Calidad de las revisiones sistemáticas de COVID-19 en personas con diabetes: una revisión sistemática

ObjectiveTo investigate the methodological quality of published systematic reviews of factors associated with COVID-19 in people with diabetes.MethodSystematic review with registration protocol in PROSPERO, under the number CRD42020222418. Searches were carried out from October to November 2020 in the databases of the Medline, Web of Science, Scopus, LILACS, Embase and Cochrane Library, in addition to searching the reference list of the selected studies. Systematic review studies with or without meta-analysis and without date and language restrictions were included. Data were extracted in a standardized way and the quality of the studies was assessed using the Assessment of Multiple Systematic Reviews scale.ResultsTwelve reviews, published between 2020 and 2021, with a predominance of the English language, systematic reviews of observational studies with meta-analysis with a sample ranging from 6 to 83 studies, were included. Regarding financing, most of the study reported did not receive this type of support. Regarding to the assessment of the methodological quality of the studies, 3 were of moderate quality, 5 were classified as low quality and 3 with critically low quality.ConclusionsThe analyzed articles presented a bias in the preparation of reports on their studies, suggesting the need to use mechanisms to improve adherence to the established reporting guidelines and methodological evaluation tools.     

Instrumentos para valorar la convivencia del paciente con un proceso crónico: una revisión sistemática

Objective

To analyse the currently available instruments to assess living with a chronic illness and related aspects.

Complicaciones relacionadas con la inserción y el mantenimiento del catéter venoso central de acceso periférico

ObjectiveTo evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal.MethodsProspective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate.Results144 PICCs were inserted, of which 94 corresponded to the ICU group (65.28%) and 50 (34.72%) to the non-ICU group. The most important complication was the suspicion of infection: 17.36% (rate of 15.2 per 1000 days of PICC). The total number of confirmed infections was 6.25% (5.5 per 1000 days of PICC), 1.39% (1.2 per 1000 days) being in the ICU group and 4.86% (4.2 per 1000 days) in the non-ICU group. There were 5 bacteraemias, all in the non-ICU group (3 per 1000 days). The most frequent germ was Staphylococcus epidermidis (6 cases). Phlebitis had an incidence of 9.03% (7.9 per 1000 days of PICC).ConclusionsPICC, effective device for central venous access due to the minimal incidence of risks in implantation and to its advantages with regard to the classic central venous catheters, is a further nursing technique.     

Barreras en la asistencia sociosanitaria en personas transexuales: revisión sistemática de estudios cualitativos

Aim

To explore the barriers to requesting social and healthcare assistance perceived by transgender persons and professionals involved in the assistance.

Percepción del mobbing entre el personal de enfermería de la Unidad de Cuidados Intensivos

Aimto determine the perception of intensive care unit nursing staff on mobbing.Methodqualitative approach study, Grounded Theory was used, 12 intensive care unit nurses of 2 public hospitals in our country during December 2017.Resultsfemale sex predominated with an average age of 41.33 years old, mostly married, on night shift and trained a nursing technicians; 4 categories emerged: general knowledge about mobbing, the origin of mobbing and its main actors, experiences of mobbing as a victim and as a spectator and the implications of mobbing in working life.Discussionissues of workplace harassment are sensitive for most health workers, since they deal with private situations and lack of support from superiors when they have been victims of harassment. The evidence shows that one of the reasons why mobbing can be perceived in different ways is because little is known about the real concept, it can be associated with multiple forms of violence and there is heterogeneity in the use of the term.Conclusionthe majority of intensive care unit nursing staff have been victims and witnesses of mobbing behaviour, with negative repercussions on their job satisfaction and performance; It is also the cause of constant staff turnover.     

Evaluación del efecto de la terapia de relajación en pacientes con hipertensión arterial

ObjectivesTo evaluate whether the application of a relaxation therapy reduces the blood pressure in hypertensive patients and whether there is improvement in several parameters which can influence blood pressure such as anxiety, quality of life and sleep.MethodsA quasi-experimental study (measures before-after) was performed in 25 Primary Care patients with hypertension poorly controlled by pharmacological treatment. The intervention consisted of relaxation therapy composed of 3 techniques: passive relaxation of Schwartz-Haynes, diaphragmatic breathing and imaginary visualization. A total of 14 group sessions of 30 min each (2/week) were conducted. Systolic and diastolic blood pressure were taken at the beginning and end of the relaxation programme implemented and after each of the programme sessions. The Pittsburgh Sleep Quality, Quality of Life Hypertension, State-Trait Anxiety and Perceived Stress questionnaires were used to measure psychosocial parameters.ResultsAfter intervention, a reduction in systolic blood pressure of 20 mmHg (p < .001) and of 8 mmHg (p < .001) in diastolic blood pressure was observed. Regarding other factors, sleep quality (p < .001), quality of life (p< .001) and state anxiety (p = .004) were significantly improved.ConclusionsRelaxation therapy had positive effects in improving blood pressure parameters, as well as the other factors evaluated. In our opinion, such strategies should be evaluated more thoroughly to consider their inclusion in Primary Care.     

Uso de la simulación clínica para entrenar equipos en el manejo de conflictos durante los cuidados en salud: una revisión sistemática exploratoria

ObjectiveTo assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.MethodsA structured literature review was performed with the terms clinical simulation OR patient simulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.Results10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.ConclusionMultiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.     

Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España

ObjectiveTo identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse’ Association of Ontario, so that future experiences could benefit from the assessments presented here.MethodEvaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats.ResultsReports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted.ConclusionA useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.     

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis

ObjectivePreventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.MethodsA literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.ResultsOf the 1,056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P < 0.01). We found no significant difference between results of studies conducted in intensive care settings (RR = 0.25, 95%CI: 0.15-0.43, P < 0.01) and non-intensive care settings (RR = 0.38, 95%CI: 0.17-0.83, P = 0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P < 0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P = 0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).ConclusionThe present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.     

La escala APACHE III: un factor pronóstico en la aparición de úlceras por presión en una Unidad de Cuidados Intensivos

ObjectiveTo analyze total APACHE III score association to pressure ulcers development in patients hospitalized in an intensive care unit (ICU).Material and methodsProspective cohort study conducted in an intensive care unit of the Hospital General de VIC. All the patients hospitalized between January 2001 to December 2001 were enrolled. Age, gender, length of stay, total Norton and APACHE III score and pressure sore development were collected.ResultsPressure sore incidence was 12.5% of the patients. The factors were significantly associated with the appearance of pressure sores in those patients with a length of stay in the intensive care unit, total Norton and severity of the disease measured by the APACHE III score. Patients having the greatest risk of pressure ulcers development were those whose Norton score was less than or equal to 14, and an APACHE III score higher than or equal to 50 (Odds Ratio: 37.9, 95% CI 11.16-128.47)ConclusionThe severity of the diseases measured with the APACHE III scale showed a relationship with the appearance of in-hospital pressure ulcers.The joint use of the APACHE III and Norton scale could be a good strategy to detect patients with very high risk of suffering pressure sores.