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Introducción. El cáncer es uno de los problemas de salud pública más graves a nivel mundial. A pesar de los tratamientos y avances tecnológicos, continúan presentándose elevadas cifras de infecciones en los pacientes oncológicos. La enfermería cumple un papel fundamental al prevenir el riesgo de infección que conllevan las diferentes medidas terapéuticas utilizadas. El control de las Infecciones Asociadas a la Atención en Salud (IAAS) es imprescindible, dado que se considera la labor del cuidado permanente de la enfermera. El objetivo del presente artículo es el de realizar una búsqueda de literatura sobre las principales estrategias de control para la prevención de infecciones en pacientes oncológicos. División de los temas tratados. Se realizó una búsqueda en las bases de datos Medline, Pubmed, Ebsco, Scielo y Clinicalkey entre el 2011 y el 2018 con el propósito de encontrar información sobre la prevención de infecciones en pacientes oncológicos. Se expone la definición, epidemiología y las diferentes formas de control en la prevención de infecciones en pacientes oncológicos, clasificando tales medidas preventivas en generales y específicas. Conclusiones. La literatura científica ofrece una gran variedad de recomendaciones para la prevención de infecciones en pacientes oncológicos. Se pueden minimizar los riesgos a través de la implementación de estrategias que demuestren evidencia científica como es la nutrición y las medidas de higiene. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376 Introduction. Cancer is one of the most serious global public health problems. Despite the treatments and technological advances, cancer patients continue to present high rates of infection. Nursing plays an essential role in preventing the risk of infection brought by the different therapeutic measures used. Control of Health Care-Associated Infections (HAIs) is essential, because it is considered part of the ongoing care work of nurses. The aim of this article is to conduct a literary review of the main control strategies for the prevention of infections in cancer patients. Division of Covered Topics. A search was conducted in the Medline, Pubmed, Ebsco, Scielo and Clinicalkey databases between 2011 and 2018 to find information about the prevention of infections in cancer patients. The definition, epidemiology and different control methods in the prevention of infections in cancer patients are described, classifying these preventive measures as general or specific. Conclusions. The scientific literature offers a great variety of recommendations for the prevention of infections in cancer patients. The risks can be minimized through the implementation of strategies supported by scientific evidence, such as nutrition and hygiene measures. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376 Introdução. O câncer é um dos mais graves problemas de saúde pública em todo o mundo. Apesar dos tratamentos e avanços tecnológicos, uns grandes números de infecções em pacientes oncológicos continuam a ocorrer. A enfermagem desempenha papel fundamental na prevenção dos riscos de infecção associados às diferentes medidas terapêuticas utilizadas. O controle das Infecções Associadas aos Cuidados de Saúde (IACS) é essencial, uma vez que é considerada a função de cuidado permanente do enfermeiro. O objetivo deste artigo é realizar uma pesquisa bibliográfica sobre as principais estratégias de controle para a prevenção de infecções em pacientes oncológicos. Divisão dos tópicos discutidos. Foram realizadas buscas nas bases de dados Medline, Pubmed, EBSCO, ScIELO e Clinical Key no período de 2011 a 2018 com o objetivo de encontrar informações sobre a prevenção de infecções em pacientes oncológicos. Apresentam-se a definição, epidemiologia e as diferentes formas de controle na prevenção de infecções em pacientes oncológicos, classificando essas medidas preventivas em geral e específica. Conclusão. A literatura científica oferece uma ampla variedade de recomendações para a prevenção de infecções em pacientes oncológicos. Os riscos podem ser minimizados através da implementação de estratégias que demonstram evidencia científica como a nutrição e as medidas de higiene. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium, 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge.Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms.Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects.Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19.Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.

Advanced Chronic Kidney Disease (ACKD) supposes a public health problem in Ecuador that requires a comprehensive approach. In view of the scarcity of studies on the subject in this country, the objective of this research was to determine the signs and symptoms associated with the patients’ physical, social and psychological spheres that allow properly developing palliative care. A longitudinal, prospective and observational study was conducted with ACKD patients. In order to assess the symptomatic burden and suffering of these patients, the Edmonton Symptom Assessment System Revised: renal (ESAS-r) for renal patients and the Distress Thermometer (DT) were used. The sample consisted of a total of 246 patients. The most common symptoms that affect them, causing them suffering in their daily lives, are those related to well-being, difficulty falling asleep and itching. It is necessary that health professionals adapt care measures and help patients undergoing renal treatment, especially those who have suffered the disease for a longer period of time, in order to alleviate the patients’ suffering and therefore improve their daily lives. To such an end, a care plan could be designed that includes early palliative care.

Objective: This study aimed at exploring the compassion attitudes and needs for awareness and training related to a compassionate approach for Medicine, Nursing, and Psychology students, as well as for the academic and administration personnel from the Universidad T&eacute, cnica Particular de Loja (UTPL, Ecuador) Health Sciences area. Methods: A cross-sectional observational study, based on a self-administered questionnaire through a sample of 788 UPTL students. STROBE guidelines were followed and applied. Results: A positive correlation was found between life engagement and compassion for others, from others, and self-compassion. The Nursing students were those who reported having previous experiences of contact with people with an advanced disease or in an end-of-life situation and having received some type of training compared to Medicine and Psychology students and lecturers (faculty members). Differences were found on the &ldquo, self-compassion&rdquo, and &ldquo, compassion for others&rdquo, subscales, noting a higher level of compassion among Psychology students. Conclusions: To implement the philosophy of compassionate universities it is necessary to design trainings that include the students, the faculty members, and the administrative staff, centered on sensitization and training about assistance, care, and accompaniment at the end of life, as well as cultivating compassion in the workplace.

Objective. Chronic pain conditions profoundly affect the daily living of a significant number of people and are a major economic and social burden, particularly in developing countries. The Change Pain Latin America (CPLA) advisory panel aimed to identify the most appropriate guidelines for the treatment of neuropathic pain (NP) and chronic low back pain (CLBP) for use across Latin America. Methods. Published systematic reviews or practice guidelines were identified by a systematic search of PubMed, the Guidelines Clearinghouse, and Google. Articles were screened by an independent reviewer, and potential candidate guidelines were selected for more in-depth review. A shortlist of suitable guidelines was selected and critically evaluated by the CPLA advisory panel. Results. Searches identified 674 and 604 guideline articles for NP and CLBP, respectively. Of these, 14 guidelines were shortlisted for consensus consideration, with the following final selections made: • 'Recommendations for the pharmacological management of neuropathic pain from the Neuropathic Pain Special Interest Group in 2015-pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.' • 'Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society' (2007). Conclusions. The selected guidelines were endorsed by all members of the CPLA advisory board as the best fit for use across Latin America. In addition, regional considerations were discussed and recorded. We have included this expert local insight and advice to enhance the implementation of each guideline across all Latin American countries. © 2017 American Academy of Pain Medicine.

Cancer is a major public health issue. Poor pain management has devastating consequences that seriously affect quality of life, diminish functionality and place a huge emotional burden on patients and their relatives. A group of Latin American opinion leaders were invited to participate in a meeting to discuss areas associated with cancer pain. The expert panel reviewed the latest literature to draft region-specific guidelines for effective pain management. The guidelines make recommendations on tailoring treatment to the specific type of pain and provide local physicians with the state-of-the art findings in the field. Management should be with pharmacological approaches (nonopioid, adjuvant and opioid analgesics, as well as oncologic therapies and interventional procedures) and nonpharmacological approaches.

Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America. Resumo: O controle da dor no período pós-operatório é um problema significativo na prática clínica na América Latina. O controle insuficiente ou inadequado da dor é devido, em grande parte, à insuficiência de conhecimento, atitudes e formação e à comunicação precária em vários níveis. Além disso, a falta de conscientização da disponibilidade e importância de políticas e diretrizes inequívocas para avaliar a intensidade da dor, o uso de analgésicos específicos e a abordagem adequada para instruir o paciente levaram ao subtratamento consistente da dor na região. Contudo, esses problemas não são insuperáveis e podem ser abordados no âmbito tanto do provedor quanto do paciente. Políticas e diretrizes robustas podem ajudar a garantir a continuidade dos cuidados e reduzir as variações desnecessárias na prática. O objetivo deste artigo é chamar a atenção para os problemas associados à dor aguda no pós-operatório (DAPO) e sugerir recomendações para solucioná-los na América Latina. Um grupo de especialistas em anestesiologia, cirurgia e dor desenvolveu recomendações que levarão a um controle mais eficiente e eficaz da dor. Será preciso mudar o conhecimento e o comportamento dos profissionais de saúde e pacientes e obter um compromisso por parte de legisladores. O sucesso dependerá de uma atitude positiva e do compromisso de cada parte através do desenvolvimento de políticas e programas e da promoção de um sistema mais eficiente e eficaz para a prestação de serviços para a DAPO, como recomendado pelos autores deste trabalho. O grupo que as redigiu acredita que a aplicação dessas recomendações deve melhorar de modo significativo a eficiência e eficácia do controle da dor no período pós-operatório na América Latina. Keywords: Acute post-operative pain, Pain management, Latin America, Chronic pain, Palavras chave: Dor aguda no pós-operatório, Controle da dor, América Latina, Dor crônica

Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.

Supplemental Digital Content is Available in the Text., Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

Objective: Change Pain Latin America (CPLA) was created to enhance chronic pain understanding and develop pain management improving strategies in this region. During its seventh meeting (August 2016), the main objective was to discuss tramadol’s role in treating pain in Latin America. Furthermore, potential pain management consequences were considered, if tramadol was to become more stringently controlled. Methods: Key topics discussed were: main indications for prescribing tramadol, its pharmacological characteristics, safety and tolerability, effects of restrictions on its availability and use, and consequent impact on pain care quality. Results: The experts agreed that tramadol is used to treat a wide spectrum of non-oncological pain conditions (e.g. post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia), as well as cancer pain. Its relevance when treating special patient groups (e.g. the elderly) is recognized. The main reasons for tramadol’s high significance as a treatment option are: its broad efficacy, an inconspicuous safety profile and its availability, considering that access to strong analgesics–mainly controlled drugs (classical opioids)–is highly restricted in some countries. The CPLA also agreed that tramadol is well tolerated, without the safety issues associated with long-term nonsteroidal anti-inflammatory drug (NSAID) use, with fewer opioid-like side effects than classical opioids and lower abuse risk. Conclusions: In Latin America, tramadol is a valuable and frequently used medication for treating moderate to severe pain. More stringent regulations would have significant impact on its availability, especially for outpatients. This could cause regression to older and frequently inadequate pain management methods, resulting in unnecessary suffering for many Latin American patients. © 2017 Informa UK Limited, trading as Taylor and Francis Group.

Objective. The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management. Design and Setting. The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America. Methods. A PubMed search was conducted using the terms 'opioid,' 'chronic,' and 'pain' and then refined using the filters 'practice guidelines' and 'within the last 5 years' (2007-2012). Once the publications were identified, they were selected using five key criteria: 'Evidence based,' 'Comprehensive,' 'From a well-recognized source,' 'Current publications,' and 'Based on best practice' and then critically analyzed considering 10 key criteria for determining the most relevant guidelines to be applied in Latin America. Results. The initial PubMed search identified 177 reviews and guidelines, which was reduced to 16 articles using the five preliminary criteria. After a secondary analysis according to the 10 key criteria specific to OU in Latin America, 10 publications were selected for critical review and discussion. Conclusions. The CPLA advisory panel considered the 'Safe and effective use of opioids for chronic non-cancer pain' (published in 2010 by the NOUGG of Canada) to be valid, relevant to Latin America, practical, evidence-based, concise, unambiguous, and sufficiently educational to provide clear instruction on OU and pain management and, thus, recommended for uniform adoption across the Latin America region. © 2015 American Academy of Pain Medicine.

Este artículo aborda analíticamente aspectos conceptuales del Modelo de Autocuidado de Orem, como estrategia que apunta a demostrar que el autocuidado es la forma más eficaz, pertinente, económica y oportuna para enfrentar la cronicidad y particularmente la insuficiencia cardiaca. Fenómenos específicos como el envejecimiento poblacional y el uso de nuevas tecnologías, han repercutido en el aumento de la Insuficiencia Cardiaca. El perfil epidemiológico del país muestra cómo las dos primeras causas de mortalidad, al sumarlas, superan tasas del 300 %, se refieren a eventos que afectan la salud cardiovascular. Esta alarmante situación lleva a reflexionar cómo la investigación disciplinar puede identificar lagunas en la literatura, en un tema específico y propio como es el autocuidado y formular recomendaciones para futuras investigaciones, que contribuyan al enfrentamiento de este flagelo This articleapproaches the analytical conceptual aspects of Orem's Model, as a strategy to demonstrate that self-care is avery effective, pertinent, economic and opportune way to confront chronic diseases, particularly heart failure. Specific phenomena like population aging and the use of new technologies have reverberated in the increase of the heart failure. The epidemiological profile of the country shows that the first two reasons of mortality, which together total over300 %, have to do with events that affect cardiovascular health. This alarming situation leads one to reflect on how research into this area may identify gaps in the literature, in a specific topic like self-care and to formulate recommendations for future investigations to counterthis scourge

Pathogenic and non-pathogenic free-living amoebae from an activated-sludge plant were investigated. The greatest species diversity occurred in the raw, settled sewage and at the beginning of the aeration tank, whilst the lowest number of species occurred in the final sedimentation tanks. Thirteen species of free-living amoebae representing eleven genera were isolated; these included three species of Acanthamoeba (A. castellanii, A. culbertsoni and A. polyphaga), all of wich were pathogenic to mice with varying degrees of virulence. The implications for the public health risk of the presence of pathogenic free-living amoebae in activated-sludge plants are discussed.