PICC vs Catéter central insertado en vena subclavia en pacientes críticos

[Es]Introducción: actualmente, en servicios como UCIs, quirófanos y Urgencias cada vez es más común el empleo de CVCS y PICC. Ambos están asociados a graves complicaciones como CLABSI, TVP, EP, arritmia, etc. Dado que la enfermería juega un papel importante tanto en la inserción de estos dispositivos, como en el mantenimiento y prevención de las adversidades, es necesario poseer los conocimientos y habilidades adecuados para su afrontamiento. Objetivo y metodología: determinar cuál de los dos supone menor riesgo de complicaciones en pacientes críticos mediante la evidencia científica y utilizando la EBE. Para ello se ha realizado una revisión bibliográfica de estudios encontrados en bases de datos como Pubmed, Cochrane y Cinhal mediante la combinación de términos MeSH y palabras clave con operadores booleanos. Resultados y discusión: se han incluido en total 13 publicaciones (6 RS, 4 estudios de cohorte, 1 ECA y 2 GPC), de las cuales 3 poseen calidad alta, 3 media y 5 baja. Tanto los PICC como los CVCS implican diversas complicaciones, divididas en infecciosas, trombo-embolicas y mecánicas/otras. Existe insuficiente evidencia científica y gran heterogeneidad entre los artículos, lo que dificulta su extrapolación. Conclusiones: en pacientes críticos los PICC poseen mayor riesgo de TVP, los CVCS de complicaciones mecánicas, y ambos presentan tasas similares de CLABSI. Es importante escoger de forma individualizada el catéter a implantar, estimando los riesgos-beneficios de cada uno. Los cuidados preventivos son fundamentales en la reducción de estas contingencias. Son necesarios más estudios prospectivos comparativos.

Design of an optimised wheel profile for rail vehicles operating on two track gauges

This paper sets out an optimum synthesis methodology for wheel profiles of railway vehicles in order to secure good dynamic behaviour with different track configurations. Specifically, the optimisation process has been applied to the case of rail wheelsets mounted on double gauge bogies, that move over two different gauges, which also have different types of rail: the Iberian gauge (1668 mm) and the UIC gauge (1435 mm). Optimisation is performed using Genetic Algorithms and traditional optimisation methods in a complementary way. The objective function used is based on an ideal equivalent conicity curve which ensures good stability on straight sections and also proper negotiation of curves. To this end the curve is constructed in such a way that it is constant with a low value for small lateral wheelset displacements (with regard to stability), and increases as the displacements increase (to facilitate negotiation of curved sections). Using this kind of ideal conicity curve also enables a wheel profile to be secured where the contact points have a larger distribution over the active contact areas, making wear more homogeneous and reducing stresses. The result is a wheel profile with a conicity that is closer to the target conicity for both gauges studied, producing better curve negotiation while maintaining good stability on straight sections of track. The paper shows the resultant wheel profile, the contact curves it produces, and a number of dynamic analyses demonstrating better dynamic behaviour of the synthesised wheel on curved sections with respect to the original wheel.

Metal-Free Polymethyl Methacrylate (PMMA) Nanoparticles by Enamine "Click" Chemistry at Room Temperature

"Click" chemistry has become an efficient avenue to unimolecular polymeric nanoparticles through the self-crosslinking of individual polymer chains containing appropriate functional groups. Herein we report the synthesis of ultra-small (7 nm in size) polymethyl methacrylate (PMMA) nanoparticles (NPs) by the "metal-free" cross-linking of PMMA-precursor chains prepared by reversible addition-fragmentation chain transfer (RAFT) polymerization containing beta-ketoester functional groups. Intramolecular collapse was performed by the one-pot reaction of beta-ketoester moieties with alkyl diamines in tetrahydrofurane at r.t. (i.e., by enamine formation). The collapsing process was followed by size exclusion chromatography and by nuclear magnetic resonance spectroscopy. The size of the resulting PMMA-NPs was determined by dynamic light scattering. Enamine "click" chemistry increases the synthetic toolbox for the efficient synthesis of metal-free, ultra-small polymeric NPs.

Cooperative learning strategies to teach nutrition to geriatric nursing staff

[EN] The objective of this study was to test the hypothesis that cooperative learning strategies will help to increase nutrition knowledge of nurses and nursing assistants caring for the elderly in different institutional communities of the Basque Country, Spain. The target population was a sample of volunteers, 16 nurses and 28 nursing assistants. Training consisted of 12 nutrition education sessions using cooperative strategies conducted over a period of 3 consecutive weeks. The assessment instruments included two pretest and two posttest questionnaires with questions selected in multiplechoice format. The first questionnaire was about general knowledge of applied nutrition (0-88 point scale) and the second one on geriatric nutrition knowledge (0-18 point scale). Data were analyzed using SPSS vs. 11.0. The outcomes indicated a significant increase in general nutrition knowledge (difference between the pre- and posttest mean score: 14.5±10.1; P<0.001) and in geriatric nutrition knowledge for all participants (difference between the pre- and post-test mean score: 4.6±4.6; P<0.001). So the results indicated that cooperative learning strategies could improve the nutrition knowledge of nursing staff. Additionally, the results of this study provide direction to continuing nutrition education program planners regarding appropriate content and methodology for programs.

Implementation of a nursing competency assessment system in public hospitals

Numerous problems are frequently observed when nursing competency assessment systems (NCAS) are implemented. How to effectively implement a nursing competency assessment system, according to academic and practical contributions, is poorly reported in the literature. The purpose of this paper is to present a set of recommendations for public hospitals and nursing management in order to facilitate the implementation of a NCAS. To achieve this objective we have revised the existing literature and conducted a Delphi study with nursing managers and human resource managers of the public hospitals of the Basque Health Service. The results are that the implementation of a NCAS requires a well-planned strategy that managers must consider before implementing any NCAS. This strategy must include, at minimum, the following aspects: communication, training, leadership, and content where the NCAS is concerned. The context of the organisations and the cultural dimensions may also influence the results of the application of the system.

Implementation of the nursing process in a health area: models and assessment structures used

Objective: to analyze what nursing models and nursing assessment structures have been used in the implementation of the nursing process at the public and private centers in the health area Gipuzkoa (Basque Country). Method: a retrospective study was undertaken, based on the analysis of the nursing records used at the 158 centers studied. Results: the Henderson model, Carpenito's bifocal structure, Gordon's assessment structure and the Resident Assessment Instrument Nursing Home 2.0 have been used as nursing models and assessment structures to implement the nursing process. At some centers, the selected model or assessment structure has varied over time. Conclusion: Henderson's model has been the most used to implement the nursing process. Furthermore, the trend is observed to complement or replace Henderson's model by nursing assessment structures.

Research on operating conditions at the catalytic reactor for the combined removal of NOx and PCDD/PCDFs from MWI plants

The management of municipal solid waste (MSW), particularly the role of incineration, is currently a subject of public debate. Incineration shows to be a good alternative of reducing the volume of waste and eliminating certain infectious components. Moreover, Municipal Waste Incinerators (MWI), are reported to be highly hygienic and apart from that MWIs are immediately effective in terms of transport (incinerators can be built close to the waste sources) and incineration's nature. Nevertheless, the emissions of many hazardous substances make the Municipal Waste Incineration (MWI) plants to be unpopular. Metals (especially lead, manganese, cadmium, chromium and mercury) are concentrated in fly and bottom ashes. Furthermore, incomplete combustion produces a wide variety of potentially hazardous organic compounds, such as aldehydes, polycyclic aromatic hydrocarbons (PAH), chlorinated hydrocarbons including polychlorinated dibenzodioxins (PCDD) and dibenzofurans (PCDF), and even acid gases, including NOx. Many of these hazardous substances are carcinogenic and some have direct systemic toxicity.