, with a study quasi experimentally without control group (pre-post trial) combined with qualitative methods. The final evaluation carried out in the period 2017-2018 exhibited positive modifications in indicators of the familiar clinical history of the settlers, what reverberated in the Analysis of the Situation of Health, carried in April, 2018 and the community environment. It was demonstrated the importance of the application of the strategy of community intervention from the disciplines of the social sciences, by the infirmary personnel as change agent of local development and protagonist of sustainability.

Impacto del Diplomado Prevención de Burnout en el autocuidado del personal de enfermería / Impact of Postgraduate Course Prevention of Burnout in the self-care of the personnel of infirmary

RESUMEN Introducción: El proceso de cuidar es el resultado de una construcción propia de cada situación, se origina con la identificación de los problemas de salud y las necesidades reales o potenciales de las personas, familia y comunidad que demandan cuidado. Objetivo: Evaluar el impacto del Diplomado Prevención del Síndrome de Burnout, en el autocuidado del personal de enfermería de la Atención Secundaria de Salud de la provincia Camagüey. Métodos: Se realizó un estudio descriptivo observacional, en el Hospital Amalia Simoni Argilagos de Camagüey, durante el Diplomado Prevención del Síndrome de Burnout dirigido al personal de enfermería de la Atención Secundaria de Salud. Para ello se aplicó una encuesta y el Test Psicológico de Maslach y Jackson al inicio y al final de la aplicación del Diplomado. Los datos aportados por estos instrumentos se complementaron con los provenientes de la aplicación de la técnica del PNI. Resultados: Predominó el sexo femenino. El total de los cursistas son licenciados en Enfermería. Con la ejecución del diplomado se constatan cambios importantes en cuanto a la autopreparación, el rendimiento, los hábitos de descanso, satisfacción personal y realización de ejercicios físicos. Discusión: La aplicación del diplomado logró transformar estilos de trabajo, afrontamientos al estrés, así como una mejor satisfacción personal y colectiva.

ABSTRACT Introduction: The process of taking care is the result of a proper construction of every situation, it originates with the identification of the problems of health and the real or potential needs of the persons, family and community that demand care. Objective: To evaluate the impact of Postgraduate Course Prevention of the Syndrome of Burnout, in the self-care of the personnel of infirmary of the Secondary Attention of Health of the Camagüey province. Methods: a descriptive, observational study was carried out in the Hospital Amalia Simoni Argilagos of Camagüey, during Postgraduate Course Prevention of the Syndrome of Burnout directed to the personnel of infirmary of the Secondary Attention of Health. For that reason, a survey and the Psychological Test of Maslach and Jackson was applied at the beginning and at the end of the application of the course. The information contributed by these instruments complemented itself with the originated ones from the application of the technique of the PNI. Results: The sex that predominated was the feminine one. All of the students are licensed in Infirmary. With the execution of the course important changes are stated as for the self-preparation, the yield, the habits of rest, personal satisfaction and achievement of physical exercises. Discussion: The application of the course managed to transform styles of work, confrontations to the stress, as well as a better personal and collective satisfaction.

Neurosurgery in Aberdeen Royal Infirmary c. 1920-c.1940: knowledge, skills and styles.

A neurosurgical unit was established in Aberdeen Royal Infirmary (ARI) in 1948 with the appointment of Martin Nichols as its first full-time neurosurgeon. Despite there being no formal neurosurgical ward or specialist dedicated to neurosurgery in ARI prior to this, a number of neurosurgical procedures were undertaken between 1920 and 1940. From 1923 to 1932, the procedures were predominantly cranial and were performed by general surgeons. The operations evolved in 1933 to include the spine and peripheral nerves after the arrival of Sir James Learmonth. This paper chronicles the development of surgical neurology at the ARI in the 30 years preceding a formal unit. It considers the factors and background that enabled neurosurgical practices to be undertaken and led to evolution of neurosurgery from general surgery.

Metodología para el Desarrollo de la Personalidad Profesional en la carrera de Enfermería / Infirmary Professional Personality Methodology development

RESUMEN Introducción: la estrategia formativa curricular del plan de estudio D incluye la formación básica como concepto amplio al incorporar, con igual prioridad, los aspectos básico-específicos de la carrera de Enfermería. Objetivo: elaborar una metodología para el tratamiento de la estrategia curricular Desarrollo de la Personalidad Profesional: Ética en el profesional de Enfermería en todas sus disciplinas. Método: se realizó una investigación de desarrollo, en la Filial de Ciencias Médicas Arides Estévez Sánchez, de Holguín, en el período septiembre del 2017 a febrero del 2018. Se tomaron como universo 11 disciplinas, 35 profesores y 152 estudiantes de 1ro. a 4to. años. Se utilizaron métodos teóricos y empíricos. Se aplicaron cuestionarios a profesores y estudiantes. Resultados: se encontró que el 85,76% de los profesores incorporan los problemas de la Ética Médica en la clase (77,14%) y analizaron en los colectivos de asignaturas la estrategia de desarrollo de la Personalidad Profesional y la Ética en el profesional de Enfermería. En cuanto a la aplicación de la ética en las disciplinas del currículo, se observa que el 77,14% lo utiliza; la disciplina de Educación Física incide con el 50%; y el 95,34% de los estudiantes reconoce que se aborda la Ética Médica desde las asignaturas. Se diseñó una metodología de 4 etapas, con acciones y orientaciones para su ejecución y vías de evaluación. Conclusiones: se identificaron insuficiencias en la aplicación de la estrategia principal: el desarrollo de la Personalidad Profesional y la ética en el profesional de Enfermería en el proceso de formación. Se elaboró una metodología para facilitar el tratamiento de las disciplinas, a través de la implementación de la estrategia principal en la actuación del enfermero.

ABSTRACT Introduction: curricular strategy for Infirmary teaching plan D with basic formation as a wide concept, includes in the same way, specific aspects of Infirmary career. Objective: a methodology to develop a strategy of Curricular Professional Personality and Ethics in Infirmary's professionals, including all its diciplines. Method: a universe of 11 disciplines, 35 professors and 152 students from 1rst to 4th years. We used theoretic and empiricists methods. Questionnaires applied to professors and students. Results: the 85.76% of professors incorporated problems of the medical ethics; 77.14% examined the strategy of development of the Professional Personality and Ethics in Infirmary's students. The 77.14% applied for ethics in the Curricula disciplines, where Physical Education affected up to 50%. A 95.34% of students recognized Medical Ethics from the subjects of study discussed. A Four- stages methodology was elaborated for his execution and evaluation. Conclusions: insufficiencies in the application of the principal strategy: the development of Professional Personality and Medical Ethics in Infirmary career were identified, during formation and boarding. Methodology and a principal strategy in the male nurse's acting were elaborated to handle treatment.

Perfeccionamiento de los Fundamentos de Enfermería para el personal técnico / Infirmary Foundations Program development for technical personnel

RESUMEN Introducción: a finales del siglo XIX en nuestro país, la enseñanza técnica comenzó con diferentes planes de estudios, todos ajustados al perfil de salida técnico-profesional. Objetivo: perfeccionar el programa Fundamentos de Enfermería para la formación de técnicos, en correspondencia con el perfil del egresado. Método: se realizó un estudio cuanti-cualitativo, donde se diagnosticaron las dificultades en el programa de la asignatura Fundamentos de Enfermería, en la filial de Ciencias Médicas Aridez Estévez Sánchez, de Holguín. El universo fueron nueve profesores de la asignatura, 163 estudiantes de primer año y diez especialistas de Enfermería, que conformaron el grupo de informantes clave. Resultados: se corroboró la factibilidad de la propuesta del programa elaborado, pues los contenidos son muy abarcadores en las diferentes formas de organización de la enseñanza y afectan la formación del estudiante. Las propuestas de modificaciones por los profesores tuvieron un sentido lógico, asequible y necesario para la formación de enfermeros técnicos. Según la estructura de las actividades docentes, se incumplió en las clases teórico-prácticas y las prácticas de laboratorio. La valoración del nuevo contenido fue inadecuada para dicha organización de la enseñanza. Conclusiones: se diagnosticaron las dificultades del programa Fundamentos de Enfermería, por lo que, para su perfeccionamiento, se propuso aumentar el tiempo total para impartirlo, adecuar las formas de organización de la enseñanza a los objetivos y contenidos propios de de la asignatura Enfermería Clínica y Quirúrgica.

ABSTRACT Introduction: in our country, technical nursing teaching begins at the end of the XIX century, based on different academical plans, adjusted to professional and technician profiles. Objective: an Infirmary Foundations program for technicians, in correspondence to their profiles. Methods: an evaluation study based on quality and quantity, was carried out. Difficulties for the Infirmary Foundations program were diagnosed; at the medical sciences branch "Aridez Estévez Sánchez" from Holguín. Universe was 9 professors, 163 first year students and 10 Infirmary specialists conformed the key group of informants. Results: to allow the feasibility of the elaborated program. Very comprehensive contents in different forms of teaching, and how organization affects student's formation. Modification proposals made a logical, affordable and necessary sense in the technical male nurses' formation. According to educational activities structure in the practical theoretical lessons, laboratory practice and new contents' development, were also inadequate in these forms of teaching. Conclusions: difficulties of Infirmary Foundations program were diagnosed. Improvement proposals increased the total time of the program and allowed organization, as well as teaching, according to objectives and contents. Clinical Surgical Infirmary subjects 'teaching methods were excluded.

Henry Wade (1876-1955), pioneer of urological surgery, museum conservator and war veteran.

Henry Wade graduated in the Edinburgh Medical School in 1898 before spending two years with the British army during the Anglo-Boer war. Returning to this country, he joined Francis Caird, surgeon to the Edinburgh Royal Infirmary. Appointed Conservator of the museum of the Royal College of Surgeons of Edinburgh, Wade met young William Ford Robertson. In a study of experimental cancer they concluded that some neoplasms were caused by bacteria. Wade became increasingly recognised as an authority in urology. His growing practice was interrupted by the First World War. Already a member of the Royal Army Medical Corps, he served for five years in the Middle East, in Gallipoli and then with the army in an approach to Jerusalem. Resuming civilian life, Wade combined an extensive urological practice with membership of the Council of the RCSEd. He became President in 1935. Married in 1924, his wife died four years later after an operation by a colleague, David Wilkie. Director of Surgery to the Scottish Emergency Medical Service when the Second World War broke out, Wade was made a Knight Bachelor in 1946. He died in 1955.

Promoción de comportamientos saludables: actividad física y nutrición en adolescentes en condición de sobrepeso/obesidad / Promotion of healthy behaviors: physical activity and nutrition in overweight/obese adolescents

Introducción. El Sobrepeso y la obesidad se consideran un problema de salud pública, por su creciente incidencia en la población adolescente. Para hacerle frente se cuenta con la promoción de estilos de vida saludables como vía para mantener y alcanzar la salud de los jóvenes que se encuentran con exceso de peso. El reconocimiento de fortalezas desde la gestión del joven, se constituye en una propuesta para cambiar o mejorar comportamientos en nutrición y actividad física del adolescente, es así como las cogniciones relativas a la conducta: percepción de barreras y beneficios para el consumo de frutas y verduras y para el ejercicio y la percepción de autoeficacia se consideran como factores que modulan las percepciones de los adolescentes y conducen al cambio o modificación de comportamiento. En la revisión de la literatura no se encontró evidencia de intervenciones multicomponente: cognitiva, motivacional y comportamental en una misma intervención como propuesta para mejorar las condiciones de los jóvenes. Objetivo. Determinar el efecto de una intervención multicomponente "Promoción de salud del adolescente" en el IMC y las cogniciones relativas a la conducta específica: percepción de barreras, beneficios y autoeficacia, relacionada con nutrición y actividad física en los adolescentes escolarizados en condición de sobrepeso/obesidad de Ibagué (Tolima). Materiales y métodos. Estudio cuasi-experimental con grupo intervención y control, mediciones pre prueba, pos prueba y seguimiento a los 2 y 4 meses. Al grupo experimental se ofreció la intervención "Promoción de salud del adolescente" el grupo control recibió la actividad educativa anual. El estudio contó con el aval del comité de ética de la Universidad Nacional de Colombia y de los rectores de las instituciones educativas, se firmaron consentimientos y asentimientos informados. El análisis se realizó con las pruebas T para comparación de medias, U de Mann-Whitney y g de Hedges para cálculo del tamaño del efecto. Resultados. Al comparar los grupos después de la intervención hay diferencia en las variables de Índice de masa corporal, (p=0,001), actividad física (p=0,042) y nutrición (p=0,010). Post intervención el índice de masa corporal disminuyo en el grupo intervención; el 43,8% paso de sobrepeso a normal, el 47,9% permaneció en sobrepeso y la obesidad disminuyo de 10,4% a 8,3. El tamaño del efecto fue moderado con valor de 0,571. En las mediciones de seguimiento se encontró que en el grupo intervención en la medición de 2 meses después de finalizada la intervención el peso aumento en un 26,74% y disminuyo nuevamente en un 37,32 de los adolescentes a los 4 meses Conclusión. La intervención "Promoción de la salud adolescente" tuvo un efecto moderado en el Índice de masa corporal (peso) y la nutrición, las cogniciones relativas a la conducta no presentaron cambios significativos, ni la actividad física, pero su comportamiento varió en el tiempo. El efecto no se mantuvo en el periodo de seguimiento, por lo que se debe desarrollar de manera continua y buscando estrategias de seguimiento efectivas

Introduction. Overweight and obesity are considered a public health problem, due to their increasing incidence in the adolescent population. To cope with it, there is the promotion of healthy lifestyles as a way to maintain and achieve the health of people who are in these conditions. The recognition of strengths from the management of the young person, constitutes a proposal to change or improve behaviors in nutrition and physical activity of the adolescent, as well as behavioral cognitions: perception of barriers and benefits for the consumption of fruits and vegetables and for the exercise and the perception of self-efficacy are considered as factors that modulate the perceptions of adolescents and lead to change or modification of behavior. In the literature review there was no evidence of multicomponent interventions: cognitive, motivational and behavioral in the same intervention as a proposal to improve the conditions of young people. Objective. Determine the effect of a multi-component intervention "Teenager health promotion" in the Body Mass Index and the cognitions relative to a specific conduct: perception of barriers, benefits and Self-Efficacy related to nutrition and physical activity in teenagers from Ibagué (Tolima) who are in school who suffer of overweight/obesity. Materials and methods. Quasi-experimental study with an intervention and a control group, pre-test and post-test measurements, and follow-up after 2 and 4 months. The intervention "Teenager health promotion" was offered to the intervention group, and the control group received the annual educational activity. The study had the approval of the ethics committee of the Universidad Nacional de Colombia and the headmasters of the schools. Informed consent and assent forms were signed. The analysis was done with T tests to compare means, U of Mann-Whitney and g of Hedges to calculate the size of the effect. Outcomes. Comparing the groups after the intervention, there is a difference in the Body Mass Index variables, (p=0,001), physical activity (p=0,042) and nutrition (p=0,010). After the intervention the Body Mass Index decreased in the intervention group; 43,8% passed from overweight to normal, 47,9% stayed with overweight and obesity decreased from 10,4% to 8,3%. In the follow-up measurements we found that in the measurement after 2 months of having finished the intervention, weight increased 26,74% and decreased again 37,32% in teenagers after 4 months. The size of the effect was moderate with a value of 0,571. Conclusion. The intervention "Teenager health promotion" had a moderate effect in the Body Mass Index (weight) and nutrition, cognitions related to conduct did not suffer significant changes, nor physical activity, but their behavior varied with time. The effect did not maintain its effect through time. The elements that did not have significant changes in the intervention must be strengthened.

Summer Camp Health Initiative: An Overview of Injury and Illness in Two Canadian Summer Camps.

INTRODUCTION: Summer camp is an important part of the lives of millions of youth worldwide. Injuries and illnesses at general residential camps have not been quantified in a Canadian setting. The objective of this study was to examine the incidence of injuries and illnesses that present to camp health centres at two Canadian residential summer camps. METHOD: This prospective cross-sectional study examined the incidence of new-onset injuries and illnesses that presented to camp infirmaries and circumstances surrounding their occurrence. Data collection forms were completed by trained infirmary staff during each camper's presentation to the infirmary at two general residential camps in Canada in the summers of 2015 and 2016. RESULTS: There were 1872 infirmary presentations, resulting in a frequency of 52.6 presentations per 1000 camp days (CD). The incidence of illness was 34.8 per 1000 CD and the incidence of injury was 17.9 per 1000 CD. Communicable disease was the most common diagnosis (15.2/1000 CD), most often an upper respiratory tract infection. The most common symptoms upon presentation were sore throat (14.1/1000 CD), headache (9.9/1000 CD), runny nose/congestion (6.2/1000 CD), cough (6.0/1000 CD) and nausea and vomiting (4.8/1000 CD). The most common injuries were cuts/lacerations/bruises (4.9/1000 CD), followed by muscle/tendon injury (4.9/1000 CD). The most frequent cause of injuries was participation in sports (3.9/1000 CD) and sports fields and courts were the most frequent location for injuries to occur (2.7/1000 CD). Females accounted for 52.8% of infirmary presentations. Senior campers (ages 12-16 years) presented most frequently (43.4%), followed by junior campers (ages 6-11 years; 38.1%) and staff (age ≥17 years; 18.0%). When age-specific CDs were calculated, junior campers had the highest frequency of infirmary presentations relative to their time spent at camp (79.7/1000 CD). Fifty people (1.4/1000 CD) were sent to a hospital for further assessment. CONCLUSION: Injuries and illnesses presenting for infirmary care in summer camp are generally minor in nature. Canadian data compares similarly to United States (US) studies. Future studies should focus on interventions to reduce these injuries and illnesses, particularly communicable illnesses.

Evaluación de la calidad de la atención de Enfermería en el Servicio de Neonatología / Evaluation of the quality of Enfermería's attention in Neonatología's Service

RESUMEN Introducción: la Academia Americana de Pediatría define a los cuidados Intensivos como aquellos que recibe el recién nacido gravemente enfermo o los que requieren de una vigilancia estricta de los profesionales de la unidad neonatal. La calidad de la atención sanitaria es un atributo cada vez más valorado por todos los implicados en la atención a la salud (profesionales, usuarios y gestores) aunque cada uno de estos grupos enfatiza algunos aspectos en particular con relación al resto. Objetivo: evaluar la calidad de la atención de Enfermería en el Servicio de Neonatología. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en el Servicio de Neonatología del Hospital Infantil Norte Docente "Juan De La Cruz Martínez Maceira" de Santiago de Cuba en el periodo enero-diciembre de 2013. El universo lo constituyeron 754 pacientes egresados del servicio, sus madres acompañantes y 40 enfermeras que se encontraban laborando en el servicio. Se confeccionaron indicadores de calidad con estándares establecidos para estructura, proceso y resultado, se aplicó un instrumento evaluativo a las enfermeras y encuesta de satisfacción a las madres de los neonatos. Resultados: el indicador estructura alcanzó estándares no aceptables en cuanto a equipamiento no apto para su uso y la estructura del servicio, en el proceso y resultados todos sus indicadores fueron evaluados de aceptables, existiendo buen grado de satisfacción de la totalidad de las madres que acudieron con sus bebitos. Conclusión: no se detectaron dificultades en los indicadores de proceso y resultados evidenciando que existe calidad de la atención de enfermería en el servicio de neonatología(AU)

ABSTRACT Introduction: You define Pediatría's American Academy as intensive care those that you receive the gravely sick newborn baby or the ones that call for a close watch of the professionals of the neo-natal unit. The quality of the sanitary attention is an attribute more and more appraised for all the implicated in the attention to health (professionals, users and managers) although each one of these groups emphasizes some aspects in particular with respect to the rest. Objective: Evaluating the quality of Enfermería's attention in Neonatología's Service. Methods: Juan De accomplished a Descriptive, prospective and longitudinal study himself, in Neonatología's Service of the Infantile North Teaching Hospital James's Cross Martínez Maceira of Cuba in the period January December 2013. The universe was constituted by 754 patients left of the service, his accompanying mothers and 40 nurses that were meeting laboring in the service. They manufactured indicators of quality with standards established for structure, process and result, evaluativo applied over itself an instrument to the nurses and polls of satisfaction the mothers of the neo-born. Results: The indicator structure caught up with standards not acceptable as to unsuited equipamiento for his use and the structure of the service, in the process and once all his indicators were proven to be they were evaluated of acceptable, existing good grade of satisfaction of the totality of the mothers that attended with his little babies. Conclusion: They did not detect difficulties in the indicators of process and results evidencing that quality of the attention of infirmary in neonatología's service exists(AU)

Collection of Viable Aerosolized Influenza Virus and Other Respiratory Viruses in a Student Health Care Center through Water-Based Condensation Growth.

The dynamics and significance of aerosol transmission of respiratory viruses are still controversial, for the major reasons that virus aerosols are inefficiently collected by commonly used air samplers and that the collected viruses are inactivated by the collection method. Without knowledge of virus viability, infection risk analyses lack accuracy. This pilot study was performed to (i) determine whether infectious (viable) respiratory viruses in aerosols could be collected from air in a real world environment by the viable virus aerosol sampler (VIVAS), (ii) compare and contrast the efficacy of the standard bioaerosol sampler, the BioSampler, with that of the VIVAS for the collection of airborne viruses in a real world environment, and (iii) gain insights for the use of the VIVAS for respiratory virus sampling. The VIVAS operates via a water vapor condensation process to enlarge aerosolized virus particles to facilitate their capture. A variety of viable human respiratory viruses, including influenza A H1N1 and H3N2 viruses and influenza B viruses, were collected by the VIVAS located at least 2 m from seated patients, during a late-onset 2016 influenza virus outbreak. Whereas the BioSampler when operated following our optimized parameters also collected virus aerosols, it was nevertheless overall less successful based on a lower frequency of virus isolation in most cases. This side-by-side comparison highlights some limitations of past studies based on impingement-based sampling, which may have generated false-negative results due to either poor collection efficiency and/or virus inactivation due to the collection process. IMPORTANCE The significance of virus aerosols in the natural transmission of respiratory diseases has been a contentious issue, primarily because it is difficult to collect or sample virus aerosols using currently available air sampling devices. We tested a new air sampler based on water vapor condensation for efficient sampling of viable airborne respiratory viruses in a student health care center as a model of a real world environment. The new sampler outperformed the industry standard device (the SKC BioSampler) in the collection of natural virus aerosols and in maintaining virus viability. These results using the VIVAS indicate that respiratory virus aerosols are more prevalent and potentially pose a greater inhalation biohazard than previously thought. The VIVAS thus appears to be a useful apparatus for microbiology air quality tests related to the detection of viable airborne viruses.

"Byoin" in Modern Japan: Focusing on the Terminological Introduction of "Hospital" and the Complex Formation of Its Concept.

This paper aims to clarify when the term of Byoin (hospital) was introduced and how its concept was developed in modern Japan. The word "Byoin" was introduced in Japan in 1787 for the first time, but it had not been in use until early 1860s. Instead, various medical institutions performing the functions of modern medical facilities, such as Yojosho (A place for preserving health), Shijuku (private school), called by traditional names as ever. Japanese intellectuals already adopted the word Byoin and the concept of western hospital in early 1860s when their national delegates were dispatched to Europe to revise the treaties forged with western powers. Japanese translations of hospital appeared in English-Japanese/Japanese-English dictionaries published in the 1860s. For instance, the word Byoin (hospital in Japanese) was first published in a dictionary published in 1867 and unclearly connected to the words, hospital, infirmary. This paper will argue that the concept of Byoin was sophisticated through Meiji government's efforts to implement reforms distinguishing medical facilities based on their capacity of inpatients and quality. The first medical law (Isei) proclaimed by the Meiji government in 1874 articulated regulations for a hospital in eight different articles. The government established hospitals in various parts of the country, following its newly established modern medical care policies. However, in this process, Iin (hospital/clinic), another term for "hospital" appeared. Regional differences and financial issues made standardizing the concept of a hospital even more difficult. In response to the widely embedded confusion, the Japanese government made an effort to clarify the concept of a hospital, setting up provisions regarding the size of medical facilities. As a result, the word Byoin finally came to be used for a hospital with more than ten beds, while a clinic with beds below ten was called Shinryojo (clinic). On the other hand, Iin meant a medical facility less qualified than a hospital since 1933 when Japanese government made a harder restriction on the usage of Byoin.