Mediating effect of job crafting dimensions on influence of burnout at self-efficacy and performance: revisiting health-impairment process of JD-R theory in public administration.

Introduction: In recent years, job crafting has greatly interested Work and Organizational Psychology. Different research studies have shown its positive impact on people and organizational performance. However, it knows little about the differential effect of the two dimensions that make up this variable (prevention-focused and promotion-focused) and its role in the health-impairment spiral process of the job demand-resources theory (JD-R). Method: This research aims to analyze the mediating effect of the different dimensions of job crafting on the influence of burnout on performance and self-efficacy in the workplace. The study used a sample of 339 administrative employees of a university. Results: The results indicate that promotion-focused job crafting is a mediating variable in the relationship between the influence of burnout on performance and self-efficacy. Unexpectedly, prevention-focused job crafting does not have this mediating role in the same relationship. Discussion: These findings confirm the adverse impact of burnout on personal and organizational improvement, while showing the absence of prevention/protection responses of employees when they are burned out. The theoretical and practical implications show an advance in knowledge about the process of health deterioration and about the spiral of health deterioration in the JD-R theory.

Leading the Challenge: Leader Support Modifies the Effect of Role Ambiguity on Engagement and Extra-Role Behaviors in Public Employees.

The assumption of new challenges and services to provide, and the evolution of new technologies in public administration, give employees an important perception of ambiguity when carrying out their work. Role ambiguity has been conceptualized as one of the main impeding demands at work with negative consequences. The objective of the present study is to analyze the moderating effect of the support by the department head in the negative influence of the role ambiguity on the engagement and the extra-role performance behaviors of the employees. The hypothesis is proposed that the support of the department head will mean the transformation of role ambiguity into a challenging job demand with positive results. A total of 315 public employees with administrative staff have participated in this study. Results confirmed that the support of the leader moderates the effects of role ambiguity. The inclusion of this variable as a moderator transforms the influence of role ambiguity on the employees' engagement into a positive one and reduces their negative effect on extra-role performance behaviors. These results reinforce the role of leader support as a protective element against job demands in public administrations. Theoretical and practical implications and future lines of research are discussed at the end of the work.

A critical appraisal of the prognostic predictive models for patients with sepsis: Which model can be applied in clinical practice?

BACKGROUND: Sepsis is associated with high mortality and predictive models can help in clinical decision-making. The objective of this study was to carry out a systematic review of these models. METHODS: In 2019, we conducted a systematic review in MEDLINE and EMBASE (CDR42018111121:PROSPERO) of articles that developed predictive models for mortality in septic patients (inclusion criteria). We followed the CHARMS recommendations (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies), extracting the information from its 11 domains (Source of data, Participants, etc). We determined the risk of bias and applicability (participants, outcome, predictors and analysis) through PROBAST (Prediction model Risk Of Bias ASsessment Tool). RESULTS: A total of 14 studies were included. In the CHARMS extraction, the models found showed great variability in its 11 domains. Regarding the PROBAST checklist, only one article had an unclear risk of bias as it did not indicate how missing data were handled while the others all had a high risk of bias. This was mainly due to the statistical analysis (inadequate sample size, handling of continuous predictors, missing data and selection of predictors), since 13 studies had a high risk of bias. Applicability was satisfactory in six articles. Most of the models integrate predictors from routine clinical practice. Discrimination and calibration were assessed for almost all the models, with the area under the ROC curve ranging from 0.59 to 0.955 and no lack of calibration. Only three models were externally validated and their maximum discrimination values in the derivation were from 0.712 and 0.84. One of them (Osborn) had undergone multiple validation studies. DISCUSSION: Despite most of the studies showing a high risk of bias, we very cautiously recommend applying the Osborn model, as this has been externally validated various times.

Positive Influence of Role Ambiguity on JD-R Motivational Process: The Moderating Effect of Performance Recognition.

Most previous research has shown the negative influence of role ambiguity on employes' motivational process. This has led to role ambiguity being perceived as a main hindrance demand in the workplace, with a negative effect on the Job Demands Resources (JD-R) model's motivational process. Recent theories propose that job demands can be perceived by employes as a challenge, rather than a hindrance. However, there is little evidence on which elements of the organizational context shape this perception. The objective of this study is to elucidate the possible effect of performance recognition from the team leader on employes' interpretation of role ambiguity as a hindrance or a challenge. Data were obtained from 706 employes of a multinational company headquartered in Almería, Spain. Results confirmed that performance recognition moderates the effects of role ambiguity: specifically, performance recognition changes the effect of role ambiguity on engagement from negative to positive and reduces role ambiguity's negative influence on extra-role behaviors.

Quality assessment of meta-analyses evaluating randomized clinical trials to improve the prognosis of septic shock: an overview of systematic reviews.

Objective: Clinical guidelines for the treatment of septic shock are based on the studies with the best scientific evidence, which are meta-analyses of clinical trials. However, these meta-analyses may have methodological limitations that prevent their conclusions from being extrapolated to routine clinical practice. Therefore, the objective of this study is to determine the quality of these meta-analyses through a systematic review.Methods: In this systematic review, we searched MEDLINE, Scopus and EMBASE from inception to May 2019. We selected meta-analyses from clinical trials that determined the effectiveness of an intervention in reducing the incidence of mortality in patients with septic shock. All items were extracted from the Overview Quality Assessment Questionnaire (OQAQ), which collects information from both systematic reviews and meta-analyses.Results: A total of 34 studies were included. Most elements of the OQAQ were conducted satisfactorily, although 35.3% of meta-analyses did not use a quality assessment of the studies included in other analyses. In 52.9% of meta-analyses, the quality of the studies was high or very high.Conclusions: The methods used to obtain the results should be taken into account when recommending an intervention to treat septic shock if the evidence comes from a meta-analysis of the analyzed characteristics.

Características clínicas de la anemia intrahospitalaria / Clinical features of in-hospital anemia

RESUMEN Introducción: la anemia intrahospitalaria es el descenso de hemoglobina (Hb) durante la internación por debajo de los valores del ingreso, no asociada a pérdidas objetivables de sangre. Es un fenómeno frecuente que puede afectar la evolución clínica. Objetivo: determinar las características clínicas de la anemia intrahospitalaria en pacientes internados en Dpto. de Medicina Interna del Hospital Nacional de Itauguá desde febrero hasta noviembre de 2018. Metodología: estudio observacional, prospectivo, descriptivo de corte transverso realizado en pacientes de ambos sexos, mayores de 15 años internados en el Dpto. de Medicina Interna. Se consideró anemia a todo descenso de Hb de más de 2 mg/dL a partir de 15 días de internación. Resultados: se estudiaron 80 pacientes, de los cuales 44% fueron mujeres y 56% del sexo masculino. La media de edad fue 52±17 años. El 72% presentó anemia. Los pacientes ingresaron con valor medio de Hb 13±1 g/dL y hematocrito (Hto) 38±8%. A los 15 días se detectó descenso de Hb media a 11±2 g/dL y Hto a 33±5%. A los 30 días la media de Hb fue 10±2 g/dL y Hto 31±5%. La cantidad de sangre extraída para estudios tuvo una media de 348 ±214 cc. La presencia de infección y el uso de antibióticos durante la internación se detectaron en 83% de los pacientes estudiados. Conclusión: la anemia intrahospitalaria tuvo una alta frecuencia (72%) en la muestra estudiada. Es multifactorial y usualmente es un diagnóstico subestimado, situación que debería cambiar dadas las implicaciones en la morbilidad y mortalidad intra y extra hospitalarias.

ABSTRACT Introduction: in-hospital anemia is the decrease in hemoglobin values (Hb) during hospital stage below the admission values, not associated with objective blood loss. This is a frequent phenomenon that can affect the clinical evolution. Objective: to determine the clinical characteristics of intrahospital anemia in patients hospitalized in the Department of Internal Medicine of the Hospital Nacional de Itauguá from February to November 2018. Methodology: observational, prospective, descriptive study of transverse cut made in patients of both sexes, older than 15 years admitted in the Department of Internal Medicine. Anemia was considered to be any decrease in Hb of more than 2 mg / dL after 15 days of hospitalization. Results: 80 patients were studied, from which 44% were women and 56% were male. The mean age was 52 ± 17 years. 72% presented anemia. The patients admitted with a mean Hb value of 13 ± 1 g / dL and a hematocrit (Hct) of 38 ± 8%. After 15 days, a decrease in the mean Hb value was at 11 ± 2 g / dL and Hto at 33 ± 5%. At 30 days the mean Hb was 10 ± 2 g / dL and Hto 31 ± 5%. The amount of blood extracted for studies was an average of 348 ± 214 cc. The presence of infection and the use of antibiotics during hospitalization were detected in 83% of the patients studied. Conclusion: intrahospital anemia had a high frequency (72%) in the sample studied. It is multifactorial and is usually an underestimated diagnosis, a situation that should change given the implications in intra and extra hospital morbidity and mortality.

A cardiovascular risk score for hypertensive patients previously admitted to hospital.

BACKGROUND: Cardiovascular risk scales in hypertensive populations have limitations for clinical practice. AIMS: To develop and internally validate a predictive model to estimate one-year cardiovascular risk for hypertensive patients admitted to hospital. METHODS: Cohort study of 303 hypertensive patients admitted through the Emergency Department in a Spanish region in 2015-2017. The main variable was the onset of cardiovascular disease during follow-up. The secondary variables were: gender, age, educational level, family history of cardiovascular disease, Charlson score and its individual conditions, living alone, quality of life, smoking, blood pressure, physical activity and adherence to the Mediterranean diet. A Cox regression model was constructed to predict cardiovascular disease one year after admission. This was then adapted to a points system, externally validated by bootstrapping (discrimination and calibration) and implemented in a mobile application for Android. RESULTS: A total of 93 patients developed cardiovascular disease (30.7%) over a mean period of 1.68 years. The predictors in the points system were: gender, age, myocardial infarction, heart failure, peripheral arterial disease and daily activity (quality of life). The internal validation by bootstrapping was satisfactory. CONCLUSION: A novel points system was developed to predict short-term cardiovascular disease in hypertensive patients after hospital admission. External validation studies are needed to corroborate the results obtained.

A one-year risk score to predict all-cause mortality in hypertensive inpatients.

The aim of this study was to construct and internally validate a scoring system to estimate the probability of death in hypertensive inpatients. Existing predictive models do not meet all the indications for clinical application because they were constructed in patients enrolled in clinical trials and did not use the recommended statistical methodology. This cohort study comprised 302 hypertensive patients hospitalized between 2015 and 2017 in Spain. The main variable was time-to-death (all-cause mortality). Secondary variables (potential predictors of the model) were: age, gender, smoking, blood pressure, Charlson Comorbidity Index (CCI), physical activity, diet and quality of life. A Cox model was constructed and adapted to a points system to predict mortality one year from admission. The model was internally validated by bootstrapping, assessing both discrimination and calibration. The system was integrated into a mobile application for Android. During the study, 63 patients died (20.9%). The points system prognostic variables were: gender, CCI, personal care and daily activities. Internal validation showed good discrimination (mean C statistic of 0.76) and calibration (observed probabilities adjusted to predicted probabilities). In conclusion, a points system was developed to determine the one-year mortality risk for hypertensive inpatients. This system is very simple to use and has been internally validated. Clinically, we could monitor more closely those patients with a higher risk of mortality to improve their prognosis and quality of life. However, the system must be externally validated to be applied in other geographic areas.

Valoración del diámetro interno del dializador en hemodiafiltración on-line / Evaluation of the dialyser inner diameter in online haemodiafiltration

Introducción: Se ha asociado la hemodiafiltración on-line (HDF-OL) a un aumento de la supervivencia. Hasta el momento no está bien establecida la influencia del diámetro interno de las fibras capilares del dializador sobre la capacidad convectiva. El objetivo del estudio fue valorar el efecto del aumento del diámetro interno del dializador sobre el volumen convectivo y la capacidad depurativa. Material y métodos: Se incluyeron 16 pacientes en HDF-OL posdilucional con reposición automática. Cada paciente recibió 4 sesiones, en las que se varió el diámetro interno, 185μm (FX60 Cordiax y FX80 Cordiax) versus 210μm (FX600 Cordiax y FX800 Cordiax). En cada sesión se determinaron diferentes solutos al inicio y al final de la diálisis. Resultados: El incremento de diámetro interno entre FX60 vs. FX600 y FX80 vs. FX800 no reflejó diferencias en el volumen convectivo: 32,3±3,1 vs. 31,8±3,6 y 33,7±4,3 vs. 33,5±3,8L/sesión, respectivamente. Los porcentajes de reducción tampoco mostraron diferencias: urea 83,7±4,5 vs. 84,1±3,4 para FX60 y FX600 y 82,7±4,1 vs. 83,6±3,8 para FX80 vs. FX800; creatinina similar 78,2±5,6 vs. 77,8±4,6 y 77,1±5,4 vs. 78,1±4,9; β2-microglobulina 82,2±4,3 vs. 82,9±4,2 y 82,9±4,7 vs. 84,0±3,8; mioglobina 71,0±10, vs. 70,2±9 y 72,8±11 vs. 75,0±10; prolactina 70,4±9 vs. 68,1±9 y 72,2±10 vs. 73,4±8,2; y α1-microglobulina 22,9±10 vs. 21,6±10 y 26,5±12 vs. 28,8±11, respectivamente. Conclusión: El incremento del diámetro interno de las fibras capilares no ha significado una mayor eficacia en el volumen convectivo ni en la capacidad depurativa (AU)

Introduction: Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective volume and removal capacity. Material and methods: We included 16 patients in posdilutional OL-HDF with autosubstitution. Each patient was analysed in 4 sessions in which the inner diameter varied; 185μm (FX60 Cordiax and FX80 Cordiax) versus 210μm (FX600 Cordiax and FX800 Cordiax). Different solutes were measured at the beginning and end of each dialysis session. Results: No differences in the convective volume were found with an increased inner diameter: 32.3±3.1 vs. 31.8±3.6 l/session (FX60 vs. FX600) and 33.7±4.3 vs. 33.5±3.8 l/session (FX80 vs. FX800). The reduction percentages also did not differ: urea 83.7±4.5 vs. 84.1±3.4 for FX60 and FX600, and 82.7±4.1 vs. 83.6±3.8 for FX80 vs. FX800; creatinine similar 78.2±5.6 vs. 77.8±4.6 y 77.1±5.4 vs. 78.1±4.9; β2-microglobulin 82.2±4.3 vs. 82.9±4.2, and 82.9±4.7 vs. 84.0±3.8; myoglobin 71.0±10 vs. 70.2±9 and 72.8±11 vs. 75.0±10; prolactin 70.4±9 vs. 68.1±9, and 72.2±10 vs. 73.4±8.2; and α1-microglobulin 22.9±10 vs. 21.6±10, and 26.5±12 vs. 28.8±11, respectively. Conclusion: The increase in the inner diameter of the hollow fibres did not result in improved convective volume and removal capacity (AU)

Evaluation of the dialyser inner diameter in online haemodiafiltration. / Valoración del diámetro interno del dializador en hemodiafiltración on-line.

INTRODUCTION: Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective volume and removal capacity. MATERIAL AND METHODS: We included 16 patients in posdilutional OL-HDF with autosubstitution. Each patient was analysed in 4 sessions in which the inner diameter varied; 185µm (FX60 Cordiax and FX80 Cordiax) versus 210µm (FX600 Cordiax and FX800 Cordiax). Different solutes were measured at the beginning and end of each dialysis session. RESULTS: No differences in the convective volume were found with an increased inner diameter: 32.3±3.1 vs. 31.8±3.6 l/session (FX60 vs. FX600) and 33.7±4.3 vs. 33.5±3.8 l/session (FX80 vs. FX800). The reduction percentages also did not differ: urea 83.7±4.5 vs. 84.1±3.4 for FX60 and FX600, and 82.7±4.1 vs. 83.6±3.8 for FX80 vs. FX800; creatinine similar 78.2±5.6 vs. 77.8±4.6 y 77.1±5.4 vs. 78.1±4.9; ß2-microglobulin 82.2±4.3 vs. 82.9±4.2, and 82.9±4.7 vs. 84.0±3.8; myoglobin 71.0±10 vs. 70.2±9 and 72.8±11 vs. 75.0±10; prolactin 70.4±9 vs. 68.1±9, and 72.2±10 vs. 73.4±8.2; and α1-microglobulin 22.9±10 vs. 21.6±10, and 26.5±12 vs. 28.8±11, respectively. CONCLUSION: The increase in the inner diameter of the hollow fibres did not result in improved convective volume and removal capacity.

Nonadherence to guidelines for prescribing antiplatelet/anticoagulant therapy in patients with atrial fibrillation.

BACKGROUND: We have found no papers evaluating nonadherence to guidelines for the treatment of atrial fibrillation (AF), taking into account the two risk scales [C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke (CHADS2) and C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke; V, vascular disease; A, age; Sc, sex category (CHA2DS2-VASc)] and the two types of treatment that are recommended (antiplatelet/anticoagulant therapy). OBJECTIVE: To determine the extent of lack of adherence when prescribing anticoagulant and antiplatelet therapy to patients with AF and associated factors. METHODS: Cross-sectional, observational study of 144 patients with AF who visited the emergency department of Elda Hospital in 2013-14 (Spain). Main variable: the patient was prescribed a therapy different from that indicated by the guidelines (nonadherence) or not prescribed any therapy. Secondary variables: CHADS2, CHA2DS2-VASc, HAS-BLED, type of AF and symptoms related to AF. Multivariate models were constructed to identify the associated factors by calculating the adjusted odds ratios (OR). RESULTS: Nonadherence occurred in 90 patients [62.5%, 95% confidence interval (CI): 54.6-70.4%]. Associated factors were higher CHADS2 (OR = 1.30, 95% CI: 0.96-1.75, P = 0.091) and CHA2DS2-VASc (OR = 1.23, 95% CI: 1.02-1.47, P = 0.027), and lower HAS-BLED (OR = 0.67, 95% CI: 0.49-0.91, P = 0.011). CONCLUSIONS: Nonadherence to guidelines was found in three out of every five patients. A greater cerebrovascular risk and a lower haemorrhagic risk were associated with this behaviour. Qualitative studies are needed to determine the causes.

A four-year cardiovascular risk score for type 2 diabetic inpatients.

As cardiovascular risk tables currently in use were constructed using data from the general population, the cardiovascular risk of patients admitted via the hospital emergency department may be underestimated. Accordingly, we constructed a predictive model for the appearance of cardiovascular diseases in patients with type 2 diabetes admitted via the emergency department. We undertook a four-year follow-up of a cohort of 112 adult patients with type 2 diabetes admitted via the emergency department for any cause except patients admitted with acute myocardial infarction, stroke, cancer, or a palliative status. The sample was selected randomly between 2010 and 2012. The primary outcome was time to cardiovascular disease. Other variables (at baseline) were gender, age, heart failure, renal failure, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidaemia, insulin, smoking, admission for cardiovascular causes, pills per day, walking habit, fasting blood glucose and creatinine. A cardiovascular risk table was constructed based on the score to estimate the likelihood of cardiovascular disease. Risk groups were established and the c-statistic was calculated. Over a mean follow-up of 2.31 years, 39 patients had cardiovascular disease (34.8%, 95% CI [26.0-43.6%]). Predictive factors were gender, age, hypertension, renal failure, insulin, admission due to cardiovascular reasons and walking habit. The c-statistic was 0.734 (standard error: 0.049). After validation, this study will provide a tool for the primary health care services to enable the short-term prediction of cardiovascular disease after hospital discharge in patients with type 2 diabetes admitted via the emergency department.

Valoración nutricional de pacientes con insuficiencia renal crónica terminal al iniciar terapéutica dialítica / Nutritional assessment of patients with end-stage chronic renal failure at the begining of dialysis therapy

Se utiliza un esquema de valoración nutricional en 9 pacientes con insuficiencia renal crónica terminal al iniciar tratamiento dialítico. Se tienen en cuenta aspectos dietéticos, antropométricos, bloquímicos e inmunológicos y se evidencia en los 9 enfermos cierto grado de desnutrición proteico-calórica; se destaca cómo el estado nutricional de un paciente interviene en la evolución posterior del mismo

Valoración nutricional de pacientes con insuficiencia renal crónica terminal al iniciar terapéutica dialítica / Nutritional assessent of patients with end-stage chronic renal failure at the begining of dialysis therapy

Se utiliza un esquema de valoración nutricional en 9 pacientes con insuficiencia renal crónica terminal al iniciar tratamiento dialítico. Se tienen en cuenta aspectos dietéticos, antropométricos, bloquímicos e inmunológicos y se evidencia en los 9 enfermos cierto grado de desnutrición proteico-calórica; se destaca cómo el estado nutricional de un paciente interviene en la evolución posterior del mismo (AU)