Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

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

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

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

The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation.

INTRODUCTION: Deep sedation in critically ill patients is associated with a longer duration of mechanical ventilation and a prolonged length of stay in the intensive care unit. Several protocols have been used to improve these outcomes. We implement and evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to treat critically ill patients who receive mechanical ventilation. METHODS: We performed a prospective, two-phase (before-after), non-randomized multicenter study that involved 13 intensive care units in Chile. After an observational phase (observational group, n=155), we designed, implemented and evaluated an analgesia-based, goal-directed, nurse-driven sedation protocol (intervention group, n=132) to treat patients who required mechanical ventilation for more than 48 hours. The primary outcome was to achieve ventilator-free days by day 28. RESULTS: The proportion of patients in deep sedation or in a coma decreased from 55.2% to 44.0% in the interventional group. Agitation did not change between the periods and remained approximately 7%. Ventilator-free days to day 28, length of stay in the intensive care unit and mortality were similar in both groups. At one year, post-traumatic stress disorder symptoms in survivors were similar in both groups. CONCLUSIONS: We designed and implemented an analgesia-based, goal-directed, nurse-driven sedation protocol in Chile. Although there was no improvement in major outcomes, we observed that the present protocol was safe and feasible and that it resulted in decreased periods of deep sedation without increasing agitation.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

Swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy.

BACKGROUND: The aim of this study was to determine the incidence of swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy (PDT) for prolonged mechanical ventilation (MV) and to compare the duration of the cannulation period and length of stay in the critical care unit (CCU) in patients with and without swallowing dysfunction. METHODS: A total of 40 consecutive patients without neurologic disorders who require PDT for prolonged MV were included. Previous to the tracheostomy decannulation process, an otolaryngologist performed a fiberoptic endoscopic evaluation of swallowing (FEES). We used analysis of variance for the analysis; the results are presented as mean values +/- SD. RESULTS: Mean age was 62 +/- 15 years. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 21 +/- 2 and 9 +/- 1, respectively. Time of MV previous to PDT was 20 +/- 11 days, total MV duration was 38 +/- 16 days, and CCU stay was 63 +/- 27 days. The incidence of swallowing dysfunction in this group of patients was 38% (15/40). No difference was found in the age or time period of MV previous to PDT between groups. The time period between FEES to tracheostomy decannulation process was 19 +/- 11 days in patients with swallowing dysfunction vs 2 +/- 4 days in those patients without dysfunction (P < .001). Patients who developed swallowing dysfunction stayed longer in the CCU (69 +/- 23 vs 47 +/- 19 days, P < .01). CONCLUSIONS: Nearly 40% of nonneurologic critically ill patients requiring PDT for prolonged MV presented swallowing dysfunction and experienced a significant delay in their tracheostomy decannulation process.

Implantacao de protocolo de reducao de sedacao profunda baseado em analgesia comprovadamente seguro e factivel em pacientes submetidos a ventilacao mecanica / The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation

INTRODUÇÃO: A sedação profunda em pacientes gravemente enfermos se associa a uma maior duração da ventilação mecânica e à permanência mais longa na unidade de terapia intensiva. Diversos protocolos foram utilizados para melhorar esses desfechos. Implantamos e avaliamos um protocolo de sedação baseado em analgesia, direcionado por objetivos e cuidado por enfermeiros, em pacientes gravemente enfermos submetidos à ventilação mecânica. MÉTODOS: Realizamos um estudo multicêntrico prospectivo em duas fases (antes e depois), que envolveu 13 unidades de terapia intensiva localizadas no Chile. Após uma fase observacional (grupo observacional, N=155), delineamos, implantamos e avaliamos um protocolo de sedação cuidado por enfermeiros, direcionado por objetivos (grupo de intervenção, N=132) para tratar pacientes que necessitaram de ventilação mecânica por mais do que 48 horas. O parâmetro primário de avaliação foi a obtenção de dias livres de ventilador até o dia 28. RESULTADOS: No grupo de intervenção, a proporção de pacientes com sedação profunda ou coma diminuiu de 55,2 para 44,0%. A incidência de agitação não se alterou entre os períodos, permanecendo em cerca de 7%. Dias livres de ventilador até o dia 28, permanência na unidade de terapia intensiva e mortalidade foram similares em ambos os grupos. Após 1 ano, a presença de sintomas de desordem de estresse pós-traumático nos sobreviventes foi similar entre os grupos. CONCLUSÕES: Delineamos e implantamos no Chile um protocolo de sedação baseado em analgesia, direcionado por objetivos e cuidado por enfermeiros. Embora não se tenha observado melhora nos principais desfechos, observamos que o presente protocolo foi ...

INTRODUCTION: Deep sedation in critically ill patients is associated with a longer duration of mechanical ventilation and a prolonged length of stay in the intensive care unit. Several protocols have been used to improve these outcomes. We implement and evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to treat critically ill patients who receive mechanical ventilation. METHODS: We performed a prospective, two-phase (before-after), non-randomized multicenter study that involved 13 intensive care units in Chile. After an observational phase (observational group, n=155), we designed, implemented and evaluated an analgesia-based, goal-directed, nurse-driven sedation protocol (intervention group, n=132) to treat patients who required mechanical ventilation for more than 48 hours. The primary outcome was to achieve ventilator-free days by day 28. RESULTS: The proportion of patients in deep sedation or in a coma decreased from 55.2% to 44.0% in the interventional group. Agitation did not change between the periods and remained approximately 7%. Ventilator-free days to day 28, length of stay in the intensive care unit and mortality were similar in both groups. At one year, post-traumatic stress disorder symptoms in survivors were similar in both groups. CONCLUSIONS: We designed and implemented an analgesia-based, goal-directed, nurse-driven sedation protocol in Chile. Although there was no improvement in major outcomes, we observed that the present protocol was safe and feasible and that it resulted in decreased periods of deep sedation without increasing agitation. .

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

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

[Prevalence of cardiovascular risk factors among patients suffering vascular events on admission and one year later]. / Insuficiente control de factores de riesgo en prevención secundaria cardiovascular.

BACKGROUND: International studies show a low compliance with norms for the management of cardiovascular risk factors. AIM: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. MATERIAL AND METHODS: Three hundred and fifty seven patients aged 64+/-13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9+/-2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. RESULTS: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). CONCLUSIONS: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

Angioplastía y stenting carotideo: serie clínica en Clínica Las Condes / Carotid angioplasty and stenting: clinical series at Clinica Las Condes

En este artículo se describe una serie clínica de angioplastía y stenting carotideo con sistema de protección distal para el tratamiento de la estenosis significativa del bulbo carotideo en Clínica Las Condes. El análisis de trabajos clínicos multicéntricos, junto a nuestros resultados, permite concluir que la angioplastía y stenting carotideo es una alternativa válida y de bajo riesgo para el tratamiento de la estenosis carotidea significativa.

In this article we describe a case series of carotid angioplasty and stenting with distal protection technique for the treatment of significant carotid bulb stenosis in Clínica Las Condes. The results of past clinical trials, and our case series allow us to conclude that carotid angioplasty and stenting is a valid alternative therapy with low risks associated, for the treatment of significant carotid stenosis.

Proteína C reactiva y fibrilación auricular: evidencia de un proceso inflamatorio en la iniciación y perpetuación de la arritmia / C-reactive protein and atrial fibrillation: evidence for an inflammatory process in the initiation and perpetuation of the arrhythmia

Propósitos del estudio: Determinar la existencia de un proceso inflamatorio en los pacientes (ptes) con fibrilación auricular (FA) y su eventual relación con la trombogénesis. Métodos: Se incluyeron 109 pts con valvular, tanto crónica (n =40) como paroxística (n =69) sin tratamiento anticoagulante. Se determinaron niveles de proteína C –reactiva (PCR), niveles de complejo trombina-antitrombina (TAT) y parámetros clínicos y ecocardiográficos predictores de embolia y, exámenes generales de laboratorio. Resultados: La edad promedio del grupo fue 67 ± 14 años. Los niveles de PCR fueron de 1,0 ± 1,4 mg/dl en los FA paroxística y 1,1 ± 2,4 mg/dl en los con FA crónica versus 20 controles). Los niveles de TAT confirmaron la existencia de un estado protrombótico, pero se demostró asociación entre PCR y TAT. En el análisis multivariado, la PCR se relacionó a otros marcadores de inflamación sistémica (VHS y recuento de glóbulos blancos) y la presencia de disfución VI (p =0,02). A 30 días y 1 año, se constató una caída significativa de los niveles de PCR en el grupo FA paroxística. Finalmente, los niveles de PCR resultaron ser predictores de la mantención de ritmo sinusal a 1 año (PCR =1,2 ± 1,8 mg/dl en ptes con FA versus 0,5 ± en los con ritmo sinusal a 1 año, p = 0,048). Conclusiones: Existe evidencia de un estado inflamatorio en los ptes con FA no valvular. Su persistencia se asocia a la matención de la arritmia en la evolución alejada a 1 año.