Flebotomía (sangría) terapéutica en domicilio / Therapeutic phlebotomy (bloodletting) at home

Introducción: Paciente de sexo femenino de 86 años de edad, seguida en la unidad de hematología de nuestro hospital por una anemia normocitica-normocromica que tras tratamiento con darbopoetina alfa 40 mcg subcutánea semanal durante tres meses, es diagnostica-da de poliglobulia. Se solicitó flebotomía terapéutica de 400 cc de sangre. Tras su realización, se realiza control analítico resultando hemoglobina: 14.8mg/dl y hematocrito:42.2% (valores en rango). Desarrollo de la experiencia: El procedimiento se llevó a cabo en casa de la paciente sin necesidad de movilizarla de su cama, pues se encuentra encamada. Extraemos la cantidad de sangre indicada en la prescripción(400cc), sin ninguna complicación. Conclusiones: En este caso pudimos realizar un procedimiento de rango hospitalario en el domicilio de la paciente, liberando, por un lado, a los familiares de la “carga” del desplazamiento al hospital, y por otro, protegiendo la paciente de complicaciones relacionadas con la asistencia hospitalaria (infecciones nosocomiales, desorientación entre otras).Así mismo, con menos recursos, pudimos realizar una atención humanizada y segura, logrando el objetivo terapéutico. (AU)

Introduction:An 86-year-old woman with normocytic-normochromic anemia was diagnosed with polyglobulia after three months of weekly treatment with subcutaneous Darbopoetin alfa 40 mcg. She was treated with a Therapeutic phlebotomy of 400 cc of blood. The post treatment blood analysis showed values within range, Hemoglobin 14.8mg/dl and Hematocrit 42.2%. Development of Experience: The procedure was carried out in the patient’s house avoiding to move her from her own bed since she is a bedbridden patient. The ammount of blood prescribed, 400 cc, was drawn without any com-plications.Conclusions: This time, we have been able to develop a procedure that ussually we have to perform in the hospital in the patient best enviroment, her house. Avoiding both, the patient to be expose to the potential complication from an hospital enviroment ( infeccions, desorientation as many others) and the family to move the patient from her own bed. In summary, we reach the terapeuthic goal with an holistic and safe care attention but using less resources. (AU)

Necesidades y demandasde servicios de salud por parte del cuidador principal del paciente inmovilizado / Needs and demands for health services by the main caregiver of the immobilized patient

Objetivo: Evaluar las necesidades y las demandas de servicios desalud del cuidador principal de pacientes inmovilizados en el Centrode Salud de Caranza. Metodología: Estudio descriptivo transversalsobre los cuidadores principales de pacientes inmovilizados, mediantela identificación de inmovilizados y captación de 39 cuidadoresprincipales que voluntaria y anónimamente participaron. Inclusiónde variables de calidad (≥ 2 visitas/año), clínicas (sobrecarga, apoyo,estrés, ansiedad y depresión), sociodemográficas y de satisfaccióncon el servicio. Resultados: El indicador de calidad se superó en el89,8% de inmovilizados. Entre sobrecarga y parentesco (p = 0,040),nivel de cobertura (p = 0,012) o tiempo de respuesta (p = 0,015) seobservaron diferencias estadísticamente significativas. También hubodiferencias estadísticamente significativas entre apoyo social y nivelde cobertura (p < 0,001), tiempo de respuesta (p = 0,022), sobrecarga(p = 0,003), ansiedad (p = 0,046) o depresión (p = 0,040). Por último,se apreciaron diferencias estadísticamente significativas entre nivel deestrés y género (p = 0,035). Conclusiones: El presente trabajo muestraque las necesidades y demandas de servicios de salud se deben dirigir adisminuir el elevado nivel de sobrecarga, estrés y depresión detectado.De este modo, el estudio pone en evidencia el tipo de actuacionesmultidisciplinarias que los servicios de salud deben implementar paramejorar la calidad de vida y mitigar los problemas de salud de loscuidadores principales de pacientes inmovilizados. (AU)

Objective: Assess the needs and demands for health servicesof the main caregiver of immobilized patients at the CaranzaHealth Center. Methodology: Cross-sectional descriptive studyon the main caregivers of immobilized patients, through theidentification of immobilized patients and recruitment of 39main caregivers who voluntarily and anonymously participated.Inclusion of quality variables (≥ 2 visits/year), clinical (burden,support, stress, anxiety, and depression), sociodemographic, andsatisfaction with the service. Results: The quality indicator wasexceeded in 89.8% of fixed assets. Between burden and kinship(p = 0.040), level of coverage (p = 0.012) or response time(p = 0.015), statistical differences were observed. There were alsostatistically significant differences between social support andcoverage level (p < 0.001), response time (p = 0.022), overload(p = 0.003), anxiety (p = 0.046) or depression (p = 0.040). Finally,statistically significant differences were observed between stresslevel and gender (p = 0.035). Conclusions: The present workshows that the needs and demands of health services shouldbe aimed at reducing the high level of overload, stress anddepression detected. In this way, the study highlights the type ofmultidisciplinary actions that health services must implement toimprove the quality of life and mitigate the health problems of themain caregivers of immobilized patients. (AU)

Comparación entre las escalas Norton, Braden y EMINA originales y las escalas Braden y EMINA modificadas para pacientes inmovilizados en atención domiciliaria / Comparison between Norton, Braden and EMINA original scales and Braden and EMINA modified scales for immobilized patients in home care

Objetivo: General: Clasificar en niveles de riesgo a los pacientes según las escalas Norton, EMINA y Braden originales y las escalas Braden y EMINA modificadas para pacientes de atención domiciliaria incluidos en programa de inmovilizados. Específicos: a) analizar la concordancia entre las escalas y su nivel de significación; b) determinar la incidencia de lesiones por presión en los pacientes valorados con las escalas Braden y EMINA modificadas para pacientes inmovilizados incluidos en programa de atención domiciliaria. Metodología: Estudio descriptivo longitudinal del total de los pacientes incluidos dentro del programa de atención domiciliaria, inmovilizados, de un cupo de enfermería. Muestra conceptual de 45 pacientes. El estudio se desarrolló en la Unidad de Gestión Clínica de Algarrobo, perteneciente al Área de Gestión Sanitaria Este de Málaga-Axarquía, desde enero 2021 hasta julio 2021. Resultados: Al comparar las escalas originales con la escala Braden modificada para pacientes inmovilizados en atención domiciliaria, se obtuvo un valor de kappa de 0,0727 con la escala Norton, de 0,404 con la escala Braden original y de 0,286 con la escala EMINA original. Los valores de kappa para la comparación entre la escala EMINA modificada para pacientes inmovilizados en atención domiciliaria y las originales arrojaron un resultado de 0,345 con Norton, de 0,503 con Braden original y de 0,5 con EMINA original. Al terminar el estudio se registraron 5 pacientes que habían padecido úlceras por presión, 4 fuera del ámbito de la atención domiciliaria y 1 con úlceras de Kennedy. Conclusiones: Las escalas Norton, Braden y EMINA originales catalogan como de alto riesgo a más pacientes que las escalas Braden y EMINA modificadas para pacientes inmovilizados en atención domiciliaria (AU)

Objective: General: Classify in risk levels the patients according to scales Norton, EMINA and Braden originals and Braden and EMINA modified scales for patients in home care included in the immobilized programme. Specifics: a) analysis the concordance between the scales and its significance level; b)determine the incidence of pressure ulcers in patients evaluated with Braden and EMINA scales modified for immobilized patients included in the home care program. Methodology:Longitudinal descriptive study of the total of patients included in the home care program, immobilized, of a nursing quota. Conceptual sample of 45 patients. The study was carried out in the Clinical Management Unit of Algarrobo, belonging to the Area of Health Management East of Málaga-Axarquía. From January 2021 to July 2021. Results: Comparing the original scales with the Braden modified scale for immobilized patients in Home Care, a Kappa value of 0.0727 was obtained with the Norton scale, 0.404 with the original Braden scale and 0.286 with the original EMINA scale. Kappa values for the comparison between the modified EMINA scale for patients immobilized in home care and the original ones yielded a result of 0.345 with Norton, 0.503 with original Braden and 0.5 with original EMINA. At the end of the study, 5 patients were registered having suffered pressure ulcers, 4 outside the scope of home care and 1 with Kennedy ulcers. Conclusions: Norton, Braden and EMINA original scales lists as high-risk more patients than the modified Braden and EMINA scales for patients immobilized in home care. The agreement between the original and modified scales for patients immobilized in home care is mild or moderate, with high levels of significance, due to changes in cut-off points of modified scales for home care. The incidence found there are no studies that refer to modified scales for home care. Non-validated scales continue to be applying for the home care environment(AU)

Calidad de atención nutricional desde la percepción del paciente hospitalizado antes y durante la COVID-19 / Quality of nutritional care from the perception of the hospitalized patient before and during covid-19

Fundamentos: La pandemia del COVID-19 podría causar un cambio en la valoración de la calidad de atención nutricionaldel paciente hospitalizado. El objetivo principal del estudio fue analizar el impacto de la COVID-19 en la percepción delpaciente hospitalizado sobre la calidad de atención nutricional en un grupo antes y durante la COVID-19. Métodos: Hipotético deductivo, descriptivo comparativo,de diseño transversal; con población muestreada en su totalidad: 80 pacientes (antes) y 84 durante la COVID-19 delHospital Belén de Trujillo. Se aplicó el cuestionario SERVQUAL adaptado por Lora y Rebaza, con 5 dimensiones: Fiabilidad, Capacidad de respuesta, Seguridad, Empatía y Aspectos Tangibles y 22 preguntas. Resultados: La calidad de atención nutricional fue percibida como buena (65%) antes del COVID-19, regular para fiabilidad (42,5%) y bueno para capacidad de respuesta (50%), seguridad (77,5%), empatía (61,3%) y aspectos tangibles (93,8%); y durante la COVID-19, fue regular (64,3%), fiabilidad (41,7%), capacidad de respuesta (59,5%) y seguridad (52,4%); malo (40,5%) para empatía y bueno (53,6%) para aspectos tangibles. Conclusiones: El impacto de la pandemia COVID-19 en la percepción del paciente hospitalizado sobre la calidad de atención nutricional se evidenció con un cambio en la percepción de bueno a regular, así como en todas sus dimensiones. (AU)

Background: The COVID-19 pandemic could cause a change in the assessment of the quality of nutritional care for hospitalized patients. The main objective of the study was to analyzethe impact of COVID-19 on the perception of hospitalized patients on the quality of nutritional care in a group before and during COVID-19. Methods: Hypothetical deductive, descriptive comparative, cross-sectional design; with population sampled in its entirety:80 patients (before) and 84 during COVID-19 at Hospital Belén de Trujillo. The SERVQUAL questionnaire adapted by Lora and Rebaza was applied, with 5 dimensions: Reliability, Responsiveness, Security, Empathy and Tangible Aspects and 22 questions. Results: The quality of nutritional care was perceived asgood (65%) before COVID-19, fair for reliability (42.5%) and good for responsiveness (50%), safety (77.5%), empathy (61.3%) and tangible aspects (93.8%); and during COVID-19,it was regular (64.3%), reliability (41.7%), response capacity (59.5%) and safety (52.4%); bad (40.5%) for empathy and good (53.6%) for tangible aspects. Conclusions: The impact of the COVID-19 pandemic on the perception of hospitalized patients on the quality of nutritional care was evidenced with a change in perception from good to fair, as well as in all its dimensions. (AU)

Validación del cuestionario de Conocimientos sobre prevención de lesiones por presión en estudiantes de Enfermería: análisis Rasch / Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis

OBJETIVO: Medir el conocimiento de los estudiantes de enfermería de la Universidad de Jaén hacia las pautas basadas en la evidencia para la prevención de las lesiones por presión. MÉTODO: Estudio observacional transversal de validación de un cuestionario utilizando un formulario online con estudiantes de enfermería de la Universidad de Jaén. Se invitó a participar a todos los matriculados en los 4 cursos. Se evaluaron las propiedades psicométricas del cuestionario «Conocimientos sobre prevención de lesiones por presión» (PIPK) mediante un análisis de Rasch. Se calcularon porcentajes de respuestas correctas y errores para cada ítem, puntuación total y su asociación con variables formativas. RESULTADOS: El cuestionario PIPK mostró adecuadas características psicométricas (alfa=0,89) y buen ajuste del modelo de Rasch. La puntuación media de conocimientos fue de 21,0 (67,7% del máximo). Obtuvieron mayores puntuaciones aquellos estudiantes que habían realizado prácticas clínicas, más periodos de prácticas, habían asistido a jornadas específicas sobre lesiones por presión o estaban matriculados en cursos superiores. CONCLUSIONES: El cuestionario PIPK es un instrumento válido y fiable para medir los conocimientos de los estudiantes de enfermería hacia la prevención de lesiones por presión. Los estudiantes de enfermería de la Universidad de Jaén obtuvieron una puntuación de conocimientos hacia la prevención de las lesiones por presión superior al 50%

OBJECTIVE: The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD: A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS: The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS: The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%

Evaluation of the Remote-controlled Drone System using an Eye-tracking device through the Internet for patients in bedridden conditions

In many countries, the rate of aging in their population is rapidly increasing. It is expected that this increasing trend influences the number of patients in bedridden states who have difficulty moving their extremities, such as those patients with amyotrophic lateral sclerosis (ALS). The patients are limited in many aspects of their daily lives; this includes not seeing what is outside of their rooms, affecting their quality of life (QOL). Thus, this study aims to evaluate the Remote-controlled Drone System using the Eye-tracking device through the Internet (RDSEI) to improve QOL for patients in bedridden conditions. The novel RDSEI is proposed and developed by the Kai laboratory. The RDSEI consists of a drone, a transmitter, a control screen, an eye-tracking device, a video capture device, a server computer, and a client computer. The subjects of this experimental evaluation of the RDSEI were five healthy male adults (average age: 20.6 years old). Experimental results indicated that all the subjects could control the drone easily by using this system, although there were delays, blurriness, and freezing of the video. Therefore, it was concluded that by using this system, the subjects could control the drone by only their eye movements, thereby enabling them to see the outside world through the drone's camera. In the future, the patients will be able to control the RDSEI from remote locations and converse with persons in remote locations

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Úlcera por pressão em idosos institucionalizados: escores de risco e determinantes clínicos / Pressure ulcer in institutionalized elderly: the risk scores and clinical determinants

Introduction: The term senescence translates the natural process of aging, which includes a sum of physiological, anatomical and functional changes. These changes can lead to morbidities and, when associated with chronic diseases, provide a situation of fragility and dependence, which may leave the elderly vulnerable to the appearance of wounds, which usually present a chronic evolution. Objective: to determine the prevalence and characteristics of pressure ulcers among institutionalized elderly people, the association between risk scores and clinical conditions of the elderly, and the measure of intensity of association of these variables with the development of the lesion. Method: This is a cross-sectional, population-based study with a quantitative approach, based on the analysis of part of the database. All the elderly included in the database (N = 324), enrolled in long-term institutions, were included in the study. Results: The prevalence of pressure ulcer was 8% in institutionalized elderly. It can be verified that of the five variables related to clinical conditions, they had a significant association (p≤0.05). The estimates of the coefficients of the binary logistic regression model showed that positive values, such as urinary incontinence, osteoarticular, neurological diseases and negative values for the change in vision, may increase and / or decrease the chance of developing the lesion. Conclusion: Pressure ulcers are preventable wounds that require constant observa-tion by the professionals responsible for the planning and implementation of care

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