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Las Unidades de Cuidados Prolongados en Psiquiatría, los ofertan a pacientes con Trastorno Mental Grave (TMG). Supone un desafío ético, queriendo mantener su autonomía y más, en situación de crisis terminal.
Las Instrucciones Previas, en este sentido, son una herramienta valiosa que busca la autodeterminación también en este tipo de usuario. El marco jurídico la salvaguarda, incluso cuando la capacidad de decisión esté comprometida.
Para hacerlo realidad, nuestra idoneidad nos privilegia para establecer una relación terapéutica, evitando el paternalismo y fomentar la cooperación valorando las particularidades cognitivas y emocionales de cada persona.
Preguntas como: qué conocimiento de la enfermedad, aceptación de tratamiento y preferencias ante medidas de reanimación, hechas desde la sensibilidad clínica y la información comprensible, persiguen esa adaptación para un formato de conversación estructurada y respetuosa.
Por ello, para la búsqueda de estrategias que den voz a los pacientes con TMG, invitamos a reflexionar a nuestro colectivo. Para un cuidado centrado en la persona.
To determine the application rate of the preventive measures, alternate air anti-decubitus mattress and postural changes in patients who develop hospital-acquired pressure injury (HAPI) on the basis of their preventive or reactive temporality.
This is an ambispective observational study that included adult patients without pressure injuries admitted to Mancha Centro Hospital (Spain) who developed at least one HAPI during hospitalisation (August 2022 to March 2023).
The main variables were the implementation of preventive measures and the time of their application. Other variables were comorbidities, sociodemographic and clinical variables, Braden and Barthel scale, variables related to the application of preventive measures and information to characterise HAPI.
180 patients who developed 276 HAPI during their admission were included; 73.9% of the patients received a risk assessment upon admission, and 53.9% were re-evaluated. At some point during admission, an anti-decubitus mattress was placed in 73.3% of the patients, and 76.1% received postural changes.
Among the patients at risk at the time of HAPI onset, 49.4% had received anti-decubitus mattress preventively, 23.9% had received it reactively, and 26.7% did not receive it. Among the patients without contraindication for postural changes, 51.4% received them before the lesions appeared, 33.6% received them after the lesions appeared, and 13.6% did not receive them.
We detected a significant association between the preventive application of anti-decubitus mattress and postural changes with the Braden reassessment; admission to the intensive care unit; mechanical ventilation, vasopressors, nasogastric tube; mental state confused; hospital isolation; low Barthel and Braden scores; impaired mobility; inability to perform postural changes; diaper; urinary/faecal incontinence; and sedatives.
Only approximately half of the patients received preventive measures. Although patients with a more unfavourable clinical profile were more likely to receive these measures, increased awareness and training among healthcare professionals are necessary to ensure broader and more consistent implementation of preventive strategies.
This study explores the real-world use of preventive measures in hospitalized patients who develop HAPI. In half of the patients, these measures were applied reactively, highlighting the need to introduce strategies that facilitate the implementation of evidence-based practices.
This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
In the present study, data from patients have been obtained, but the patients or caregivers have not contributed to the development of the manuscript.
Women constitute the majority of the global healthcare workforce—especially in nursing—yet remain under-represented in formal leadership roles. Understanding how gender disparities intersect with profession, age, and governance models is critical to advancing equity and strengthening nursing leadership within health systems.
Cross-sectional ecological study across publicly funded healthcare entities in Catalonia, Spain.
Data from 124 entities were collected as of 31 December 2023 and analyzed by gender, profession (physician, nurse, or other), age group (≤ 55, > 55), and governance model (direct vs. indirect management) across five hierarchical leadership levels. Descriptive and inferential analyses were conducted to examine gender disparities in leadership distribution.
A total of 8015 leadership positions were identified, of which 62.2% were held by women, despite women representing 75% of the workforce. A clear gender gradient emerged across leadership levels, with women's representation decreasing systematically at each step upward in the hierarchy. Women's representation declined significantly with increasing seniority, whereas men's representation increased at higher organizational levels. Among professions, male physicians were markedly represented at senior levels, while nurses—both women and men—were concentrated in lower and mid-level positions. Gender disparities were also shaped by age and governance model: younger women were clustered in frontline roles, and female leaders in indirectly managed entities were more evenly distributed across leadership levels than those in directly managed organizations.
Persistent gender disparities—particularly affecting nurses and younger professionals—highlight the need for inclusive leadership development, transparent promotion pathways, and robust gender-disaggregated data for workforce planning. Strengthening nursing leadership is not only a matter of equity but a strategic priority for building inclusive and responsive health systems.
Este editorial reflexiona sobre la cocina como espacio esencial de cuidado doméstico en un mundo donde la prisa y la urbanización amenazan con vaciar de sentido la vida cotidiana. Frente a la predicción de que en 2050 las casas ya no tendrán cocina, se defiende que este espacio no es un habitáculo más, sino el corazón del hogar, donde se tejen vínculos con el mundo y donde cuidar se convierte en un acto radical de resistencia y humanidad. La cocina contiene la sabiduría de nuestras raíces y la historia de las mujeres que, durante generaciones, han cuidado de las familias mientras alimentaban cuerpos y almas. Renunciar a ella es un síntoma de la transformación de nuestra forma de habitar, olvidando que la ciudad misma nació del trabajo de la tierra y que la casa es un lugar de acogida, no solo de lo humano, sino de toda forma de vida. La casa, al sostener la intimidad y el cuidado, nos conecta con lo que somos, y su hospitalidad requiere ser defendida frente a la mercantilización del tiempo y la pérdida de vínculos comunitarios. Frente al avance de un planeta convertido en ciudad, la casa debe convertirse en un espacio de cuidado expandido, recordándonos que la tierra no nos pertenece, sino que vivimos en ella y por ella. Recuperar la cocina como espacio de encuentro, de saberes compartidos y de cuidado cotidiano es clave para resistir a la homogeneización social y al sinsentido contemporáneo, permitiéndonos regresar a los rituales y valores que sostienen la vida. Así, las casas del mañana podrán seguir siendo espacios donde la felicidad cotidiana se construya a través del cuidado.
by Halid Worku Jemil, Sonia Worku Semayneh, Altaseb Beyene Kassaw, Kassahun Dessie Gashu
IntroductionSevere stunting is one of the primary public health challenges in LMIC including Eastern African Countries, which affects millions of children. In addition, it was a major contributor for mortality and related complication of children aged under five. However, there is limited study conducted severe form of stunting by employing Machine learning (ML) in Eastern African Countries. Therefore, our study was demonstrated to predict and identify its major determinants using ML algorithms, furthermore, to improve model explainablity. Our study used Shapley Additive explanations (SHAP) and ARM to identify the determinants of severe stunting among under-five.
Methodscross-sectional study was conducted using DHS data from 2012–2022 in East Africa. 136,074 children were the source populations, and 76,019 children were the study population. Data were analyzed using Python version 3.7 and R version 4.3.3 for data preprocessing, modeling, and statistical analysis. Model performance was evaluated using accuracy and AUC. Furthermore, the SHAP analysis and ARM was used to further explain and interpret the determinants of severe stunting among children under five.
ResultsThe Random Forest performed the best in this analysis, with an accuracy of 87% and an AUC score of 0.83. The analysis indicated that women’s who do not practicing exclusive breastfeeding (SHAP value = +0.41), being from Burundi (SHAP value = +0.04), children being underweight (SHAP value = +0.25), lived in poor household (SHAP value = +0.40), child gender being male(SHAP value = +0.23), mothers height being short (SHAP value = +0.03), mothers being underweight (SHAP value = +0.18), child size at birth being small (SHAP value = +0.21), women’s being delivered in home(SHAP value = +0.07), mothers education being primary (SHAP value = +0.20), unimproved toilet (SHAP value = +0.06), distance to health facility being a big problem (SHAP value = +0.02), were associated with increase the risk of severe stunting among under five.
ConclusionThe Random Forest was the best-performing model for predicting severe stunting in Eastern African countries. To decrease the effects of severe stunting, integrated interventions should provide support for mothers with lower socioeconomic conditions, strengthen maternal education, empower women to practice exclusive breastfeeding, encourage facility deliveries, increase access for households to sanitary facilities, provide education on personal and environmental hygiene, provide mothers with information on the importance of complementary feeding for children as well as for the mothers, and provide near health facilities for mothers and essential care services.
Higher levels of individual health literacy have been associated with better health outcomes, greater medication adherence and improved self-management of chronic conditions. Hence, higher health literacy levels are expected to be indirectly associated with lower healthcare costs. The aim of this review is to identify and synthesise available studies on the relationship between individual health literacy and healthcare costs.
Systematic review with qualitative evidence synthesis.
MEDLINE, Scopus, Web of Science Core Collection and CINAHL were searched up to 7 March 2025.
We considered only studies that investigated and quantified the relationship between individual health literacy and healthcare costs sustained by individuals, insurance companies or health providers.
Article screening and data extraction were performed by two authors independently. We critically appraised the identified study by using the AXIS checklist and evaluated the methodology adopted for cost analysis. Finally, we performed a qualitative synthesis of the study results.
Of a total of 5801 articles identified, 23 studies met the inclusion criteria. Almost half of the studies were conducted in the USA and about one-third in European countries. The included studies showed fair average quality and great heterogeneity in health literacy measures and cost analyses. The analyses considered general medical, treatment-related, inpatient, outpatient and emergency costs, out-of-pocket expenses and financial hardship. Fifteen studies reported statistically significant results, estimating the association between health literacy and costs or evaluating the difference in costs incurred by different health literacy subgroups. All study results supported the hypothesised negative association between health literacy levels and healthcare costs.
Individual health literacy was found to be negatively associated with a range of healthcare costs, although the supporting evidence was not always robust. Interventions aimed at containing healthcare expenditure should consider this association, while further research is needed to define its nature.
The review has been registered in the PROSPERO International prospective register of systematic reviews (registration code CRD42023435502).
by Federica Biassoni, Giulia Vismara, Martina Gnerre
The objective of this study was to examine whether different types of mental-imagery training focused on the vocal apparatus can enhance awareness of the vocal tract and diaphragm (vocal awareness) in non-professional singers.Sixty participants with no singing education received one of three training conditions: following instructions based on 1) a description of the physiological changes that take place during phonation (physiological description), 2) imitating an action using the vocal apparatus (imitative action), and 3) a metaphorical narration. Imitative action and metaphorical narration were conceptualized as more imaginative forms of training. Vocal awareness was assessed with a questionnaire that participants completed before and after the training. The questionnaire measured three indices: vocal apparatus representation, vocal apparatus interoceptive awareness, and vocal self-regulation. Results showed that all three types of training program significantly enhanced vocal awareness, but imitative action and metaphorical narration were more effective for interoceptive awareness, and metaphorical narration was more effective for self-regulation. In conclusion, the two imaginative forms of training were more effective than physiological description for improving vocal awareness.To assess the feasibility of conducting a cluster randomised controlled trial comparing the effects of Advanced Trauma Life Support (ATLS) and Primary Trauma Care (PTC) with standard care on patient outcomes.
This was a pilot pragmatic three-armed parallel, cluster randomised, controlled trial conducted between April 2022 and February 2023. Patients were followed up for 30 days.
Tertiary care hospitals across metropolitan areas in India.
Adult trauma patients and residents managing these patients were included.
ATLS or PTC training was provided for residents in the intervention arms.
The outcomes were the consent rate, loss to follow-up rate, missing data rates, differences in the distribution between observed data and data extracted from medical records, and the resident pass rate.
Two hospitals were randomised to the ATLS arm, two to the PTC arm and three to the standard care arm. We included 376 patients and 22 residents. The percentage of patients who consented to follow-up was 77% and the percentage of residents who consented to receive training was 100%. The loss to follow-up rate was 14%. The pass rate was 100%. Overall, the amount of missing data for key variables was low. The data collected through observations were similar to data extracted from medical records, but there were more missing values in the extracted data.
Conducting a full-scale cluster randomised controlled trial comparing the effects of ATLS, PTC and standard care on patient outcomes appears feasible, especially if such a trial would use data and outcomes available in medical records.
Monitoring physical rehabilitation is an essential component of patient recovery after knee arthroplasty. Monitoring can be remote, or clinic based. In India, unsupervised home-based physical rehabilitation is a common practice, but there is a lack of evidence to demonstrate the effectiveness of remote monitoring. Therefore, we developed and piloted a mobile application (TeleREhabilitation after knee ArThroplasty app) based on behaviour design thinking to support the recovery period. This trial aims to compare the effectiveness, acceptability, cost and safety of this app-supported home-based intervention against usual care using an open label, 1:1 individual randomised superiority trial at two tertiary care hospitals in India.
Consecutive adults undergoing partial or total, unilateral or bilateral knee arthroplasty who can use a smart phone will be invited to participate in this trial. Consenting individuals will be randomised to either an app-supported intervention or a usual home-based rehabilitation which typically consists of provision of oral or written instructions at discharge and follow-up check-up with the surgeon or physiotherapist at their discretion or as per individual need. We aim to recruit 300 individuals over a period of eighteen months. The primary objective is to compare patient-reported knee function between the two groups at 3 and 6 months postsurgery. Secondary objectives are to compare patient-reported outcomes (pain and activity), performance-based outcomes (lower limb strength and knee function), resource utilisation and quality of life. Fidelity of implementation, end-user experiences and challenges in implementing this intervention will be measured using both quantitative and qualitative methods. Quantitative data will be analysed in Stata, and group comparisons will be done using mixed effect linear regression. A mixed-methods approach will be used to analyse and interpret the process evaluation data. A modified intention-to-treat approach will be taken, which includes all those who were randomised irrespective of their adherence to trial protocol if they had at least one follow-up visit after enrolment.
The protocol has been approved by the ethics committees of the sponsor institute (The George Institute for Global Health) and the two clinical sites (All India Institute for Medical Sciences, Delhi & Indraprastha Apollo Hospitals, Delhi). The results will be disseminated via peer-reviewed publications, conference presentations and via plain language newsletters to the trial participants.
CTRI/2024/06/068838.
To describe how implementation leadership manifests among formal and informal point of care nurse leaders during a successful evidence-based practice implementation.
A collective case study.
A conceptual framework on shared implementation leadership guided the study. Two units known for strong implementation were selected as instrumental cases from a healthcare network. Data were collected from multiple sources (2022–2023), including document review, site visits, focus group and individual interviews with formal managerial and non-managerial nurse leaders, staff nurses, interdisciplinary clinical staff and departmental leaders. The Framework Method was used to thematically analyse within-case findings, followed by cross-case comparison.
Nurse leaders in formal and informal roles engaged in collaborative processes to collectively enact leadership behaviours throughout the implementation phases. Change-, relation- and task-oriented behaviours aimed to foster staff readiness, ensure supportive presence, structure implementation activities and reinforce the use of evidence-based practices on the units. Collaborative processes fostered leaders' engagement and kept one another informed to align and synchronise their collective actions.
This study extends our understanding of implementation leadership in nursing by highlighting a shared and relational approach among diverse point of care leaders. Strengthening team-level processes is essential to enhance leadership capacity for implementation in nursing.
Given the global push for innovative, high-quality healthcare, strong leadership is needed to create conditions for implementation and practice change. This study makes visible how multiple and diverse leaders collectively support implementation.
With much focus on nurse manager roles, there is a gap in the research showing how multiple point of care leaders facilitate implementation, which this study addresses. This study can serve as a template to assist nurse leaders in their implementation efforts and to advocate for developing diverse nurse leadership roles.
The report adheres to the COnsolidated criteria for REporting Quality research (COREQ) guidelines.
This study did not include patient or public involvement in the design, conduct or reporting.
International Registered Report Identifier (IRRID): DERRI-10.2196/54681
Introducción: El personal de enfermería afrontó diversas situaciones para salvar vidas durante la COVID-19. Objetivos: Describir las experiencias de enfermeras (os) que brindan cuidado a personas con COVID 19 en un hospital público. Métodos: Estudio cualitativo, abordaje fenomenológico. Participaron 12 profesionales de enfermería que cuidaron a pacientes con COVID-19 en un Hospital público en Chachapoyas, Perú. Los datos se recolectaron por entrevista online. Resultados: Se obtuvo cuatro categorías: a) Entre la tristeza ante la muerte y la felicidad ante el alta del paciente crítico con COVID-19, b) Situaciones más desalentadoras de la COVID-19: falta de recursos, equipos de protección personal, maltrato y miedo, c) Situaciones más alentadoras de la COVID-19: espiritualidad, trato humano, aprendizaje, y equipamiento de hospitales, d) Recomendaciones: autocuidado, salud mental y trabajo en equipo. Conclusiones: Los(as) enfermeros(as) brindaron cuidado integral a los pacientes con COVID-19 sin importar las circunstancias en las que se encontraban. Se propone la teoría temporo - espacial del Siglo XXI, donde el cuidado se hace con amplias barreras de protección y equipos sofisticados, pero para la comunicación terapéutica se usa las tecnologías de la información.
Introducción: A partir del siglo XIX, académicos e investigadores han documentado y valorado las prácticas y conocimientos familiares, poniendo de manifiesto un diálogo continuo entre la medicina oficial y las tradiciones populares. Objetivo: Describir las aportaciones y los autores, que durante el siglo XIX y hasta la actualidad, han mostrado interés por el saber popular en salud. Metodología: Revisión de obras impresas y electrónicas, integrando contribuciones desde el ámbito de la etnografía y antropología y excluyendo el ámbito literario y costumbrista. Resultados: Los estudios identificados muestran cómo las prácticas populares de salud, que incluyen desde el uso de plantas medicinales hasta rituales mágicos-religiosos, varían según la región. En muchas áreas, especialmente en Andalucía, estas prácticas han evolucionado, pero mantienen su relevancia cultural y su influencia en la salud familiar. Conclusión: Se subraya la necesidad de un reconocimiento más profundo de los saberes populares como elementos esenciales para comprender la historia cultural de la salud y su influencia en la sociedad contemporánea. Además, las futuras investigaciones deben enfocarse en el dinamismo de estos saberes, especialmente en el contexto de una sociedad en constante evolución.
Palabras clave: Medicina Popular; folclore; historia; cambio social; cuidado familiar; salud de la familia.
Caso: Hombre de 30 años con pérdida de audición bilateral progresiva y percepción de vulnerabilidad ante el riesgo de dependencia para la comunicación con los demás. Objetivo principal: Conocer las diferentes estrategias comunicativas, basadas en la evidencia, para mejorar la calidad asistencial entre el personal sanitario y las personas con pérdida de audición. Metodología: Búsqueda de evidencias siguiendo el modelo PRAXIS. Resultados principales: Recomendaciones de buena práctica: (a) adquirir conocimientos sobre el método de comunicación más apropiado para el paciente; (b) facilitar el acceso a las personas en los centros sanitarios y consultas; (c) buscar apoyo en otros recursos para evitar su exclusión; (d) conocer las competencias lingüísticas para comunicarse con personas sordas; (e) emplear intérpretes en las unidades de salud; y (f) asegurarse de la comprensión de la información aportada. Prácticas de autocuidado: Concienciarse de que la sordera es una discapacidad que tiene ciertas soluciones, conocer los derechos y recursos de los que dispone y pedir ayuda siempre que la necesite debido al desconocimiento por parte de los profesionales sanitarios sobre la comunicación con las personas sordas.
A pesar de los cambios sociales: ¿se sigue erigiendo la familia como una institución cuidadora?, ¿cómo ha cambiado su estructura?, ¿se han debilitado los lazos familiares o se están transformando? En este texto, se analiza la evolución de la familia desde las teorías sociológicas más clásicas hasta los pensadores posmodernos. Se reflexiona sobre las implicaciones de un cambio social y si las transformaciones del presente se han hecho permeables a la dinámica familiar y la función cuidadora de la misma. Como conclusión, se vislumbra que, tanto la familia como sus habilidades cuidadoras, son el espejo de una sociedad en continuo cambio. Está emergiendo un nuevo espacio que, en forma de resistencia, permite hacer uso de los modos de hacer heredados con una visión renovada.
Caso: ejemplo mujer de 52 años de edad, que vive en zona rural que, a raíz de la realización de una estoma digestivo definitivo, manifiesta rechazo afectivo-sexual. Objetivo: identificar intervenciones basadas en evidencias destinadas restablecer la vida sexual en la persona ostomizada, garantizando su seguridad, aceptación de su nueva realidad corporal y motivación hacia la práctica erótica. Metodología: búsqueda de evidencias siguiendo el modelo PRAXIS. Recomendaciones de buena práctica: (a) Orientar al paciente ostomizado en todos aquellos aspectos relacionados con su estoma para recuperar la autosuficiencia, (b) Ayudar a la persona ostomizada a mejorar su imagen corporal durante el contacto sexual, (c) Implementar aquellas estrategias que la ayuden a retomar la práctica erótica- sexual, (d) Trabajar con su entorno familiar las habilidades positivas de comunicación para favorecer la aceptación de su nueva realidad corporal, (e) Estimular el contacto y visitas con personas que ha pasado por idéntica experiencia. Prácticas de autocuidado: apoyo profesional, compartir temores y experiencia con entorno social y grupos de apoyo, superar la vergüenza, actitud positiva.
Objetivo principal: Identificar las intervenciones adecuadas, desde el preoperatorio, para recuperar progresivamente la actividad previa a la formación del estoma, de forma segura. Metodología: Búsqueda de evidencias, siguiendo el modelo PRAXIS. Recomendaciones de Buena Práctica: a) motivar el autocuidado en el preoperatorio, b) instruir, el personal de hospitalización, en la movilización temprana adecuada c) promover la actividad física progresiva de forma individual d) instruir en habilidades y estrategias para una práctica deportiva segura Prácticas de autocuidado: saber manejarse y adaptarse a los cambios físicos, conocer tu cuerpo y desmitificar miedos, disfrutar de la actividad deportiva en grupo, compartir experiencias con otras personas ostomizadas.
Objetivo principal: identificar intervenciones post quirúrgicas basadas en la evidencia que garantizarían la adaptación al nuevo estilo de vida y le ayuden a retomar la actividad física que realizaba antes de la intervención quirúrgica con seguridad y evitando complicaciones. Metodología: búsqueda de evidencia siguiendo el modelo PRAXIS. Conclusión principal: Recomendaciones de buena práctica: (a)informar a la persona ostomizada como realizar ejercicios abdominales seguros tras la cirugía para fortalecer la musculatura abdominal, (b)mostrar diferentes alternativas de dispositivos y accesorios para la realización de ejercicio /deporte, (c)instruir al paciente en vigilar la presencia de posibles complicaciones al realizar ejercicio. Prácticas de autocuidado: Contactar con su estomaterapeuta para realizar los ejercicios de manera segura, conocer la variedad de dispositivos y accesorios para la realización de deporte, prevenir complicaciones.
En este relato biográfico contamos la experiencia de una cirujana como voluntaria en varios proyectos de cirugía en países con bajos recursos. El objetivo es conocer cómo funcionan estos proyectos, la labor que llevan a cabo y la implicación física y psicológica que supone. Se realiza mediante un abordaje cualitativo de una entrevista semiestructurada para analizar diferentes aspectos. El informante aporta datos sobre la organización del proyecto y el trabajo que realizan, su visión sobre estos proyectos y sus vivencias. Cuenta con naturalidad y simpatía sus experiencias en Bolivia y Ghana, resalta su humildad a la hora de contar su participación y las críticas que realiza.
La Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) es una sociedad dedicada a dar servicio y soporte a los profesionales de las urgencias y emergencias para que estos ofrezcan una mejor asisten-cia sanitaria a todas aquellas personas a las que atienden [Fragmento de texto].
FreshRSS 