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El GES promueve la equidad en el tratamiento del gran quemado de la tercera edad
Albornoz G,Claudia R; Villegas C,Jorge; Bravo Y,Iside; Pe?a M,Verónica;
Revista médica de Chile , 2011, DOI: 10.4067/S0034-98872011001100011
Abstract: background: the guidelines for the treatment of severely burned patients, ineluded in the explicit guarantees in health care (ges), accept having a garces' index over 70, among others, as an inclusion criterion. this criterion allows elderly patients with small total burn surface area (tbsa) to have access to ges. aim: to analyze if a universal access to ges for this group of patients is justified. material and methods: revision of medical records of adult patients admitted to a burn service. causative agent, tbsa, associated illnesses and outcome were compared between 218 subjects aged 65 years or more and 720 subjects aged less than 65 years. results: older subjects had smaller tbsa, a lower prevalence of inhalation injury and more associated diseases. their lethality was three times greater than that of younger subjects and their risk of dying. when adjusting for tbsa, presence of inhalation injury and associated diseases was 11 times greater. conclusions: the inclusion of older people with lower tbsa in the explicit guarantees in health is fully justified, considering the lethality of burns in this age group.
Análisis crítico de guía clínica GES gran quemado versión 2007
Danilla E,Stefan; Norambuena B,Hernán; Searle F,Susana; Fuentes F,Patricio; Castillo D,Paulo; Feres W,Marcelo; Troncoso R,Antonio;
Revista chilena de cirugía , 2011, DOI: 10.4067/S0718-40262011000300005
Abstract: objective: critical appraisal of the clinical practice guideline (cpg) "gran quemado-extensive burn patients"(2007 issue) corresponding to "garantías explícitas en salud- explicit health guarantees" (ges). material and methods: the cpg was evaluated using the previously validated agree instrument. this instrument evaluates a series of items organized in 6 domains, that capture different dimensions of the guidelines quality comparing the scores obtained with a maximum theoretical score. the cpg was evaluated by three independent and masked authors applying the agree instrument. results: stratified by domain, in the "scope and purpose" domain there was an 88.9% of compliance; in "stakeholder involvement" 47.9%; in the "rigour of development" 47.6%; in "clarity and presentation" 79.2%; in "applicability" 30.6% and 75% in the "editorial independence" domain; reaching a 44.9% final score of compliance. conclusions: the score obtained was below 50% of the optimum for a cpg. the detailed analysis by domain makes evident the areas that may be subject of improvement, so as to optimize the applicability of the cpg and therefore guarantee better health care and treatment results for all burn patients benefiting from the "explicit health guarantees".
Análisis crítico de guía clínica GES gran quemado versión 2007 Critical appraisal of clinical guideline  [cached]
Stefan Danilla E,Hernán Norambuena B,Susana Searle F,Patricio Fuentes F
Revista Chilena de Cirugía , 2011,
Abstract: Objetivo: Evaluar críticamente la guía de práctica clínica (GPC) de Gran Quemado correspondiente a las Garantías Explícitas en Salud (GES) versión 2007. Material y Método: La evaluación se realizó con el instrumento AGREE el cual ha sido previamente validado. El instrumento AGREE evalúa una serie de ítems en 6 dominios entregando un puntaje específico que se compara con un máximo teórico. Tres autores en forma independiente y enmascarada evaluaron la GPC y puntuaron de acuerdo al instrumento utilizado. Resultados: Estratificando por dominio, en "alcance y objetivo" se obtuvo un 88,9% de cumplimiento; en participación de los implicados 47,9%; en rigor en la elaboración 47,6%; en claridad y presentación 79,2%; en aplicabilidad 30,6% y 75% en independencia editorial; entregando un puntaje final de 44,9% de cumplimiento. Conclusiones: El puntaje obtenido fue menor al 50% del óptimo para una GPC. El análisis detallado por dominio entrega en forma detallada las áreas susceptibles de perfeccionar para optimizar la aplicabilidad de la guía clínica y de tal forma garantizar la mejoría en el cuidado y los resultados del tratamiento de los pacientes quemados beneficiarios de las Garantías Explícitas en Salud. Objective: Critical appraisal of the clinical practice guideline (CPG) "Gran Quemado-Extensive Burn Patients"(2007 issue) corresponding to "Garantías Explícitas en Salud- Explicit Health Guarantees" (GES). Material and Methods: The CPG was evaluated using the previously validated AGREE instrument. This instrument evaluates a series of items organized in 6 domains, that capture different dimensions of the guidelines quality comparing the scores obtained with a maximum theoretical score. The CPG was evaluated by three independent and masked authors applying the AGREE instrument. Results: Stratified by domain, in the "scope and purpose" domain there was an 88.9% of compliance; in "stakeholder involvement" 47.9%; in the "rigour of development" 47.6%; in "clarity and presentation" 79.2%; in "applicability" 30.6% and 75% in the "editorial independence" domain; reaching a 44.9% final score of compliance. Conclusions: The score obtained was below 50% of the optimum for a CPG. The detailed analysis by domain makes evident the areas that may be subject of improvement, so as to optimize the applicability of the CPG and therefore guarantee better health care and treatment results for all burn patients benefiting from the "Explicit Health Guarantees".
Efecto del Aloe barbadensis Miller sobre la transformación linfoblástica del paciente quemado Effect of Aloe barbadensis Miller on the lymphoblastic transformation of the burned patient
Mireida Rodríguez Acosta,Tatiana Vázquez González,Adriana Sin Mayor,Edelis Castellanos Puerto
Revista Cubana de Medicina Militar , 2004,
Abstract: Se evaluó la acción del extracto acuoso inyectable Aloe b sobre la transformación linfoblástica en pacientes quemados clasificados de graves y críticos. La muestra estuvo formada por 44 sujetos distribuidos en 2 grupos: control (tratamiento habitual) y tratado (tratamiento habitual más Aloe b). Se valoró la transformación linfoblástica con fitohemaglutinina y concanavalina A, los días 0, 3 y 21 después de haber recibido el trauma térmico. Se encontró estimulación estadísticamente significativa de la proliferación celular a partir del día 21 para ambos mitógenos en todos los pacientes que recibieron el extracto acuoso al ser comparado con el grupo que se le aplicó el tratamiento habitual. El extracto acuoso inyectable Aloe b estimuló la proliferación celular en el paciente quemado. The action of the Aloe b injectable aqueous extract on the lymphoblastic transformation in burned patients classified into severe and critical was evaluated. The sample was composed of 44 individuals divided into 2 groups: control (habitual treatment) and treated (habitual treatment plus Aloe b). The lymphoblastic transformation was assessed with phytohaemagglutinin and concanavaline, 0, 3 and 21 days after having received the thermal treatment. A statistically significant stimulation of the cellular proliferaton was found from the 21st day on for both mitogens in all the patients that recieved the aqueous extract on being compared with the group that underwent the habitual treatment. The Aloe b injectable aqueous extract stimulated the cellular proliferation in the burned patient.
Manejo de morbimortalidad del paciente pediátrico quemado en el hospital "Baca Ortiz" de Quito, Ecuador Handling of morbi-mortality of pediatric burned patient at "Baca Ortiz" hospital, Quito, Ecuador  [cached]
P. Dávalos Dávalos,J. Lorena Dávila,S. Alexandra Meléndez
Cirugía Plástica Ibero-Latinoamericana , 2007,
Abstract: En la unidad de quemados del Hospital de Ni os "Baca Ortiz" de la ciudad de Quito (Ecuador) se ha realizado un estudio de la morbimortalidad de pacientes pediátricos ingresados durante el a o 2005. La principal causa de quemaduras en nuestro medio son los líquidos hirvientes, con una mayor mortalidad en varones que en mujeres: 2,55% frente a 1,7%. La mortalidad global fue de 4,25% durante el a o 2005, notablemente inferior al 17 % que teníamos como media hace 5 a os. Existen muchos factores que agravan el pronóstico evolutivo de estos pacientes como son: la edad, superficie corporal quemada, estado nutricional y antecedentes personales. El proceso infeccioso se detecta mediante la clínica; realizamos cultivos de biopsias de piel con un alto porcentaje de positividad de 67,64%. Detectamos resistencia bacteriana y empezamos a utilizar Quinolonas (Ciprofloxacina). We present a study of morbi-mortality of burned children who entered in Burned Unit at "Baca Ortiz" Children Hospital in Quito (Ecuador) during 2005. Burns main cause are boiling liquids and mortality is higher in men than in women: 2,55% vs 1,7%. Global mortality during 2005 was of 4,25% with a noted decrease than the one obtained five years ago, which was 17%. There are many factors aggravating patients' evolutional prognosis, such as: age, burned body surface, nutritional status and personal backgrounds. Infectious process is detected by the clinic and tissue biopsies cultivations are made, with a highly positive percentage (67,64%). Antibacterial resistance was detected and we began to use Quinolones (Ciprofloxacin).
Algunos aspectos del manejo del paciente quemado en un servicio de cirugía infantil: A propósito de 47 pacientes pediátricos Some aspects burned patient management in a department of surgery child: About 47 pediatric patients
R J Schwartz,C N Chirino,S V Sáenz,T V Rodríguez
Revista Argentina de Dermatología , 2008,
Abstract: Si bien el manejo inicial de los ni os quemados es fundamental para el resultado exitoso del tratamiento de esta cohorte de pacientes, el aspecto quirúrgico en el siguiente nivel tiene una importancia similar. En este estudio se presenta un análisis epidemiológico de 47 pacientes, tratados en nuestro Servicio en un período de dos a os. Se esboza un análisis de los datos estadísticos obtenidos, se sacan conclusiones y se elaboran normas de profilaxis. While the initial management of burned children is fundamental to the successful outcome of treatment of this cohort of patients, surgical appearance at the next level has an equal importance. This study provides an epidemiological analysis of 47 patients treated in our department in a period of two years, outlined an analysis of statistical data obtained, conclusions drawn and develop standards for prophylaxis.
Il Gesù di Stracci  [cached]
Nicoletta Vallorani
Altre Modernità , 2010,
Abstract: Il Gesù di Stracci (Tomaso Subini, Pier Paolo Pasolini. La ricotta, Torino, Lindau, 2009, pp.221, ISBN 978-88-7180-814-7) di Nicoletta Vallorani
Reanimación del paciente quemado Resuscitation of burned patients
Andrés Felipe Palacio Sánchez,Marco Antonio Hoyos Franco
Iatreia , 2008,
Abstract:
Calidad en la atención al quemado  [cached]
Orcilia Rodríguez Gómez,Mireya Castillo Illas,Yoania Castellanos Castillo
Revista Cubana de Enfermer?-a , 2004,
Abstract: Las quemaduras constituyen una de las causas más frecuentes de accidentes en la infancia, la mayoría son evitables ya que se producen a causa de descuidos o bien por ignorancia de los peligros potenciales de ciertas situaciones, razón por la cual el lactante y ni o peque o deben recibir protección del medio que los rodea tanto por su curiosidad como por su afán de imitar a los mayores. Se realizó un estudio descriptivo, retrospectivo en 99 pacientes ingresados en el servicio de Caumatología del Hospital Pediátrico Norte "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba, en el período comprendido entre enero y diciembre del 2000 con el objetivo de valorar la calidad de la atención de enfermería en el paciente quemado. La mayoría de los pacientes se clasificaron en menos leves. El tipo de quemadura más frecuente fue la dérmica AB, el proceder más evaluado en el personal de enfermería fue el lavado de manos, cura oclusiva y signos vitales. El personal de enfermería fue capaz de cumplir acciones que contribuyeron a una recuperación rápida de los pacientes. El desempe o de este personal y la calidad de su atención se consideró buena. Burns are one of the most frequent causes of accidents in childhood, the majority of them are preventable since they are the result of either negligence or ignorance about the potential dangers of certain situations; therefore, the nursling and the little child should be protected by the surrounding environment because they are very curious and try to imitate the adults. A retrospective, descriptive study was made on 99 patients admitted to the Burn Service of "Dr Juan de la Cruz Martínez Maceira" Northern Pediatric Hospital in Santiago de Cuba, from January to December,2000, with the objective of assessing the quality of nursing care to the burned patients. Most of the patients classified as mild burned. The most frequent type of burn was skin burn AB, the most evaluated procedure in the nursing staff was hand-washing, occlusive curing and vital signs. The nursing staff was able to carry on actions that contributed to the rapid patients′ recovery. The performance of this staff and the quality of care was considered to be good.
Modelling burned area in Africa  [PDF]
V. Lehsten,P. Harmand,I. Palumbo,A. Arneth
Biogeosciences Discussions , 2010, DOI: 10.5194/bgd-7-4385-2010
Abstract: The simulation of current and projected wildfires is crucial for predicting vegetation as well as pyrogenic emissions in the African continent. This study uses a data-driven approach to parameterize burned area models applicable to dynamic vegetation models (DVMs) and global circulation models (GCMs). Therefore we restricted our analysis to variables for which either projections based on climate scenarios are available, or which are calculated by DVMs and the spatial scale to one degree spatial resolution, a common scale for DVMs as well as GCMs. We used 9 years of data (2000–2008) for the variables tree and herb cover, precipitation over the last dry season, wet season and averaged over the last 2 years, a fire-danger index (the Nesterov index), population density and an annual proportion of area burned derived from the MODIS MCD45A1 product. Since the effect of fires on vegetation depends strongly on burning conditions, the timing of wildfires is of high interest too. We related the seasonal occurrence of wildfires to the Nesterov index and found a lognormal relationship with a maximum at a value of 104. We parameterized two generalized linear models, one with the full variable set (model I) and one (model II) considering only climate variables. All introduced variables resulted in an increase in model performance. Model I correctly predicts the spatial distribution and extent of fire prone areas though the total variability is underrepresented. Model II has a much lower performance in both aspects (correlation coefficient of predicted and observed ratio of burned area: 0.71 model I and 0.58 model II). An application of the models with simulated climate data ranging from 1980 to 2060 resulted in a strong decrease of burned area of ca. 20–25%. Since wildfires are an integral part of land use practices in Africa, this indicates a high loss in areas favourable for food production.
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