Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method.

BACKGROUND: Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. OBJECTIVE: The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. METHODS: We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients' lifestyle factors that, according to the medical literature available and experts' opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. RESULTS: After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. CONCLUSIONS: Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46961.

Enfermeria basada en la evidencia: revisión de alcance

RESUMEN Objetivos: Identificar la evidencia científica sobre el concepto, desarrollo y función, de la Enfermería Basada en la Evidencia (EBE) y analizar críticamente esta herramienta, sus elementos facilitadores y barreras para su implementación. Material y Método: Revisión de alcance según propuesta del Joanna Briggs Institute. Se consideró el rango de tiempo entre 1997 y 2019 para recuperar artículos y revisiones en inglés, portugués y español. Se utilizaron descriptores del tesauro Medical Subject Headings y términos booleanos para aplicar las estrategias de búsqueda en 4 bases de datos: PubMed, EBSCOhost, Scopus y Science Direct. Se complementó la búsqueda con la técnica de bola de nieve aplicada a la lista de referencias de los artículos relevantes seleccionados. Para evaluar la validez y el impacto de los resultados de los artículos de revisión y cualitativos se aplicó el Critical Appraisal Skills Programme Español (CASPE), y para estudios observacionales el Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Para establecer los niveles de evidencia se utilizó Canadian Task Force on Preventive Health Care (CTPFCHC). Resultados: De 163.074 manuscritos iniciales, fueron seleccionados 44 para análisis y extraer datos referentes a: Historia de la EBE; Concepto y función de EBE; Etapas, barreras y facilitadores. Conclusiones: El concepto de EBE pone de manifiesto la necesidad de utilizar esta herramienta para planificar los cuidados mediante el uso del pensamiento crítico y reflexivo; la importancia de realizar el cuidado a la cabecera del paciente y cultivar un cuidado basado en la mejor evidencia, enmarcado, todo ello, en un contexto de humanización, así como considerar las barreras y facilitadores de esta herramienta.

ABSTRACT Objective: To identify the scientific evidence on the concept, development and function of Evidence-Based Nursing (EBN) and to critically analyze this tool, its facilitating elements and barriers for implementation. Material and Method: Scoping review according to the proposal of the Joanna Briggs Institute. The period between 1997 and 2019 was considered to retrieve articles and reviews in English, Portuguese and Spanish. Medical Subject Headings thesaurus descriptors and Boolean operators were used to apply search strategies in 4 databases: Pubmed, EBSCOhost, Scopus, Science Direct. The search was complemented with the snowball technique applied to the reference list of the relevant selected articles. The Critical Appraisal Skills Programme Español (CASPE) was used to assess the validity and impact of the articles review and qualitative results, and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) was used for the observational studies. To establish the levels of evidence, The Canadian Task Force on Preventive Health Care (CTPFCHC) was used. Results: Out of 163,074 initial manuscripts, 44 were selected for analysis and data extraction regarding history of EBN; concept and function of EBN; stages, barriers and facilitators. Conclusions: The concept of EBN highlights the need to use this tool to plan nursing care through critical and reflective thinking; the importance of providing direct patient care and promoting care based on the best evidence, in a context of humanization and considering the tool's barriers and facilitators.

RESUMO Objetivo: Identificar as evidências científicas sobre o conceito, desenvolvimento e função da Enfermagem Baseada em Evidências (EBE) e analisar criticamente esta ferramenta, seus elementos facilitadores e as barreiras para sua implementação. Material e Método: Revisão do escopo de acordo com a proposta do Instituto Joanna Briggs. Considerou-se o período entre 1997 e 2019 para recuperar artigos e revisões em inglês, português e español. Foram utilizados descritores do tesauro Medical Subject Headings e operadores booleanos para aplicar estratégias de pesquisa en 4 bancos de dados diferentes: Pubmed, EBSCOhost, Scopus, Science Direct. A pesquisa foi complementada com a técnica de bola de neve aplicada à lista de referência dos artigos selecionados relevantes. O Critical Appraisal Skills Programme Español (CASPE) foi usado para avaliar a validade e o impacto da revisão dos artigos e os resultados qualitativos, e para os estudos de observação utilizou-se o Strengthening the Reporting of Observational studies in Epidemiology (STROBE). A Canadian Task Force on Preventive Health Care (CTPFCHC) foi utilizada para establecer os níveis de evidência. Resultados: Dos 163.074 manuscritos iniciais, 44 foram selecionados para análise e extração de dados referentes à história da EBN; conceito e função da EBN; etapas, barreiras e facilitadores. Conclusões: O conceito de EBN destaca a necessidade de utilizar esta ferramenta de planejamento de cuidado, através do uso do pensamento crítico e reflexivo; a importância de realizar o cuidado à beira do leito do paciente e promover cuidados baseados nas melhores evidências, em um contexto de humanização e considerando as barreiras e facilitadores desta ferramenta.

Fiabilidad de una escala para la evaluación de competencias enfermeras: estudio de concordancia / Reliability of a scale for the evaluation of nurses competence: Concordance study

INTRODUCCIÓN: Evaluar las competencias es una cuestión de importancia que ocupa un lugar primordial en el contexto de la educación superior. Para ello, es necesario disponer de instrumentos que reúnan criterios de validez y fiabilidad, y que puedan ser utilizados en escenarios de desempeño, capacidad y actuación profesional. Por esta razón, nos planteamos el siguiente objetivo: determinar la concordancia intra e interobservador de una escala para la evaluación de competencias enfermeras (ECOEnf) en España. MATERIAL Y MÉTODO: Estudio observacional, descriptivo y transversal para evaluar la fiabilidad mediante el análisis de concordancia intra e interobservadores de la escala «ECOEnf». Se utilizó la prueba no paramétrica Tau-b de Kendall para establecer la correlación, aplicada a la misma población, en el mismo tiempo, por 2observadores diferentes. RESULTADO: La concordancia intraobservador se obtuvo una excelente consistencia interna (r = 0,98). Respecto a la concordancia entre observadores se mostraron escasos ítems con una correlación menor de 0,5; sin embargo, todos los ítems cumplen con una buena fiabilidad, estadísticamente significativa, p valor < 0,05. CONCLUSIÓN: En general, al realizar la correlación entre los resultados de la herramienta medido 2veces por diferentes observadores en el mismo momento se encontró estadísticamente una buena concordancia, por lo cual se considera un instrumento fiable para ser utilizado en la evaluación de las competencias enfermeras en España

INTRODUCTION: Competences assessment is an important issue, playing a key role in higher education. It is necessary to have an evaluation instrument that meet validity and reliability criteria and can be used in different clinical scenarios for professional performance measurement. For this reason, we set ourselves the following objective: Establishing the intra- and inter-observer concordance of a scale for the evaluation of nursing competencies (ECOEnf) in Spain. MATERIAL AND METHOD: An observational, descriptive, cross-sectional study was conducted to evaluate the reliability of the "ECOEnf" scale using intra- and inter-observer analysis. Kendall's Tau-b non-parametric test was used for establishing correlation, applied to the same population, at the same time, by 2different observers. RESULTS: Intra-observer concordance was obtained an excellent degree of internal consistency (r=0.98), Regarding inter-observer concordance, few items had a correlation lower than 0.5. However, all items display a sound statistically significant reliability with a p-value <0.05. CONCLUSION: In general, when establishing the correlation between the results of the instrument measured twice by different observers at the same time, was found a statistically good concordance. For this reason, it is regarded as a reliable instrument to be used in the evaluation of nursing competencies

Early Foot Structural Changes After Lateral Column Exostectomy in Patients With Charcot Foot.

Although exostectomy for chronic midfoot plantar ulcers in Charcot foot is apparently effective, with healing rates of nearly 75%, a subset of patients develop recurrent ulceration and show an unstable foot position, especially after undergoing exostectomy confined to the lateral column. The reasons for this failure have not been investigated. The main objective of this study was to evaluate the early changes in radiographic alignment after an exostectomy in patients with Charcot neuropathic osteoarthropathy (rocker bottom) and plantar ulcer located in the lateral column. The present study evaluated retrospectively changes in radiographic alignment after an exostectomy in 12 Charcot feet (rocker bottom) with plantar ulcer located in the lateral column. Indication for plantar exostectomy was the treatment of ulcer affected by osteomyelitis. We evaluated the early changes in the alignment of the foot on weight-bearing lateral radiographs 6 months after exostectomy. Paired sample Wilcoxon test was used to calculate the differences between preoperative and postoperative measurements. Furthermore, the relationship between revision surgery and early changes in radiographic angular measurements was determined by using the Mann-Whitney U test. After exostectomy, the inclination of the calcaneal bone decreased (P = .003; r = 0.849) and declination of talus bone increased (P = .041; r = 0.589). The change in calcaneal inclination was associated with revision surgery (P = .042; r = 0.586). The present case series demonstrates that exostectomy procedure for the lateral column in patients with Charcot foot results in radiological changes in the hindfoot over the sagittal plane. The inversion of the calcaneal pitch angle suggests the possibility of further adverse events and the need for revision surgery.

The Dynamic Baropodometric Profile of Children with Idiopathic Toe-Walking A Cross-Sectional Study.

BACKGROUND: Idiopathic toe-walking (ITW) gait may present in children older than 3 years and in the absence of a medical condition known to cause or be associated with toe-walking gait. It is unknown how this gait type changes pressure distribution in the growing foot. We sought to determine whether children with ITW gait exhibit different plantar pressures and temporal gait features than typically developing children. METHODS: Children aged 3 to 6 years were recruited who had either a typical heel-toe gait pattern or a diagnosis of ITW. The ITW diagnosis was reported by the parent/caregiver and confirmed through history and physical examination. Temporal gait measures, peak pressures, and impulse percentages were measured. A minimum of ten unshod footprints were collected. Data were compared with unpaired t tests. RESULTS: The study included 40 children with typical gait and 56 with ITW gait. The ITW group displayed lower peak pressures at the hallux, midfoot, and hindfoot ( P < .05) and higher and lower pressure impulse percentages at the forefoot ( P < .001) and hindfoot ( P < .001), respectively. The ITW group spent a higher percentage of contact time at all areas of the forefoot and less at the midfoot and rearfoot ( P < .05). There were no significant differences in total step duration and foot progression angle between groups ( P > .05). CONCLUSIONS: There were differences in pressure distributions between groups. Understanding these differences may help us better understand the compensations or potential long-term impact that ITW gait may have on a young child's foot. Podiatric physicians may also consider the use of this equipment in the clinical setting to measure outcomes after treatment for ITW.

Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients.

The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.

Diseño y validación de contenido de la escala "ECOEnf" para la evaluación de competencias enfermeras / Design and content validation of the "ecoenf" scale to assess nursing competencies

Justificación: La evaluación de competencias es un proceso esencial en la educación superior y en el desarrollo profesional continuo; y requiere disponer de instrumentos validados. Objetivo: Diseñar y validar el contenido de un instrumento de evaluación para competencias enfermeras. Método: Mediante técnicas de consenso de expertos y aplicando criterios estadísticos, se establecen las unidades competenciales y resultados de aprendizaje que componen la escala. Resultados: Escala de evaluación con 7 unidades de competencia, 72 resultados de aprendizaje y un Índice de Validación de Contenido (CVI) total de 0.85 (mínimo de 0.53 y un máximo de 0.93 en las diferentes UC). La puntuación total del índice de Kappa para la herramienta es de 0.83. Conclusiones: se obtiene una escala con alta validez de contenido para la evaluación de competencias enfermeras. El método para su diseño puede utilizarse para diseñar otros instrumentos de evaluación

Background: Competency assessment is an essential process in higher education and in continuous professional development, and needs to have reliable tools. Aim: To design and validate the content of an assessment tool for nursing competencies. Methods: Using expert consensus techniques and applying statistical criteria established the competency units and learning outcomes of the assessment tool. Results: Assessment scale consisting of 7 competency units, 72 learning outcomes and a total Content Validation Index (CVI) of 0.85 (minimum 0.53 and maximum 0.93 for different UCs). The total score of Kappa Index of the tool was 0.83. Conclusions: A high content validity scale was developed to assess nursing competencies. The method for its design can be used to design other assessment tools

Dynamic pedobarographic classification of idiopathic toe-walkers for therapeutical indication / Clasificación baropodométrica dinámica de los andadores de puntillas para la indicación terapéutica

Idiopathic toe-walkers (ITWs) pedobarographic analysis has not been described yet nor its possible relationship with orthopedical and developmental characteristics. The objective of this research is to develop a dynamic pedobarographic classification of ITWs to propose a specific therapeutical approach. Through an observational study, 56 ITWs aged 3-6 years were classified by their initial foot contact; differences between idiopatic toe-walking (ITW) types and with respect to 40 control children were calculated by means of ANOVA and Student t-tests. The results show that the three ITW types displayed different step models for pressure and impulse distribution and also for temporal development (p<.05). They also showed different orthopedic and developmental characteristics (p<.05). As a whole, they demonstrated different severity levels, which suggest different therapeutical indications. This study confirms the convenience of a specific orthopedic, developmental, and gait assessment in ITW to clarify therapeutical indication

El análisis baropodométrico de la marcha de los andadores de puntillas (AP) no ha sido aún descrito en la literatura, ni tampoco su posible relación con sus características ortopédicas y neuromadurativas. El objetivo de este trabajo es desarrollar una clasificación baropodométrica dinámica de los AP para proponer un abordaje terapéutico específico. En un estudio observacional, 56 AP de 3 a 6 años han sido clasificados por su contacto inicial del pie, calculándose las diferencias entre los diferentes tipos de AP y con respecto a 40 niños que conformaron el grupo control, mediante los tests ANOVA y t de Student. Los resultados demostraron que los tres tipos de AP tenían diferentes modelos de paso en cuanto a la distribución de presiones e impulsos y también en su desarrollo temporal (p<.05). También se encontraron diferencias significativas en sus características ortopédicas y neuromadurativas (p<.05). En conjunto, los tres grupos de AP demostraron diferentes niveles de severidad que sugieren la indicación de abordajes terapéuticos diversos. Este estudio confirma la necesidad de una valoración específica de la marcha ortopédica y neuromadurativa en los AP para clarificar la indicación terapéutica

Variabilidad circadiana de la efectividad de la técnica de reperfusión y del pronóstico del infarto de miocardio con elevación del ST tratado mediante angioplastia primaria / Circadian variation in the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction treated with primary angioplasty and circadian associations with prognosis

Objetivo: Estudiar la presencia de un patrón de variabilidad circadiana en la efectividad del tratamiento con angioplastia coronaria transluminal percutánea (ACTPp) del infarto agudo de miocardio con elevación del segmento ST (IAMCEST), así como su relación con la extensión del infarto y la presencia de complicaciones intrahospitalarias. Método: Estudio observacional de cohortes retrospectivo que incluyó a pacientes con IAMCEST tratados con ACTPp en un hospital terciario universitario entre marzo 2003 y agosto 2009. La variable de estudio fue la hora de inicio de los síntomas del IAMCEST, agrupando en periodos de riesgo cronobiológico de 6 horas. La variable de resultado principal fue la efectividad de ACTPp. Las variables de resultado secundarias fueron la extensión del infarto y la presencia de complicaciones intrahospitalarias. Resultados: Se incluyeron 522 pacientes con una edad media de 62,3 (DE 13,6) años, de los cuales 404 (77,4%) fueron hombres. La franja horaria entre las 6-12 h fue la que presentó una mayor frecuencia de IAMCEST tratado con ACTPp (201 casos, 38,5%) (p < 0,001). Del total, 122 casos (23,4%) mostraron una ACTPp no efectiva. La franja horaria de 6-12 h fue un factor independiente de ACTPp no efectiva (OR 1,79; IC95% 1,09-2,94; p = 0,012). Además, se asoció con la extensión del infarto, aunque no con la presencia de complicaciones durante el ingreso hospitalario. Conclusiones: La hora de inicio de infarto de miocardio, en la franja de 6-12 h, es un predictor independiente de ACTPp no efectiva y de una mayor extensión del infarto, pero no de complicaciones intrahospitalarias (AU)

Objectives: To explore circadian variation in the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) to treat ST-elevation myocardial infarction (STEMI) To explore the effects of circardian variation on infarct extension and in-hospital complications. Methods: Observational retrospective cohort study including patients with PTCA-treated STEMI in a tertiary care university hospital between March 2003 and August 2009. The independent variable of interest was the time of onset of STEMI symptoms, grouped in 6-hour time frames. The main outcome variable was PTCA effectiveness. Secondary outcome variables were infarct extension and the presence of in-hospital complications. Results: A total of 522 patients records were studied. The mean (SD) age was 62.3 (13.6) years and 404 (77.4%) were men. The largest proportion of PTCA-treated STEMI cases first experienced symptoms between 6 AM and 12 PM (201 cases, 38.5%) (P<.001). PTCA was ineffective in 122 (23.4%). The 6 AM to 12 PM time frame was an independent predictor of PTCA ineffectiveness (odds ratio, 1.79; 95% CI, 1.09–2.94; P=.012). Onset in this interval was also associated with infarct extension but not with in-hospital complications. Conclusions: A time of onset of STEMI between 6 AM and 12 PM predicts the ineffectiveness of PTCA and greater infarct extension but not in-hospital complications (AU)

[Circadian variation in the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction treated with primary angioplasty and circadian associations with prognosis]. / Variabilidad circadiana de la efectividad de la técnica de reperfusión y del pronóstico del infarto de miocardio con elevación del ST tratado mediante angioplastia primaria.

OBJECTIVES: To explore circadian variation in the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) to treat ST-elevation myocardial infarction (STEMI) To explore the effects of circardian variation on infarct extension and in-hospital complications. MATERIAL AND METHODS: Observational retrospective cohort study including patients with PTCA-treated STEMI in a tertiary care university hospital between March 2003 and August 2009. The independent variable of interest was the time of onset of STEMI symptoms, grouped in 6-hour time frames. The main outcome variable was PTCA effectiveness. Secondary outcome variables were infarct extension and the presence of in-hospital complications. RESULTS: A total of 522 patients records were studied. The mean (SD) age was 62.3 (13.6) years and 404 (77.4%) were men. The largest proportion of PTCA-treated STEMI cases first experienced symptoms between 6 AM and 12 PM (201 cases, 38.5%) (P<.001). PTCA was ineffective in 122 (23.4%). The 6 AM to 12 PM time frame was an independent predictor of PTCA ineffectiveness (odds ratio, 1.79; 95% CI, 1.09-2.94; P=.012). Onset in this interval was also associated with infarct extension but not with in-hospital complications. CONCLUSION: A time of onset of STEMI between 6 AM and 12 PM predicts the ineffectiveness of PTCA and greater infarct extension but not in-hospital complications.

OBJETIVO: Estudiar la presencia de un patrón de variabilidad circadiana en la efectividad del tratamiento con angioplastia coronaria transluminal percutánea (ACTPp) del infarto agudo de miocardio con elevación del segmento ST (IAMCEST), así como su relación con la extensión del infarto y la presencia de complicaciones intrahospitalarias. METODO: Estudio observacional de cohortes retrospectivo que incluyó a pacientes con IAMCEST tratados con ACTPp en un hospital terciario universitario entre marzo 2003 y agosto 2009. La variable de estudio fue la hora de inicio de los síntomas del IAMCEST, agrupando en periodos de riesgo cronobiológico de 6 horas. La variable de resultado principal fue la efectividad de ACTPp. Las variables de resultado secundarias fueron la extensión del infarto y la presencia de complicaciones intrahospitalarias. RESULTADOS: Se incluyeron 522 pacientes con una edad media de 62,3 (DE 13,6) años, de los cuales 404 (77,4%) fueron hombres. La franja horaria entre las 6-12 h fue la que presentó una mayor frecuencia de IAMCEST tratado con ACTPp (201 casos, 38,5%) (p < 0,001). Del total, 122 casos (23,4%) mostraron una ACTPp no efectiva. La franja horaria de 6-12 h fue un factor independiente de ACTPp no efectiva (OR 1,79; IC95% 1,09-2,94; p = 0,012). Además, se asoció con la extensión del infarto, aunque no con la presencia de complicaciones durante el ingreso hospitalario. CONCLUSIONES: La hora de inicio de infarto de miocardio, en la franja de 6-12 h, es un predictor independiente de ACTPp no efectiva y de una mayor extensión del infarto, pero no de complicaciones intrahospitalarias.

Manejo inefectivo del régimen terapéutico e incumplimiento del tratamiento y su relación con episodios ciap / Ineffective management of therapeutic regimen and noncompliance and its relationship with episodes wonca

El no seguimiento de los tratamientos es un problema importante, tanto clínico como económico, de los sistemas sanitarios, y son las enfermeras las principales encargadas de velar por la monitorización correcta de las pautas terapéuticas acordadas con los pacientes. El objetivo de este trabajo es determinar cuáles son los problemas de salud (expresados a través de la clasificación CIAP-WONCA) en los que se presenta con más frecuencia el no seguimiento de los tratamientos, relacionando los códigos CIAP (Clasificación Internacional de Atención Primaria) con los pacientes diagnosticados de «Manejo inefectivo del régimen terapéutico» o «Incumplimiento» de la clasificación NANDA-I. MÉTODO. Estudio descriptivo, retrospectivo. Los datos utilizados se han extraído de la Historia Clínica de OMI-AP (gestor) del total de pacientes del conjunto de centros de salud de la Comunidad de Madrid, durante los años 2006, 2007 y 2008. RESULTADOS. El 36.1 % de los pacientes que incumplen o no manejan correctamente el tratamiento estaban clasificados con el código CIAP K86 Hipertensión no complicada; el 33.2 % con T90 Diabetes no insulinodependiente; el 8 % con A13 Miedo al tratamiento, y el 5.6 % con T82 Obesidad. No existen diferencias entre hombres y mujeres respecto al cumplimiento terapéutico y el grupo etario de más de 50 años es el que tiene mayores problemas en el seguimiento de sus tratamientos (AU)

At the present time, failure to follow prescribed treatments is a problem of deep draft of health systems. The problem is both clinical and economic. Nurses are main responsible, within the health system, to ensure the proper monitoring of therapeutic guidelines agreed with the patients, by themselves or by other health care professionals. The aim of this work is to determine the health problems (expressed through the ICPC-WONCA classification) in which occurs more often no tracking treatments, following a nurse methodology, specifically relating ICPC codes with patients diagnosed with «Ineffective management of therapeutic regimen» or «Noncompliance» of NANDA-I classification. METHOD. It has been made a descriptive and retrospective study. The data used are drawn from the clinical history of OMI-AP (manager) of all patients of all health centers in the Madrid region, during 2006, 2007 and 2008. RESULTS. 36.1 % of patients who fail or do not properly handle the treatment were classified with ICPC code K86 uncomplicated hypertension; 33.2 % with non-insulin dependent diabetes T90; 8 % with A13 treatment fear; and 5.6% with Obesity T8. There are no differences between men and women regarding compliance and the age group over 50 years is having major problems in monitoring their treatment (AU)

Aplicación de termoterapia en el periné durante el parto para reducir las lesiones que precisan sutura posparto / Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches

OBJETIVO: Evaluar la eficacia de la termoterapia, húmeda o seca, en el periné durante el parto para reducir las lesiones que precisan sutura posparto y valorar su seguridad en relación a la adaptación del recién nacido a la vida extrauterina. MÉTODO: Ensayo clínico multicéntrico, abierto, dirigido desde la Escuela de Enfermería de la Universidad de Barcelona y realizado durante los años 2009-2010 en 5 hospitales catalanes. La muestra fue de 198 gestantes a las que se aplicó el protocolo para la asistencia natural al parto normal. Se realizó una asignación aleatoria a los 3 grupos de estudio: grupo control (GC), calor húmedo (GCH) o calor seco (GCS). Durante el expulsivo se realizó en todos los grupos el cuidado habitual del periné y en los grupos de intervención se aplicó, además, GCH o GCS en el periné. Posteriormente se valoró el estado del periné posparto y el test de Apgar en el neonato. Se realizaron pruebas de contraste estadístico utilizando un intervalo de confianza del 95% y análisis estadístico con PASW 17. RESULTADOS: Perinés sin sutura: GCH 71% (47) versus GC 56% (37), OR: 1.803 (IC:95%:0,881-3,687); GCS 62% (41) versus GC 56% (37), OR:1.285 (IC:95%:0,641-2,577); GCH 71% (47) versus GCS 62% (41), OR:1.402 (IC:95%:0,680-2,890). Medias test de Apgar 5', GCH: 9,91; GCS: 9,98; GC: 9,98. p = 0,431. CONCLUSIONES: La aplicación de termoterapia en el periné no redujo la sutura perineal durante el parto. Se obtuvieron mejores resultados perineales con la termoterapia húmeda. La termoterapia no modificó los resultados neonatales medidos mediante test de Apgar

OBJECTIVE: Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD: An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS: Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). Mean: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p = 0.431. CONCLUSIONS: The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score

[Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches]. / Aplicación de termoterapia en el periné durante el parto para reducir las lesiones que precisan sutura posparto.

OBJECTIVE: Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD: An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS: Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). MEAN: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p=0.431. CONCLUSIONS: The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score.

Professional regulation, public protection and nurse migration.

UNLABELLED: Nurse mobility, developments such as health tourism and the rapid expansion of health systems have increased the need for regulatory bodies to reach beyond their normal stakeholder groups so as to familiarize themselves with the legislation of other jurisdictions. PURPOSE: A systematic examination of a cross-section of nursing legislation, to ascertain the degree of consistency in the number of definitions specified as well as their underlying structure, was conducted to identify opportunities to strengthen public protection and reduce barriers to freedom of movement. METHOD: A purposeful sample of legislation, drawn to maximize differences, was subjected to documentary analysis to identify possible relationships between the variables of interest and the way terms and processes were defined in fourteen nurse practice acts. RESULTS: Potential relationships were identified between factors such as geographic region, legal tradition, administrative approach, regulatory model and economic status and the number and approaches used to specify definitions. A major weakness in the precision of definitions was discovered. DISCUSSION: Several international organizations have started to develop lexicons but all have weaknesses. By drawing upon these lexicons a more comprehensive and precise dictionary could be formulated to support the development of next-generation nurse practice acts. CONCLUSIONS: Current legislation lacks precision and, within the context of increased mobility of nurses, there is an urgent need to develop an authoritative source of definitions that can contribute to increasing public safety as well as reducing delays in the freedom of movement of nurses from one jurisdiction to another.

Venous International Assessment, VIA scale, validated classification procedure for the peripheral venous system.

PURPOSE: VIA scale is a dynamic performance status tool of the peripheral venous system that is divided into five different grades, composed of three parameters: number of observable puncture points; optimal catheter size for cannulation and ease of performing venipuncture and risk of extravasation. METHODS: Prospective single-center, observational, open, non-randomized study divided into two phases. In the first longitudinal phase, we studied the clinical characteristics and the changes in their peripheral venous systems during intravenous chemotherapy for 16 patients (n=16) for an average period of 24 months. In the second transverse phase, we measured the vein's diameter at the selected puncture points with a high-resolution ultrasound and paired this figure with VIA scale. We selected a group of oncology patients (n=52) and a control group (n=56). RESULTS: In the first phase, the level of agreement between the three reviewers was excellent. The second step was to assess the relationship between the measurements obtained with ultrasound and the VIA scale. The vein diameter measurements show a decrease directly related to the assessment of observers in the VIA scale. CONCLUSIONS: The VIA scale is a simple, easy and practical method for classification of the peripheral venous system in terms of vascular access. The practical application of our VIA scale significantly increases the quality of life of patients by increasing the chances of successful venipuncture and cannulation and thus reducing the risk of extravasation and material costs, allowing both an economical and a safe venous assessment tool.

[INEFFECTIVE MANAGEMENT OF THERAPEUTIC REGIMEN AND NONCOMPLIANCE AND ITS RELATIONSHIP WITH EPISODES WONCA]. / Manejo infectivo de régimen terapéutico e incumplimiento de tratamento y su relacíon con episodios CIAP.

UNLABELLED: At the present time, failure to follow prescribed treatments is a problem of deep draft of health systems. The problem is both clinical and economic. Nurses are main responsible, within the health system, to ensure the proper monitoring of therapeutic guidelines agreed with the patients, by themselves or by other health care professionals. The aim of this work is to determine the health problems (expressed through the ICPC-WONCA classification) in which occurs more often no tracking treatments, following a nurse methodology, specifically relating ICPC codes with patients diagnosed with <> or <> of NANDA-I classification. METHOD: It has been made a descriptive and retrospective study. The data used are drawn from the clinical history of OMI-AP (manager) of all patients of all health centers in the Madrid region, during 2006, 2007 and 2008. RESULTS: 36.1 % ofpatients who fail or do not properly handle the treatment were classified with ICPC code K86 uncomplicated hypertension; 33.2 % with non-insulin dependent diabetes T90; 8 % with A13 treatment fear; and 5.6% with Obesity T8. There are no differences between men and women regarding compliance and the age group over 50 years is having major problems in monitoring their treatment.

Influence of the location of nonischemic diabetic forefoot osteomyelitis on time to healing after undergoing surgery.

The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology. Location of the lesion was classified into 4 groups: hallux, first metatarsal head, lesser metatarsal heads, and lesser toes. The time required to achieve healing and the cumulative rate of wounds healed and likelihood of healing were analyzed at 4, 8, and 12 weeks after surgery. Time of healing (mean ± SD) in the whole series was 10.7 ± 8.4 weeks. Osteomyelitis located in the lesser toes has a higher probability of healing by the fourth week (odds ratio [OR] = 5.7, 95% confidence interval [CI] = 2.8-11.6, P < .001), eighth week (OR = 3.2, 95% CI = 1.6-6.4, P < .001), or twelfth week (OR = 3.1, 95% CI = 1.3-7.0, P = .008) than other osteomyelitis locations. Osteomyelitis located in the first metatarsal joint was less likely to heal by the eighth week (OR = 0.4, 95% CI = 0.2-0.9, P = .037) and 12th week (OR = 0.4, 95% CI = 0.2-1.0, P = .040). In conclusion, time to healing is significantly different according to the location of the bone infection in the forefoot.

Histopathologic characteristics of bone infection complicating foot ulcers in diabetic patients.

BACKGROUND: A universally accepted histopathologic classification of diabetic foot osteomyelitis does not currently exist. We sought to evaluate the histopathologic characteristics of bone infection found in the feet of diabetic patients and to analyze the clinical variables related to each type of bone infection. METHODS: We conducted an observational prospective study of 165 diabetic patients with foot ulcers who underwent surgery for bone infection. Samples for microbiological and histopathologic analyses were collected in the operating room under sterile conditions. RESULTS: We found four histopathologic types of osteomyelitis: acute osteomyelitis (n = 46; 27.9%), chronic osteomyelitis (n = 73; 44.2%), chronic acute osteomyelitis (n = 14; 8.5%), and fibrosis (n =32; 19.4%). The mean ± SD time between the initial detection of ulcer and surgery was 15.4 ± 23 weeks for acute osteomyelitis, 28.6 ± 22.4 weeks for chronic osteomyelitis, 35 ± 31.3 weeks for chronic acute osteomyelitis, and 27.5 ± 27.3 weeks for the fibrosis stage (analysis of variance: P = .03). Bacteria were isolated and identified in 40 of 46 patients (87.0%) with acute osteomyelitis, 61 of 73 (83.5%) with chronic osteomyelitis, 11 of 14 (78.6%) with chronic acute osteomyelitis, and 25 of 32 (78.1%) with fibrosis. CONCLUSIONS: Histopathologic categorization of bone infections in the feet of diabetic patients should include four groups: acute, chronic, chronic acute, and fibrosis. We suggest that new studies should identify cases of fibrosis to allow comparison with the present results.

Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis.

BACKGROUND: The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. METHODS: Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. RESULTS: The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. DISCUSSION: Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot.

Consumo español de antibióticos tópicos asociados a otros principios activos (2005-2007) / Outpatient use of topical antimicrobials in Spain associated with other drugs

Introducción: El consumo de antibióticos de uso sistémico ha sido bien estudiado. Sin embargo, conocer cifras de su uso tópico en nuestro país, no deja de ser una mera referencia anecdótica dentro de la bibliografía especializada. Objetivo: Conocer el uso y consumo extrahospitalario en España de los antimicrobianos tópicos, asociados a otros principios activos, durante el periodo comprendido entre diciembre de 2005 y noviembre de 2007. Material y métodos: estudio cuantitativo descriptivo, realizado de forma sistémica y continuada, a lo largo del un periodo de tiempo, comprendido entre el 1 de diciembre de 2005 y el 30 de noviembre de 2007. La muestra ascendió a un total de 112 fármacos, lo que representaba 131 formas galénicas. Los datos referentes a consumos de fármacos fueron cedidos por la empresa Intercontinental Marketing Services (IMS), mientras que los datos demográficos, se obtuvieron del padrón municipal de los años 2006 y 2007. Las variables a estudio se agruparon en tres categorías: aquellas referentes al consumo, las relativas a los medicamentos y otras variables como la localización geográfica y el periodo temporal. Resultados: Durante el periodo del estudio se consumieron en España de forma extrahospitalaria, 41.755.951 envases (130.637.368 euros) de fármacos tópicos, en cuya composición se encontraban asociaciones entre antimicrobianos o entre estos y otros principios activos. El consumo medio mensual ascendió a 1.739.831 envases y 5.443.223 euros. La vía de administración dérmica fue la más dispensada y según el Sistema de Clasificación Anatómica, Terapéutica y Química (ATC), el subgrupo más consumido fue el D07CC. La asociación entre tobramicina y dexametasona, en forma de suspensión oftálmica al 30%, fue el fármaco más consumido en España. Introducción: El consumo de antibióticos de uso sistémico ha sido bien estudiado. Sin embargo, conocer cifras de su uso tópico en nuestro país, no deja de ser una mera referencia anecdótica dentro de la bibliografía especializada. Objetivo: Conocer el uso y consumo extrahospitalario en España de los antimicrobianos tópicos, asociados a otros principios activos, durante el periodo comprendido entre diciembre de 2005 y noviembre de 2007. Material y métodos: estudio cuantitativo descriptivo, realizado de forma sistémica y continuada, a lo largo del un periodo de tiempo, comprendido entre el 1 de diciembre de 2005 y el 30 de noviembre de 2007. La muestra ascendió a un total de 112 fármacos, lo que representaba 131 formas galénicas. Los datos referentes a consumos de fármacos fueron cedidos por la empresa Intercontinental Marketing Services (IMS), mientras que los datos demográficos, se obtuvieron del padrón municipal de los años 2006 y 2007. Las variables a estudio se agruparon en tres categorías: aquellas referentes al consumo, las relativas a los medicamentos y otras variables como la localización geográfica y el periodo temporal. Resultados: Durante el periodo del estudio se consumieron en España de forma extrahospitalaria, 41.755.951 envases (130.637.368 euros) de fármacos tópicos, en cuya composición se encontraban asociaciones entre antimicrobianos o entre estos y otros principios activos. El consumo medio mensual ascendió a 1.739.831 envases y 5.443.223 euros. La vía de administración dérmica fue la más dispensada y según el Sistema de Clasificación Anatómica, Terapéutica y Química (ATC), el subgrupo más consumido fue el D07CC. La asociación entre tobramicina y dexametasona, en forma de suspensión oftálmica al 30%, fue el fármaco más consumido en España(AU)

Introduction: The consumption of antibiotics for systemic use has been well studied. However, data of topical use in our country are an anecdotal reference in the literature. Objective: To evaluate the outpatient use of topical antimicrobials in Spain associated with other drugs during the period December 2005 and November 2007. Methods: A descriptive quantitative study was conducted between December 1, 2005 to November 30, 2007. The sample amounted to a total of 112 drugs, representing 131 dosage forms. The data on consumption of drugs were sold by the company Intercontinental Marketing Services (IMS), while demographic data were obtained from the municipal census of 2006 and 2007. The study variables were grouped into three categories: those relating to consumption, those on medications and other variables such as geographic location and time period. Results: During the study period the outpatient consumption of topical antimicrobials in Spain was 41.755.951 vials (130.637.368 euros) whose composition included associations between antimicrobials or antimicrobials with other drugs. The average monthly consumption amounted to 1.739.831 vials and 5.443.223 euros. The dermal route of administration was the most dispensed and according to the Anatomical, Therapeutic, Chemical classification system (ATC) and the D07CC subgroup was the most used. The association between tobramycin and dexamethasone ophthalmic suspension as 30% was the drug most used in Spain. Conclusions: The consumption of topical antimicrobials in Spain during the period 2006-2007 increased by 2.36% in the number of vials and 7.28% in economic cost. These antimicrobials were more used in summer. The average cost of a topical antimicrobial was half (3.13 euros) compared to the average cost of a drug (7.89 euros)(AU)