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To explore the experience of primary healthcare (PHC) professionals in their professional role during the pandemic and to describe collective coping strategies.
We conducted a qualitative study using interviews, focus groups and photovoice techniques from February to September 2021. The qualitative data were transcribed, aggregated and analysed, from a hermeneutic perspective, using applied thematic analysis and ethnographic approaches.
Primary Care Health Madrid region (Spain).
Convenience sampling was used to select 71 multidisciplinary primary care professionals who were working in 12 PHCs representing diverse socioeconomic, social vulnerability and COVID impact levels in the Madrid region (Spain).
Findings from this study show how lack of protection in the early days, uncertainty about how the disease would evolve and the daily challenges they faced have had an impact on the participants’ perceptions of their professional role. Nuanced differences in impact were found between men and women, age groups, professional roles and territories. The questioning of the basic foundations of primary care and the lack of prospects led to a feeling of demotivation. They perceive a wide gap between their levels of involvement and commitment, the recognition they receive and the attention to resources they need to do their work to a high standard. The support of their colleagues was seen as the most valuable resource for coping with the crisis.
The practitioners’ discourses offer knowledge that could help to face new global health threats; they also identify an urgent need to restore the role and motivation of PHC professionals as part of a wider regeneration of health systems.
The pathogenesis of the long-lasting symptoms which can follow an infection with the SARS-CoV-2 virus (‘long covid’) is not fully understood. The ‘COroNaVirus post-Acute Long-term EffectS: Constructing an evidENCE base’ (CONVALESCENCE) study was established as part of the Longitudinal Health and Wellbeing COVID-19 UK National Core Study. We performed a deep phenotyping case-control study nested within two cohorts (the Avon Longitudinal Study of Parents and Children and TwinsUK) as part of CONVALESCENCE.
From September 2021 to May 2023, 349 participants attended the CONVALESCENCE deep phenotyping clinic at University College London. Four categories of participants were recruited: cases of long covid (long covid(+)/SARS-CoV-2(+)), alongside three control groups: those with neither long covid symptoms nor evidence of prior COVID-19 (long covid(-)/SARS-CoV-2(-); control group 1), those who self-reported COVID-19 and had evidence of SARS-CoV-2 infection, but did not report long covid (long covid(-)/SARS-CoV-2(+); control group 2) and those who self-reported persistent symptoms attributable to COVID-19 but no evidence of SARS-CoV-2 infection (long covid(+)/SARS-CoV-2(-); control group 3). Remote wearable measurements were performed up until February 2024.
This cohort profile describes the baseline characteristics of the CONVALESCENCE cohort. Of the 349 participants, 141 (53±15 years old; 21 (15%) men) were cases, 89 (55±16 years old; 11 (12%) men) were in control group 1, 75 (49±15 years old; 25 (33%) men) were in control group 2 and 44 (55±16 years old; 9 (21%) men) were in control group 3.
The study aims to use a multiorgan score calculated as the cumulative total for each of nine domains (ie, lung, vascular, heart, kidney, brain, autonomic function, muscle strength, exercise capacity and physical performance). The availability of data preceding acute COVID-19 infection in cohorts may help identify the consequences of infection independent of pre-existing subclinical disease and also provide evidence of determinants that influence the development of long covid.
For assessing health-related quality of life in patients with chronic wounds, the Wound-QoL questionnaire has been developed. Two different versions exist: the Wound-QoL-17 and the Wound-QoL-14. For international and cross-cultural comparisons, it is necessary to demonstrate psychometric properties in an international study. Therefore, the aim of this study was to test both questionnaires in a European sample, using item response theory (IRT). Participants were recruited in eight European countries. Item characteristic curves (ICC), item information curves (IIC) and differential item functioning (DIF) were calculated. In both questionnaires, ICCs for most items were well-ordered and sufficiently distinct. For items, in which adjacent response categories were not sufficiently distinct, response options were merged. IICs showed that items on sleep and on pain, on worries as well as on day-to-day and leisure activities had considerably high informational value. In the Wound-QoL-14, the item on social activities showed DIFs regarding the country and age. The same applied for the Wound-QoL-17, in which also the item on stairs showed DIFs regarding age. Our study showed comparable results across both versions of the Wound-QoL. We established a new scoring method, which could be applied in international research projects. For clinical practice, the original scoring can be maintained.
The Wound-QoL assesses the impact of chronic wounds on patients' health-related quality of life (HRQoL). A 17-item and a shortened 14-item version are available. The Wound-QoL-17 has been validated for multiple languages. For the Wound-QoL-14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound-QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound-QoL versions for the overall sample and, if feasible, country-wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound-QoL-17 (Cronbach's α: 0.820–0.933) and Wound-QoL-14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound-QoL-17 and Wound-QoL-14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country-wise results were similar. Both Wound-QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound-QoL-14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated.
Chronic wounds can severely limit patient's social life. This cross-sectional study investigated quantitatively social support of patients with chronic wounds, its association with health-related quality of life as well as qualitatively changes in social participation of these patients. Overall, 263 patients from seven countries participated. The most frequent wound class was leg ulcer (49.2%). Results revealed generally high levels of social support (mean global score: 5.5) as measured with the Multidimensional Scale of Perceived Social Support. However, individuals differed considerably (range 1.0–7.0). All dimensions of social support differed by patients' family and living situations (p < 0.001 to p = 0.040) and were positively correlated with generic health-related quality of life (r = 0.136–0.172). Having children, living with others and being in a relationship were significant predictors of having higher global social support. Patients reported great support from family members. Many participants reported no changes in relationships with friends. Wound care managers took an important role and provided additional emotional support. Patients reported a range of discontinued activities. Despite the high overall level of social support, inter-individual differences should be acknowledged. The importance of family carers should be acknowledged to be able to reduce caregiver burden and to ensure high-qualitative wound care.
Paciente de 5 años con diagnóstico de neuroblastoma abdominal metastásico de alto grado desde 2022, acude a la unidad de trasplante infantil para someterse a megaterapia con Busulfan y Melfalan como tratamiento mieloabrasivo, con posterior rescate mediante trasplante autólogo de progenitores hematopoyético (TPH). Tras realizar la valoración enfermera por patrones de M. Gordon en dos momentos, al ingreso y tras el trasplante, se detectó la alteración de 6 patrones y se estableció un plan de cuidados individualizado, que incluye al paciente y a la cuidadora principal, empleándola taxonomía NANDA-NOC-NIC.
Objetivo principal: Valorar si la terapia con sanguijuelas, es beneficiosa en el alivio de la congestión venosa. Metodología: Lectura crítica con CARE. Resultados principales: Nivel de evidencia bajo, según GRADE. Conclusión principal: A pesar de la falta de evidencia, con-cluimos que la terapia con sanguijuelas, mejora la congestión venosa en heridas.
Objetivo principal: Evaluar la efectividad de la miel para la tos aguda en niños. Metodología: Lectura crítica con CASPe y Prisma 2. Pro-cedimientos metodológicos estándar esperados por Cochrane. Resultados principales: Nivel de evidencia baja. Conclusión principal: A pesar de la falta de evidencia plausible,la miel puede reducir la tos aguda en niños, frente a la no utilización de otro producto, tomándo-se como una recomendación favorable pero no concluyente, siendo mayor el beneficio obtenido que el perjuicio.
Objetivo principal: Valorar si masticar chicle, tras una cesárea, mejora la función intestinal. Metodología: Lectura crítica con CASPe y Prisma 2. Resultados principales: Nivel de evidencia baja, según GRADE. Conclusión principal: A pesar de una falta de evidencia plausible, concluimos que masticar chicle, mejora la recuperación temprana de la función intestinal.
Objetivo principal: cuantificar el ruido ambiental en una unidad de cuidados intensivos y detectar las fuentes que generan los picos más altos de ruido. Metodología: se llevó a cabo un estudio observacional descriptivo en una unidad de cuidados intensivos de adultos. Se realizaron veinticinco mediciones del ruido ambiental, no consecutivas, aleatorias, durante las 24 horas del día. El nivel de ruido fue medido en decibelios. Los datos obtenidos fueron analizados descriptivamente. Resultados principales: la media de los picos máximos de ruido registrados fue de 80.8 ± 4.05 decibelios y la media de los picos mínimos fue de 37.8 ± 1.3 decibelios. El nivel de significación considerado para todos los contrastes fue p< 0.05. Los picos máximos de ruido coincidieron con las alarmas de los monitores, las llamadas telefónicas, con algunas conversaciones y con el paso del carro de las comidas. Conclusión principal: los niveles de ruido ambiental registrados fueron elevados y estuvieron muy por encima de las recomendaciones dictadas por la Organización Mundial de la Salud. Existe la necesidad de establecer estrategias educativas y estructurales para la reducción del ruido. Se proponen una serie de medidas para disminuir el ruido en nuestra unidad.
Artículo en alemán de divulgación científica, cuyo objetivo es dar a conocer la técnica de aposición con pelo para laceraciones tipo scalp (Arrancamiento accidental, total o parcial, del cuero cabelludo), que consiste en el acercamiento de los bordes de la herida mediante el enrollado de haces de pelo colindante y su aseguramiento con pegamento tisular; así como reflejar las ventajas de este método frente a las suturas convencionales y a las grapas. Se trata de una reseña en la sección de “foco de formación” o “foco educativo” de una revista médica [fragmento de texto].
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