Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach.

OBJECTIVE: To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital. METHOD: Descriptive cross-sectional study with an analytical approach. SETTING: 6 intensive care units of a third level hospital. SAMPLE: nurses and doctors. Consecutive type non-probabilistic sampling. DATA COLLECTION: sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health." RESULTS: A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9. CONCLUSIONS: The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.

Esophageal cancer in Uruguay: a case-control study.

Esophageal cancer has constituted a major public health problem in Uruguay, with age-adjusted death rates of 14.5 X 10(5) for males and of 3.8 X 10(5) for females. A case-control study was undertaken to ascertain the possible association of the local custom of drinking infusions of Ilex paraguariensis ("maté") with cancer of the esophagus, after controlling for well-known risk factors, such as alcohol and tobacco consumption. Two hundred twenty-six patients with esophageal cancer and 469 controls (control:case = 2.1) were interviewed at the time of admission or consultation at the Oncology Institute of Montevideo from 1979 through 1984. Males showed elevated risks of esophageal cancer associated with heavy tobacco [relative risk (RR) = 10.8] and alcohol (RR = 10.3) exposures. Among females, the independent effects of tobacco and alcohol were nonsignificant. Maté consumption had an independent effect in both males and females, with odds ratios of 6.5 and 34.6, respectively, for heavy users. Moreover, a well-defined dose response was evident in both sexes.

Ewing's sarcoma: value of tumor necrosis as a predictive factor.

Forty cases of Ewing's sarcoma filed at the Uruguayan Committee for the Study of Bone Tumors, in the 1956-1979 period, were reviewed in order to determine the prognostic importance of several clinical and histological factors. Necrosis showed a strong association with survival (regression coefficient of -0.59). In fact, those cases with slight necrosis presented an actuarial survival of 48 per cent at a five-year period, contrasting with no survivors in the group with marked necrosis. Multivariate techniques (Multiple Linear Regression and Analysis of Variance) were employed to identify possible subsets of Ewing's sarcoma. In particular, the combination of longer delay (time between the appearance of the first symptom and histologic diagnosis) and slight necrosis as well as treatment with multidrug chemotherapy and slight necrosis resulted in rather prolonged survivals. This suggests interactions between necrosis and delay, and necrosis and treatment. The strong predictive value of tumor necrosis is probably related with rapidly growing Ewing's sarcoma.

[Soft tissue sarcoma: histologic factors of prognosis]. / Sarcomes des tissus mous: facteurs histologiques de pronostic.

With the intention of evaluating the prognostic value of 4 histopathological factors (cellularity polymorphism, mitotic index and necrosis), 80 cases of soft tissue sarcomas treated between 1960 and 1979 at the Oncology Institute of Montevideo, Uruguay were reviewed. There was a high correlation between the 4 variables. Their results provided similar models for actuarial survival rates and coefficients of regression. Nevertheless, when the factors were combined according to a linear regression model, cellularity lost almost all of its prognostic value, while necrosis and mitosis increased the prognostic influence of the equation. The percentage of variance explained by the combination of these factors was only 27 per cent. It is supposed that a substantial part of residual variance is due to factors which have not been included in the model, that is, the size of tumor, the depth of the lesion and its location. It is also conceivable that the intermediate number of cases and, more important, the heterogeneous distribution of histopathological types and primary sites might modify these results. Multiple prognostic evaluations are recommended for each histopathological type and for each different site.

[Alveolar rhabdomyosarcoma of the skin]. / Rabdomiosarcoma alveolar de localización cutánea.

The authors present the case of an 18 years old male patient with a tumor localized in the skin of the nose, which had a fast evolution provoking in a month regional metastases. Histologically it proved to be an alveolar rhabdomyosarcoma. The clinical and histopathological characters are described, and considerations about the origin of this tumor are made.

[Keratosis palmaris and visceral cancer]. / Queratosis palmar y cáncer visceral.

The authors describe the clinical and histological characteristics of palmar keratose associated to visceral cancer. Their clinical forms are small and numerous keratotic rings, large papulae, 4 to 8 mm., scarce two or three lesions and multiple punctiform depressions. The histology shows a compact orthokeratotic hiperkeratosis accompanied in a variable way to an epidermic depression. In a strict sense it is not a paraneoplase, it is a clinic visceral cancer marker. It is suggested to name it oncogenic lenticular acrokeratose.

Laryngeal cancer in Uruguay (1958-1981). An epidemiologic study.

According to international comparative data on age-adjusted death rates, male mortality caused by laryngeal cancer in Uruguay is ranked second in the world. This fact has prompted the authors to study time trends and to perform cohort analysis of all deaths due to larynx cancer during the 1958 to 1981 period. Localization as well was investigated by means of incident cases taken from Registry of the University Hospital (1960-1981). Trend analyses have shown an increase in age-adjusted death rates among men. This was largely due to the older age of patients. Cohort analysis showed a decline in mortality among younger patients. As far as anatomic location is concerned, a marked predominance of supraglottic cancer was observed. This was particularly high among those belonging to the low-income group.

Hematoma retroperitoneal traumático: a propósito de 35 casos / Traumatic retroperitoneal hematoma: apropos of 35 cases

Fueron analizados 35 casos de hematoma retroperitoneal traumático del archivo de CTI del Hospital Pasteur. Se analizaron los mismos con tablas de datos que incluyeron : edad, sexo, mecanismo lesional, tipo de trauma (abierto-cerrado), presencia de shock, necesidad de transfusiones, injurias asociadas y tratamiento realizado. Se clasificaron los hematomas según la clasificación de la Asociación Argentina de Cirugía, en cinco tipos. De los 35 casos, 21 fueron traumatismos abiertos (60 por ciento) y 14 lo fueron cerrados (40 por ciento). De los abiertos, 71 por ciento fueron causados por arma de fuego, mientras que de los cerrados 86 por ciento lo fueron por accidente de tránsito. La topografía más frecuente fue de la zona 2 con 12 casos, seguida de la zona 3 con 11 y la zona 1 con 9. De los 29 pacientes intervenidos quirúrgicamente, en 65 por ciento se actuó sobre el hematoma. La mortalidad global de la serie fue de 25,7 por ciento, siendo la causa más frecuente el shock mantenido. Del análisis de los resultados surge la necesidad de adoptar protocolos de diagnóstico y terapéutica que mejorarán el pronóstico de estos pacientes