RESUMEN
Background: Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Methods: Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. Results: In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Conclusions: Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.
Asunto(s)
Asfixia Neonatal/terapia , Competencia Clínica , Personal de Salud/educación , Resucitación/educación , Curriculum , Femenino , Personal de Salud/estadística & datos numéricos , Honduras , Hospitales Comunitarios , Humanos , Recién Nacido , Masculino , Evaluación de Programas y Proyectos de Salud , Servicios de Salud RuralRESUMEN
BACKGROUND: To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. METHODS: Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. RESULTS: Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. CONCLUSION: In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.
Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Capacitación en Servicio/métodos , Mejoramiento de la Calidad , Resucitación/educación , Estudios de Casos y Controles , Competencia Clínica , Femenino , Honduras , Hospitales Comunitarios , Humanos , Recién Nacido , Masculino , Atención Perinatal/métodos , Embarazo , Población Rural , Factores de TiempoRESUMEN
BACKGROUND: Lung hydatid cyst caused by Echinococcus granulosus is endemic in many areas of the world. We aimed to compare the outcome of surgical treatment in intact and ruptured (infected or noninfected) cysts. METHODS: We reviewed the medical records of 115 patients with lung hydatid disease who were surgically treated between 2001 and 2005 in a tertiary hospital in Lima, Peru. Patients were divided into 3 groups based on cyst characteristics: intact cysts (n = 41), ruptured noninfected cysts (n = 47) and ruptured infected cysts (n = 27). If a patient had more than one type of cyst, the most severe form of disease was recorded. Data related to symptoms, morbidity and mortality were recorded and compared. We also calculated direct patient costs. RESULTS: Mean age of patients was 23.6 +/- 15.1 years old. Ruptured cysts were present in 64 % of patients and giant cysts (> 10 cm diameter) were present in 26 % of patients. Hemoptysis was present in 47.0 % of patients and was more frequent in patients with ruptured infected cysts. Lung resection was performed in 58 % of patients. The most common postoperative complication was infection of the operative wound (6.08 %). Perioperative mortality was zero. Patients with ruptured cysts had a longer hospitalization time and higher total cost (12.28 +/- 0.92 days, US$ 890.34 +/- 303.35) than patients with intact cysts (10.17 +/- 0.79 days, US$ 724.81 +/- 14.38). CONCLUSION: Surgical treatment of lung hydatid disease is safe, with a good outcome and a low mortality rate. The lung resection rate was higher than most published series and reflects the relatively high proportion of patients with giant and ruptured infected cysts.
Asunto(s)
Equinococosis Pulmonar/cirugía , Neumonectomía , Adolescente , Adulto , Análisis Costo-Beneficio , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/economía , Equinococosis Pulmonar/mortalidad , Femenino , Costos de la Atención en Salud , Hemoptisis/etiología , Humanos , Tiempo de Internación , Masculino , Perú , Neumonectomía/efectos adversos , Neumonectomía/economía , Neumonectomía/mortalidad , Rotura , Infección de la Herida Quirúrgica/etiología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
We present a review of 240 patients with penetrating thoracic injuries seen in a period of 10 years at a general university hospital in Lima, Peru. The majority of the patients were young males who suffered stab wounds (76.2 per cent). The most frequent symptoms were thoracic pain (N = 202) and dyspnoea (N = 138); and the commonest physical findings were diminished respiratory sounds (N = 192) and tachypnoea (N = 167). Haemopneumothorax (N = 92), haemothorax (N = 81) and pneumothorax (N = 59) were the most frequent lesions. Cardiac lesions were present in 11 patients. The commonest extrathoracic associated lesions was penetrating abdominal injury (N = 43). The majority of the patients only required tube thoracostomy as definitive therapy (N = 143). There were 31 thoracotomies and 54 laparotomies. The most frequent complications were respiratory (N = 34) and neurological (N = 8). Gunshot wounds were more destructive than stab wounds. The first group of patients had a longer hospital stay (11.7 and 7.25 days), longer time with tube thoracostomy (5.98 and 4.18 days), more injured abdominal organs (3.8 and 2.38 organs) and higher mortality (7.01 per cent and 3.82 per cent) than the second group. The overall mortality was 4.58 per cent. The patients with a cardiac lesion had a higher mortality (27.27 per cent) than those who did not (3.49 per cent).
Asunto(s)
Traumatismos Torácicos/cirugía , Heridas Penetrantes/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Laparotomía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Perú/epidemiología , Traumatismos Torácicos/mortalidad , Toracotomía , Resultado del Tratamiento , Heridas por Arma de Fuego/mortalidad , Heridas por Arma de Fuego/cirugía , Heridas Penetrantes/mortalidad , Heridas Punzantes/mortalidad , Heridas Punzantes/cirugíaRESUMEN
We present a case of traumatic diaphragmatic hernia of delayed presentation, 2 years after a stab wound in the inferior thorax. The patient, a 31 year-old man, arrived to the hospital complaining of abdominal pain and vomiting, but then developed a clinical picture of low intestinal obstruction. When the abdominal cavity was surgically explored, a diaphragmatic defect of 2.5 cm was found, through which the omentum and part of the colon were herniated to the thorax. After the operation, the patient had a good outcome and was discharged 8 days later.
Asunto(s)
Enfermedades del Colon/etiología , Hernia Diafragmática Traumática/complicaciones , Obstrucción Intestinal/etiología , Heridas Punzantes/complicaciones , Adulto , Humanos , Masculino , Factores de Tiempo , Adherencias Tisulares/cirugíaRESUMEN
Although the effect of maternal age as a risk factor for Down syndrome (DS) is well known, the role of paternal age in the cause of DS has not been clearly established. To investigate this phenomenon we conducted a case-control study between July 1989 and February 1990. The cases were 318 children and teenagers with DS studied at the Specialized Educational Institutions of Lima City, Perú. They were paired with 1,196 control individuals that were selected from the birth records of 2 general hospitals of the city. For each case we tried to obtain 4 controls, paired by their date of birth, sex, and maternal age. The means of paternal age in the 2 groups were compared, first globally and then by groups of maternal age (< 21 years, 21-29 years, 30-34 years, 35-39 years and > 39 years). None of the comparisons gave a statistically significant difference between the 2 groups, using either the Student t-test or the Mann-Whitney U-test. The results obtained in this study give no evidence that paternal age can be considered a risk factor for the conception of a child with DS.
Asunto(s)
Síndrome de Down/epidemiología , Edad Paterna , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Masculino , Edad Materna , Persona de Mediana Edad , Perú/epidemiología , Embarazo , Factores de RiesgoRESUMEN
1. Seven cases of pulpal lesions due to accidental trauma in young individuals anterior permanent teeth are studied clinically and histologically. 2. Etiopathogenic concepts of the specific lesions under study are synthesized. 3. Characteristics of the material and utilized methods are established. 4. By means of a detailed description of the cases, the histopathological and clinical qualities are coordinated, formulating commentaries. 5. Synoptic charts of the results obtained are included and the total analysis of all the material studied is completed with a general clinical-histopathological commentary.