The increasing complexity of care needed by patients with advanced diseases or end-of-life situation, added to variability of health professionals who participate in patient care, make necessary to clarify the specific role of nurses in a interdisciplinary Palliative Care team (PC). Aim: To establish a reflection about the nurse practice in PC. Methodology: Nominal group study. Ten nurses with more than 10 years of experience in PC were selected. The main areas of discussion were: the evolution of care and nursing profession, the general practice of nurses and Palliative Care history. Conclusion: There is the need: a) define nurse's competences in PC; b) describe the professional practice in the frame of a conceptual model and the application of nurse's scientific method; c) advance in a practice based on scientific evidence; d) start a research line about nurse's competences in PC.

La creciente complejidad de los cuidados que requieren las personas en situación de enfermedad avanzada y al final de vida, y la variabilidad de profesionales sanitarios que intervienen en el proceso asistencial, nos conduce a clarificar el rol profesional enfermero en el equipo multidisciplinar de Cuidados Paliativos (CP). Objetivo: reflexionar sobre la práctica enfermera en CP. Metodología: Técnica del grupo nominal. Se seleccionaron 10 enfermeras con más de 10 años de experiencia profesional en CP. Categorías elegidas para la atención enfermera: Evolución de los cuidados, de la profesión enfermera, funciones y actividades de enfermería, historia de los cuidados paliativos. Conclusiones: Necesidad de definir las competencias enfermeras en CP; Necesidad de contemplar la práctica profesional en el marco de un modelo conceptual y la aplicación del método científico enfermero; Necesidad de avanzar en prácticas reflexivas basadas en evidencias científicas; Iniciar una línea de investigación en competencias enfermeras en CP.

Introduction: The Oncology Catalonian Institute (ICO) launched the training and education unit (UFiD) in 2006, in order to enhance professional development, dissemination of knowledge and quality of the oncology care. Here are described the tune-up of this process and the results of the training needs survey carried out among the professionals and collectives of the centre. Materials and methods: Training and educational actions deployed during 2008 and 2009 and its evaluation results are presented. A total of 60 training activities were carried out in which 719 students of all professional categories participated, and with a score of participant's satisfaction of 7.8 out of 10. In the area of education, the paths of the different services were reorganized and new initiatives were supported. A total of 3 masters, 3 post-graduate degrees, 59 update courses with semi-presential (blended learning) methodology and 19 on-line methodology courses, all of them with academic accreditation were imparted with a satisfaction average score of 8 out of 10. Results and conclusions: The activity carried out by the UFiD during this period, has made possible to articulate the continuing training based on the study of the professionals needs. This has allowed promoting the professional development and the quality of the care. Supporting existing training activities and promoting new initiatives encourage the dissemination of knowledge in the area of oncology and has positioned us as a centre committed to oncology training.

Introducción: El Institut Català d'Oncologia (ICO) puso en marcha la Unidad de Formación y Docencia (UFiD), en el año 2006, con el objetivo de potenciar el desarrollo profesional, la difusión del conocimiento y la calidad de la atención oncológica. En el presente artículo se describe el proceso de puesta en marcha de la UFiD, los resultados del estudio de las necesidades formativas realizada por los profesionales y colectivos de la institución, las acciones formativas organizadas, y en el área de docencia, los resultados de la reorganización de las trayectorias docentes de los diferentes servicios, así como el apoyo de nuevas iniciativas. Materiales y métodos: Durante el periodo 2008-2009, se implantaron acciones formativas y docentes en concordancia con los resultados del estudio de necesidades y con las líneas estratégicas de la institución. Se realizaron un total de 71 actividades formativas, con 898 participantes de todas las categorías profesionales, con una tasa de satisfacción de los participantes de 7,8 sobre 10. En el apartado de docencia, durante el mismo periodo se realizaron 3 másteres, 3 posgrados, 59 cursos de actualización con metodología semipresencial y 19 cursos con metodología online, todos ellos con acreditación académica. La satisfacción media fue de 8 sobre 10. Resultados y conclusiones: La actividad llevada a cabo por la UFiD ha permitido, por una parte, articular la formación continuada en base al estudio de las necesidades de los profesionales, lo que ha contribuido a promover el desarrollo profesional y la calidad asistencial de éstos, y por otra parte, dar soporte a las actividades docentes ya existentes y promover nuevas iniciativas para favorecer la difusión de conocimientos en el área oncológica, lo que ha posicionado al ICO como un centro absolutamente comprometido con la formación oncológica.

Foram estudados 50 pacientes com AIDS. Todos estes pacientes apresentavam anticorpos anti-HIV1 (ELISA) e preenchiam os critérios de pontuação OPAS/Caracas de definição de casos de AIDS em adultos. A análise do liquido cefalorraqueano (LCR) incluiu: pressão; citologia (número de células e aspectos citomorfológicos); proteína total e eletroforese; concentrações de glicose, cloretos e testes imunológicos para sífilis, toxoplasmose e infecções virais (citomegalovírus, varicela-zoster, Herpes simplex, e HI VI). Investigações bacteriológicas e micológicas (pesquisa direta e cultura), além de teste de aglutinação (látex) para Cryptococcus foram também realizados. Os testes imunológicos usados foram fixação do complemento, imunofluorescência indireta, hemaglutinação passiva e/ou ELISA. Todos os LCR foram analisados no mesmo laboratório seguindo sempre a mesma metodologia. O LCR esteve alterado em 45 pacientes (90,0%) dos 50 pacientes estudados. As principais alterações encontradas no LCR foram: aumento de gamaglobulina em 25 casos (55,5%); aumento da proteína total em 23 (51,1%); hipercitose em 22 (48,9%) e diminuição dos cloretos em 18(40,0%). A detecção de anticorpos anti- HIV1 estiveram presentes em 42 pacientes (93,3%). Toxoplasmose isolada ou associada a outros agentes foi a infecção oportunista mais freqüente, detectada em 26 casos (57,7%). O LCR deverá ser sempre analisado em todos os pacientes com AIDS, com ou sem sintomas neurológicos.

Fifty AIDS patients were studied. AH patients had anti-HIV antibodies (ELISA) present and met OPAS/ Caracas punctuation criteria for AIDS cases in adults. Cerebrospinal fluid (CSF) analysis included pressure, cytology (number and cytomorphological aspects), total protein and electrophoresis, glucose and chloride concentration. Bacteriological and mycological investigations were performed as well as agglutination tests for Cryptococcus. Complement fixation, indirect immunoflorescence, passive hemagglutination and/or ELISA tests were performed for syphilis, toxoplasmosis, viral and fungal infections. AH CSF analysis were made in the same laboratory following the same methodology. CSF was alterated in 45 cases (90.0%) of the 50 patients studied. The most important alterations observed were: gammaglobulin (55.5%) and total protein (51.1%) increase, hypercytosis (48.9%) and decrease of chloride concentration (40.0%). HIV antibodies were detected in 42 patients (93.3%). Toxomoplamosis, isolated or associated to other agents, was the most frequent opportunistic infection (57.7%). Cerebrospinal fluid should always be examined in AIDS patients with or without neurological symptoms.