Actitudes negativas y barreras percibidas por profesionales de enfermería hacia la prevención de úlceras por presión

[Resumen] Introducción: Los actuales datos epidemiológicos sobre las úlceras por presión de los diferentes países de nuestro entorno, indican que estamos ante un serio problema para la salud que revierte negativamente en el sistema sanitario. Con el paso de los años, no se ha conseguido reducir significativamente las tasas de prevalencia, a pesar de contar con evidencias y recursos para su evitabilidad. Por todo ello, parece necesario el escuchar las opiniones del personal de enfermería, que desempeña un rol importante en los cuidados y prevención de estas úlceras, y analizar la información aportada por dicho colectivo, principalmente en lo referente a posibles dificultades y limitaciones para la aplicación de las medidas de prevención. Objetivo: Identificar y evaluar las actitudes negativas y barreras con las que se encuentra el personal de enfermería a la hora de prevenir las ulceras por presión (UPP) en pacientes hospitalizados. Metodología: Para este proyecto de investigación se llevará a cabo un estudio observacional, transversal y descriptivo. La información, se obtendrá a través de los cuestionarios validados PIPK (Conocimientos en prevención de úlceras por presión), APuP (Actitud hacia la prevención de las úlceras por presión) y Cuestionario de barreras para la prevención e intervención de las úlceras por presión (BPIUPP). La muestra, será seleccionada por conveniencia entre el personal de enfermería (enfermeras y auxiliares) adscritos al Complejo Hospitalario Universitario de Ferrol (CHUF). Aplicabilidad: Se pretende conocer las actitudes y barreras de las que se parte; con ello, se obtendrá una información relevante y crucial para que se lleve a cabo un cambio en las estrategias sanitarias y procedimientos de cuidados, incidiendo en todas las carencias que se presentan.[Resumo] Introdución: Os datos epidemiolóxicos actuais sobre as úlceras por presión nos diferentes países que nos rodean indican que estamos ante un grave problema de saúde que ten un efecto negativo sobre o sistema sanitario. Co paso dos anos, as taxas de prevalencia non se reduciron significativamente, a pesar de contar con evidencias e recursos para evitalo. Por todos estes motivos, parece necesario escoitar as opinións do persoal de enfermaría, que desempeñan un papel importante na atención e prevención destas úlceras, e analizar a información proporcionada por este grupo, principalmente en relación a posibles dificultades e limitacións para a aplicación. de medidas de prevención. Obxectivo: Identificar e avaliar as actitudes e barreiras negativas que atopan os enfermeiros á hora de previr as úlceras por presión (UPP) en pacientes hospitalizados. Metodoloxía:. Neste proxecto de investigación realizarase un estudo observacional transversal e descritivo. A información obterase a través dos cuestionarios validados PIPK (Coñecemento na prevención das úlceras por presión), APuP (Actitude cara á prevención das úlceras por presión) e BPIUPP (Cuestionario de barreiras para a prevención e intervención das úlceras por presión). A mostra seleccionarase para comodidade entre o persoal de enfermaría (enfermeiras e auxiliares) asignado ao Complexo Hospitalario Universitario de Ferrol (CHUF). Aplicabilidade: Preténdese coñecer as actitudes e barreiras a partir das cales se inicia; Con isto obterase información relevante e crucial para que se realice un cambio nas estratexias e nos procedementos asistenciais para a saúde, influíndo en todas as deficiencias que xurdan.[Abstract] Introduction: The epidemiological data you act on pressure ulcers in different countries around us indicate that we are facing a serious health problem that has a negative effect on the health system. Over two years, prevalence taxa were not significantly reduced, despite having evidence and resources to avoid it. For all these reasons, it seems necessary to choose the views of the nursing staff, which play an important role in the care and prevention of these ulcers, and to analyze the information provided by this group, mainly in relation to possible difficulties and limitations for the application of prevention measures. Objective: Identify and evaluate the negative attitudes and barriers that nurse’s encounter when it comes to preventing pressure ulcers (UPP) in hospitalized patients. Methodology: For this research project, an observational, cross-sectional and descriptive study will be carried out. The information will be obtained through the validated questionnaires PIPK (Pressure Injury Prevention Knowledge), APuP (Attitude towards the prevention of pressure ulcers) and BPIUPP (Barriers for the prevention and intervention of pressure ulcers). The sample will be selected for convenience among the nursing staff (nurses and auxiliaries) assigned to the Ferrol University Hospital Complex (CHUF). Applicability: It is intended to know the attitudes and barriers from which it starts; with this, relevant and crucial information will be obtained so that a change in health strategies and care procedures is carried out, influencing all the deficiencies that arise.Traballo fin de grao (UDC.FEP). Enfermaría. Curso 2019/202

Smoking and Pulmonary Fibrosis: Novel Insights

The relationship between smoking and pulmonary fibrosis is under debate and intense investigation. The aim of this paper is to review the existing literature and identify further areas of research interest. Recently the negative influence of cigarette smoking on IPF outcome was highlighted, as non-smokers exhibit a better survival than ex-smokers and combined current- and ex-smokers. In patients with non-specific interstitial pneumonia (NSIP), a high prevalence of emphysema was recently demonstrated, providing an indirect support for a smoking pathogenetic hypothesis in NSIP. The coexistence of pulmonary fibrosis and emphysema has been extensively described in a syndrome termed combined pulmonary fibrosis and emphysema (CPFE). Connective tissue disorders (CTDs) are a group of autoimmune diseases which affect the lung, as one of the most common and severe manifestations. However, the relationship between smoking and autoimmune disorders is still conflicting. Rheumatoid arthritis results from the interaction between genetic and environmental factors, while the best established environmental factor is tobacco smoking. Smoking has also a negative impact on the response of the RA patients to treatment. The aforementioned smoking-related implications give rise to further research questions and certainly provide one more important reason for physicians to advocate smoking cessation and smoke-free environment

Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.</p> <p>Cases presentation</p> <p>We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.</p> <p>Conclusion</p> <p>Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Microsatellite DNA instability analysis in sputum cell subpopulations in obstructive airway disease

Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide with increasing prevalence morbidity and mortality. Although chronic obstructive pulmonary disease (COPD) is a common disease and its primary cause, cigarette smoking, is well known, a large number of questions remain to be elucidated regarding disease pathogenesis involving genetics environmental and epigenetic factors. The genetic background of COPD has been the focus of many recent studies. The role of acquired somatic mutations in the pathogenesis of COPD has been shown to be important. Acquired somatic mutations are considered as sporadic changes in genes or gene regulatory regions that occur spontaneously and rarely. However, they dramatically increase in frequency in tissues exposed to repeated exogenous mutagenic insults. Although the susceptibility to acquiring such mutations might be controlled by inherited genes, somatic mutations do not affect the germ line and are not heritable. Loss of heterozygosity and microsatellite DNA instability are genetic alterations that have been initially reported in a number of human malignancies. However, during recent years such phenomena have also been detected in various benign pulmonary and extra-pulmonary diseases. We have recently detected microsatellite DNA instability (MSI) and/or loss of heterozygosity (LOH) in sputum cells of COPD and asthmatic patients. To our knowledge MSI and/or LOH have not yet been detected in BAL samples from COPD patients. However, the particular sputum and/or BAL cell population exhibiting this genetic instability has not yet been identified. The aims of this study were to examine whether airway and bronchoalveolar cells are prone to somatic acquired genetic alterations by evaluating sputum and BALF cells and to determine which specific cell population is affected by these somatic acquired genetic alterations. The identification of the susceptible cell population to somatic DNA damage in COPD may elucidate an important component of disease pathogenesis. The natural ability of the injured lung in COPD to shut down persisting inflammation and initiate proper tissue repair is dependent on intact DNA auto repair mechanisms. Thus, our study could answer whether increased inflammatory burden on COPD patients results in acquired somatic DNA mutations of lung epithelia. A total of 35 patients were studied. All were diagnosed with COPD stage II and were ex-smokers for a period of >6 months.Η Χρόνια Αποφρακτική Πνευμονοπάθεια (ΧΑΠ) αποτελεί μια από τις κυριότερες αίτιες νοσηρότητας και θνητότητας παγκοσμίως και έχει ως αποτέλεσμα οικονομική και κοινωνική επιβάρυνση η οποία είναι ουσιαστική και αυξανομένη. Αν και η ΧΑΠ είναι μια ασθένεια συχνή της οποίας ο κυριότερος αιτιολογικός παράγοντας είναι γνωστός και είναι το κάπνισμα τσιγάρων, εντούτοις πολλά ερωτήματα παραμένουν αδιευκρίνιστα σε ότι αφορά την παθογένεια της νόσου και ιδιαίτερα την επίδραση γενετικών περιβαλλοντικών αλλά και επιγενετικών παραγόντων [1,2]. Το γενετικό υπόβαθρο της ΧΑΠ έχει αποτελέσει το επίκεντρο πολλών προσφάτων μελετών [3]. Σημαντικός φαίνεται να είναι ο ρόλος των επίκτητων σωματικών μεταλλάξεων στην παθογένεση της ΧΑΠ [4,5]. Οι επίκτητες σωματικές μεταλλάξεις θεωρούνται σποραδικές αλλαγές σε γονίδια ή περιοχές ελέγχου των γονίδιων οι οποίες προκύπτουν αυτόματα και μάλλον σπάνια. Η συχνότητα των μεταλλάξεων αυτών όμως αυξάνεται κατά πολύ σε ιστούς οι οποίοι εκτίθενται σε επαναλαμβανόμενες εξωγενείς μεταλλαξιογόνες προσβολές. Αν και η «ευπάθεια» στην εμφάνιση μεταλλάξεων κατ’ αυτόν τον τρόπο ενδέχεται να υπόκειται σε έλεγχο από κληρονομούμενα γονίδια οι σωματικές μεταλλάξεις δεν κληρονομούνται [4]. Η απώλεια ετεροζυγωτίας και η αστάθεια του μικροδορυφορικού DNA είναι γενετικές αλλοιώσεις οι οποίες αποτελούν φαινόμενα που έχουν ανευρεθεί στις περισσότερες ανθρώπινες κακοήθειες [6-12]. Πρόσφατες μελέτες ωστόσο ανέδειξαν ότι η LOH και η MSΙ ανευρίσκονται και σε αρκετές καλοήθεις παθήσεις πνευμονικές και εξω-πνευμονικές [5,6,13-15]. Σε πρόσφατες μελέτες από την ομάδα μας ανιχνεύθηκαν αστάθεια του μικροδορυφορικού DNA ή/και απώλεια ετεροζυγωτίας σε δείγματα κυττάρων πτυέλων ασθενών με ΧΑΠ και βρογχικό άσθμα [5,13-15]. Ωστόσο ο συγκεκριμένος κυτταρικός υποπληθυσμός ο οποίος εμφανίζει την γενετική αυτή αστάθεια δεν έχει εξακριβωθεί. Έτσι σκοπός της παρούσας μελέτης ήταν αφ’ ενός να εξετάσει την παρουσία επίκτητων σωματικών γενετικών αλλοιώσεων σε κύτταρα πτυέλων και βρογχοκυψελιδικού εκπλύματος καθώς και η διερεύνηση του συγκεκριμένου κυτταρικού πληθυσμού που εμφανίζει τις αλλοιώσεις αυτές. Η αναγνώριση του κυτταρικού πληθυσμού που είναι ευπαθής σε βλάβες του DNA στην ΧΑΠ μπορεί να διαφωτίσει ένα σημαντικό κομμάτι της παθογένεσης της νόσου. Η φυσική ικανότητα του πνεύμονα να λύνει την φλεγμονή και να ξεκινά ιστική επιδιόρθωση μετά από έκθεση σε εισπνεόμενους βλαπτικούς παράγοντες είναι μια διαδικασία η οποία εξαρτάται από την ακεραιότητα των μηχανισμών αυτόματης επιδιόρθωσης του DNA κάτι που όπως φαίνεται δεν ισχύει στην ΧΑΠ