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Objetivo. Evaluar el grado de satisfacción con los cuidados brindados durante el parto y el posparto en el Hospital Álvaro Cunqueiro (HAC) y explorar su posible relación con variables sociodemográficas y obstétricas. Metodología. Se realizó un estudio observacional descriptivo transversal. La población incluyó mujeres con partos entre enero y octubre de 2024 en el HAC. El muestreo fue no probabilístico y de tipo consecutivo. Para la recolección de datos, se utilizó un cuestionario ad hoc que recopiló información sobre variables sociodemográficas y obstétricas, complementado con el instrumento “Care in Obstetrics: Measure for Testing Satisfaction” (COMFORTS) en su versión validada en español. Resultados. La muestra estuvo compuesta por 319 mujeres. La mediana de satisfacción global obtenida con el cuestionario COMFORTS fue de 171 (RIC: 155–186), lo que indica un alto nivel de satisfacción general. Sin embargo, las áreas de cuidados en el posparto [Me: 46 (RIC: 40–53)] y al recién nacido [Me: 40 (RIC: 30–46)] fueron identificadas como susceptibles de mejora. Se encontró una relación estadísticamente significativa entre la paridad y la percepción de la calidad de los cuidados neonatales, así como entre el modo de finalización del parto y el grado de satisfacción materna con la experiencia del parto. Discusión. Aunque la satisfacción general con los cuidados obstétricos en el HAC es alta, existen áreas de mejora en el posparto y en la atención al recién nacido. Además, variables como la paridad y el modo de finalización del parto influyen en la percepción materna de los cuidados.
ABSTRACT
Objective. To assess the degree of satisfaction with the care provided during labor and postpartum at the Hospital Álvaro Cunqueiro (HAC) and to explore its possible relationship with sociodemographic and obstetric variables. Methodolgy. A cross-sectional descriptive observational study was conducted. The population included women with deliveries between January and October 2024 at the HAC. Sampling was non-probabilistic and consecutive. For data collection, an ad hocquestionnaire was used to obtain information on sociodemographic and obstetric variables, complemented with the instrument Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) in its validated Spanish version. Results.The sample consisted of 319 women. The median overall satisfaction with the COMFORTS questionnaire was 171 (IQR: 155–186), indicating a high level of overall satisfaction. However, the areas of postpartum [Me: 46 (IQR: 40–53)] and newborn care [Me: 40 (IQR: 30–46)] were identified as areas for improvement. A statistically significant relationship was found between parity and perceived quality of neonatal care, as well as between the mode of delivery and maternal satisfaction with the birth experience. Discussion: Although overall satisfaction with obstetric care at the HAC is high, there are areas for improvement in postpartum and newborn care. In addition, variables such as parity and mode of delivery influence maternal perceptions of care.
Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines.
A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015.
Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months.
Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost–utility analysis was performed using the NHS and Social Care perspective.
A total of 49 patients were included; 35 were treated within 48 hours, ‘early’ (median (IQR) 8.25 [3.7–20.5]) and 14 were treated after 48 hours ‘delayed’ (median (IQR) 93.9 [66.7–100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0–3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p
This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.
Introducción: La motivación cumple un rol fundamental sobre todo en el desempeño laboral del profesional de Enfermería. Esta motivación representa un factor protector tanto para el profesional de Enfermería como también al paciente que se encuentra a su cuidado. Se objetivó analizar la relación existente entre factores motivacionales y desempeño laboral del profesional de Enfermería quienes ejercen funciones en dos hospitales del departamento Central 2023. Metodología. Estudio observacional descriptivo transversal realizado en dos centros asistenciales de referencia nacional, de alta complejidad de la República del Paraguay, muestreo no probabilístico por conveniencia. El instrumento, un cuestionario pre-elaborado y validado. Resultados. Respeto al desempeño laboral, predominó el nivel alto. En referencia a las dimensiones del desempeño laboral, ha predominado mayoritariamente el nivel alto, no registrándose ningún participante en el nivel bajo. Al relacionar los factores motivacionales con el desempeño laboral, se encontró asociación estadísticamente significativa, con lo que se acepta la hipótesis de investigación que indica que existe asociación entre factores motivacionales y el desempeño laboral de profesionales de enfermería. Discusión. Al relacionar los factores motivacionales con el desempeño laboral, se observó una asociación estadísticamente significativa. Esto se respalda en un estudio realizado en Perú, cuyos resultados sugieren que el desempeño laboral de los profesionales de enfermería estaría influenciado por la dependencia de factores motivacionales extrínsecos. Conclusión: Se recomienda fortalecer programas de reconocimiento y mejora de condiciones laborales para estimular la motivación extrínseca, como implementar oportunidades de desarrollo profesional y participación en la toma de decisiones.
ABSTRACT
Introduction: Motivation plays a fundamental role, especially in the work performance of nursing professionals. This motivation represents a protective factor for both the nursing professional and the patient under their care. The objective was to analyze the existing relationship between motivational factors and work performance of nursing professionals who work in two hospitals in the Central department 2023. Methodology. A cross-sectional, descriptive, observational study carried out in two national reference, highly complex healthcare centers in the Republic of Paraguay, using a non-probabilistic convenience sampling. The instrument was a pre-prepared and validated questionnaire. Results. Regarding work performance, a high level predominated. Regarding the dimensions of work performance, the high level predominated, with no participants registered at the low level. When relating motivational factors with work performance, a statistically significant association was found, thereby accepting the research hypothesis that indicates an association between motivational factors and the work performance of nursing professionals. Discussion. When relating motivational factors to job performance, a statistically significant association was observed. This is supported by a study conducted in Peru, whose results suggest that nursing professionals' job performance may be influenced by their dependence on extrinsic motivational factors. Conclusion. Strengthen recognition programs and improve working conditions is recommended to stimulate extrinsic motivation, such as implementing opportunities for professional development and participation in decision-making.
Salvage prostatic bed radiotherapy (PBRT) is a standard in case of biochemical recurrence following radical prostatectomy (RP) for prostate cancer (PC). The management of isolated prostatic bed recurrence following RP and PBRT is debated. Reirradiation within stereotactic body radiotherapy (SBRT) guided by metabolic imaging could be a relevant option in this case. In parallel, metformin, an economically viable and well-tolerated oral antidiabetic agent, has demonstrated its radiosensitising properties. This phase I/II clinical trial aims to (i) determine the optimal dose for SBRT reirradiation, (ii) conduct safety assessments and (iii) evaluate the efficacy of the metformin and SBRT combination.
We conducted a prospective, non-randomised, open-label, multicentre, dose escalation, phase I/II study involving a minimum of 44 patients. Eligible patients must have biochemical recurrence (Prostate Specific Antigen (PSA)>0.2 ng/mL and confirmed ascending trend in at least two successive assays), occurring at least 2 years after PBRT and prior RP for PC (including low, intermediate and high risk with a single risk factor) and no Common Terminology Criteria for Adverse Events (CTCAE) grade>=2 toxicity following PBRT. The recurrence should be visible on MRI and/or Positron Emission Tomography (PET) Choline and/or PET PSMA, without evidence of pelvic lymph node recurrence or metastatic disease. The primary objective of phase I is to determine the optimal SBRT dose (5x6, 6x6, or 5x5 Gy) based on dose-limiting toxicity (DLT). The dose will be chosen using a time-to-event continual reassessment method based on DLT, defined as CTCAE grade ≥3 gastrointestinal or genitourinary toxicity, or any other grade 4 adverse event. The primary outcome of the phase II is to estimate the efficacy of SBRT in combination with metformin in terms of biological relapse-free survival (bRFS) rate at 3 years. Secondary outcomes include 5-year bRFS rate, early/late genitourinary and gastrointestinal toxicities, quality of life, biochemical response rate, clinical progression-free survival and overall survival (OS).
Ethical approval has been obtained from the Ethics committee "SUD EST III Bron" Ref.CPP 2020-042B (20.05.07.72735) and the National Agency for the Safety of Medicines (ANSM) Ref. ANSM MEDAECNAT-2020-05-00009. The ethics approval obtained covers all the sites that will take part in this study. The study’s findings will be disseminated through publications and conference presentations.
NCT04536805, Registration Date: 2020-08-17
Ventral hernia repair is among the most commonly performed general surgical procedures, during which meshes are often used to provide further support to weakened or damaged tissue surrounding the hernia repair site. Slowly resorbable synthetic meshes have recently emerged as a valid choice, as confirmed by published clinical evidence on launched meshes in the repair of ventral hernias showing satisfactory results. This study was designed to assess the performance and safety of a newly developed slowly fully resorbable self-gripping synthetic mesh in patients undergoing ventral hernia repair through open surgery in clean and clean-contaminated fields.
This is a prospective, multicentre, single-arm study that will be conducted in up to 20 European and US sites with a total of 163 patients undergoing midline primary or incisional ventral hernia repair in clean or clean-contaminated surgical fields using an open surgical approach and implanted with Transorb self-gripping resorbable mesh in retrorectus placement with or without transversus abdominis release. The study will include patients ≥18 years old, presenting at least one risk factor impairing wound healing. The primary endpoint will be hernia recurrence rate within 12 months, postoperatively evaluated by physical exam; secondary endpoints will include hernia recurrence rate within 1 month, 6 months, 24 months, 36 months, 48 months and 60 months postoperatively, hernia recurrence rate resulting in reoperation, hernia recurrence rate reported by patients, time to hernia recurrence, rate of surgical site occurrence (SSO), rate of SSO requiring procedural interventions, surgeon satisfaction and change in patient-reported pain and quality of life. The study will be considered successful if the upper limit of the 95% Bayesian credible interval for the primary endpoint is less than 14.2%. Descriptive statistics will be used to summarise secondary study endpoints unless otherwise noted.
The multicentre, single-arm, prospective study of Transorb self-gripping resorbable mesh in subjects undergoing open repair of ventral hernia study will be conducted in compliance with the Good Clinical Practice standards, ISO 14155:2020 and the Declaration of Helsinki. The publication plan includes dissemination of the 12-month, 24-month, 36-month, 48-month and 60 month study results.
The RECOVER study has been registered at clinicaltrials.gov (NCT06449378).
Social accountability is a key value and aspirational goal of many medical institutions. While much has been studied on social accountability in the context of medical education and institutions, less research has examined how social accountability influences research. In light of this absence, the objective of our scoping review is to research the following questions: (1) What characterises socially accountable research (SAR), and how is it expressed and experienced? (2) How do language, positionality, and worldview influence SAR?, and (3) What structures and considerations are necessary to support successful SAR in local and global contexts?
To answer the above research questions, the Arksey and O’Malley, Levac et al, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute (JBI) guidelines will be followed. The search strategy was adapted and applied to MEDLINE, Embase, ERIC, and CINAHL databases. A total of n=5289 eligible articles were identified. Articles were excluded if they were published before 1995, were in a language other than English, or were duplicates, leaving n=2840 articles for title/abstract screening.
Ethical approval is not required to complete this study. We will take an integrated knowledge translation approach. Throughout the project, results will be disseminated to knowledge users (ie, consultations, following Arksey and O’Malley). Our findings will be presented to the larger academic community, policymakers, and healthcare practitioners through presentations, reports, newsletters, and an online repository.
Open Science Framework 16 July 2024. osf.io/mvhnu.
There are no clearly defined family profiles with an overall view of the predictors of early childhood caries (ECCs). The aim of our study was to identify the profiles of families that are particularly affected by ECCs. We also examined the factors that can be acted on to promote oral health.
In this single-centre cross-sectional study, the researchers examined the mouths of 300 children with caries and recorded the Decayed, Missing and Filled Teeth Index (dmft). These observations were supplemented by a questionnaire completed by the families, focusing in particular on their sociodemographic characteristics (e.g. age, parents’ professions and jobs, social assistance and family composition).
This work was conducted at Lille University Hospital between 2019 and 2024.
The participants included 300 caregiver-child dyads with children under the age of 6 years.
Childhood Caries Index (dmft) and family characteristics associated with ECCs.
A multiple correspondence analysis was used, followed by a hierarchical clustering on principal components analysis, to identify the family profiles associated with ECC risk.
Of the patients included in the study, 42% were girls, 58% were boys and their mean age was 4 years (±1.1 years). The mean dfmt index was 8.7 (±4.6); 77% of the participants had lesions on the smooth surfaces of the teeth, and 80% of the participants had a severe stage of caries disease. The analysis revealed three high-risk profiles based on the characteristics of the child’s mother and the family sibling composition. The first profile was larger families where the focal child was not the eldest. The second profile was families with foreign-born mothers and a low socioeconomic level. The third profile was families with mothers facing geographical and financial difficulties in accessing healthcare.
This study enabled us to identify the profiles of families at risk of caries. These at-risk profiles highlight the need to implement specific interventions acting at different levels and focused on oral health education in interprofessional practice during the key period of the first 1000 days of life. These factors could help to bridge the gap between oral health and general health, improve children’s oral health and reduce social health inequalities.
This human study has been ethically approved by the French Committee for the Protection of Individuals (N° 2019-A00827-50).
The protocol is recorded on clinicaltrials.gov, with ID: NCT04195607.
Breast cancer is the most commonly diagnosed cancer among women worldwide. Survivors often experience physical and psychological effects arising from breast cancer and its treatment, which can last months and years, adversely impacting quality of life. As the number of early breast cancer survivors increases, models of specialist-led follow-up care in hospital settings are not sustainable and evidence suggests that they may not meet survivors’ needs. Nurse-enabled, shared-care, follow-up models between cancer specialist and primary care teams have potential to address this need.
The proposed research is a multicentre, prospective, pragmatic, stepped-wedge cluster-randomised trial designed to test the effectiveness and implementation of IBIS-Survivorship, a follow-up care model for patients with early breast cancer who have completed primary treatment. The IBIS-Survivorship intervention involves a nurse-led consultation, development of a Survivorship Care Plan and case-conferencing between a breast care nurse and the patient’s primary care provider. This study seeks to recruit 1079 breast cancer survivors across six cancer centres (clusters) in Australia. Health-related quality of life at 12 months assessed by the Functional Assessment of Cancer Therapy - Breast Cancer questionnaire will be the primary endpoint, along with a range of patient-reported outcomes, safety indicators and cost-effectiveness measures as secondary endpoints. General and generalised linear mixed models will be used to assess the effectiveness of the intervention versus usual care. Implementation and process outcomes will be assessed using the Reach Effectiveness Adoption Implementation Maintenance framework.
Ethical approval was provided by the Metro South Hospital and Health Service Human Research Ethics Committee (HREC/2020/QMS/59892) and reciprocally across the other five trial sites under National Mutual Acceptance arrangements. Results will be disseminated through peer-reviewed academic journal publications and presentations at national and international conferences.
Australia and New Zealand Clinical Trials Registry (ANZCTR) Trial ID: ACTRN12621000188831.
Maternal preconception obesity and adverse gestational metabolic health increase the risk of childhood obesity in offspring, but the preconception period may be an opportune time to intervene, given the motivation of the mother and the epigenetic changes that may be beneficial for the gametes during this period. However, there is a lack of studies evaluating children born to women who have had a preconception intervention. Our group has therefore designed an ancillary study to assess children born to women enrolled in the obesity-fertility randomised controlled trial (RCT), who were 6–12 years of age, with the objective of evaluating the effect of a lifestyle intervention delivered during preconception and pregnancy on adiposity and cardiometabolic parameters in the offspring. This manuscript details the study protocol.
This is an ancillary nested cohort study of the obesity-fertility RCT. Women with obesity and infertility were recruited at an academic fertility clinic and randomised to the control group, which followed usual care, or to the intervention group, which received a lifestyle intervention alone for the first 6 months and then in combination with fertility treatments for up to 18 months or until the end of pregnancy. Those who have given birth to a single child are invited to participate in this follow-up study with their child aged 6–12 years. This study started in November 2023 and is expected to end in May 2025. The primary outcome is age-adjusted and sex-adjusted body mass index z-scores in children. Secondary outcomes are anthropometry, body composition, lifestyle, physical fitness level and blood or saliva markers of cardiometabolic health in both mothers and children. Of the 130 women who participated in the obesity-fertility RCT, 52 mother-child dyads (24 in the control group; 28 in the intervention group) were potentially eligible for this follow-up study. Comparisons between groups will be performed using unpaired tests and adjusted for potential confounders using multivariable regression models. This study will provide important new data on the impact of a preconception lifestyle intervention, maintained throughout pregnancy, on the health trajectory of children and mothers 6–12 years after delivery.
The study has been approved by the institutional research ethics review boards of the Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke. The results will be widely disseminated to the scientific community, relevant health professionals and general public.
ClinicalTrials.gov (NCT06402825).
Colombia enfrenta constantes desafíos en la gestión del riesgo de emergencias y desastres, demandando la participación activa de todos los actores del territorio nacional. Reconociendo el papel esencial de la disciplina enfermera en el cuidado de individuos y comunidades en situaciones de riesgo, se llevó a cabo una investigación-acción-participativa con el objetivo de promover la participación de una comunidad en la gestión del riesgo de emergencias y desastres de su municipio. La investigación se estructuro en 4 etapas en las cuales se recogieron datos mediante entrevistas, video-paseos y talleres comunitarios, que fueron procesados en el software Atlas.Ti mediante análisis de contenido. Se logró un proceso de co-creación en el cual la comunidad identificó los riesgos locales, asumió un rol activo en la prevención y mitigación de los mismos y aportó en la construcción de una herramienta innovadora que utiliza la tecnología para involucrar a la comunidad en la gestión del riesgo. Se concluyó que la inclusión de la comunidad en la gestión del riesgo posibilita la comprensión contextualizada del riesgo y fomenta un cambio social liderado por la comunidad, reflejado en la generación de estrategias adaptadas a sus necesidades particulares.
Objetivos: Comparar la validez diagnóstica entre la escala Neuropathy Disability Score (NDS) sin Monofilamento (MF) y NDS modificada con MF frente a Electromiograma (EMG) de extremidades Inferiores. Concordancia entre neuropatía detectada y registrada en Historial Clínico Informatizado (HCI) Metodología: Estudio de concordancia. Duración: 12 meses. Ámbito: Dos centros de Atención Primaria (AP) del Institut Català de Salut. Población diana: Personas con EMG registrado en HCI por sospecha de neuropatía diabética y otras neuropatías de extremidad inferior. Muestreo: Para un coeficiente kappa de 0,8 y precisión de 0,2 necesitamos 104 personas. Criterios de inclusión por Grupos: A: DM con registros del pie de riesgo sin neuropatía. B: DM con diagnóstico de neuropatía. C: Sin neuropatía ni DM conocidas. Selección: Simple, mediante listado de candidatos por centros participantes. Captación: Telefónica y programados en agenda única. Intervenciones: Entrevista clínica (Cuestionario sintomático Neuropathy Symptoms Score) (NSS) (0-9 puntos), Examen clínico: (Valoración sensitivomotora mediante escala NDS modificada (0-5 puntos por pie). Neuropatía si NDS > 6 puntos). Exploraciones: Tres por Enfermería, dos consecutivas y una espaciada 2 semanas. Variables Independientes: Puntuación de NDS y NSS. Dependientes: Factores de Riesgo Cardiovascular. Complicaciones DM. Análisis estadístico: Si la muestra es homogénea, mediante t de Student y ANOVA. Se calculará la fiabilidad y validez inter observador. Concordancia mediante Kappa, sin descartar métodos no paramétricos si la distribución lo aconseja. STATA. Resultados esperados: Disponer de un procedimiento exploratorio que mejore la actual valoración del pie de riesgo en AP. Aplicabilidad: Mejorar el diagnóstico de neuropatía diabética en AP.
ABSTRACT
Objectives: Compare the diagnostic validity between the Neuropathy Disability Score (NDS) scale without Monofilament (MF) and NDS modified with the MF and Lower Extremity Electromyogram (EMG). Concordance between neuropathy detected and recorded in the Computerized Clinical History (HCI) Methodology: Concordance study. Duration: 12 months. Setting: Two Primary Care (PC) centers of the Institut Català de Salut. Target population: People with EMG recorded in HCI for suspected diabetic neuropathy and other lower extremity neuropathies. Sampling: For a kappa coefficient of 0.8 and precision of 0.2 we need 104 people. Inclusion criteria by Groups: A: DM with risk foot records without neuropathy. B: DM with diagnosis of neuropathy. C: No known neuropathy or DM. Selection: Simple, through a list of candidates by participating centers. Capture: Telephone and scheduled in a single agenda. Interventions: Clinical interview (Neuropathy Symptoms Score) (NSS) symptomatic questionnaire (0-9 points), Clinical examination: (Sensorimotor assessment using modified NDS scale) (0-5 points per foot). Neuropathy if NDS > 6 points. Examinations: Three per Nursing, two consecutive and one spaced 2 weeks apart.Variables Independent: NDS and NSS score. Dependents: Cardiovascular Risk Factors. DM complications. Statistical analysis: If the sample is homogeneous, using Student's t-test and ANOVA. Inter-observer reliability and validity will be calculated. Agreement using Kappa, without ruling out non-parametric methods if the distribution recommends it. STATA. Expected results: To have an exploratory procedure that improves the current assessment of the risk foot in PC. Applicability: Improve the diagnosis of diabetic neuropathy in PC.
A lo largo del Antiguo Régimen el llamado arte de partear se constituyó como uno de los oficios mujeriles por excelencia. Una labor de carácter asistencial en la que se entremezclaba la tradición, la sabiduría popular y el conocimiento médico. Por constituirse como personajes de referencia social, en este artículo nos proponemos analizar la historia de las “comadres municipales” de Palencia. Unas mujeres, contratadas y pagadas por el propio ayuntamiento, que se encargaban de asistir a las pobres de la ciudad. A través del estudio de las Actas Capitulares conformadas entre 1700-1825, nos proponemos conocer la identidad de todas ellas, los salarios que percibieron, el tiempo que ejercieron el oficio y los requisitos que se las exigieron para poder ocupar el puesto Del mismo modo, queremos saber las reformas que llevó a cabo el ayuntamiento en relación al oficio (reglamentación, exámenes, reformas salariales emprendidas..); y cómo, a raíz del surgimiento de los colegios de cirugía, se avanzó hacia una masculinización del empleo.
The aim of this paper is to develop a preliminary theory that explores in depth into understanding the experiences of women who have suffered a spontaneous perinatal loss during any trimester of their pregnancy regarding their emotional response to this loss.
A grounded theory approach was used, and 25 in-depth interviews were conducted with Spanish women who suffered a spontaneous perinatal loss.
Theoretical sampling and constant comparative analysis were used to reach theoretical saturation. EQUATOR guidelines were followed, using the COREQ checklist.
The “Perinatal loss, a devastating cyclone,” a situation-specific nursing theory, explains the process that a woman experiences when she loses her baby at any stage of pregnancy, drawing an analogy with tropical cyclones as natural disasters that destroy everything in their path. This situation-specific theory includes three dimensions, explaining the phases identified in the perinatal loss process (phase prior to impact [before the perinatal loss], impact phase [diagnostic moment], emergency phase [hospital care], relief or honeymoon phase [return home], disillusionment or stock-taking phase [after the first postloss days at home], reconstruction and recovery phase [grief construction process] and consequences [with an eye to the future]). Three intervention areas were described around the perinatal loss process: “rescue area” (partner, grandparents, and siblings of the deceased baby), “relief area” (healthcare professionals), and “base camp” (society).
The situation-specific nursing theory “Perinatal loss, a devastating cyclone” is the final product of a grounded theory study that provided an in-depth analysis of women's experiences when they suffer a spontaneous perinatal loss at any point in their pregnancy.
The situation-specific theory “Perinatal loss, a devastating cyclone” with the seven identified phases and the three areas of intervention could be used as a framework for healthcare professionals in their clinical practice as a guide to support women in this disfranchised grief.
To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD-CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections.
A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD-CVC).
A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries.
Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4-point Likert-type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study.
A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon.
This Delphi study provides international expert consensus definitions of ESI and TI in HD-CVC, laying the groundwork for the validation of an HD-CVC ES clinical assessment scale for early identification of ESI.
In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD-CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.
El 27 de septiembre de 2023 seis jóvenes portugueses llevaron ante el Tribunal Europeo de Derechos Humanos a 32 gobiernos por su inacción ante la crisis climática global.
A pesar de que las enfermeras somos titulares de obligaciones del derecho a la salud, sus protectoras y defensoras, este suceso, como muchas otras iniciativas que luchan por la salud global, ha pasado desapercibido para la mayoría de las compañeras de profesión. ¿Dónde estamos como colectivo sanitario mayoritario en estas causas? ¿Dónde está nuestro apoyo manifiesto a la lucha por la salud planetaria?
Como enfermeras debemos movernos con la realidad del planeta y responder a los retos de salud globales. Si queremos mirar al futuro de la profesión, la profesión del presente debe actuar.
Objetivo principal: Comprender la experiencia en la atención del parto respetado de una mujer atendida en una unidad de partería profesional. Metodología: Estudio cualitativo fenomenológico llevado a cabo en una usuaria con control de embarazo casi exclusivo en la Unidad de Partería seleccionada a conveniencia. Se realizaron entrevistas en profundidad y análisis de contenido. Resultados principales: Surgieron las siguientes categorías que dan sentido a la experiencia de parir: 1) parir con amor, 2) la partera como vía del empoderamiento de la mujer y su familia e 3) Interculturalidad-respeto a las tradiciones. Conclusión principal: El análisis de las categorías muestra que el parto respetado es una vivencia única, personalizada, con resultados positivos tanto para la madre y el recién nacido como para los familiares.
It is common for community-based healthcare providers (CHPs)—many of whom have not received specialised training in wound care—to deliver initial and ongoing management for various wound types and diverse populations. Wounds in any setting can rapidly transition to a stalled, hard-to-heal wound (HTHW) that is not following a normal healing trajectory. Failure to recognise or address issues that cause delayed healing can lead to increased costs, healthcare utilisation and suffering. To encourage early intervention by CHPs, a panel of wound care experts developed actionable evidence-based recommendations for CHPs delineating characteristics and appropriate care in identifying and treating HTHWs. A HTHW is a wound that fails to progress towards healing with standard therapy in an orderly and timely manner and should be referred to a qualified wound care provider (QWCP) for advanced assessment and diagnosis if not healed or reduced in size by 40%–50% within 4 weeks. HTHWs occur in patients with multiple comorbidities, and display increases in exudate, infection, devitalised tissue, maceration or pain, or no change in wound size. CHPs can play an important initial role by seeing the individual's HTHW risk, addressing local infection and providing an optimal wound environment. An easy-to-follow one-page table was developed for the CHP to systematically identify, evaluate and treat HTHWs, incorporating a basic toolkit with items easily obtainable in common office/clinic practice settings. A flow chart using visual HTHW clinical cues is also presented to address CHPs with different learning styles. These tools encourage delivery of appropriate early interventions that can improve overall healthcare efficiency and cost.
Objetivo principal: Evaluar la calidad de un artículo experimental y efectividad de una técnica de enfermería para cubrir el catéter venoso central en pacientes adultos. Metodología: Revisión crítica de un ensayo clínico aleatorizado, basado en la mejor evidencia científica para la Práctica de Enfermería Basada en la Evidencia que diera respuesta a ¿El uso del apósito con clorhexidina comparado con apósito estándar al cubrir el sitio de inserción del catéter venoso central en pacientes adultos disminuye las infecciones locales o sistémicas? Para la lectura crítica se empleó la Escala de Jadad, el Programa de Habilidades de Evaluación Crítica en español, se calcularon medidas de efecto del tratamiento y medidas de riesgo. Resultados principales: El artículo mostró buena calidad con 4 puntos, tuvo validez en sus resultados al obtener respuestas afirmativas en preguntas de eliminación. La técnica de enfermería en métodos comparados fue efectiva y segura en beneficio del paciente, existió baja incidencia de infección primaria a nivel sanguíneo y buena fijación en ambos grupos, pero elevada tasa de reacción local. Conclusión principal: Ambos métodos fueron efectivos y seguros de utilizar en beneficio del paciente crítico, demostraron baja incidencia de infección primaria de la corriente sanguínea en los grupos. El apósito con clorhexidina no fue efectivo para disminuir la infección primaria de la corriente sanguínea.
Objetivo: Describir la representación de la enfermedad que tienen las personas adultas costarricenses con hipertensión arterial. Metodología: Estudio descriptivo, con muestreo por conveniencia de 81 personas adultas con hipertensión arterial. La representación de la enfermedad se midió con el Cuestionario Breve de Percepción de la Enfermedad. Los datos se analizaron con estadística descriptiva. Resultados principales: Se evidenció una representación de la enfermedad poco amenazante. La dimensión duración presentó mayor grado de amenaza y la emocional, control personal y del tratamiento, y coherencia menor grado de amenaza. Las principales causas de hipertensión arterial percibidas fueron estrés, genética y nutrición. Conclusión principal: Las personas perciben la hipertensión arterial poco amenazante, lo cual podría llevarlos a tener dificultades para adoptar conductas saludables. Una mejor comprensión de las representaciones de las enfermedades en la población costarricense tiene el potencial de dirigir futuras intervenciones para mejorar el bienestar.
La vivencia de un proceso quirúrgico supone un alto grado de ansiedad para la persona que lo padece y para su entorno familiar. Duran-te el tiempo de estancia del paciente en quirófano, los familiares se encuentran angustiados, hasta que éste sale por la puerta de quiró-fano, debido en parte por la escasez de información y su desconocimiento del ámbito sanitario. Fruto de esas reflexiones surge la idea de realizar este trabajo, un relato bibliográfico a través de una entrevista en profundidad, cuyo objetivo es dar a conocer las v vivencias y los sentimientos de las personas que se operan con nosotros. El relato que a continuación se expone me lo facilitó una paciente que fue intervenido de un cáncer de colon en el quirófano de cirugía. Se describen las categorías extraídas del relato observando como una vida de una persona normal sufre un cambio tras la enfermedad que la lleva a un primer periodo de sufrimiento y temor, un segundo periodo en el que hay una búsqueda de solución no dando por perdidas las esperanzas y cargadas de un gran optimismo. Como enfermera de quirófano me planteé la realización de este trabajo, para tratar el tema de la espera de los familiares mientras los pacientes se están operando, dentro del esfuerzo constante por humanizar la asistencia en los hospitales y por mejorar la calidad de los cuidados que reci-ben nuestros pacientes.
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