Impacto de la rotaci��n c��clica de antibi��ticos sobre la etiolog��a de las neumon��as nosocomiales por gramnegativos en una unidad de cuidados intensivos (uci)

La rotaci�� c��clica d'antibi��tics (RCA) consisteix a restringir de forma determinada i establerta un antibi��tic o classe d'antibi��tics durant un determinat per��ode de temps, per a tornar a reintroduir-lo posteriorment. D'aquesta manera es pret��n evitar l'aparici�� de resist��ncies bacterianes derivades d'un ��s continuat del mateix. En aquest treball, proposem la RCA com una estrat��gia per al control d'infeccions per g��rmens multirresistents i veure la seva influ��ncia en els g��rmens m��s freq��ents que intervenen en les pneum��nies nosocomials (NN). A trav��s del registre ENVIN es van recollir les dades de tots els pacients ingressats a la UCI de l'Hospital Universitari la Fe durant dotze mesos consecutius. Es van dividir en 4 cicles de 3 mesos de durada cadascun d'ells. En el primer cicle es va restringir ampicilina/sulbactam, amikacina, cefalosporines i vancomicina; en el segon cicle carbapenems, amikacina i linezolid; en el tercer cicle tigeciclina, quinolones, tobramicina i linezolid i al quart i ��ltim cicle, piperacilina/tazobactam, tobramicina i teicoplanina. Es va comparar amb els tres mesos previs al inici del treball, al qual l'��s d'antibi��tics va ser lliure. El temps global de l'estudi va ser de 15 mesos. El percentatge d'a��llaments d��Acinetobacter spp en el per��ode basal va ser del 46,15% (n=6), de Pseudomonas aeruginosa 15,38% (n=2) i d'Escherichia coli 7, 69% (n=1). Al final de l'estudi els g��rmens a��llats van ser en un 8,57% (n=3) Acinetobacter spp i en un 37,14% (n=13) Pseudomonas aeruginosa.

Dolor oncol��gico en una unidad de cuidados paliativos

S���avalu�� l���impacte de la intervenci�� d���un equip de cures pal���liatives de malalts de c��ncer avan��at i terminal sobre la intensitat del dolor, mitjan��ant els instruments d���avaluaci�� Support Team Assessment Schedule (STAS) i Edmonton Symptom Assessment System (ESAS) en el moment de la inclusi�� (T1) i als 7 dies (T2). La intensitat del dolor va disminuir significativament a ambdues escales (1.79 vs 1.04 i 5.29 vs 3.42, respectivament, p&0.001), essent la magnitud de la difer��ncia major per al grup de dolor ESAS moderat-greu (6.43 vs 3.86, p&0.001).

Influencia de sobrepeso y obesidad sobre la infertilidad: Plan de cuidados y programa educacional

The scientific evidence, demonstrates that the obesity reduces the possibility that a woman, conceive naturally and diminishes the success of the treatment for the fertility. Nurses of the Unit of Attended Reproduction and of the Units of Nutrition and Dietary, they consider necessary to design an educational program of Formation and Information, to change attitudes related with the overweight and the obesity, in even not fertile. The strategy of this Program is based in the control and reduction of the weight, assuring the adhesion to the treatment of fertility, with interactive works shops for the change of alimentary habits, giving emotional support and indications to practice adapted physical exercise. This Nursing Intervention is applied like one tool that develops abilities for the learning and training; never using diets or products of the denominated miracle. The narrow collaboration and investigating participation among the nurses of these Units, bear the design of a methodology channeled to the obtaining of some prospective results that can be evaluated regarding the obtained results.

Comportamiento del orificio de implantaci��n del cat��ter en pacientes en di��lisis peritoneal en relaci��n a los cuidados

Infections of the catheter wound in peritoneal dialysis are the most frequent cause of morbility in patients who undergo this technique. There are a number of procedures for the care of the wound and it is not easy to define a single method that will guarantee good condition of the wound. In order to evaluate the behaviour of the wound related to the procedure used in their care, we studied 306 patients over 24 months, compiling socio-demographic and clinical variables. We found a high incidence of infections caused by gram-positive skin and mucous germs, with a strong correlation with the fact that the patient/family carer is a nasal carrier of staphylococcus aureus and that they appear more frequently in patients who do not remove the wound dressing in the shower. We also detected an increase in pseudomonas infections when the patient does not dry the wound with a hair-dryer

Gu��a de dise��o y mejora continua de procesos asistenciales integrados. 2�� ed

Publicado en la p��gina web de la Consejer��a de Igualdad, Salud y Pol��ticas Sociales: www.juntadeandalucia.es/salud (Consejer��a de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Cuidarte : una estrategia para los cuidados en la Andaluc��a del siglo XXI

Publicado en la p��gina web de la Consejer��a de Igualdad, Salud y Pol��ticas Sociales (Consejer��a de Igualdad, Salud y Pol��ticas sociales / Ciudadan��a / Qui��nes Somos / Planes y Estrategias)

Plan Andaluz de Cuidados Paliativos, 2008-2012

Publicado en la p��gina web de la Consejer��a de Igualdad, Salud y Pol��ticas Sociales: www.juntadeandalucia.es/salud (Consejer��a de Igualdad, Salud y Pol��ticas Sociales / Ciudadan��a / Qui��nes somos / Planes y Estrategias)

Gu��a de informaci��n sobre cuidados paliativos : respuestas sencillas a las preguntas m��s frecuentes sobre los cuidados paliativos

Cub. sustituto de la port. Publicado en la p��gina web de la Consejer��a de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejer��a de Salud y Bienestar Social / Ciudadan��a / Nuestro Compromiso por la Calidad / Gu��as de informaci��n para pacientes)

Continuidad De Cuidados y Comunicaci��n interniveles entre equipos de emergencias sanitarias y Atenci��n Primaria.

The gradual incorporation of the nurses to the extrahospital emergency teams give them a holistic aspect in the field of care. And this is not possible without addressing the possibility of continuity of care and communication with other levels of care. All efforts in this regard and made speeches themselves as nursing, "Refer" (Nic 8100) and "Exchange of information on health care" (Nic 7960), is the conceptual framework of this work, which objetives are to quantify and exposing the proceedings in this line taken by the nurses of emergency team.

Recepci��n, clasi���caci��n seg��n escala Manchester y atenci��n sanitaria inicial al paciente que acude a un Dispositivo de Cuidados Cr��ticos y Urgencias (DCCU) con motivo de consulta ���Diabetes���: Posibilidad de intervenci��n ���nalista de la enfermera en la consulta de triage (Triage Avanzado) ante la hipoglucemia. Colaboraci��n multidisciplinar y criterios de derivaci��n

The Andalusian Public Health System (SSPA) is considering the last time an attempt urgent process management through triage consultation, both hospital and primary care environment and tables situations in which the nurse responsible for these consultations can carry out a ���nal statement of which only she is directly responsible through their independent intervention and referral (Triage Advanced). Pose, at once and consistently to the idea of teamwork, where they can be the limits to that intervention ���nalist and the circuits to follow. This paper proposes a de���nition line of one of those situations through triage concepts universally tested, and takes full advantage of advanced practice pro���le offered by nurses Device Critical Care (DCCU) of the SSPA and any the emerging legal and regulatory framework in terms of standardized collaborative prescription, us know legitimate receivers. This work stems from the vision of professionals and our contribution to that line of institutional work that must be consensus.

Paciente transferido desde Equipo M��vil de Dispositivo de Cuidados Cr��ticos y Urgencias (EM DCCU) a sistema de helitransporte sanitario (HEMS): Gu��a de actuaci��n

Assistance and transfer of critical patients often takes place in an environment in which the medium response time, playing against an appropriate and de���nitive treatment at a center useful. The relationship in this sense arises between the resources of the level of primary care and the medical helicopter transport system (HEMS), is caused by the need to shorten those response times and referral in areas where initial care is taken to DCCU out by, despite being timedependent pathology that requires a fast transfer can not be offered by them with the possibility of optimization. The support in this sense of HEMS is essential: The knowledge of the environment and the establishment of policy guidance are necessary.

Continuidad de cuidados de enfermer��a a trav��s de un protocolo asistencial de transferencia

The creation and establishment within the healthcare team of the Primary Healthcare Centre of Baena of a Protocol and Procedures for healthcare that provides a communication tool for nurses enabled the healthcare team to develop a dynamic circuit and at the same time communication with nurses of the Critical Care and Emergency Team (DCCU) assigned to that centre. The created work environment for healthcare included Case Management Nurse, Primary Healthcare Nurse and Critical Care and Emergency Nurse. Thus, nursing assessment and actions for programmed and urgent healthcare, provided the first contact with DCCU nurses and reoriented them for the proposed healthcare plan for the patients, in addition to communicate with the rest of the healthcare team. This article presents the results of continuous nurse healthcare over nine months, applying this protocol.

Gu��a para el desarrollo de Programas de intercambio de Jeringuillas (PIJ) desde la consulta de triage de los Dispositivos de Cuidados Cr��ticos y Urgencias (DCCU)

There are exceptional situations where emergency services are required Primary Care in the application of material used by drug-dependent patients, being the response to this demand is something that many of the cases, to individual discretion and the randomness and variability every situation leads to an answer. It calls for a response commensurate to public services and preventive health philosophy in most cases will be carried out by the nurse to perform assistance Devices Critical Care (DCCU), often this first contact these patients and slots at the supply of resources diminishes the possibilities of acquisition of such material to them. That is why, and in the absence in this area of patient safety and professional, a workflow model and according to the prevailing philosophy of working in primary care in terms of prevention policies and recruitment of patients concerned, this project raises guidance for the development of a needle exchange program from the triage consultations DCCU.