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by Mario Gómez-Martínez, Greta Arias-Merino, Juan Benito-Lozano, Ana Villaverde-Hueso, Renata Linertová, Verónica Alonso-Ferreira
Inherited Epidermolysis Bullosa (EB) is a group of rare, genetic skin diseases characterized by extreme fragility of the skin and mucous membranes, leading to blistering and wounds in response to minimal trauma or friction. These clinical manifestations significantly reduce health-related quality of life (HRQoL). The objective of this protocol article is to provide information about the methods planned to be used to assess the measurement properties of HRQoL instruments specifically developed for EB patients of all age groups through a systematic review and meta-analysis. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) guideline. The literature search will be conducted in PubMed, Web of Science (WOS) and EMBASE, including terminology that aligns with the four key elements of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) research question (construct, target population, measurement properties and type of PROM), as well as the terminology proposed by COSMIN for measurement properties. Studies that include information on measurement properties (specifically, validity and/or reliability) with a sample of patients with inherited EB will be selected. Both title and abstract screening and full text review, will be conducted by two independent reviewers using the Rayyan tool. In addition, the risk of bias will be assessed using the COSMIN-Risk of Bias checklist. The data from each study and each measurement property will be summarized in accordance with the COSMIN guidelines. The evidence gathered will strive to adjudicate data on measurements properties of HRQoL instruments used in EB patients, and the limitations of the future systematic review will be discussed. Ultimately, results of the future systematic review will help develop more personalized guidelines for the assessment of HRQoL in EB patients of all age groups. The protocol is registered in OSF with registration number vrm87: https://osf.io/vrm87/
To evaluate the impact of a multilevel intervention in a surgical department on the segregation of non-hazardous healthcare waste (plastic and paper) during the perioperative period as well as its effect on the carbon footprint of the healthcare organisation.
A prospective before–after interventional study without a control group was carried out in the operating room of the Universitary Hospital Mútua Terrassa in Catalonia (Spain). A multilevel programme to improve the segregation process during the surgical interventions was implemented in several phases from May 2023 to December 2024. Data collection was conducted in each phase of the study through questionnaires addressed to the professionals along with calculations of the carbon footprint and the volume of waste segregation. The study is framed within the socio-ecological model and employs a collaborative design. The study population included all professionals working in the operating room (n = 320).
A multidisciplinary team was formed with consideration for all stakeholders. The project phases were implemented consecutively. A total of 141 professionals (44.4%) completed the baseline questionnaire. As a result of the project's development, the carbon footprint has been reduced to 79.1 kg CO2 eq/week, representing an 85% reduction in emissions.
The implementation of the recycling project has led to significant reductions in the amount of waste generated and it has been positively evaluated by the professionals.
The benefits of fostering a behavioural change among the professionals, coupled with the implementation of a well-designed segregation and recycling system, lead to significant benefits for the institution in carbon footprint.
Nurses can lead this type of project with a clear impact on both the institution and the environment.
Reduction of the carbon footprint in the operating room increased satisfaction among professionals for contributing to environmental improvement.
The reporting of intervention evaluation studies using nonrandomized designs: the TREND statement Des Jarlais et al. (2004) was used to evaluate the quality of the study.
N/A. Only professionals are involved in this study.
Membranous nephropathy is an autoimmune kidney disease and the most common cause of nephrotic syndrome in non-diabetic Caucasian adults. Rituximab is now recommended as first-line therapy for membranous nephropathy. However, Kidney Disease Improving Global Outcomes guidelines do not recommend any specific protocol. Rituximab bioavailability is reduced in patients with membranous nephropathy due to urinary drug loss. Underdosing of rituximab is associated with treatment failure. We have previously developed a machine learning algorithm to predict the risk of underdosing. We have retrospectively shown that patients with a high risk of underdosing required higher doses of rituximab to achieve remission. The aim of this prospective study is to evaluate the efficacy of algorithm-driven rituximab treatment in patients with membranous nephropathy compared to standard treatment.
A multicentre, randomised, controlled, open-label, prospective superiority clinical trial will be conducted in 13 French hospitals. 130 consecutive patients with primary membranous nephropathy and active nephrotic syndrome will be randomised to either the standard protocol control group (two 1 g rituximab infusions on days 0 and 15) or the algorithm-driven rituximab treatment group. In the latter, the rituximab dose will depend on the algorithm-estimated risk of underdosing. Patients with an algorithm-estimated risk of underdosing ≤50% will receive 1 g of rituximab on days 0 and 15. Patients with an algorithm-estimated risk of underdosing between 51% and 75% will receive 1 g of rituximab on days 0, 15 and 30. Finally, patients with an estimated risk of underdosing >75% will receive 1 g of rituximab on days 0, 15, 30 and 45. The primary study outcome is the rate of clinical remission (complete or partial) at month 6 after treatment initiation. The secondary outcomes include clinical remission at month 12, immunological remission, proteinuria, albuminuria, serum creatinine, estimated glomerular filtration rate, phospholipase A2 receptor type 1 antibody titre, anti-rituximab antibody occurrence, lymphocyte count, serum rituximab level and related adverse events.
The trial received ethics approval from the local ethics boards. The results of this study will confirm whether algorithm-driven rituximab treatment is more effective in inducing remission than the standard regimen and thus may contribute to improving management of patients with membranous nephropathy. The results of our study will be submitted to a peer-review journal.
NCT06341205 trial number. Registered on 2 April 2024.
Introducción: El asma, enfermedad crónica infantil más frecuente, está aumentando probablemente en relación a la exposición a factores ambientales. Estos están asociados a la aparición de asma y como desencadenante de síntomas. La literatura al respecto es controvertida. El objetivo de este trabajo es comprobar la posible influencia de la exposición a animales y/o humo de tabaco en el domicilio sobre el grado de control de la enfermedad y el número de exacerbaciones en población pediátrica asmática. Metodología: Estudio observacional realizado en población pediátrica que acudía a consulta de Neumología Pediátrica del hospital de referencia diagnosticados de asma y que tuviera pautado tratamiento inhalado. Como variable dependiente se consideró el número de exacerbaciones y como variables independientes se incluyeron sociodemográficas, variables asociadas a factores ambientales, así como a la técnica de inhalación. Resultados: Participaron 204 familias (66,7% niños). El 70,6% no tenían animales y el 78% no eran fumadores. La media de las exacerbaciones durante el periodo a estudio fue de 1,62. Un 84,8% de los/las pacientes presentan un buen control de la enfermedad. Discusión: Se encuentra relación entre el tener o no animales en casa y/o estar expuestos al tabaco y el grado de control de la enfermedad y número de exacerbaciones, confirmando lo descrito por varios autores. Es importante realizar una intervención individual donde se evalúen los factores que afectan a niños asmáticos y tratar los que sean modificables: manejo guiado de síntomas y tratamiento de exacerbaciones, consejo antitabaco, fomento actividad física… para mejorar su calidad de vida.
ABSTRACT
Introduction: Asthma, the most common chronic disease in childhood, is probably increasing in relation to exposure to environmental factors. These are associated with the onset of asthma and as a trigger for symptoms. The evidence on this is controversial. The objective of this study is to verify the possible influence of exposure to animals and/or tobacco smoke at home on the degree of control of the disease and the number of exacerbations in the paediatric asthmatic population. Methodology: Observational study carried out in a paediatric population that were attended at the paediatric pulmonology consultation of the reference hospital diagnosed with asthma and who had scheduled inhaled treatment. The number of exacerbations was considered as a dependent variable, and sociodemographic variables, variables associated with environmental factors, as well as the inhalation technique were included as independent variables. Results: 204 families participated (66,7% boys). 70,6% did no have animals and 78% were not smokers. The mean number of exacerbations during the study period was 1,62. 84,4% of the patients have good control of the disease. Discussion: A relationship was found between having or not having animals at home and/or being exposed to tobacco smoke and the degree of control of the disease and the number of exacerbations, confirming what has been described by several authors. It is important to carry out an individual intervention where the factors that affect asthmatic children are evaluated and treat those that are modifiable: guided management of symptoms and treatment of exacerbations, anti-smoking advice, physical activity promotion … to improve their quality of life.
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.
Los tumores de células germinativas del ovario constituyen un grupo de tumores de rara presentación, malignos y de rápida evolución, que suelen aparecer en mujeres jóvenes, siendo el disgerminoma un tipo de ellos. El disgerminoma requiere cirugía y biopsia, pues al no secretar hormonas no tiende a causar elevación de los marcadores séricos. Su silente y rápida evolución, muchas veces dificulta su precoz diagnóstico y tratamiento adecuado. El objetivo del presente trabajo ha sido realizar un proceso de atención de enfermería en una paciente diagnosticada con disgerminoma. Se ha llevado a cabo una búsqueda bibliográfica sobre el disgerminoma en diferentes bases de datos y páginas web. En conclusión, se busca aportar unos cuidados enfermeros individualizados de mayor calidad a la pa-ciente y un mayor conocimiento de la enfermedad por parte del profesional de enfermería.
Objetivo principal: Evaluar si el uso de catéter venoso central (CVC) impregnado en antimicrobiano es útil para la reducción de la bacteriemia relacionada con el catéter en pacientes ingresados en la Unidad de Cuidados Intensivos (UCI), e identificar el antimicrobiano más efectivo. Metodología: Se realizó una revisión sistemática en Bases Datos (CINAHL, PUBMED, CUIDEN, EMBASE, LILACS y SCIELO). Incluidos artículos de 2009 a 2017, inglés y español, que fuesen ensayos clínicos aleatorizados e incluyeran pacientes de UCI con CVC impregnado comparado con CVC convencional. Se evaluó la calidad metodológica de los artículos mediante la herramienta CASPE. Resultados principales: De los 8 estudios, 4 mostraron significancia en cuanto al uso de CVC impregnados para la reducción de infecciones relacionadas con el catéter. Dentro de los antimicrobianos usados, la minociclina-rifampicina muestra la mayor efectividad. Conclusión principal: El uso de CVC impregnado, puede ser efectivo en la reducción de infecciones en UCI. Dentro de las limitaciones de este tipo de catéter, a mayor número de luces y tiempo de mantenimiento de CVC, menor efectividad antimicrobiana.
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