Cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica. Revisión sistemática

ObjectiveTo assess the efficacy of eight nursing care interventions in the prevention of ventilator-associated pneumonia (VAP).MethodWe performed a search of the MEDLINE, CINAHL, Cochrane and Cuiden databases for articles published from 1990 to 2005. We included randomized clinical trials in adults undergoing mechanical ventilation in intensive care units that provided data on the incidence of VAP when the following nursing interventions were applied: oral rinse with chlorhexidine 0.12%; subglottic secretion aspiration; semirecumbent patient positioning; ventilator circuit changes; heat and moisture filter changes; body position changes (rotational therapy); closed aspiration system; and percussion and vibration.Results and conclusionsTwenty articles meeting all the inclusion criteria were analyzed. The VAP-preventive interventions supported by the strongest evidence were: oral rinse with chlorhexidine 0.12%, subglottic secretion aspiration, semirecumbent patient positioning, avoidance of routine circuit ventilation changes, and changing the heat and moisture filter every 48 hours. Body position changes (rotational therapy) may be useful in patients who tolerate it. There is no evidence to support the closed aspiration system, percussion and vibration as preventive measures against VAP.The results show the importance of nursing care in the prevention of VAP.     

Discapacidad intelectual,rediseño del proceso e introducción de elementos de mejora

The need to offer a better sanitary product and the markup of this one forces to look for new formulae of management and to that the organizations adapt to new organizational structures. The flat flowcharts, the decentralization and the clinical management open way themselves in the sanitary management. The present article tries to offer an experience in the redesign of a process of intellectual disability. Orientating his activity towards the clinical management and the management of the quality, in order to optimize the interventions and to obtain the best results for our users.     

Reductionist inference-based medicine, i.e. EBM

RATIONALE, AIMS AND OBJECTIVES: Unbeknown to many, reductionist and postmodern worldviews competitively coexist in science and society. The debate on evidence-based medicine (EBM) is at the tip of this 'iceberg'. Via systems thinking and complexity science EBM reveals crucial flaws and its reductionism entails an inability to appreciate (even tolerate) contrasting ideas and/or 'see a bigger picture'. An interdisciplinary approach provides insight into novel explanations. Thereafter, the conceptual barrier shifts to communication, a challenge which mandates attempts to steer the discourse by reframing the debate. METHOD: Interdisciplinary perspectives serve to illustrate a 'bigger picture'. Also, 'wicked' questions stimulate reflection, discern leverage points and dismantle resilient defences. Lastly, a proposal: exploring the value of 'glasses half full'. CONCLUSION: Some may realize that postmodern concepts behind compelling criticisms to EBM have already taken root, being shared by policymakers, practitioners and patients as well.     

La nécrosectomie pancréatique endoscopique : une nouvelle arme dans l’arsenal thérapeutique de la nécrose infectée

Endoscopic pancreatic necrosectomy appears to be an effective treatment and less morbid than traditional open necrosectomy. In this article, we propose to define the indications, describe the technique and positioning the endoscopic pancreatic necrosectomy in the treatment of infected necrosis, particularly in relation to surgical techniques.