Antropología de los cuidados

Este artículo tiene como objetivo describir la Antropología y los Cuidados en la Enfermería Comunitaria. Instrumento éste que las enfermeras de atención primaria utilizamos para cuidar, o hacer que la población se cuide, dado que la comunidad es el instrumento básico con el que la enfermera actúa y cuida.This article has the objective of describe to the Anthropology and the Cares in the Nursing Communitarian. This Instrument is used to caring and also for the population takes care of itself, then, community is the basic instrument with which the nurse acts, and cares

Health councils as an instrument of community participation: a qualitative research in La Rioja (Spain)

Objetivo: Describir el funcionamiento y la normativa de los consejos de salud de La Rioja como órganos de participación ciudadana en la gestión de la salud. Método: Se ha realizado un estudio cualitativo que emplea una triangulación del examen del marco institucional nacional y regional de los consejos de salud, con la revisión de 58 actas oficiales de las sesiones y la realización de 11 entrevistas semiestructuradas a personas vinculadas. Resultados: En el estudio se observa la presencia dominante de una visión biomédica-tecnológica, una baja formación en dinámicas de participación comunitaria y un funcionamiento desestructurado de los consejos, dominados por la Administración pública sanitaria y centrados en una función de transmisión de información que genera la pérdida de implicación proactiva de la ciudadanía. Conclusiones: A pesar de estas deficiencias, los consejos pueden constituir un instrumento eficaz para la gestión sanitaria si existe voluntad política y una adecuada conciencia ciudadana.Objective: To describe the functioning and regulations of health councils in La Rioja (Spain) as vehicles for citizen participation in health management. Method: A qualitative analysis was conducted triangulating the national and regional institutional framework reviews of health councils, the official minutes of 58 meetings, and 11 semi-structured interviews with related persons. Results: The analysis revealed a predominantly biomedical-technological standpoint, a lack of training in community participation dynamics, and an absence of structure in council operations. The councils were also found to be over-powered by public healthcare administration and restricted to a role of simply transmitting information, thereby neglecting an opportunity for proactive community involvement. Conclusions: In spite of these shortcomings, community health councils can operate as efficient instruments in health management as long as the necessary political will and appropriate community awareness both exist

O homem ea gênese do trabalho de enfermagem comunidade

Se describe el origen del trabajo enfermero y su relación con el ser humano de acuerdo al contexto cultural donde se realiza. Se examinan términos que son interpretados y aceptados socialmente y que están repletos de significados de acuerdo al modelo médico hegemónico occidental. Así mismo se analiza el concepto de ser humano y la aparente contradicción entre universalidad y diversidad particular. Conceptos que, desde la óptica del cuidado, trascienden lo puramente biológico y permiten construir toda una red de significados de orden psicológico y social y que se reinventan continuamente.It describes the origin of nursing work and its relationship with human beings according to cultural context where it is performed. It exams terms that are socially interpreted and accepted and that are full of meanings according to Western hegemonic medical model. It also discusses the concept of man and the apparent contradiction between universality and particular diversity . Concepts, from the point of care, beyond the purely biological that allow to build a network of meanings with a psychological and social origin and continually reinvent themselves.Ele descreve a origem do trabalho dos enfermeiros e sua relação com os seres humanos de acordo com o contexto cultural em que ele executa. Ele examina os termos são interpretados e socialmente aceites e são cheias de significados de acordo com o modelo médico hegemônico ocidental. Ele também discute o conceito de ser humano ea aparente contradição entre universalidade e diversidade particular. Conceitos que, do ponto de atendimento, além do puramente biológico e permitir-lhe construir uma rede de significados psicológicos e sociais e reinventou continuamente

Fuentes documentales para el estudio de la historia de la enfermería desde 1915 en La Rioja

El concepto de cuidar ha estado li-gado al concepto de caridad más que al de pro-fesión, sin embargo, en 1915 la enfermería na-ció con el propósito de extenderlo a religiosasy no religiosas. Nuestro objetivo es describir yvalorar las fuentes documentales que aportaninformación sobre el desarrollo e institución dela enfermería desde 1915 en la Rioja. Los archi-vos hasta ahora explorados, nos muestran undesarrollo de la asistencia sanitaria muy ligadoa la beneficencia, puesto que a nivel municipaly provincial son estas instituciones principal-mente las que se encargan de establecer loscentros asistenciales. Conocer los factores quehan intervenido en la evolución de la enferme-ría es clave para comprender nuestro presente.The concept of care has beenlinked to the concept of charity rather thanthe profession, however, nursing born in 1915in order to extend it to religious and non reli-gious. Our aim is to describe and evaluate thedocumentary sources that provide informationon the development and institution of nursingsince 1915 in La Rioja. The files so far explored,show a development closely linked to charityhealthcare, since the municipal and provinciallevel are mainly those institutions that areresponsible for establishing health centers.Knowing the factors that have intervened in theevolution of nursing will help us understand ourpresent

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies