Factores perinatales asociados con los valores de pH de sangre de cordón umbilical

Objective: Perinatal asphyxia is the mayor cause of neonatal morbidity and mortality. The analysis of umbilical arterial cord blood pH remains an objective criterion used to determine the metabolic state of the newborn after birth, and therefore of fetal wellbeing. The aim was to identify the perinatal factors associated with umbilical arterial cord blood pH values.  Materials and methods: A descriptive and analytical study was conducted between January 2010 and January 2013 at a tertiary hospital in the Southern Spain. The inclusion criteria were: Uncomplicated pregnancy and vaginal single delivery at term with vertex presentation. Independent variables with greater significance after the univariate analysis were: Age, parity, gestational age, epidural analgesia, birth plan, and episiotomy, duration of first labor stage and oxytocin use. It was considered as a dependent variable the umbilical arterial blood pH values (< = 7.24; > 7.24). The total number of women was 165. Statistical analysis was performed using logistic regression. Results: Epidural analgesia and gestational age more than or equal to 41 weeks have negatively influence the neonatal umbilical cord pH, while having presented a birth plan could have a protective influence.  Conclusions: findings of this study provide to the professionals  more evidence on the elements that may influence neonatal wellbeing, in order to act accordingly, anticipating risk situations and applying more effective care.Objetivo: El análisis del pH de sangre arterial de cordón umbilical sigue siendo un criterio objetivo usado para determinar el estado metabólico  del recién nacido tras el parto, y por tanto del bienestar fetal. El objetivo de este estudio fue identificar los factores perinatales asociados con los valores de sangre arterial de cordón umbilical.Material y métodos: Se realizó un estudio descriptivo y analítico entre Enero de 2010 y Enero de 2013 en un hospital de tercer nivel en el sur de España, con mujeres atendidas por parto. Los criterios de inclusión fueron: embarazo sin complicaciones y parto vaginal único, a término, con presentación cefálica. Las variables independientes con gran significación tras un análisis univariante fueron: edad, paridad, edad gestacional, analgesia epidural, plan de parto, episiotomía, duración de la primera fase del parto, y uso de oxitocina. Como variable dependiente se consideró: los valores de pH de sangre arterial de cordón umbilical (< = 7.24; > 7.24). El número total de mujeres fue de 165. El análisis estadístico se realizó mediante regresión logística múltiple. Resultados: La analgesia epidural y la edad gestacional mayor o igual a 41 semanas influyeron negativamente en el pH de cordón umbilical neonatal, mientras que haber presentado un plan de parto tuvo una influencia protectora.Conclusiones: Los hallazgos de este estudio proporcionan a los profesionales más evidencias sobre los elementos que pueden influenciar en el bienestar neonatal, con el fin de actuar en consecuencia, anticipándose a las situaciones de riesgo y  aplicando  una atención más eficaz

Relationships among general health, job satisfaction, work engagement and job features in nurses working in a public hospital: A cross‐sectional study

Aim and objective: To describe relations among health, job satisfaction, work en‐ gagement and job features in Spanish nurses working in a public hospital. Background: It has been established that nursing staff health affects the quality of their work and is associated with job satisfaction, work engagement and different job features. Understanding the relationships among these variables could provide use‐ ful information to improve staff performance and prevent work‐related illnesses. Design: A descriptive, cross‐sectional, correlational and comparative study was per‐ formed between January–April 2016. This research adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guideline. Methods: A total of 926 nurses were requested to complete an online questionnaire. Nurses on sick leave or in period of unpaid leave during data collection were ex‐ cluded. The final study population reached 392 nurses. The online survey was fully completed by 373 nurses. General health, job satisfaction and work engagement were measured. Tools used were as follows: sociodemographic questions, the General Health Questionnaire, the Overall Job Satisfaction Scale and the Utrecht Work Engagement Scale. Results: Significant correlations among general health, job satisfaction and work en‐ gagement were found. Specifically, general health levels were negatively correlated with job satisfaction and work engagement subscales. Job features with influence on these constructs were the type of shift, type of contract, type of service, salary, type of continuous formation and having a specialty/profile. Conclusions: Our results indicate that job‐related features affect job satisfaction, general health and work engagement. The organisation should make interventions over these features to increase job satisfaction and work engagement levels, since they are relevant for nursing staff health and patient security. Relevance to clinical practice: The analysis of the relationships among general health, job satisfaction, work engagement and job features in nurses could offer a basis to design preventive programmes to improve staff performance and prevent work‐re‐ lated illnesses.S

Epinephrine in cardiac arrest: systematic review and meta-analysis

Objetivo: avaliar a efetividade da adrenalina na parada cardíaca e seu efeito na sobrevivência e no estado neurológico. Métodos: revisão sistemática da literatura científica com meta-análise utilizando um modelo de efeitos aleatórios. Revisão em Medline, Embase e Cochrane, desde 2005 até 2015 de ensaios clínicos e estudos observacionais. Resultados: observou-se aumento nas taxas de retorno de circulação espontânea com a administração de adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparadas com a não administração de adrenalina. A meta-análise mostrou um aumento da sobrevivência na alta ou depois de 30 dias da administração de adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). Quando estratificados por ritmos desfibrilháveis e não desfibrilháveis apareceu um aumento da sobrevivência nos ritmos não desfibrilháveis (OR 1,52; 95% IC 1,29-1,78; I2=42%). Também observou-se um incremento de sobrevivência na alta ou depois de 30 dias, quando administrada a adrenalina antes de 10 minutos, isto comparado com administração tardia (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusão: a administração de adrenalina parece incrementar a taxa de retorno da circulação espontânea, mas não se tem encontrado um efeito positivo nas taxas de sobrevivência nem nas taxas de pacientes com estado neurológico favorável, em comparação com outras terapias.Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.Objetivo: evaluar la efectividad de la adrenalina en el paro cardíaco y su efecto en la supervivencia y en el estado neurológico. Métodos: revisión sistemática de la literatura científica con metaanálisis utilizando un modelo de efectos aleatorios. Revisión en Medline, Embase y Cochrane, desde 2005 hasta 2015, de ensayos clínicos y estudios observacionales. Resultados: se observó aumento en las tasas de retorno de circulación espontánea cuando administrada adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparada con la no administración de adrenalina. El metaanálisis mostró un aumento de la supervivencia al alta hospitalaria o a los 30 días cuando administrada adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). La estratificación por ritmos desfibrilables y no desfibrilables mostró un aumento de la supervivencia en ritmos no desfibrilables (OR 1,52; 95% IC 1,29-1,78; I2=42%). También, se observó un incremento en la supervivencia al alta hospitalaria o a los 30 días en la administración de adrenalina antes de 10 minutos comparada con la administración tardía (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusión: la administración de adrenalina parece incrementar la tasa de retorno de circulación espontánea, pero no se ha encontrado un efecto positivo en tasas de supervivencia ni en tasas de pacientes con estado neurológico favorable, en comparación con otras terapias

Revisión sistemática de las complicaciones de los dispositivos de administración de tratamiento al paciente oncológico

Objetives: To know the scientific production releated with the delivery treatment devices to the oncology patients and to know the main complications of central venous catheters with reservoir (Port-A-Cath) and Percutaneously Inserted Central Catheters (PICC).Methods: Systematic review of the scientific literature in databases, whose data collection was realized from January to May 2015.Results: 124 articles were selected by its title and abstract. 42 documents of them had the inclusion criteria. Port-A-Cath scientific production is greater than PICC’s and infectious and thrombotic complications are the most common in both devices.Conclusions: Most complications can be prevented because their development is due to errors in the implementation of the device or due to inappropriate care. It is difficult knowing which device provides better quality of life, although patients usually perfer Port-A-Cath because of its aesthetic result.Objetivos: Conocer la producción científica que hay en relación a los dispositivos de administración de tratamiento al paciente oncológico, así como conocer las principales complicaciones de los Catéteres Venosos Centrales con reservorio (Port-A-Cath) y los Catéteres Centrales Insertados Percutáneamente (CCIP).Metodología: Estudio de revisión sistemática de la literatura científica en las bases de datos, cuya recogida de datos se realizó de enero a mayo de 2015. Resultados: Se seleccionaron un total de 124 artículos por título y resumen. De ellos, 42 documentos cumplieron los criterios de inclusión. La producción científica de los Port-A-Cath es mayor que de los CCIP y las complicaciones infecciosas y trombóticas son las más frecuentes en ambos dispositivos.Conclusiones: La mayoría de las complicaciones pueden ser prevenidas ya que se desarrollan debido a errores en la implantación del dispositivo o a unos cuidados inapropiados. Es difícil determinar qué dispositivo proporciona mayor calidad de vida, aunque los pacientes suelen preferir los Port-A-Cath por su resultado estético

Estudo transversal sobre fatores de risco de violência por parceiro íntimo entre enfermeiras

This study aimed to identify factors underlying the risk of suffering abuse by a partner. A cross-sectional study of 622 female nurses was accomplished, randomly chosen at their place of work, at a hospital and health centers. We used a self-administered validated questionnaire that covered psychological, physical and sexual abuse, complemented by a set of sociodemographic questions. The nurses at most risk of being abused by their partners were those who supported their family by their own salary (Odds Ratio: 2.41 [0.63-9.15]), those who lived with dependents (Odds Ratio: 4.27 [1.43-2.78]) and had a partner from social class IIIa (Odds Ratio: 2.62 [1.37-5.00]). The data appear to indicate financial independence as a risk factor for this type of abuse.Se tuvo por objetivo investigar los factores de riesgo relacionados al maltrato por compañero íntimo. Se trata de un estudio transversal realizado en 622 enfermeras, elegidas por aleatorización de sus lugares de trabajo, Hospitales y Centros de Salud. Se utilizó un cuestionario autoadministrado sobre maltratos psicológico, físico y sexual, complementado con preguntas de carácter sociodemográfico. Las mujeres enfermeras con mayor probabilidad de sufrir violencia del compañero íntimo fueron las que mantienen la familia con su salario (Odds Ratio: 2,41 [0,63-9,15]), las que conviven con hijos (Odds Ratio: 4,27 [1,43-2,78]) y las con pareja de clase social IIIa (Odds Ratio: 2.62 [1.37-5.00]). Se concluye que los datos parecen indicar que la independencia constituye un riesgo de maltrato.O objetivo deste estudo foi identificar os fatores de risco de abuso por parceiro íntimo entre enfermeiras. Trata-se de estudo transversal, realizado com 622 enfermeiras, selecionadas aleatoriamente nos seus locais de trabalho (hospitais e centros de saúde). Utilizou-se um questionário autoadministrado sobre maus-tratos psicológico, físico e sexual, complementado com perguntas de caráter sociodemográfico. As mulheres enfermeiras com maior probabilidade de sofrer violência foram: aquelas que mantinham a família com seu salário (Odds Ratio: 2,41 [0,63-9,15]), as que conviviam com filhos (Odds Ratio: 4,27 [1,43-2,78]) e com parceiro íntimo de classe social IIIa (Odds Ratio: 2.62 [1.37-5,00]). Os dados parecem indicar que a independência representa fator de risco para esse abuso

Aprendizaje cooperativo sobre la práctica clinica en enfermería: evaluación de docentes

Chobaut Alfred. Nouvelles observations sur les relations des Anthicides avec les Vésicants [Col.]. In: Bulletin de la Société entomologique de France, volume 2 (4),1897. pp. 74-78

Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes

Objetivo: avaliar os efeitos da estimulação do parto com oxitocina nos resultados maternos e neonatais. Método: estudo descritivo e analítico, com 338 mulheres que deram à luz em um hospital de nível terciário. Variáveis obstétricas e neonatais foram medidas e comparadas em mulheres com e sem estimulação com oxitocina. Estatísticas foram feitas utilizando-se o teste Qui-quadrado, teste exato de Fisher e o teste t-Student; e as Odds Ratio brutas com intervalo de confiança de 95% foram calculadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: a estimulação com oxitocina aumentou as taxas de cesarianas, anestesia peridural, febre materna intraparto em primíparas e multíparas. Ela também foi associada com baixos valores de pH do cordão umbilical e com uma menor duração da primeira fase do parto em primíparas. No entanto, ela não afetou as taxas de laceração perineal de terceiro e quarto graus, a episiotomia, a reanimação neonatal avançada, o teste de Apgar de 5 minutos e o mecônio. Conclusão: a estimulação com oxitocina não deveria ser utilizada de maneira sistemática, mas apenas em casos muito específicos. Estes resultados fornecem evidências adicionais aos profissionais de saúde e às parteiras sobre o uso de oxitocina durante o parto. Em condições normais, as mulheres deveriam ser informadas sobre os possíveis efeitos da estimulação com oxitocina.Objetivo: valorar los efectos de la estimulación del parto con oxitocina en los resultados maternos y neonatales. Método: estudio descriptivo y analítico con 338 mujeres que parieron en un hospital de tercer nivel. Variables obstétricas y neonatales fueron medidas y comparadas en mujeres con y sin estimulación con oxitocina. Estadísticos Chi-cuadrado, test exacto de Fisher, test t-Student, Odd Ratio cruda y un intervalo de confianza del 95% fueron calculados. Un valor p < 0,05 se consideró estadísticamente significativo. Resultados: la estimulación con oxitocina incrementó el ratio de cesáreas, analgesia epidural, fiebre materna intraparto en primíparas y multíparas; también se relacionó con bajos valores de pH de cordón umbilical, y menor duración de la primera fase del parto en primíparas. Sin embargo no afectó la tasa de desgarros de 3-4 grado, episiotomías, reanimación neonatal avanzada, test de Apgar a los 5 minutos o meconio. Conclusión: la estimulación con oxitocina no debería emplearse de forma sistemática, sino solo en casos muy indicados. Estos hallazgos proporcionan mayor evidencia a los profesionales y matronas a cerca del uso de oxitocina durante el parto. En condiciones normales, las mujeres deberían estar informadas de los posibles efectos de la estimulación con oxitocina.Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin

Percepción de riesgo en alumnos de enfermería

The objective of this study is to analyze the scientific production that exists about the relationship between the risk perception and the accidents during the clinical practice in nursing students. A systematic search was carried out in the data bases MEDLINE and CUIDEN, and also in the documentary heritage of the National Institute of Safety and Hygiene at Work, gathering publications from 1992 to 2010. A total of 89 articles were analyzed. Among the resulting thematic fields are: work setting, step measurements, psychosocial factors. As a conclusion, a lack of studies which prove in an explicit way the role that the real risk perception that the nursing students are exposed to exists. So, the necessity to go on in this line is set out, in order to improve the safety of nursing studentsEl objetivo de este estudio, es analizar la producción científica que existe sobre la relación entre la percepción de riesgo y los accidentes en la práctica clínica en alumnos/as de Enfermería. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y CUIDEN, así como en el fondo documental del Instituto Nacional de Seguridad e Higiene en el Trabajo, recopilando publicaciones comprendidas entre 1992 y 2010. Se analizaron un total  de 89 artículos. Entre los campos temáticos emergentes se encuentran: entorno laboral, medidas preventivas, factores psicosociales. Se llega a la conclusión de que existe una carencia de estudios que demuestren de forma explícita el papel que la percepción de riesgo juega en el riesgo real al que los alumnos de enfermería se ven expuestos, por lo que se plantea la necesidad de investigar en esta línea, para así poder mejorar la seguridad  de los alumnos de enfermería

Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients

Objetivo: estimar la prevalencia de ansiedad del paciente laringectomizado, en el preoperatorio y postoperatorio y su relación con el nivel de autocuidados. Método: investigación observacional de 40 pacientes con cáncer de laringe estadio IV. Se realizaron 3 observaciones: en el preoperatorio, a los 7 y 14 días del postoperatorio; en el periodo junio 2010 a diciembre de 2012. Se definieron dos niveles de autocuidados: autosuficientes y necesitar ayuda para las actividades de la vida diaria y derivadas del tratamiento; para evaluar la ansiedad se utilizó la escala de ansiedad hospitalaria de Zigmond (1983). Resultados: en el preoperatorio y postoperatorio los pacientes presentaron niveles elevados de ansiedad. En relación a los autocuidados, los pacientes autosuficientes presentaron en media niveles más bajos de ansiedad que los pacientes que necesitaban ayuda para realizar las actividades de la vida diaria y las derivadas de la cirugía, sin llegar a ser significativas estas diferencias Conclusión: la ansiedad está presente en todo momento en el paciente con laringectomia y la disminución del déficit de autocuidados parece disminuirla sin terminar definitivamente con ella.Objetivo: estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. Método: pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). Resultados: no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser significativas estas diferenças. Conclusão: a ansiedade está presente a todo momento no paciente laringectomizado e a diminuição do déficit de autocuidados parece diminuí-la sem acabar definitivamente com ela.Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it

Psychological distress in health sciences college students and its relationship with academic engagement

P. 715-722Objective: To determine the prevalence of psychological distress and its relationship with academic engagement (absorption, dedication and vigor), sex and degree among students from four public universities. Method: A non-experimental, comparative correlational, quantitative investigation without intervention. Study population: 1840 nursing and physical therapy students. The data collection tool used was a questionnaire. Results: A 32.2% prevalence of psychological distress was found in the subjects; a correlation between vigor and psychological distress was found for all of the subjects and also for women. High absorption and dedication scores and low psychological distress scores predicted higher vigor scores. Conclusion: The risk of psychological distress is high, especially for women. Women seem to have a higher level of psychological distress than men. Vigor, energy and mental resilience positively influence psychological distress and can be a vehicle for better results during the learning and studying process.S