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BACKGROUND AND AIMS: Digital tomosynthesis has proven useful in the evaluation of damage to joints. This study aims to describe the most common digital tomosynthesis findings for four rheumatological entities and to compare the usefulness of this technique with that of other imaging techniques. MATERIALS AND METHODS: Following the PRISMA guidelines, we systematically searched the literature for articles about the use of digital tomosynthesis in rheumatoid arthritis, osteoarthritis, spondyloarthritis, and gout. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to evaluate the quality of the articles included. RESULTS: We included 13 articles. For rheumatoid arthritis, osteoarthritis, and spondyloarthritis, digital tomosynthesis detected bone abnormalities better than plain-film X-rays; however, for gout, the results were variable. CONCLUSIONS: Digital tomosynthesis can play an important role in the evaluation of skeletal abnormalities in rheumatological disease, especially compared to plain-film X-rays.

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In 1994, sponsored by the European Communities Commission and the FRICE (Foundation for Research on Intensive Care in Europe), the EURICUS proyect was born, which, among other objectives, sets out to know objectively the work loads of the nursing staff in the intensive medicine services. As a consequence, the FRICE developed and validated a new therapeutic index, the nine equivalents of nursing manpower use score, NEMS. This scale (NEMS) can determine the therapeutic effort required by critically ill patients in a simple way and only using nine therapeutic variables. The objectives of this study are: to know if the NEMS scale reflects the therapeutic effort of the pediatric critical patients and validate if the NEMS scale measures the health care effect of the nursing staff in a pediatric intensive care unit (PICU). The study was performed in the Pediatrics Intensive Care Unit of the Hospital Sant Joan de Déu in Barcelona. The population studied was made up by the patients admitted to the PICU during a three week period (January 17 to February 6, 2001). Eight nurses from the unit having different shifts participated in the data collection. The NEMS scale was measured at 7 am.m. and 7 p.m. respectively in all the patients and then a qualitative assessment of the data obtained was performed. During this period, there were 50 admissions in the unit: 2.2 admissiions per day. The occupancy rate during the days of the study was 75%. A total of 389 measurements were performed, obtaining a mean value of 26.1 on the NEMS scale. Principal contributions of the nurses participating in the study were:They believe that use of the health care effort scales is useful in the intensive care units. The NEMS scale is easy to use and requires little time to be filled out. The NEMS scale reflects the therapeutic effort of the pediatric critically ill patients, but does not reflect the nursing staff cares. In a pediatric ICU, the age of the patient who is hospitalized influences the requirements of the nursing staff. Depending on at what time the scale is measured, not all the nursing activity is reflected, due to the high number of daily admissions and discharges. The NEMS scale is simple to use and reflects the therapeutic effort of the patients admitted to a PICU; however it only measures those cares delegated from therapeutic intervention and does not reflect the basic nursing cares.

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En 1994, auspiciado por la Comisión de Comunidades Europeas y la FRICE (Foundation for Reseach on Intensive Care in Europe), nace el proyecto Euricus, que entre otros objetivos, se plantea conocer de forma objetiva las cargas de trabajo del personal de enfermería en los servicios de medicina intensiva. Como consecuencia, la FRICE desarrolla y valida un nuevo índice terapéutico, the nine equivalents of nursing manpower use score , NEMS. Esta escala (NEMS) es capaz de determinar de una manera sencilla y a través de sólo nueve variables el esfuerzo terapéutico que requieren los pacientes críticos. Los objetivos de este trabajo son: conocer si la escala NEMS refleja el esfuerzo terapéutico de los pacientes críticos pediátricos y validar si esta escala mide el esfuerzo asistencial de enfermería en una unidad de cuidados intensivos pediátricos (UCIP).El estudio se ha realizado en la Unidad de Cuidados Intensivos Pediátricos del Hospital Sant Joan de Déu de Barcelona. La población estudiada han sido los pacientes ingresados en la UCIP durante un período de tres semanas (17 de enero al 6 de febrero del 2001). Participaron en la recogida de datos 8 enfermeras de la unidad de diferentes turnos. A las 7 y 19 horas respectivamente, medían la escala NEMS a todos los pacientes ingresados y posteriormente realizaban una valoración cualitativa de los datos obtenidos. Durante este período se produjeron 50 ingresos en la unidad; 2,2 ingresos por día. El índice de ocupación durante los días del estudio fue del 75 per cent. Se realizaron un total de 389 mediciones, obteniéndose un valor medio en la escala NEMS de 26,1. Las principales aportaciones de las enfermeras participantes en el estudio han sido: creen que la utilización de escalas de esfuerzo asistencial son útiles en las unidades de cuidados intensivos. La escala NEMS es de fácil utilización y requiere poco tiempo para su cumplimentación. La escala NEMS refleja el esfuerzo terapéutico de los pacientes críticos pediátricos, pero no refleja los cuidados de enfermería. En una UCI pediátrica, la edad del paciente ingresado influye en los requerimientos del personal de enfermería. Dependiendo de a qué hora se mida la escala, no refleja toda la actividad de enfermería, debido al alto número de ingresos y altas diarias. La escala NEMS es de sencillo manejo y refleja el esfuerzo terapéutico de los pacientes ingresados en una UCIP; pero sólo mide los cuidados delegados de la intervención terapéutica y no refleja los cuidados básicos de enfermería (AU)

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