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Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals

Por: Agulnik · A. · Malone · S. · Puerto-Torres · M. · Gonzalez-Ruiz · A. · Vedaraju · Y. · Wang · H. · Graetz · D. · Prewitt · K. · Villegas · C. · Cardenas-Aguierre · A. · Acuna · C. · Arana · A. E. · Diaz · R. · Espinoza · S. · Guerrero · K. · Martinez · A. · Mendez · A. · Montalvo · E. · So

Paediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals.


Participants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility.


The CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8–4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents’ perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p


We present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.

Disease-related knowledge measurement instruments of people affected by multiple sclerosis: protocol for a systematic psychometric review


Disease-related knowledge is a key component of shared decision making and a relevant outcome to measure the effectiveness of information provision interventions. However, no systematic psychometric reviews have been found that assess the measurement instruments aimed at evaluating the disease-related knowledge of people affected by multiple sclerosis. This review aims to systematically assess the quality of the measurement properties of all available disease-related knowledge measurement instruments of people affected by multiple sclerosis.

Methods and analysis

A systematic psychometric review will be carried out in accordance with the guidelines proposed by the international ‘COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)’ initiative. Studies that meet the following criteria will be selected: (1) those whose aim is to measure disease-related knowledge, (2) those whose study populations are affected by multiple sclerosis and (3) those whose aims are to develop measurement instruments or evaluate one or more of their measurement properties. The information sources will be MEDLINE (via PubMed), CINAHL, PsycINFO and OpenGrey. The methodological quality will be assessed using the ‘COSMIN Risk of Bias’ checklist. Available evidence will be synthesised and graded using a modified Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination

As this is a systematic review, no ethics approval is needed. Study findings will be shared with multiple sclerosis patient support groups and in reports to funders. The results will be submitted to a peer-reviewed journal and will be presented at national and international conferences.

PROSPERO registration number


Resultados de la cirugía ginecológica de la unidad de cirugía mayor ambulatoria de un hospital comarcal

Objetivo. Describir los resultados de la Unidad de Cirugía Mayor Ambulatoria del Servicio de Ginecología del Hospital Público Valdeorras. Material y métodos. Estudio descriptivo, prospectivo y analítico realizado desde mayo/2017-mayo/2019. La captación de pacientes se realizaba en las consultas de Ginecología según el protocolo de inclusión. El día de la intervención se procedía al protocolo de acogida del servicio, la cirugía con o sin anestesia, y los controles de valoración post operatoria. La paciente además recibía una encuesta de satisfacción anónima y voluntaria. Resultados. Registramos 302 pacientes, de 52 años de edad media. El índice de cancelación fue 2,32%, de ambulatorización 54.31%. Identificamos 6 pernoctas no planificadas y 1 reingreso de una complicación mayor. La intervención más realizada fue histeroscopia diagnóstica, 85.16% sin anestesia y 30.22 % con polipectomía asociada. La analgesia post quirúrgica fue más necesaria en mujeres jóvenes y en intervenciones más largas. El tiempo quirúrgico medio fue de 19.7 minutos, aumentando en caso de sedación, anestesia regional o general. El tiempo medio de estancia total fue de 161.1 minutos. En su duración, las variables más influyentes eran la anestesia regional con sedación y la anestesia general (F=91,6; p<0,001; R2=0.924). El 20.2% contestaron una encuesta de satisfacción y 94.7 % estaban satisfechas.

Discusión. Nuestros resultados fueron similares a otros estudios. Los factores que más influyen en la estancia total fueron la anestesia regional más sedación y la anestesia general. El grado de satisfacción fue muy elevado.


Objective. To describe the results of the Outpatient Major Surgery Unit of the Gynecology Service of the Valdeorras Public Hospital. Methods. Descriptive, prospective and analytical study carried out from May/2017-May/2019. Recruitment of patients was carried out in gynecology consultations according to the inclusion protocol. On the day of the intervention, we proceeded with the reception protocol in Outpatient Major Surgery with or without anesthesia, and post-operative care. The patient also received an anonymous and voluntary satisfaction survey. Results. We registered 302 patients, 52 years of average age. The cancellation rate was 2.32%, outpatient 54.31%. We identified 6 unplanned overnight stays and 1 re-entry of a major complication. The most performed intervention was diagnostic hysteroscopy, 85.16% without anesthesia and 30.22% with associated polypectomy. Post-surgical analgesia was more necessary in young women and in longer interventions. The average surgical time was 19.7 minutes, increasing in the case of sedation, regional or general anesthesia. The average total stay time in CMA was 161.1 minutes. In its duration, the most influential variables were regional anesthesia with sedation and general anesthesia (F = 91.6; p <0.001; R2 = 0.924). The 20.2% of patients answered a satisfaction survey and 94.7% were satisfied. Discussion. Our results were similar to other studies. The most influential factors in the total stay were regional anesthesia plus sedation and general anesthesia. The degree of satisfaction was very high.


Impacto físico y psicosocial frente al diagnóstico de léntigo maligno. Superación de la enfermedad

El léntigo maligno es una enfermedad que tiene un gran impacto a nivel físico y psicosocial en las personas que son diagnosticadas. Por esto, es fundamental que los profesionales conozcan y entiendan las consecuencias a nivel psicológico que se van a producir en estas personas tras los cambios producidos en la imagen corporal y que van a repercutir en sus actividades de la vida diaria. La informante del relato es una mujer de 43 años que ha superado el proceso de enfermedad en los últimos meses. El objetivo de este relato es mostrar las experiencias vividas durante el desarrollo de esta en los 2 últimos años de su vida.

Experience in the use of midclavicular catheters: An inception cohort study


Aims and objectives

To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal.


Midclavicular catheters are peripheral venous catheters that are typically 20–25 cm in length.


Inception cohort study.


We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5–9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed.


Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure.


Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal.

Relevance to clinical practice.

Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.

Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic (IMPACCT COVID-19): protocol for a prospective, multicentre, mixed-methods cohort study


The ongoing pandemic could affect the duration, variety and severity of the mental, physical, and cognitive impairments intensive care unit (ICU) survivors and their families frequently present. We aim to determine the impact of the COVID-19 pandemic on the mental, physical, and cognitive health of survivors, the experience of their families and their treating healthcare professionals.

Methods and analysis

Prospective, multicentre, mixed-methods cohort study in seven Chilean ICUs. Sample: 450 adults, able to walk independently prior to admission, in ICU and mechanical ventilation >48 hours with and without COVID-19. Clinical Frailty Scale, Charlson comorbidity index, mobility (Functional Status Score for the Status Score for the Intensive Care Unit) and muscle strength (Medical Research Council Sum Score) will be assessed at ICU discharge. Cognitive functioning (Montreal Cognitive Assessment–blind), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Impact of Event Scale-Revised) symptoms, disability (WHO Disability Assessment Schedule 2.0), quality of life (European Quality of Life Health Questionnaire), employment and survival will be assessed at ICU discharge, 3 months and 6 months. A sample will be assessed using actigraphy and the Global Physical Activity Questionnaire at 6 months after ICU discharge. Trajectories of mental, physical, and cognitive impairments will be estimated using multilevel longitudinal modelling. A sensitivity analysis using multiple imputations will be performed to account for missing data and loss-to-follow-up. Survival will be analysed using Kaplan-Meier curves. The perceptions of family members regarding the ICU stay and the later recovery will be explored 3 months after discharge. Healthcare professionals will be invited to discuss the challenges faced during the pandemic using semistructured interviews. Interviews will be thematically analysed by two independent coders to identify the main themes of the experience of family members and healthcare professionals.

Ethics and dissemination

The study was approved by the Clinica Alemana Universidad del Desarrollo Ethics Committee (2020–78) and each participating site. Study findings will be published in peer-reviewed journals and disseminated through social media and conference meetings.

Trial registration number


Barreras de comunicación: experiencia de la persona sorda en la unidad de urgencias

Objetivo: Conocer experiencias relacionadas con las barreras de comunicación, en la asistencia sanitaria recibida por personas sordas en una unidad de urgencias. Metodología: Cualitativa fenomenológica con muestreo de conveniencia mediante entrevistas semiestructuradas ad hoc. Se transcribió, codificó y categorizó por medio del método de análisis de contenido. Resultados principales: La falta de recursos humanos y técnicos, así como la carencia en autonomía, información y accesibilidad experimentada, ha hecho que se hayan sentido limitadas, con ansiedad, frustración e inseguridad. Las valoraciones positivas estuvieron vinculadas con la presencia de personas signantes. Conclusión principal: Las barreras de comunicación son un factor de riesgo en la atención sanitaria de la persona sorda, no garantizan el cumplimiento del marco legal existente y disminuyen la calidad asistencial percibida. Existe la necesidad de adaptar y ampliar la disponibilidad de intérpretes y fomentar el aprendizaje del personal sanitario.

Percepciones de los estudiantes de enfermería sobre el uso del portafolio en la integración teórico-práctica

Objetivo: explorar las percepciones de los estudiantes sobre el uso del portafolio y su potencial para integrar la teoría y la práctica. Metodología: estudio descriptivo e interpretativo con un enfoque cualitativo. Se realizó analizando los datos recopilados de los portafolios y cuestionarios de los estudiantes de enfermería de cuarto año, haciendo prácticas durante el año 2014-2015. Resultados: las percepciones de los estudiantes corroboran que el portafolio permite establecer un vínculo entre la teoría y la práctica, así como poner en práctica lo aprendido. Conclusiones: El análisis de los portafolios ha revelado que la teoría y la práctica se retroalimentan mutuamente, lo que hace que los estudiantes tengan el papel principal. El componente reflexivo ha contribuido a reducir el llamado choque de la realidad, permitiendo una transferencia de teoría a una práctica dinámica.

e‐Health as a tool to improve the quality of life of informal caregivers dealing with stroke patients: Systematic review with meta‐analysis



The objective of this review was to elucidate the evidence related to utilizing e-Health as a tool in improving the quality of life of informal caregivers of dependent patients due to cerebrovascular accident (CVA).


This systematic review with meta-analysis includes 13 studies. For these studies, seven databases were searched between 2009 and 2019. A random-effects model was adopted for overall estimation and to explain the heterogeneity.


A random-effects model was adopted for overall estimation and to explain heterogeneity. The results did not demonstrate statistical significance (p<0.05) and low heterogeneity (I 2 = 0).


There is a tendency toward improvement in psychological health, solving care-related problems, as well as better prevention of problems arising from the burden. Therefore, new studies with larger sample size and primarily to conduct them for more than 6 months for the accuracy.

Clinical relevance

This study reflects a trend toward improving psychological health, solving care-related problems, as well as improved the prevention of problems arising from the burden.

Interventions to empower cardiorenal patients: A systematic review



To identify the most effective interventions to empower cardiorenal patients.


A systematic review of the literature has been carried out.

Data sources

The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020.

Review methods

Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected.


The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.


A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment.


There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.

Predicting hospital admissions from individual patient data (IPD): an applied example to explore key elements driving external validity

Por: Meid · A. D. · Gonzalez-Gonzalez · A. I. · Dinh · T. S. · Blom · J. · van den Akker · M. · Elders · P. · Thiem · U. · Küllenberg de Gaudry · D. · Swart · K. M. A. · Rudolf · H. · Bosch-Lenders · D. · Trampisch · H. J. · Meerpohl · J. J. · Gerlach · F. M. · Flaig · B. · Kom · G. · Sne

To explore factors that potentially impact external validation performance while developing and validating a prognostic model for hospital admissions (HAs) in complex older general practice patients.

Study design and setting

Using individual participant data from four cluster-randomised trials conducted in the Netherlands and Germany, we used logistic regression to develop a prognostic model to predict all-cause HAs within a 6-month follow-up period. A stratified intercept was used to account for heterogeneity in baseline risk between the studies. The model was validated both internally and by using internal-external cross-validation (IECV).


Prior HAs, physical components of the health-related quality of life comorbidity index, and medication-related variables were used in the final model. While achieving moderate discriminatory performance, internal bootstrap validation revealed a pronounced risk of overfitting. The results of the IECV, in which calibration was highly variable even after accounting for between-study heterogeneity, agreed with this finding. Heterogeneity was equally reflected in differing baseline risk, predictor effects and absolute risk predictions.


Predictor effect heterogeneity and differing baseline risk can explain the limited external performance of HA prediction models. With such drivers known, model adjustments in external validation settings (eg, intercept recalibration, complete updating) can be applied more purposefully.

Trial registration number

PROSPERO id: CRD42018088129.

The Daily Mile in practice: implementation and adaptation of the school running programme in a multiethnic city in the UK

Por: Routen · A. · Gonzalez Aguado · M. · O' Connell · S. · Harrington · D.

The aim of this study was to generate new evidence on how The Daily Mile (TDM), a popular school-based running programme in the UK, is implemented in a diverse and multiethnic city in the UK and also the barriers faced by non-implementer schools.


Mixed method cross-sectional study (including survey data collection and qualitative interviews).


Primary schools in a multiethnic city in the East Midlands, UK.


Forty-two schools in Leicester city completed an online survey, and five teaching staff from five schools took part in follow-up semistructured qualitative interviews.


Overall, 40.5% of schools who completed the survey reported having never implemented TDM, and 96.0% of implementer schools reported delivering TDM on three or more days per week. Reported barriers included space limitations and safety issues, timetabling and curriculum pressures, and pupil and teacher attitudes. Facilitators of implementation were teacher engagement and school culture/ethos, communication of the initiative and substantial delivery adaptations.


The findings from this study, based on data from schools in a multiethnic city in the UK, suggest that implementation of TDM is variable, and is influenced by a range of factors related to the school context, as well as the characteristics of TDM itself.

Influencia del apoyo social y la sobrecarga del cuidador en la calidad de vida del adulto mayor

Introducción: La cantidad de adultos mayores se ha incrementado por lo que las familias se encuentran ante el reto del cuidado; por lo que es necesario el apoyo social para que el cuidador no presente sobrecarga y no afecte los cuidados que proporciona y por ende la calidad de vida del adulto mayor. Objetivo: Determinar la influencia del apoyo social y la sobrecarga del cuidador en la calidad de vida del adulto mayor. Metodología: estudio correlacional, muestra de 151 adultos mayores con su cuidador. Se aplicaron dos encuestas sociodemográficas una para el adulto mayor y otra para el cuidador, test de Zarit, cuestionario Duke-Unk, cuestionario Whoql – Bref, índice de Barthel. Resultados: Los cuidadores son hijas (27.8%), edad media de 49 años, el 45.69% cuenta con empleo, dedican de 9 a 12 horas de cuidado (33.77%), el 50.3% presenta sobrecarga. Los adultos mayores son mujeres (51%), edad media de 69 años, el 54.4% padece enfermedades crónico-degenerativa, el 39.7% percibe apoyo social bajo y el 100% tiene alteración de la calidad de vida. Se encontró asociación entre apoyo social y calidad de vida (p<0.05) Discusión: Estos resultados contribuyen a comprender el impacto que tiene la sobrecarga del cuidador en sí mismos y el apoyo social en la calidad de vida del adulto mayor. En este sentido el profesional de enfermería debe establecer planes de cuidado con una visión de atención integral, que incluya al adulto mayor y a su cuidador, con la finalidad de mejorar la calidad de vida de ambos.



Introduction: The number of older adults has increased so that families are faced with the challenge of care; therefore, social support is necessary so that the caregiver does not present overload and does not affect the care provided and therefore the quality of life of the elderly. Objective: To determine the influence of social support and caregiver overload on the quality of life of the elderly. Methodology: correlational study, sample of 151 older adults with their caregiver. Two sociodemographic surveys were applied, one for the elderly and the other for the caregiver, Zarit test, Duke-Unk test, Whoql – Bref test and Barthel index. Results: The caregivers are daughters (27.8%), mean age 49 years, 45.69% have a job, dedicate 9 to 12 hours of care (33.77%), 50.3% present overload. Older adults are women (51%), mean age 69 years, 54.4% suffer from chronic degenerative diseases, 39.7% perceive low social support and 100% have an alteration in the quality of life. An association was found between social support and quality of life (p <0.05). Discussion: These results contribute to understanding the impact that caregiver overload has on themselves and social support on the quality of life of the elderly. In this sense, the nursing professional must establish care plans with a vision of comprehensive care, which includes the elderly and their caregivers, to improve the quality of life of both.

Análisis de adherencia y supervivencia al sondaje vesical intermitente y factores de riesgo asociados

El sondaje vesical intermitente consiste en el drenaje periódico de la orina a través de una sonda que se retira inmediatamente finalizada la eliminación urinaria. El cumplimiento de la prescripción del número de sondajes diarios que debe realizarse el paciente y las medidas de prevención de la infección, son determinantes. Esto necesita de la capacitación por parte de una enfermera, quien le entrena en la realización de la técnica, en sus autocuidados y en la integración del tratamiento en su vida habitual. Objetivo: Determinar la supervivencia de adherencia al sondaje vesical intermitente y los factores de riesgo asociados al abandono. Metodología: estudio observacional prospectivo multicéntrico en 24 hospitales españoles, con un periodo de seguimiento de los pacientes de 1 año. Las fuentes de información serán las historias clínicas de los pacientes, un cuaderno de recogida de información desarrollado ad hoc para este estudio y una serie de cuestionarios validados (calidad de vida, depresión y ansiedad, adherencia al sondaje vesical intermitente). Para el análisis de los datos se realizará estadística descriptiva, análisis de supervivencia univariante, para determinar el ritmo de pérdida de adherencia, estudio bivariante y multivariante entre adherencia y los potenciales factores de riesgo de abandono de adherencia. Se cumplirán todos los requisitos éticos. Relevancia científica y sociosanitaria: conociendo los factores que se asocian a la pérdida de adherencia se podrán adaptar los programas de capacitación de los pacientes y hacer una práctica basada en la evidencia. Además, mejorar la adherencia al sondaje vesical intermitente hará disminuir la tasa de complicaciones, como las infecciones urinarias y el impacto económico asociado.



Intermittent urinary catheterization consists of the periodic drainage of urine through a catheter that is removed immediately after urinary elimination has finished. Compliance with the prescription of the number of daily catheters that the patient must perform, and the infection prevention measures are decisive. This requires training from a nurse, who trains you in performing the technique, in your self-care and in integrating the treatment into your normal life. Objective: To determine the survival of adherence to intermittent bladder catheterization and associated risk factors. Methods: a multicenter prospective observational study in 24 Spanish hospitals, with a follow-up period of 1 year for patients. The sources of information will be the patients' medical records, an information collection notebook developed ad hoc for this study, and a series of validated questionnaires (quality of life, depression and anxiety, adherence to intermittent bladder catheterization). For data analysis, descriptive statistics, univariate survival analysis will be performed to determine the rate of loss of adherence, bivariate and multivariate study between adherence and potential risk factors for abandonment of adherence. All ethical requirements will be met. Scientific and socio-sanitary relevance: knowing the factors that are associated with the loss of adherence, it will be possible to adapt the training programs for patients and carry out an evidence-based practice. In addition, improving adherence to intermittent bladder catheterization will reduce the rate of complications, such as urinary tract infections, and the associated economic impact.

Leche materna versus sacarosa ante punción venosa y heel prick

Introducción: Las intervenciones que realizamos a los RN ingresados en nuestra unidad pueden causar dolor y estrés, traduciéndose en signos conductuales y fisiológicos. Método: Se realizó un ensayo clínico controlado aleatorizado en la UCI de neonatos durante un año, el objetivo fue conocer si existen diferencias significativas en cuanto al uso de leche materna vs sacarosa 25% como método analgésico no farmacológico en la realización de procedimientos dolorosos (punción venosa y punción del talón). Se usó para evaluar el dolor la escala de Susan Given Bells (antes y tras 2minutos de nuestra intervención). Material: Se incluyeron los recién nacidos entre 25-40 se-manas de gestación y que no cumpliesen criterios de exclusión. Resultados: Se usó para el análisis estadístico la t-student y el test de chi cuadrado, observando como principal resultado que en la extracción venosa (N=59) es más efectivo el uso de leche materna, sufriendo menor aumento del dolor tras la misma(p<0,029). También se observa relación significativa entre la edad gestacional corregida y el dolor tras la extracción venosa, obteniendo que los recién nacidos > 32 semanas tienen mayor aumento de dolor posterior (p<0,011). En la de punción de talón (N=76), no se hallaron diferencias entre la sacarosa y leche materna, tampoco al analizar otras variables (sexo, edad gestacional, crecimiento intrauterino retardado, llanto o canguro) Conclusiones: Se propone el uso de leche materna como método anal-gésico para el control del dolor en punción de talón y extracción venosa. Ya que demuestra su eficacia y carece de efectos secundarios.

Ensayo sobre el sufrimiento emocional de las enfermeras durante la pandemia de la Covid-19. Una mirada a Brasil.

Trata-se de um breve ensaio reflexivo escrito em língua portuguesa onde tento descrever os problemas que estão surgindo a nível emocional e psíquico nas enfermeiras brasileiras a causa desta pandemia da Covid19. Desejo mandar muita força e esperança às minhas companheiras desde as Ilhas Canárias na Espanha.


Contribución y desafíos de las enfermeras en tiempos de Covid-19: una revisión narrativa de la literatura

La pandemia por Covid-19 ha puesto a prueba el liderazgo y experiencia práctica de las enfermeras, y ha visibilizado el cuidado como un tema esencial para la vida humana y la salud global. Objetivo. El propósito de esta revisión de la literatura es reflexionar sobre las contribuciones y desafíos de las enfermeras en tiempos de pandemia. Método. Se realizó una revisión de la literatura, usando la base de datos Wos y SciencieDirect con la búsqueda de las palabras claves “nursing” AND “Covid-19” AND “disaster”, luego se complementó con otros documentos seleccionados de variadas fuentes, principalmente informes de organizaciones internacionales que han sido relevantes en el quehacer de enfermería y de la salud pública durante el periodo de pandemia. Resultados. Se revisaron 48 documentos y artículos que cumplieron con los criterios de inclusión.  Conclusiones. La principal contribución de las enfermeras a la pandemia se relaciona con la capacidad de formar una gran fuerza de contención en contra del Covid-19, guiada por un cuidado compasivo. Mientras algunos desafíos son el autocuidado y la planificación para la recuperación del sistema salud postpandemia. 

Hasta siempre Francisca: Un sentido adiós a una pionera de la historia de la enfermería en España

En este obituario se rinde sentido homenaje a la profesora Francisca Hernández
Martín. Se hace un recorrido a tavés de las diferentes facetas que desarrollo a lo largo de
su vida.

Relation between hyponatraemia and falls by acute hospitalised patients: A case‐control study


Aims and objectives

To investigate the possible association between hyponatremia and falls, in a sample of hospitalised adult patients.


In-hospital falls are a problem of major importance, provoking a significant decline in the quality of life of many patients. Recent studies have identified a relationship between such falls and the presence of hyponatremia.


Analytical retrospective observational case-control study.


The study population consisted of hospitalised patients who had suffered an in-hospital fall during the period 2014–2016. For each case, two controls who had not suffered any such fall were recruited. These cases and controls were matched according to gender, age, hospitalisation unit and date of admission. Study data were obtained from the hospital’s record of falls, regarding the patients’ socio-demographic factors, physical and psychological conditions and blood levels of sodium, potassium, urea and creatinine. The study is reported in accordance with STrengthening the Reporting of OBservational studies in Epidemiology guidelines.


The study sample consisted of 555 patients (185 cases and 370 controls). Hyponatraemia was detected in 57 cases (30.8%). A statistically significant relationship was found between the presence of hyponatraemia and the occurrence of falls: OR = 2.04. Other risk factors for falls were hypercreatinaemia OR 2.49, hyperuraemia OR 1.82, disorientation, need for ambulatory assistance and longer hospital stay.


From the study findings, we conclude that hyponatraemia is a predictor of falls by acute hospitalised patients. Further research is needed on the relationship between hypercreatinaemia, hyperuraemia and falls.

Relevance to clinical practice

The assessment of risk factors for falls, such as hyponatraemia, can alert us to the possibility of this event occurring and facilitate the implementation of preventive measures. This parameter should be included as a significant new factor in assessment instruments designed to assess the risk of falls, thus enhancing the reliability and diagnostic validity of these instruments.

Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies


Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed-incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies.