Grado de satisfacción de los usuarios del circuito de diagnóstico rápido del cáncer / Patients' satisfaction with the rapid diagnosis and treatment programme for cancer (RDTPC). Observational study

Objetivo. Conocer el grado de satis-facción de los usuarios del Circuito de Diagnóstico Rápido del Cáncer (CDRC) así como la percepción de ansiedad. Método. Estudio transversal de una muestra de personas (n=294) atendidas de forma consecutiva en un CDRC de pulmón, mama y colon. La recogida de datos se realizó median-te cuestionario en la primera visita al CDRC y llamada telefónica al mes de la última visita al CDRC. El cuestionario contenía 23 preguntas que exploraban distintas dimensiones de satisfacción (accesibilidad, trato personal, información y coordinación), una sobre ansiedad percibida y una de satisfacción global. También se recogieron variables sociodemográficas, procedencia de la derivación y diagnóstico de cáncer. Resultados. La media de edad fue de 60,1 años (DE =1 2,9) con un 57,8% de mujeres. Fueron diagnosticados de cáncer el 34,4%. El grado de satis-facción global con la asistencia recibida en el CDRC fue de 9,3 (DE = 1,2) sobre 10. El 92,2% de los pacientes afirmó que el hecho de haber entrado en el CDRC le había ayudado a disminuir la ansiedad de todo el proceso. Según el diagnóstico final de cáncer o no, observamos diferencias significativas en las áreas de accesibilidad y trato. Los pacientes diagnosticados de cáncer estuvieron más satisfechos con el tiempo trascurrido entre la primera visita y el diagnóstico y entre el diagnóstico e inicio del tratamiento y valoraron mejor el trato de la enfermera gestora. Conclusiones. La satisfacción de los pacientes que entran en el CDRC es muy alta. Su evaluación complementa otros indicadores de eficacia del programa

Objective. Evaluation of patients' satisfaction with the Rapid Diagnosis and Treatment Programme for Cancer (RDTPC) and perception of anxiety Method. A cross-sectional study was performed on a sample (n = 294) of patients who subsequently were followed at the RDTPC for lung, breast and colon cancer. Data collection was carried out using a questionnaire administered to users during their first visit at the RDTPC and a tele-phone call one month after their last visit. The questionnaire included 23 items that explore different aspects of satisfaction (accessibility, personal treatment, information and coordination), one item on perceived anxiety and one on overall satisfaction. Socio-demographic variables, origin of referral and diagnosis of cancer were also collected. Results. The mean age was 60.1 years (SD=12.9); 57.8% were women. A total of 34.4%. were diagnosed of cancer. The level of overall satisfaction with the care received at the RDTPC was 9.3 (SD =1.2) out of 10 and 92.2% of patients reported that entering the RDTPC had helped them decrease their anxiety throughout the whole process. Depending on whether cancer was finally diagnosed or not, significant differences were observed in areas of accessibility and attention received. Patients diagnosed with cancer were more satisfied with the time period between the initial visit and diagnosis and between time of diagnosis and start of treatment. They also reported a higher satisfaction with the attention they received from the nurse in charge. Conclusions. The satisfaction of patients on the RDTPC is very high. Their assessment completes other indicators of the efficacy of the programme

Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea.

OBJECTIVE: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. METHODS: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. RESULTS: The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis. CONCLUSIONS: Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia.

Aleteo nasal como factor pronóstico de mortalidad en el paciente con disnea grave / Nasal flaring as a predictor of mortality in patients with severe dyspnea

Objetivos: Determinar si la presencia de aleteo nasal es un factor de gravedad clínica y pronóstico de mortalidad hospitalaria en el paciente que consulta en urgencias por disnea. Método: Estudio prospectivo observacional un céntrico. Se incluyeron pacientes mayores de 15 años, que demandaron atención urgente por disnea, catalogados como niveles II y III por el Modelo Andorrano de Triaje (MAT). Se evaluó la presencia de aleteo nasal por dos observadores. Se recogieron variables demográficas, clínicas, signos de dificultad respiratoria, signos vitales, gasometría arterial y evolución clínica (ingreso hospitalario y mortalidad). Se realizaron análisis bivariantes y multivariantes con modelos de regresión logística. Resultados: Se incluyeron 246 pacientes, de edad media ± DE 77 (13) años (DE: 13,2) y un 52% de mujeres. Un19,5% presentaron aleteo nasal. Los pacientes con aleteo nasal tuvieron mayor gravedad en el triaje, más taquipnea, peor oxigenación, más acidosis y más hipercapnia. En el análisis bivariante los factores pronósticos de mortalidad hospitalaria fueron la edad (OR 1,05; IC95%: 1,01-1,10), la atención prehospitalaria por el servicio emergencias médicas (OR 3,97; IC95%: 1,39-11,39), el nivel de triaje II (OR 4,19; IC95%: 1,63-10,78), la presencia de signos de dificultad respiratoria como el aleteo nasal (OR 3,79; IC 95%: 1,65-8,69), la presencia de acidosis (OR 7,09; IC95%: 2,97-16,94) y la hipercapnia (OR 2,67; IC95%: 1,11-6,45). En el análisis multivariante, la edad, el nivel de triaje y el aleteonasal se mantuvieron como factores pronósticos independientes de mortalidad (AU)

Objective: To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. Methods: Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. Results: We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01–1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39–11.39), triage level II (OR, 4.19; 95% CI, 1.63–10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65–8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97–16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11–6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. Conclusions: In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality (AU)

[Nasal flaring as a predictor of mortality in patients with severe dyspnea]. / Aleteo nasal como factor pronóstico de mortalidad en el paciente con disnea grave.

OBJECTIVES: To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. MATERIAL AND METHODS: Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. RESULTS: We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39-11.39), triage level II (OR, 4.19; 95% CI, 1.63-10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65-8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97-16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11-6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. CONCLUSION: In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality.

OBJETIVO: Determinar si la presencia de aleteo nasal es un factor de gravedad clínica y pronóstico de mortalidad hospitalaria en el paciente que consulta en urgencias por disnea. METODO: Estudio prospectivo observacional unicéntrico. Se incluyeron pacientes mayores de 15 años, que demandaron atención urgente por disnea, catalogados como niveles II y III por el Modelo Andorrano de Triaje (MAT). Se evaluó la presencia de aleteo nasal por dos observadores. Se recogieron variables demográficas, clínicas, signos de dificultad respiratoria, signos vitales, gasometría arterial y evolución clínica (ingreso hospitalario y mortalidad). Se realizaron análisis bivariantes y multivariantes con modelos de regresión logística. RESULTADOS: Se incluyeron 246 pacientes, de edad media ± DE 77 (13) años (DE: 13,2) y un 52% de mujeres. Un 19,5% presentaron aleteo nasal. Los pacientes con aleteo nasal tuvieron mayor gravedad en el triaje, más taquipnea, peor oxigenación, más acidosis y más hipercapnia. En el análisis bivariante los factores pronósticos de mortalidad hospitalaria fueron la edad (OR 1,05; IC95%: 1,01-1,10), la atención prehospitalaria por el servicio emergencias médicas (OR 3,97; IC95%: 1,39-11,39), el nivel de triaje II (OR 4,19; IC95%: 1,63-10,78), la presencia de signos de dificultad respiratoria como el aleteo nasal (OR 3,79; IC 95%: 1,65-8,69), la presencia de acidosis (OR 7,09; IC95%: 2,97- 16,94) y la hipercapnia (OR 2,67; IC95%: 1,11-6,45). En el análisis multivariante, la edad, el nivel de triaje y el aleteo nasal se mantuvieron como factores pronósticos independientes de mortalidad. CONCLUSIONES: El aleteo nasal es un signo clínico de gravedad y predictor de mortalidad en los pacientes que demandan atención urgente por disnea.

Intervención educativa de enfermería para la gestión del dolor post-operatorio en cirugía mayor ambulatoria / Nursing educational intervention for the management of postoperative pain in ambulatory surgery

Objetivo. Evaluar la eficacia de una intervención educativa de enfermería preoperatoria mediante entrega de material gráfico para la gestión del dolor agudo post-operatorio en los pacientes intervenidos de hernias en una unidad de cirugía mayor ambulatoria (UCMA). Método. Estudio cuasi experimental (no aleatorizado). Grupo control, pacientes intervenidos de hernia entre julio de 2006 y junio de 2007 y grupo intervención, pacientes intervenidos entre julio de 2007 y junio de 2008. Ambos grupos recibieron la misma acción formativa para la preparación quirúrgica y recomendaciones para el post-operatorio en la consulta de enfermería. Al grupo intervención se reforzó la información con la entrega de material gráfico. La recogida de datos se realizó mediante cuestionario al ingreso y llamada telefónica a las 24h post-operatorias. La medición del dolor se realizó con la escala visual analógica/escala verbal numérica (EVA/EVN). Resultados. Se incluyeron 205 pacientes en el grupo control y 292 en el grupo intervención. En el análisis bivariado el porcentaje de pacientes con EVA > 3 fue del 23,9% para el grupo control y del 15,1% para el grupo intervención. En el análisis multivariante las variables asociadas al dolor post-operatorio fueron la edad joven, género femenino, problemas para movilizarse y caminar, y falta de conocimiento de los cuidados a seguir en casa. Conclusiones. Una intervención educativa de enfermería con la entrega de material gráfico sugiere que puede reducir la percepción individual del dolor agudo post-operatorio así como disminuir el porcentaje de pacientes con problemas para caminar, movilizarse y mejorar el cumplimiento y adhesión al tratamiento (AU)

Objective. Evaluate the effectiveness of educational intervention of perioperative nursing by providing graphic material for the management of postoperative pain in patients operated on for hernia in an Ambulatory Surgery Unit (ASU). Method. A quasi-experimental (non-randomised) study, with a control group with patients undergoing hernia between July 2006 and June 2007 and an intervention group with patients treated between July 2007 and June 2008. Both groups were given the same training on the surgical and postoperative recommendations for perioperative nursing clinics. The intervention group was reinforced with the provision of information in graphic form. The data was collected using a questionnaire at admission and phone call within 24 hours postoperative. Pain measurement was made with the visual analogue scale / verbal numerical rating scale (VAS/VNRS). Results. A total 205 patients were included in the control group and 292 in the intervention group. In the bivariate analysis, the percentage of patients with VAS >3 was 23.9% for the control group and 15.1% for the intervention group. In the multivariate analysis, the variables associated with postoperative pain were: low age, female sex, mobility and walking problems, and lack of knowledge about post-discharge home-care guidelines. Conclusions. Nursing educational intervention with the provision of graphic material, suggests that it may reduce the individual's perception of postoperative pain, decrease the percentage of patients with mobility and walking problems, and improve compliance and adherence to treatment (AU)