RESUMO
Wastewater surveillance represents an alternative approach to regulating contamination and the early detection of infectious agents and outbreaks of diseases of public health importance. This study evaluated domestic wastewater effects on recreational waters in estuarine and seawater bodies in Guayas and Santa Elena provinces in Ecuador, South America. Fecal indicator bacteria (thermotolerant coliforms) served as key indicators for evaluation. Physical, chemical, and microbiological quality markers following the Ecuadorian environmental quality standard and the discharge of effluents to the water resource were analyzed. Samples were collected from 44 coastal sites and 2 oxidation lagoons during the dry and rainy seasons of 2020 and 2021, respectively. SARS-CoV-2 RNA was detected in samples with higher E. coli concentrations using reverse transcription quantitative PCR to detect the genes N and ORF1ab. All samples analyzed for SARS-CoV-2 showed Ct Ë 40 for at least one gene. Four samples showed at least 20 genome copies of gene N per reaction. These were at an artisanal fishing port, an estuarine area (Palmar), a recreational bay, and an oxidation lagoon. A moderate correlation was found between SARS-CoV-2 RNA, thermotolerant coliform and E. coli (p-value ≤ 0.0037), and a strong and positive correlation between thermotolerant coliform and E. coli. (p-value ≤ 0.00001), highlighting the utility of these established parameters as a proxy of the virus. Significant differences were found in the concentrations of thermotolerant coliforms between seasons (p-value = 0.016) and sites (p-value = 0.005). The highest levels of coliforms were found in the dry season (63000 MPN/100 mL) in Anconcito and during the rainy season (14000 MPN/100 mL) at Esterillo in Playas County. It is recommended that the decentralized autonomous governments of the surveyed provinces in Ecuador implement urgent corrective actions and establish medium-term mechanisms to minimize a potential contamination route. Additional parameters must be included in the monitoring, such as Enterococcus and intestinal parasites, due to their public health implications. In the oxidation lagoons, maintenance actions must be carried out, including the dissolution of sediments, an increase in water retention times, and in situ treatment of the sludge, to improve the system's performance.
Assuntos
COVID-19 , RNA Viral , SARS-CoV-2 , Esgotos , Qualidade da Água , Equador , Esgotos/virologia , Esgotos/microbiologia , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/genética , RNA Viral/genética , RNA Viral/isolamento & purificação , RNA Viral/análise , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/genética , Microbiologia da Água , Monitoramento Ambiental/métodos , Água do Mar/virologia , Água do Mar/microbiologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Águas Residuárias/virologia , Águas Residuárias/microbiologiaRESUMO
BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.
Assuntos
Embolia , Endocardite Bacteriana , Endocardite , Esplenopatias , Humanos , Esplenopatias/cirurgia , Esplenopatias/complicações , Abscesso/etiologia , Abscesso/cirurgia , Valva Aórtica/cirurgia , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Embolia/complicaçõesRESUMO
Objectives: The study aims to identify the correlation between human papillomavirus (HPV) infection and sociodemographic and sexual reproductive health factors in Ecuadorian women from March to August 2019. Methods: 120 women were randomly selected from two gynecological clinics to complete a questionnaire and provide a biospecimen. PCR-Hybridization was used to genotype 37 HPV serotypes in samples obtained by endo-cervical brushing for liquid-based cytology. Sociodemographic and sexual health data were collected through a validated questionnaire during a medical consultation. Mathematical modeling of HPV infection was done using bivariate logistic regression. Results: 65.0% of the women sampled had an HPV infection; 74.3% of these women had co-infections with other HPV genotypes. Out of the women who were HPV positive, 75.6% were diagnosed with high-risk genotypes from HPV strains 18, 35, 52, and 66. Parity, immunosuppression, and use of oral contraception/intrauterine devices (IUDs) were identified as associated variables. The explanatory model had a sensitivity of 89.5% and a specificity of 73.8%. Conclusion: The predominant strains of HPV among Ecuadorian women are diverse. The risk of HPV infection is a complex phenomenon where biological and psychosocial variables are integrated into a model. In populations with limited access to health services, low socioeconomic status, and negative sociocultural beliefs about sexually transmitted infections (STIs), surveys can be used as a pre-screening step for HPV infections. The diagnostic value of the model should be tested in multicenter studies that include women from all over the country.
Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Feminino , Humanos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/epidemiologia , Equador/epidemiologia , Colo do Útero , DemografiaRESUMO
PURPOSE: Depression is inadequately recognized and managed, and physicians' attitudes toward this condition and its treatment may play a part in this. This study aimed to assess Ecuadorian physicians' attitudes toward depression. METHODS: This was a cross-sectional study conducted using the validated Revised Depression Attitude Questionnaire (R-DAQ). The questionnaire was delivered to Ecuadorian physicians, and the response rate was 88.8%. RESULTS: 76.4% of participants had never received previous training in depression, and 52.1% of them indicated neutral or limited professional confidence when dealing with depressed patients. More than two-thirds of the participants reported an optimistic attitude toward the generalist perspective of depression. CONCLUSION: Overall, physicians in Ecuador's healthcare settings were optimistic and held positive attitudes toward patients with depression. However, a lack of confidence in the management of depression and a need for ongoing training were found, especially among medical professionals who are not in daily contact with patients with depression.
Assuntos
Depressão , Médicos , Humanos , Depressão/terapia , Equador , Atitude do Pessoal de Saúde , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosRESUMO
Introducción: La calidad de atención de Enfermería no se puede resumir en aspectos técnicos mecanizados, pues implica cuidado humano, que sustenta la necesidad evaluarla desde la percepción del sujeto. Objetivo: Validar un instrumento para medir la calidad percibida de los servicios de Enfermería en el contexto hospitalario. Métodos: Se realizó un estudio instrumental, en los servicios de hospitalización del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", La Habana, Cuba, en el período de enero a julio de 2021. Participaron nueve expertos, 15 jueces, 30 pacientes y 10 profesionales de la Enfermería del área de hospitalización. Se emplearon la revisión documental, el grupo focal, el método Delphi y la prueba piloto. Como métodos estadísticos se emplearon los coeficientes de V de Aiken y Alfa de Cronbach. Resultados: El instrumento quedó conformado por tres dimensiones: Componente Técnico (24 indicadores); Componente Interpersonal (17 indicadores); Confort (7 indicadores). El consenso entre los expertos, determinado por el Coeficiente de Concordancia, resultó igual al 100 por ciento. El índice de coeficiente de V de Aiken, estuvo en todos los ítems por encima de 0,9 y global de 0,97. El coeficiente de alfa de Cronbach alcanzó resultados superiores a 0,9 en cada ítem y 0,96 global. Conclusiones: El estudio permitió validar un instrumento para medir la calidad percibida de los servicios de Enfermería en el contexto hospitalario. El instrumento alcanzó una buena validez de contenido, alta fiabilidad y consistencia(AU)
Introduction: The quality of nursing care cannot be summarized based on mechanized technical aspects, since it implies human care, which is supported by the need to assess it focusing on the subject's perception. Objective: To validate an instrument to measure the perceived quality of nursing services in the hospital context. Methods: An instrumental study was carried out in the hospitalization services of Hospital Clínico Quirúrgico Hermanos Ameijeiras, in Havana, Cuba, in the period from January to July 2021, with the participation of 9 experts, 15 judges, 30 patients and 10 nursing professionals from the hospitalization area. Documentary review, focus group, the Delphi method and the pilot test were used. Aiken's V and Cronbach's alpha coefficients were used as statistical methods. Results: The instrument consisted of three dimensions: technical component (24 indicators, interpersonal component (17 indicators), and comfort (7 indicators). The consensus among the experts, determined by the concordance coefficient, was equal to 100 por ciento. The Aiken's V coefficient index was above 0.9 for all items, while the global one was 0.97. Cronbach's alpha coefficient reached results above 0.9 in each item, while the global one was 0.96. Conclusions: The study allowed to validate an instrument for measuring the perceived quality of nursing services in the hospital context. The instrument achieved good content validity, high reliability and consistency(AU)
Assuntos
Humanos , Qualidade da Assistência à Saúde , Estudo de Validação , Assistência ao Paciente/métodosRESUMO
Brazil is Latin America's largest country and has a strong economy, but it is also characterised by many inequalities. These are very conspicuous in the health sector, particularly in health education, which is expected to modernise according to the planetary health (PH) perspective. This paper describes the health education scenario in Brazil and undertakes an analysis of the postgraduate health programmes and policies in place, identifying the extent to which these support the cause of PH. To achieve this goal, this paper deploys a bibliometric analysis to gain a better understanding of the research streams related to higher education and PH. In addition, it presents and discusses selected case studies in the field and cross-checks documents from the Brazilian Ministry of Education against five domains of PH in education. The results indicate that despite some progress to date and the fact that some programmes are in place, there is a perceived need for policies and efforts from education organisations towards connecting PH principles in the education of current and future health professionals.
Assuntos
Educação em Saúde , Pessoal de Saúde , Brasil , Escolaridade , Pessoal de Saúde/educação , HumanosRESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic with serious consequences that have led to the implementation of unprecedented social isolation measures. At the early stages of the pandemic, Ecuador was one of the most affected countries in Latin America. The objective of this study was to assess the levels of depression, anxiety and stress in the Ecuadorian general population during the social isolation period due to COVID-19. METHODS: A web-based survey consisting of 31 short-answer and multiple-choice questions was administered to the general population from April 22-May 3, 2020. Mental health status was assessed through the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire. Ordinal logistic analyses were used to identify potential risk factors associated with the severity of mental health issues. RESULTS: A total of 626 individuals were included. Most of them were females (60.5%), and their mean age was 29.6 ± 11.7 years. Approximately 17.7% of the respondents had moderate to very severe levels of depression, 30.7% had similar levels of anxiety, and 14.2% experienced stress. Female sex, younger age, student status, and having a relative diagnosed with COVID-19 were associated with significantly higher levels of depression, anxiety and stress. Ordinal regression models showed that being a student was a risk factor for having more severe levels of depression (OR = 3.67; 95% CI = 2.56-5.26, p: 0.0001), anxiety (OR= 1.86; 95% CI= 1.35-2.55, p: 0.0001), and stress (OR = 2.17; 95% CI= 1.47-3.19, p: 0.0001). Having a relative with COVID-19 was also found to be a risk factor only for depression (OR= 1.70; 95% CI= 1.03-2.80, p: 0.036) and anxiety (OR = 2.17; 95% CI= 1.35-3.47, p: 0.001). Additionally, male sex, older age, and having more children were found to be protective factors for the three conditions. CONCLUSIONS: Our findings suggest that social isolation due to the COVID-19 outbreak has impacted the mental health of the general population in Ecuador. We identified potential risk and protective factors that could serve as a foundation from which to develop psychological strategies to safeguard the mental health of our population during the current pandemic.
Assuntos
COVID-19 , Depressão , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Surtos de Doenças , Equador/epidemiologia , Feminino , Humanos , Masculino , SARS-CoV-2 , Isolamento Social , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Introducción: La implementación de protocolos asistenciales como proyección estratégica en la prestación de servicios de salud permite contribuir a mejorar la calidad de la atención. Objetivo: Identificar el nivel de adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave. Métodos: Estudio descriptivo y transversal en cinco servicios de atención al grave del Hospital Hermanos Ameijeiras, desde octubre a diciembre de 2019. Según criterios, la muestra quedó constituida por 31 personal de enfermería, de ellos, 16 licenciados en enfermería (51,61 por ciento) y 15 enfermeros técnicos (48,39 por ciento). Fueron evaluadas 21 historias clínicas. La recolección de la información se realizó mediante un test de conocimientos y una lista de chequeo, validados a través de criterios de expertos. Se realizó prueba piloto con el test, que permitió evaluar su validez y confiabilidad. Resultados: El 92,09 por ciento del total de los evaluados presentaron conocimientos medianamente suficientes (64,51 por ciento) y suficientes (27,58 por ciento). En cuatro servicios evaluados (80 por ciento) tenían disponible los recursos materiales. En 21 historias clínicas (100 por ciento) se valoraron los factores de riesgo. La identificación del riesgo, así como la planificación y ejecución de intervenciones de enfermería, solamente se reflejaron en 10 historias (47,61 por ciento). Se obtuvieron 4,33 puntos en la sumatoria total. Conclusiones: Se determinó como de nivel medio la adherencia al protocolo asistencial para la prevención de lesiones por presión en servicios de atención al grave(AU)
Introduction: The implementation of care protocols as a strategic projection in the provision of health services allows to contribute to improving the quality of care. Objective: To identify the level of adherence to the care protocol for the prevention of pressure injuries in care services for severely ill patients. Methods: Descriptive and cross-sectional study carried out in five care services for severely ill patients at Hermanos Ameijeiras Hospital, from October to December 2019. Based on to criteria, the sample consisted of 31 nursing staff members, of which sixteen were diploma nurses (51.61 percent) and fifteen were associate nurses (48.39 percent). Twenty-one medical records were assessed. The information was collected using a knowledge test and a checklist, validated through expert criteria. A pilot test was carried out with the test, which made it possible to evaluate its validity and reliability. Results: 92.09 percent of those evaluated had moderately sufficient (64.51 percent) and sufficient (27.58 percent) knowledge. In four assessed services (80 percent), the material resources were available. Risk factors were assessed in 21 medical records (100 percent). The identification of risk, as well as the planning and execution of nursing interventions, were only reflected in ten medical records (47.61 percent). In the total sum, 4.33 points were obtained. Conclusions: Adherence to the care protocol for the prevention of pressure injuries in serious care services was determined as medium level(AU)
Assuntos
Humanos , Qualidade da Assistência à Saúde/tendências , Úlcera por Pressão/prevenção & controle , Avaliação em Enfermagem/métodos , Epidemiologia Descritiva , Estudos Transversais , Coleta de Dados/métodosRESUMO
El vólvulo del ciego es la torsión intestinal que afecta al colon ascendente o al íleon terminal debido a un ciego móvil. Descrita por Bundschuh en 1913, representa el 1 % de los casos de obstrucción intestinal y del 10 % al 40 % de los vólvulos colónicos. Su incidencia es baja, afecta de 2,8 a 7,1 millones de individuos por año, con prevalencia en mujeres jóvenes. Se puede presentar en pacientes con antecedentes quirúrgicos, masas abdominales y estreñimiento. Las imágenes diagnósticas son importantes para su identificación: la radiografía de abdomen muestra hallazgos poco específicos, pero representativos; la tomografía computarizada muestra hallazgos más sensibles y específicos. A continuación, se presenta un caso clínico y por medio de este se revisan los hallazgos más importantes del vólvulo cecal.
The cecum volvulus is intestinal torsion that affects the ascending colon or terminal ileum due to a mobile cecum. Described by Bundschuh in 1913, it represents 1 % of cases of intestinal obstruction and between 10 % to 40 % of colonic volvulus cases. Its incidence is low, affecting 2.8 to 7.1 million individuals per year, with a higher prevalence in young women. It can occur in patients with a surgical history, abdominal masses and constipation. Diagnostic images are important for its identification; abdominal radiography shows nonspecific but representative findings, computed tomography shows more sensitive and specific findings. A clinical case is presented and the most important findings of the cecal volvulus are reviewed.
Assuntos
Obstrução Intestinal , Doenças do Ceco , Volvo IntestinalRESUMO
Introducción: El consumo de drogas es considerado un elemento favorecedor de las conductas suicidas. En la medida que aumenta la frecuencia, intensidad, tiempo de consumo y la coexistencia con otros trastornos mentales también se incrementa la probabilidad de un comportamiento violento hacia sí mismo. Objetivo: Caracterizar pacientes adictos ecuatorianos con conductas suicidas y determinar posibles interacciones entre las variables sociodemográficas y de consumo consideradas. Método: Estudio transversal con pacientes drogodependientes que han sido ingresados en la Unidad de Conductas Adictivas (UCA) del Instituto de Neurociencias de Guayaquil (INC) en el periodo 2010-2016. Se seleccionó una población de 922 pacientes que refirieron algún tipo de conducta suicida luego de haber comenzado el consumo de drogas, incluyendo la ideación y el intento suicidas en cualquiera de sus variantes. Resultados: En este análisis se observó que la población masculina predominó en este grupo de estudio, de los cuales aproximadamente 4 de cada 10 intentaron suicidarse (36,3 por ciento), mientras que las mujeres fueron aproximadamente 5 de cada 10 (46,3 por ciento). Conclusiones: Entre los pacientes con conductas suicidas que ingresaron en Unidad de Conductas Adictivas del Instituto de Neurociencias de Guayaquil, Ecuador, entre el 2014 y 2017, predominaron mujeres que sufrieron de depresión o tenían comorbilidad con la esquizofrenia. Se trata de mujeres jóvenes de entre 15 a 25 años, que se iniciaron en el consumo de drogas entre los 15 y 20 años de edad, con intentos suicidas previos y depresión(AU)
Introduction: Illicit drug use is considered a favorable element highly associated to suicidal behavior. As the frequency, intensity, time of consumption and coexistence with other mental disorders, the probability of violent behavior towards oneself also increases. Objective: To characterize drug addict patients with suicidal behavior and determine possible links between sociodemographic and consumption variables. Method: A cross-sectional study in drug addict patients admitted in the Unidad de Conductas Adictivas (UCA) setted at the Instituto de Neurociencias (INC) in Guayaquil, Ecuador, was carried out, in the period 2010 throughout 2016. A total of 922 patients who referred any kind of suicidal behavior (including any kind of suicidal ideation or suicidal intent) were selected. Results: This research revealed that male population was predominant, in which 4 of 10 attempted suicide (36.3 percent), meanwhile in females was 5 in 10 approximately (46.3 percent). Conclusions: Among patients with suicidal behavior admitted in the Unidad de Conductas Adictivas (UCA) setted at the Instituto de Neurociencias (INC) in Guayaquil, Ecuador, between 2014 and 2017, women who suffered depressive symptoms or had schizophrenia as comorbidity were predominant. Women 15 to 20 years of age and with previous suicidal intent and depressive symptoms(AU)
Introdução: O uso de drogas é considerado um elemento que favorece o comportamento suicida. À medida que aumenta a frequência, intensidade, tempo de consumo e convivência com outros transtornos mentais, aumenta também a probabilidade de comportamento violento contra si mesmo. Objetivo: Caracterizar os dependentes químicos equatorianos com comportamento suicida e determinar as possíveis interações entre as variáveis sociodemográficas e de consumo consideradas. Método: Estudo transversal com pacientes dependentes químicos internados na Unidad de Conductas Adictivas (UCA) del Instituto de Neurociencias de Guayaquil (INC), Equador, no período de 2010-2016. Foi selecionada uma população de 922 pacientes que relataram algum tipo de comportamento suicida após o início do uso da droga, incluindo ideação suicida e tentativa de suicídio em qualquer uma de suas variantes Resultados: Nesta análise observou-se que a população masculina predominou neste grupo de estudo, da qual aproximadamente 4 em 10 tentativas de suicídio (36,3 porcento), enquanto as mulheres foram aproximadamente 5 em 10 (46,3porcento). Conclusões: Entre os pacientes com comportamento suicida internados na Unidade de Comportamento Aditivo do Instituto de Neurociências de Guayaquil, Equador, entre 2014 e 2017, predominaram mulheres que sofriam de depressão ou apresentavam comorbidade com esquizofrenia. São mulheres jovens entre 15 e 25 anos, que começaram a usar drogas entre 15 e 20 anos, com tentativas anteriores de suicídio e depressão(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Tentativa de Suicídio , Transtornos Relacionados ao Uso de Substâncias , Usuários de Drogas/psicologia , Ideação Suicida , Epidemiologia Descritiva , Estudos Transversais , Estudos Retrospectivos , Estudos Longitudinais , Diagnóstico Duplo (Psiquiatria) , EquadorRESUMO
En China a finales del 2019 se puso en conocimiento esta nueva enfermedad denominada SARS-CoV-2, múltiples centros mundiales encargados de la salud pública entre ellos el Centers of Disease Control and Prevention (CDC) de Atlanta, Estados Unidos y la Orgaizacion Mundial de la Salud (OMS) publicaron diferentes clasificaciones acordes a cada grupo etáreo, dando mucha importancia a la población pediátrica, el riesgo comparativo en adultos/niños, la importancia de pruebas laboratoriales (prueba en cadena a la polimerasa (PCR) y anticuerpos), y finalmente, se discuten los tratamientos acorde al caso y la gravedad de los pacientes. Por la alta demanda de pacientes y el colapso de los sitemas de salud en todo el mundo y especialmente en los países de latinoamerica donde los sistemas de salud son muy frágiles se llegas a recurrir de herramientas técnológicas como la Teleconsulta, recomendada por la OMS. En el presente artículo de revisión se plantea múltiples conceptos clínicos propios de la enfermedad en niños, imágenológicos, tipo de presentación de la enfermedad incluyendo factores de riesgo. Criterios de hospitalización y tratamiento. Medidas de bioseguridad, aislamiento y supervisión médica. Y como pilar fundamental de atención la Telemedicina en la era COVID-19.
In China at the end of 2019, this new disease called SARS-CoV-2 was made known, multiple world centers in charge of public health, including the Centers of Disease Control and Prevention (CDC) of Atlanta USA and the world health organization (WHO), published different classifications according to each age group, with more emphasis on the pediatric population. Comparative risk in adults/children. In addition to the results of laboratory tests (Polymerase Chain Reaction (PCR) and antibodies). And later its treatment is denoted according to the case and the severity. Where, due to the demand of patients, technological tools are resorted to through Teleconsultation, recommended by the WHO. In this review article, multiple clinical concepts typical of the disease in children, imaging, type of presentation of the disease including risk factors are proposed. Criteria for hospitalization and treatment. Biosecurity measures, isolation, and medical supervision. And as a pillar of Telemedicine Care in the COVID-19 era.
Assuntos
Saúde Pública , Centers for Disease Control and Prevention, U.S. , Consulta Remota , COVID-19RESUMO
Introducción: La auditoría de enfermería basada en estándares bien definidos, enfocados a la calidad asistencial de enfermería y la seguridad del paciente, permiten identificar desviaciones de manera eficaz. Objetivo: Proponer un grupo de estándares y elementos medibles que permitan conformar auditorías concurrentes de enfermería en el contexto hospitalario. Métodos: Se realizó una investigación de desarrollo tecnológico en el Hospital Hermanos Ameijeiras, desde enero de 2016 a enero de 2018. En el primer momento del estudio participaron 20 expertos, seleccionados a través de criterios. En el segundo momento, a través del muestreo intencional, se incorporaron dos licenciadas en enfermería del Grupo Médico Auditor. Como métodos teóricos se aplicaron: análisis-síntesis; inducción-deducción; enfoque de sistema y la modelación. Como empírico en el primer momento el método Delphi y en el segundo, la verificación en la práctica. Se aplicaron las consideraciones éticas para este tipo de estudio. Resultados: La propuesta quedó conformada por 17 estándares, agrupados en las 4 funciones generales de enfermería. Los estándares, a su vez, agruparon 166 elementos medibles, que permitieron revisar y evaluar el cumplimiento de los estándares. Conclusiones: Los estándares propuestos y elementos medibles, enfocados a la calidad asistencial de enfermería y la seguridad del paciente, permitirán conformar las auditorías concurrentes de enfermería en el contexto hospitalario(AU)
Introduction: Nursing audit based on well-defined standards, focused on the quality of nursing care and on patient safety, allows that deviations be identified effectively. Objective: To propose a group of standards and measurable elements that allow structuring concurrent nursing audits in the hospital setting. Methods: A technological development research was carried out at Hermanos Ameijeiras Hospital, from January 2016 to January 2018. In the first moment of the study, 20 experts participated, selected through criteria. In the second moment, through intentional sampling, two Nursing graduates were incorporated from the Audit Medical Group. The theoretical methods applied were analysis-synthesis, induction-deduction, system approach, and modeling. The empirical method applied in the first moment was the Delphi method and, in the second moment, verification in practice. Ethical considerations were applied for this type of study. Results: The proposal was made up of 17 standards, grouped into the four general functions of nursing. The standards, in turn, grouped 166 measurable elements, which made it possible to review and evaluate compliance with the standards. Conclusions: The proposed standards and measurable elements, focused on nursing care quality and patient safety, will make it possible to shape concurrent nursing audits in the hospital setting(AU)
Assuntos
Humanos , Qualidade da Assistência à Saúde , Padrões de Referência , Segurança do Paciente , Auditoria de Enfermagem/métodos , Desenvolvimento Tecnológico , Cuidados de Enfermagem/métodosRESUMO
It remains unclear whether the genetic risk for late-onset Alzheimer disease (AD) is linked to premorbid individual differences in general cognitive ability and brain structure. The objective of the present study was to determine whether the genetic risk of late-onset AD is related to premorbid individual differences in intelligence quotient (IQ) and characteristics of the cerebral white-matter in children. The study sample included children of the Generation R Study from Rotterdam, The Netherlands. IQ was measured using a well-validated Dutch nonverbal IQ test (n = 1908) at ages 5 to 9 years. White-matter microstructure was assessed by measuring fractional anisotropy (FA) of white-matter tracts using diffusion tensor imaging (DTI) (n = 919) at ages 9 to 12 years. Genetic risk was quantified using three biologically defined genetic risk scores (GRSs) hypothesized to be related to the pathophysiology of late-onset AD: immune response, cholesterol/lipid metabolism and endocytosis. Higher genetic risk for late-onset AD that included genes associated with immune responsivity had a negative influence on cognition and cerebral white-matter microstructure. For each unit increase in the immune response GRS, IQ decreased by 0.259 SD (95% CI [-0.500, -0.017]). For each unit increase in the immune response GRS, global FA decreased by 0.373 SD (95% CI [-0.721, -0.026]). Neither cholesterol/lipid metabolism nor endocytosis GRSs were associated with IQ or cerebral white-matter microstructure. Our findings suggest that elevated genetic risk for late-onset AD may in part be manifest during childhood neurodevelopment through alterations in immune responsivity.
Assuntos
Doença de Alzheimer/genética , Encéfalo/diagnóstico por imagem , Predisposição Genética para Doença , Inteligência , Substância Branca/diagnóstico por imagem , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/diagnóstico por imagem , Criança , Imagem de Tensor de Difusão , Diagnóstico Precoce , Feminino , Humanos , Testes de Inteligência , MasculinoRESUMO
BACKGROUND: Type 2 myocardial infarction (MIT2) is characterized by higher mortality rates compared to conventional type 1 infarction according to the European Society of Cardiology (ESC) in 2018. The purpose of this case is to identify appropriate therapeutic measures. A case of an Amyand's Hernia that produced an MIT2 is described in this work. CASE REPORT: A 77-year-old male was admitted to our emergency department for acute abdominal pain in the right lower quadrant associated with the presence of an ipsilateral inguinal hernia with signs of peritoneal irritation, while complaining of chest pain. A positive troponin indicated the presence of myocardial infarction. A laparotomy was performed with the finding of an incarcerated right inguino-scrotal hernia that contained the gangrenous and perforated cecal appendix (Amyand hernia type 3). The treatment consisted of surgical correction of the hernia, an appendectomy, antibiotics and support in the intensive care unit with a positive outcome. The diagnosis of Amyand hernia type 3 was established intraoperatively, and by imaging, confirming the presence of an MIT2 according to the criteria of the fourth definition of ECS infarction. CONCLUSION: In the surgical environment it is strange to find patients who present with acute abdominal pain and a myocardial infarction at the same time. It is necessary for the consultant to recognize these two entities to make a correct diagnosis and provide timely treatment to reduce any possibility of patient mortality.
RESUMO
Introducción: Las úlceras por presión constituyen un gran problema de salud: deterioran la calidad de vida de los pacientes, con una repercusión negativa en sus familias, incrementan el consumo de recursos y los costos en salud. Objetivo: Proponer una metodología para la protocolización de la actuación de enfermería en la prevención de úlceras por presión en pacientes hospitalizados. Métodos: Se realizó una investigación de desarrollo tecnológico, en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", desde octubre de 2016 a enero de 2018. Participaron diez expertos seleccionados a través de criterios establecidos, todos con un alto nivel de competencia. Como métodos teóricos se aplicaron: análisis-síntesis; inducción-deducción; enfoque de sistema y modelación; como método empírico, el método Delphi. Se empleó el análisis de las fuentes documentales y el procesamiento de las opiniones de expertos propuesto en el método Delphi. Resultados: La metodología quedó estructurada en seis momentos (diagrama de flujo) con pasos debidamente delimitados en la prevención de úlceras por presión del paciente en el contexto hospitalario. Para la evaluación y control se establecieron indicadores de estructura, proceso y resultados. Conclusiones: La propuesta metodológica diseñada deviene en un referente de estructura y contenido para la protocolización de la actuación de enfermería en la prevención de úlceras por presión en pacientes hospitalizados. Los elementos propuestos se basaron en el consenso de expertos y en la mejor evidencia científica(AU)
Introduction: Pressure ulcers are a major health concern; they deteriorate the quality of life of patients, with a negative impact on their families, and increase the consumption of resources and health costs. Objective: To propose a methodology for the protocolization of nursing actions in the prevention of pressure ulcers in hospitalized patients. Methods: A technological development research was carried out at Hermanos Ameijeiras Clinical-Surgical Hospital, from October 2016 to January 2018. Ten experts selected through established criteria participated, all with a high level of competence. Theoretical methods were applied, such as analysis-synthesis, induction-deduction, system approach, and modeling. The empirical method used was the Delphi method. The analysis of documentary sources and the processing of expert opinions proposed in the Delphi method were used. Results: The methodology was structured in six moments (flow chart) with duly defined steps in the prevention of pressure ulcers of patients in the hospital context. For evaluation and control, structure, process and results indicators were established. Conclusions: The methodological proposal designed becomes a reference of structure and content for the protocolization of nursing actions in the prevention of pressure ulcers in hospitalized patients. The proposed elements were based on expert consensus of the best scientific evidence(AU)
Assuntos
Humanos , Qualidade de Vida , Úlcera por Pressão/prevenção & controle , Metodologia como Assunto , Cuidados de Enfermagem/métodos , Desenvolvimento Tecnológico , Custos de Cuidados de SaúdeRESUMO
Introducción: Las úlceras por presión se perfilan dentro de la seguridad clínica y constituyen un gran problema de salud. Objetivo: Proponer una metodología para la protocolización de la actuación de enfermería para el registro y notificación de úlceras por presión en pacientes hospitalizados. Métodos: Se realizó una investigación de desarrollo tecnológico, en el Hospital "Hermanos Ameijeiras", desde octubre de 2016 a enero de 2018. Participaron diez expertos seleccionados a través de criterios establecidos, todos con un alto nivel de competencia. Como métodos teóricos se aplicaron: análisis-síntesis, inducción-deducción, enfoque de sistema y la modelación. Como empírico, el método Delphi. Se empleó el análisis de las fuentes documentales y el procesamiento de las opiniones de expertos propuesto en el método Delphi. Se aplicaron las consideraciones éticas para este tipo de estudio. Resultados: La metodología quedó estructurada en siete momentos con pasos debidamente delimitados para el registro y notificación de úlceras por presión en pacientes en el contexto hospitalario. Para la evaluación y control se establecieron indicadores de estructura, proceso y resultados. Conclusiones: La propuesta metodológica diseñada, deviene en un referente de estructura y contenido para la protocolización de la actuación de enfermería en el registro y notificación de úlceras por presión en pacientes hospitalizados. Los elementos propuestos se basaron en el consenso de expertos y en la mejor evidencia científica(AU)
Introduction: Pressure ulcers are described within clinical safety and constitute a major health concern. Objective: To propose a methodology for the protocolization of nursing performance in the registration and notification of pressure ulcers in hospitalized patients. Methods: A technological development research was carried out at Hermanos Ameijeiras Hospital, from October 2016 to January 2018. Ten experts participated. All possessed a high level of competence and were selected through established criteria. The theoretical methods applied were analysis-synthesis, induction-deduction, system approach, and modeling. As empirical method, we applied the Delphi method. The analysis of documentary sources and the processing of expert opinions proposed in the Delphi method were used. Ethical considerations were applied for this type of study. Results: The methodology was structured in seven moments with duly defined steps for the registration and notification of pressure ulcers in patients in the hospital setting. For evaluation and control, indicators of structure, process and outcomes were established. Conclusions: The designed methodological proposal becomes a benchmark of structure and content for the protocolization of nursing performance in the registration and notification of pressure ulcers in hospitalized patients. The proposed elements were based on expert consensus and the best scientific evidence(AU)
Assuntos
Humanos , Desenvolvimento Tecnológico , Úlcera por Pressão/diagnóstico , Metodologia como Assunto , HospitalizaçãoRESUMO
RESUMEN Introducción: Las caídas de los pacientes durante su hospitalización se perfila como uno de los eventos adversos que más daño causan a la persona de manera directa, como pueden ser secuelas y discapacidades. Objetivo: Proponer una metodología para la protocolización de la actuación de enfermería en el registro y notificación de caídas en pacientes hospitalizados. Métodos: Se realizó una investigación de desarrollo tecnológico, en el Hospital "Hermanos Ameijeiras", desde octubre de 2016 a enero de 2017. Participaron diez expertos seleccionados a través de criterios establecidos, todos con un alto nivel de competencia. Como métodos teóricos se aplicaron análisis-síntesis; inducción-deducción; enfoque de sistema y la modelación. Como empírico el método Delphi. Se emplearon el análisis de las fuentes documentales y el procesamiento de las opiniones de expertos propuesto en el método Delphi. Resultados: La metodología quedó estructurada en siete momentos, (diagrama de flujo) con pasos debidamente delimitados para el registro y notificación de caídas en pacientes en el contexto hospitalario. Para la evaluación y control se establecieron indicadores de estructura, proceso y resultados. Conclusiones: La propuesta metodológica diseñada deviene en un referente de estructura y contenido para la protocolización de la actuación de enfermería en el registro y notificación de caídas en pacientes hospitalizados. Los elementos propuestos se basaron en el consenso de expertos y en la mejor evidencia científica(AU)
ABSTRACT Introduction: Patient falls during hospitalization are profiled as one of the adverse events that directly cause most damage to the person, such as sequelae and disabilities. Objective: To propose a methodology for the protocolization of nursing actions in the registry and notification of falls in hospitalized patients. Methods: A technological development research was carried out at Hermanos Ameijeiras Surgical Clinical Hospital, from October 2016 to January 2017. Ten experts selected through established criteria participated, all of whom had a high level of competence. As theoretical methods, analysis-synthesis, induction-deduction, system approach and modeling were applied; as empirical, the Delphi method was used. The analysis of documentary sources and the processing of expert opinions proposed in the Delphi method were used. Results: The methodology was structured in seven moments (flow chart), with duly delimited steps for recording and reporting falls in patients in the hospital context. For assessment and control, structure, process and results indicators were established. Conclusions: The methodological proposal designed becomes a reference of structure and content for the protocolization of nursing actions in the registry and notification of falls in hospitalized patients. The proposed elements were based on the consensus of experts and the best scientific evidence(AU)
Assuntos
Humanos , Acidentes por Quedas/prevenção & controle , Segurança do Paciente , Hospitalização , Cuidados de Enfermagem/métodos , Desenvolvimento TecnológicoRESUMO
PURPOSE: The aim of the study was to develop and validate a Spanish version of the Revised Depression Attitude Questionnaire (R-DAQ). METHODS: The R-DAQ was used as a baseline for the study. It was translated and tested to ensure the instrument was appropriate for the target population. 537 Ecuadorian healthcare professionals completed the revised Spanish version of the R-DAQ (SR-DAQ). Statistical and exploratory factor analyses were performed to examine construct validity, internal consistency, readability and floor and ceiling effects. RESULTS: Three factors were obtained: "Professional confidence in depression care"; "Therapeutic optimism about depression"; and "Generalist perspective about depression occurrence, recognition, and management". The internal consistency of the SR-DAQ was determined by means of Cronbach's α coefficient, with values ranging between 0.61-0.8. The correlations with the English version reflected adequate validity. The model explained 39% of the variance. Subsequent analysis with a sample restricted to those who had received training in depression produced a model that explained 42% of the variance. CONCLUSION: The SR-DAQ meets the psychometric requirements for measuring depression attitude in a Spanish-speaking population and shows adequate internal consistency and validity.