Efectividad de una intervención educativa enfermera en pacientes crónicos complejos

ObjectiveTo evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number.MethodPragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts.ResultsAmong the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p = .05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p = .10) were readmitted.ConclusionsThis study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions.     

Impacto de una intervención educacional sobre la calidad de la dieta mediterránea,la actividad física y el estado ponderal en adolescentes: ensayo clínico aleatorizado

ObjectiveTo analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents.MethodRandomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n = 36] and experimental group [n = 46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation.ResultsWe obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P = .029). No significant differences were observed between groups in the weight status (P = .916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (P control = .730; experimental P = .495) and with weight status (P control = .838; experimental P = .372), No significant differences are observed.ConclusionsThe educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future.     

Calidad de vida y afrontamiento: diferencias entre los pacientes de diálisis peritoneal continua ambulatoria y hemodiálisis hospitalaria

ObjectiveTo compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies.MethodsWe performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex.ResultsWomen accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups.No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07).ConclusionsNo differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process.     

Uso de eSalud para promover la actividad física en los supervivientes de neoplasias torácicas: revisión sistemática y metaanálisis

BackgroundSurvival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it.ObjectiveTo explore the effects of eHealth in the promotion of PA among thoracic malignancies.MethodsSuitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings.ResultsIn total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes.ConclusionOur results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.     

Experiencias de los pacientes con diabetes sobre la promoción de la actividad física durante las consultas enfermeras en Cataluña

ObjectiveAlthough physical activity (PA) is a key behaviour for controlling Type 2 Diabetes, problematic adoption and/or adherence continues to impair disease management. This study aims to understand how patients with T2D live and experience nurses PA promotion during consultations in Spanish context.MethodThe present study is a qualitative research. In 2019-2020, pre-COVID-19, 22 people living with T2D from Barcelona province contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). All interviews were recorded, transcribed, and analysed using conventional content analysis approach through constant comparative method.ResultsData analysis revealed two major themes with 16 subthemes. The two major themes include: «Intra-personal conscious PA adoption processes» and «Structural unconscious PA (non)adherence processes».ConclusionPatients’ experiences reflect two concurrent and interconnected issues. First, most patients readily adopted new PA after encouragement from nurses, who were the main proponents of PA. Indeed, adoption seemed to be most nurses’ PA priority and it was effective for most patients. Second, few nurses discussed adherence, making it an almost universal problem and source of disappointment. For adherence, patients experience that nurses’ attention needs to focus on activating processes and skills that support continued involvement in already-adopted PA.     

Evaluación del efecto de una intervención de limpieza/desinfección sobre la incidencia de infecciones por microorganismos multirresistentes en una Unidad de Cuidados Intensivos

AimEvaluate the effect of an intervention on the rate of nosocomial infections (NI) produced by multiresistant microorganisms in the Intensive Care Units.Material and methodsA study was conducted before and after an intervention in two ICUs to control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During the outbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and the equipment of both ICUs were cleaned and disinfected. A microbiological sampling was also made. The nosocomial infection rate density of the multiresistant microorganisms was compared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) and postintervention (1-3-2007 to 15-12-2007). To certify if there were any statistically significant differences between them, a rate ratio (RT) was calculated with a 95% confidence interval. The level of statistical significance was established at p < 0.05. We stratified per unit, per type of microorganism and location of the infection.ResultsThe global NI incidence rate for multiresistant microorganisms significantly declined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. A significant decrease was also observed on the NI incidence rate for the following microorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31, 95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to the infection location, a significant decrease in respiratory infection rates was observed (RT: 1.96, 95% CI: 1.29-2.99).ConclusionThe intervention conducted to control the MRAB outbreak was effective in reducing the NI incidence of multiresistant microorganisms.     

Eficacia de una intervención educativa en el manejo de un dispositivo de inhalación entre profesionales de enfermería de un servicio de urgencias

ObjetiveTo explore the most frequent errors of the inhalation technique (main topic for the pharmacological treatment of exacerbations of asthma and/or chronic obstructive pulmonary disease) in the nursing staff of an emergency department, and to evaluate the efficacy of an educational intervention.MethodsProspective quasi-experimental study, carried out in a hospital in Argentina during 2019. For the evaluation of the nursing staff, the steps of the Separ-Alat Consensus were used. The educational intervention consisted of oral explanation and visual demonstration of the inhalation technique. Paired data analysis was performed, and absolute and relative frequencies were calculated with their respective 95% confidence intervals.ResultsA consecutive sample of 72 nurses was included, of which 95.83% (95% CI 88.30-99.13) made at least one error in the baseline assessment. The most frequent errors were the lack of indication to the patient to exhale prior to inhalation (83.72%), forgetting to remove the air chamber and repeat the steps before the second dose (81.40%). After immediate evaluation after receiving the educational intervention, 74.42% (95% CI 58.83-86.49) corrected the technique. However, at one month, 53.49% (23/43; 95% CI 37.66-68.86) performed the technique correctly.ConclusionsThe educational intervention could be effective in correcting errors in this practice, although its effects tend to fade over time. Therefore, we consider periodic and systematic education relevant to maintain a correct inhalation technique among professionals.     

Análisis de 4 escalas de valoración de la sedación en el paciente crítico

BackgroundThis study aimed to verify the relationship between different Sedation Rating Scales (SRSs) for critical patients on mechanical ventilation and to know the relationship between the SRSs, clinical information and the dose of sedative and analgesia drugs (SAD).Material and methodsA longitudinal, prospective analytic pilot study conducted in a Medical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006. The sample included patients who required administration of SAP and mechanical ventilation. The following biological parameters and scales were evaluated: patient's demographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation Sedation Scale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure, cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient of interrelation was used to compare the relationship between the different scales.ResultsA total of 2.412 measurements were made for each variable: SRS, clinical information and SAD dose in 30 patients with different diseases, 63 % males, age 52 ± 19 years, APACHEII 24 ± 8, SAPSII 44 ± 16, with an ICU mortality UCI 34 %. Median and IQ range of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6 and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation was detected between all the SRSs, with p < 0.0001. The relationship between SAS, RASS and MASS was direct, whereas these were related inversely to RAMSAY. No evidence of interrelation was found between the SRSs, the clinical information and the SAD doses.ConclusionThe RAMSAY scale that has not been validated in ICU patients has a strong interrelation with the other already validated SRSs. SRSs are subjective and do not correlate with the clinical information and the SAD doses, probably due to the sample's small size and heterogeneity.     

Efecto de la música sobre la ansiedad y el dolor en pacientes con ventilación mecánica

The power of music to relieve anxiety or pain has been widely used throughout history.ObjectiveTo evaluate effects of music on anxiety and pain in patients on invasive mechanical ventilation.DesignA randomized controlled trial with repeated measures.Material and methodThis was a randomized, experimental prospective study in a tertiary hospital conducted from January 2009 to June 2010. The sample was made up of 44 participants. Intervention consisted in a 30-minute musical session in which the subject used a headset and was in an individual room. For the control group, the usual setting of an intensive care unit was maintained unchanged. Each patient underwent a minimum of 3 and maximum of 5 sessions. The patient per se selected the music from among a selection prepared by the investigator team. Anxiety and pain and hemodynamic variables of heart rate, respiratory rate systolic and diastolic blood pressure were measured at baseline, after the music session and then one-hour later.ResultsMusic therapy significantly decreased anxiety score (P = .000) when measured with the State-Trait Anxiety Inventory (STAI) scale. There were no differences in pain in the experimental group (P = .157) when measured with the visual analogue scale. No summative effects were demonstrated during multiple sessions.ConclusionMusic reduces anxiety in patients with invasive mechanical ventilation. Invasive mechanical ventilation can be established as a non-pharmacologic tool added to the available therapeutic options.     

TIC en actividad física y parámetros cardiovasculares en mayores: una revisión

IntroductionAgeing is a period of physical and psychological changes. Inactivity is one of the biggest problems among the older adult population increasing the risk of sarcopenia and chronic diseases. Physical activity is an effective intervention to improve health outcomes. In recent years, there has been an increase in the use of technology, with health technology tools (ICT) appearing as an intervention to increase physical activity and improve associated health problems.ObjectiveIn this review, we evaluated the effectiveness of health technology to increase physical activity and to improve cardiovascular parameters in older adults.MethodologyStudies with a great variety of health technology tools to increase physical activity levels, and that evaluated the effect of that increase on cardiovascular parameters were included by searching the main databases.ResultsEleven studies reporting the use of a variety of ICT tools were included in this review. Despite these differences, the effectiveness of health technology tool interventions has been demonstrated in increasing physical activity and reducing cardiovascular parameters.DiscussionThe lack of adherence of older adults to health technology would be a disadvantage, but it has been shown that younger older adults are more familiar with health technology tools and the number using them is increasing.ConclusionHealth technology tools show effectiveness in increasing physical activity in older adults and improving cardiovascular parameters.