Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study.

Background: Nutritional and inflammation status are significant predictors of morbidity and mortality risk in advanced chronic kidney disease (ACKD). To date, there are a limited number of clinical studies on the influence of nutritional status in ACKD stages 4-5 on the choice of renal replacement therapy (RRT) modality. Aim: This study aimed to examine relationships between comorbidity and nutritional and inflammatory status and the decision-making on the choice of RRT modalities in adults with ACKD. Methods: A retrospective cross-sectional study was conducted on 211 patients with ACKD with stages 4-5 from 2016 to 2021. Comorbidity was assessed using the Charlson comorbidity index (CCI) according to severity (CCI: ≤ 3 and >3 points). Clinical and nutritional assessment was carried out by prognosis nutritional index (PNI), laboratory parameters [serum s-albumin, s-prealbumin, and C-reactive protein (s-CRP)], and anthropometric measurements. The initial decision-making of the different RRT modalities [(in-center, home-based hemodialysis (HD), and peritoneal dialysis (PD)] as well as the informed therapeutic options (conservative treatment of CKD or pre-dialysis living donor transplantation) were recorded. The sample was classified according to gender, time on follow-up in the ACKD unit (≤ 6 and >6 months), and the initial decision-making of RRT (in-center and home-RRT). Univariate and multivariate regression analyses were carried out for evaluating the independent predictors of home-based RRT. Results: Of the 211 patients with ACKD, 47.4% (n = 100) were in stage 5 CKD, mainly elderly men (65.4%). DM was the main etiology of CKD (22.7%) together with hypertension (96.6%) as a CV risk factor. Higher CCI scores were significantly found in men, and severe comorbidity with a CCI score > 3 points was 99.1%. The mean time of follow-up time in the ACKD unit was 9.6 ± 12.8 months. A significantly higher CCI was found in those patients with a follow-up time > 6 months, as well as higher mean values of eGFR, s-albumin, s-prealbumin, s-transferrin, and hemoglobin, and lower s-CRP than those with a follow-up <6 months (all, at least p < 0.05). The mean PNI score was 38.9 ± 5.5 points, and a PNI score ≤ 39 points was found in 36.5%. S-albumin level > 3.8 g/dl was found in 71.1% (n = 150), and values of s-CRP ≤ 1 mg/dl were 82.9% (n = 175). PEW prevalence was 15.2%. The initial choice of RRT modality was higher in in-center HD (n = 119 patients; 56.4%) than in home-based RRT (n = 81; 40.5%). Patients who chose home-based RRT had significantly lower CCI scores and higher mean values of s-albumin, s-prealbumin, s-transferrin, hemoglobin, and eGFR and lower s-CRP than those who chose in-center RRT (p < 0.001). Logistic regression demonstrated that s-albumin (OR: 0.147) and a follow-up time in the ACKD unit >6 months (OR: 0.440) were significantly associated with the likelihood of decision-making to choose a home-based RRT modality (all, at least p < 0.05). Conclusion: Regular monitoring and follow-up of sociodemographic factors, comorbidity, and nutritional and inflammatory status in a multidisciplinary ACKD unit significantly influenced decision-making on the choice of RRT modality and outcome in patients with non-dialysis ACKD.

A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes.

BACKGROUND: The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE: The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN: A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS: Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS: The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER: ISRCTN14062994.

Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol.

AIMS: To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme. DESIGN: Quasi-experimental, pre-/post-intervention study without a control group. METHODS: Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee. DISCUSSION: The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults. IMPACT: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complications.

Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services.

BACKGROUND: The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty. OBJECTIVE: To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis. METHODS: This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire. RESULTS: The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%). CONCLUSIONS: Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.

Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study.

BACKGROUND: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. METHODS: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016-2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.

Explorando los significados y experiencias de las enfermeras españolas en torno a la compasión / Exploring the meanings and experiences of spanish nurses regarding compassion

OBJETIVO: Describir cómo las enfermeras españolas definen la compasión y cómo se refleja en su formación y práctica, qué factores influyen en su desarrollo y de quién/es la reciben. MÉTODO: Estudio descriptivo transversal. La población de estudio fueron enfermeras (asistenciales, gestoras y docentes-investigadoras) y estudiantes de cuarto curso del Grado en Enfermería residentes en España. Se realizó un muestreo intencional por conveniencia; recogida de datos mediante cuestionario online compuesto por preguntas cerradas/abiertas, entre marzo y junio de 2014. Los datos cuantitativos fueron analizados de manera descriptiva. Se realizó un análisis temático de las respuestas a las preguntas abiertas. RESULTADOS: Se recogieron 173 cuestionarios, de los cuales un 55,5% fue cumplimentado por enfermeras asistenciales. La compasión se define mayoritariamente como conciencia profunda del sufrimiento de los otros y deseo de aliviarlo, en sintonía con la vulnerabilidad, rol de abogacía enfermera y empatía. Las participantes consideran que la compasión puede enseñarse (69,9%) y es importante para la práctica enfermera (96,6%). Los valores culturales (49,7%) y la experiencia personal con relación a la compasión (34,7%) son claves en su desarrollo. Es recibida fundamentalmente de compañeros y pacientes y sólo en un 0,6%, de gestores. CONCLUSIONES: La compasión es considerada por las enfermeras un elemento central de su práctica. Se precisa crear entornos de práctica asistencial que propicien el desarrollo de la atención compasiva y donde las enfermeras perciban compasión de sus gestores

AIM: To describe how Spanish nurses define compassion and identify the way this understanding determines educational and clinical practice. We also report on the factors that influence their development of compassion and the sources from whom they receive compassion. METHODS: A cross-sectional research design with study population of nurses (clinicians, managers, teachers and researchers) and finalist student nurses living in Spain. A convenient sample was recruited through the authors' networks. An on-line survey, with both close and open questions, was used for data collection (March - June 2014). A descriptive quantitative analysis and a thematic qualitative analysis was used. RESULTS: 173 participants completed the on-line survey, 55% being clinical nurses. Participants defined compassion as the deep awareness of others' suffering and the inner motivation to relieve it. This attitude is in coherence with the concepts of vulnerability, advocacy role and empathy. Compassion can be taught (69,9%) and is central for clinical practice (96%). Cultural values (49,7%) and personal experiences related with compassion (34,7%) are key elements in its development. Compassion is received mainly from colleagues and patients and only in a 0,6% from managers. CONCLUSIONS: Compassion is considered by nurses as a central element in nursing practice. So, it is necessary to recreate care practice environments that encourage the development compassionate care and where nurses perceive compassion from their managers

Puppet show: teatro de marionetas para trabajar competencias comunicativas en el grado en Enfermería / A puppet show to work on communication skills at the nursing degree

Objetivos: trabajar competencias básicas en comunicación terapéutica y construcción de relaciones de cuidado en estudiantes del Grado en Enfermería. Metodología: actividad de simulación de alta fidelidad realizada dentro de la asignatura de Psicosociología de los Cuidados, en 2º curso del Grado en Enfermería, mediante la dramatización con marionetas. Se utilizaron marionetas para crear experiencias realistas y espontáneas de simulación mediante teatro de títeres a partir de cuatro casos o guiones teatrales. La actividad fue evaluada en términos de satisfacción y adecuación a los criterios de aprendizaje a través de nueve ítems medidos con una escala Likert de 1-5. Resultados: participaron 143 estudiantes. La evaluación resultó muy satisfactoria con medias por encima de cuatro puntos en términos de adecuación a los criterios de aprendizaje, creatividad y novedad de la propuesta y dinamización por parte de la profesora-instructora. Conclusiones: las marionetas resultan un recurso excepcional para trabajar simulación de una manera innovadora y creativa en un entorno seguro, lo que permite al estudiante superar la vergüenza e interaccionar con el paciente-instructor de igual a igual. Es una técnica eficaz que moviliza emocionalmente y que resulta factible para trabajar con grupos grandes e inexpertos en habilidades comunicativas

Objectives: to work on the basic skills on therapeutic communication and building care relationships among Nursing Degree students. Methodology: an activity of high-fidelity simulation, conducted within the subject Psychosociology of Care, in the 2nd year of the Nursing Degree, through dramatization with puppets. These puppets were used in order to create realistic and spontaneous simulation experiences through a puppet show based on four cases or play scripts. The activity was evaluated in terms of satisfaction and suitability to the learning criteria through nine items, measured with a Likert Scale from 1 to 5. Results: there was participation by 143 students. The evaluation was very satisfactory, with mean scores >4 in terms of suitability to the learning criteria, creativity and novelty in the approach, and dynamization by the professor-trainer. Conclusions: puppets represent an exceptional resource to work on simulation in an innovative and creative way, in a safe environment; this allows the student to overcome embarrassment and interact with the professor-trainer on equal terms. This is an effective technique for emotional mobilization, and it allows to work with large groups without experience in communication skills

El Reto del Malvavisco: trabajando competencias de trabajo en equipo, liderazgo y resolución de problemas / The Marshmallow Challenge: Working on skills for teamwork, leadership, and problem solving

Según la orden CIN (CIN/2134/2008) y el Libro Blanco de Enfermería, el personal docente ha de trabajar con los estudiantes de Enfermería en cuatro dominios diferentes: valores profesionales, habilidades de comunicación y relaciones interpersonales, toma de decisiones en la práctica clínica y gestión del trabajo en equipo. En el marco de la pedagogía basada en el juego se planteó introducir en el aula el Reto del Malvavisco como una actividad para reflexionar y profundizar sobre aspectos de trabajo en equipo, fomentando las capacidades de colaboración, liderazgo distribuido, empatía y creatividad desde un planteamiento lúdico y a través de situaciones cotidianas alejadas del plano clínico. Se trabajó con estudiantes del Grado de Enfermería de tercer curso, en la asignatura de Prácticas Tuteladas III. La actividad consistió primeramente en trabajar habilidades de trabajo en equipo y liderazgo compartido a través del juego para, posteriormente, transferir el conocimiento generado a una situación clínica mediante la resolución de un caso. La actividad fue evaluada por los estudiantes de forma muy positiva. Consideraron que introducir el juego en el aula es una forma muy creativa y muy útil para desarrollar habilidades que pueden implementar posteriormente en el desempeño de su rol profesional (AU)

According to 'orden CIN' (CIN/2134/2008) and the White Paper on Nursing, the teaching staff must work with Nursing students on four different areas: professional values, communication skills and interpersonal relations, decision making in clinical practice, and teamwork management. In the setting of game-based pedagogy, the introduction in the classroom of the 'Marshmallow Challenge' was considered a useful activity to reflect and delve into teamwork aspects, promoting the skills of collaboration, shared leadership, empathy and creativity from a recreational approach and through everyday situations away from the clinical level. This work was conducted with Nursing Degree students in their third year, within the subject Tutored Practices III. The activity consisted primarily in working on teamwork and shared leadership skills through the game, and subsequently translating the knowledge generated into a clinical situation by solving a case. The activity was evaluated very positively by students; they considered that introducing the game in the classroom was a very creative and useful manner to develop skills that can be subsequently implemented in the performance of their professional role (AU)

«Ruleta de emociones»: el juego como estrategia para la educación emocional en el Grado de Enfermería / The wheel of emotions: a game as a strategy for emotional education in the nursing degree

Un reto en la formación de estudiantes de Enfermería es potenciar el desarrollo transversal de competencias emocionales que les permitan comprender y regular adecuadamente las emociones. Para potenciar la reflexión sobre el papel de las emociones en la conducta profesional, se diseñó un taller dinamizado mediante el juego «Ruleta de emociones». Previamente se entregaron dos cuestionarios para activar la reflexión. Participaron 16 estudiantes de cuarto curso trabajando 14 emociones. Durante la actividad los estudiantes discriminaron emociones y analizaron comportamientos. Evaluaron la experiencia como enriquecedora. Las prácticas tuteladas son un laboratorio para testar competencias emocionales. Los métodos reflexivos constituyen herramientas potentes para tomar conciencia de las emociones propias y de otros. La ruleta de emociones estimula a identificar emociones experimentadas y a analizar la forma de gestionarlas

To strengthen the transversal development of emotional skills, allowing to understand and adjust emotions adequately, represents a challenge in the training of Nursing students. In order to strengthen the reflection on the role of emotions in professional behaviour, a dynamic workshop has been designed through the «Wheel of Emotions» game. Two questionnaires were previously handed out in order to activate reflection. Sixteen (16) students in their fourth year participated in the game, working on 14 emotions. During the activity, students distinguished between emotions and analyzed different behaviours. They assessed the experience as rewarding. Guided practices are a laboratory for testing emotional skills. Reflective methods represent powerful tools to become aware of our own emotions as well as the emotions of others. The Wheel of Emotions encourages to identify the emotions experienced, and to analyze the way to manage them

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia

Background: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia).Methodology: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression.Results: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value < 0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value < 0.05). In urban areas, risk factors were male sex, younger age and being in common-law union.Conclusions: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia.

BACKGROUND: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia). METHODOLOGY: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression. RESULTS: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value<0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value<0.05). In urban areas, risk factors were male sex, younger age and being in common-law union. CONCLUSIONS: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.