La sujeción mecánica como medida terapéutica en el cuidado de enfermería de pacientes adultos con agitación psicomotora en unidades de cuidados intensivos

RESUMEN: En la Unidad de Cuidado Intensivo, una de las medidas terapéuticas implementadas con mayor frecuencia es la sujeción mecánica, la cual tiene como objetivo, evitar que el paciente se autolesione o lesione a las personas que lo rodean; no obstante, a pesar del uso reiterativo de esta estrategia, no existen directrices claras sobre su adecuada implementación. Teniendo en cuenta, que existen múltiples complicaciones asociadas a su uso y las repercusiones éticas y legales que ésta estrategia conlleva, se identifica por tanto, como un tema de gran importancia para la práctica de enfermería, el cual debe ser estudiado en relación con las implicaciones que su utilización deriva para el paciente en estado crítico, no solo desde lo físico, sino a partir de lo social, emocional y sicológico. Es claro que, en relación con la sujeción mecánica se vislumbra una problemática alrededor de su utilización por parte del profesional de enfermería, pues es una intervención que influye en la seguridad y calidad del cuidado brindado a los pacientes; pese a ser una práctica comúnmente utilizada en las unidades de cuidados intensivos, no existen lineamientos claros sobre su implementación que permitan al enfermero analizarla y visualizarla desde una perspectiva holística. Se concluye que, la sujeción mecánica, se concibe como una práctica que genera controversias, por esto se hace pertinente que todas sus dimensiones sean conocidas, reguladas y evaluadas para minimizar la brecha entre lo que se debe hacer y lo que realmente se aplica en la práctica cotidiana; de modo que se lleve a cabo respetando la dignidad de las personas y fortaleciendo el carácter autónomo de la profesión de enfermería

Experiencias en el aula: segundo encuentro de prácticas pedagógicas innovadoras

Experiencias de profesores en su quehacer en los distintos ambientes de aprendizaje presenciales y a distancia.La segunda entrega de Experiencias en el aula es una publicación anual que recoge las ponencias ganadoras presentadas en el Segundo Encuentro de Prácticas Pedagógicas Innovadoras, organizado por el Centro de Excelencia Docente aeiou, de la Vicerrectoría General Académica de la Corporación Universitaria Minuto de Dios – UNIMINUTO Todas las ponencias publicadas en la segunda entrega de Experiencias en el aula fueron seleccionadas por evaluadores externos durante la convocatoria al Segundo Encuentro de Prácticas Pedagógicas Innovadoras en el que fueron presentadas; este evento, organizado por el Centro de Excelencia Docente aeiou, y la Vicerrectoría General Académica de la Corporación Universitaria Minuto de Dios- UNIMINUTO, tuvo lugar los días 9 y 10 de octubre de 2017

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Implante de lente intraocular trifocal difractivo: análisis y resultado de la agudeza visual

Objetivo: Evaluar el resultado visual a distancias lejana, intermedia y cercana, presencia de disfotopsias, aberrometría corneal y satisfacción visual del paciente tras el implante de un lente intraocular trifocal difractivo. Material y métodos: Estudio prospectivo, longitudinal y observacional que incluyó a pacientes sometidos a cirugía de facoemulsificación más implante de lente intraocular trifocal difractivo por catarata o disfunción de cristalino. Se evaluó agudeza visual lejana, intermedia y cercana al mes de la cirugía, así como la presencia de disfotopsias percibidas por el paciente, aberrometría corneal y su nivel de satisfacción visual. Resultados: Se evaluaron un total de 94 ojos en 52 pacientes. En el 80.7% se realizó cirugía bilateral y en el 19.3% de un solo ojo. La agudeza visual lejana, intermedia y cercana al mes de la cirugía fue de 0.06 ± 0.15, 0.04 ± 0.10 y −0.03 ± 0.10 LogMAR, respectivamente, con un equivalente esférico residual de −0.31 ± 0.60. El 23.4% de los pacientes refirió deslumbramiento, el 1.1% fotopsias y el 1.1% ambas. El 97% de los pacientes se refirieron satisfechos tras el implante del lente intraocular. No existieron cambios significativos en las aberraciones ópticas pre- y postoperatorias. Conclusiones: El implante de un lente intraocular trifocal difractivo es capaz de proporcionar una excelente visión lejana, intermedia y cercana, con escasas aberraciones ópticas, permitiendo una mejor calidad visual útil en actividades desarrolladas a diferentes distancias