Impact of the implementation of a telemedicine program on patients diagnosed with asthma.

BACKGROUND: Asthma is one of the most common respiratory ailments worldwide. Despite broad understanding of the illness and of the available therapeutic options for it, patients with serious asthma suffer poor monitoring of their illness in 50% of cases. AIM: To assess the impact of the implementation of a mobile application (ESTOI) to control asthma in patients diagnosed with the illness, their adherence to treatment, and their perceived quality of life. METHODOLOGY: Randomized clinical trial with 52 weeks' follow-up of patients with asthma seen in a specialized hospital for their treatment in Spain. Some 108 included patients will be divided into two groups. The intervention group will undergo more exhaustive follow-up than normal, including access to the ESTOI application, which will have various categories of attention: control of symptoms, health recommendations, current treatment and personalized action plan, PEF record, nutritional plan, and chat access with a medical team. The asthma control questionnaire ACT is the main assessment variable. Other variables to be studied include an adherence test for the use of inhalers (TAI), the number of exacerbations, maximum exhalation flow, exhaled nitric oxide test, hospital anxiety and depression scale, asthma quality-of-life questionnaire, forced spirometry parameters (FVC, FEV1, and PBD), and analytic parameters (eosinophilia and IGE). The data will be collected during outpatient visits. TRIAL REGISTRATION: This trial has registered at ClinicalTrials.gov (Identifier: NCT06116292).

Comparison of diluted vs concentrated regional citrate anticoagulation in continuous renal replacement therapy: A quasi-experimental study.

BACKGROUND: The incidence of coagulation of continuous renal replacement therapy circuits remains high. To the best of our knowledge, no scholar has published a protocol to avoid management errors when different types of citrates coexist in the same Intensive Care Unit. AIM: To assess the safety and efficacy of the unification of two protocols with different concentrations of citrate solution. STUDY DESING: A prospective, quasi-experimental study was carried out in the intensive care unit of a tertiary referral hospital (in Barcelona, Spain), over 3 years. Consecutive adult patients requiring continuous renal replacement therapy with citrate were included. The sample was divided into two groups, a control group (concentrated citrate) and an intervention group (diluted citrate). The decision to initiate anticoagulation with diluted (18 mmol/L) or concentrated (136 mmol/L) citrate was made based on the machine available and the decision of the doctor responsible for the patient. It was not possible to randomize the sample. Both protocols were matched with a starting citrate dose of 3.5 mmol/L, and a dialysis solution was used. Post-filter replacement was not used, and the citrate solution was the only fluid administered pre-filter. RESULTS: The analysis included 59 circuits in the concentrated citrate group and 40 circuits in the diluted citrate group. An increased need for electrolyte replacement was observed in the diluted group (p < .001). The concentrated citrate group had a longer filter life (p < .05), and there was a slight trend toward alkalosis. CONCLUSION: The diluted citrate group had a higher incidence of electrolyte replacement. The concentrated citrate group had longer circuit lifespan and a trend toward metabolic alkalosis, although this was not statistically significant. If these conclusions are considered, the protocol can be unified. RELEVANCE TO CLINICAL PRACTICE: The present work aims to provide information on the differences in the use of regional anticoagulation with diluted or concentrated citrate. The objective is to pay special attention to aspects that can lead to complications. The unified protocol proposed in this paper could be extrapolated to any machine on the market that uses either of these two types of citrate concentration.

Change in prefilter pressure as a key determinant in the decision to return blood in continuous renal replacement therapy: An observational study.

BACKGROUND: During continuous renal replacement therapy (CRRT), circuit coagulation is an important event that can result in suboptimal outcomes. Nurses must remain alert throughout the treatment and observe machine pressures. Transmembrane pressure (TMP) is commonly used for monitoring but it is sometimes too late to return blood to the patient. AIM: To compare the capacity of prefilter pressure (FP) versus TMP to predict the risk of circuit coagulation in adult patients with acute renal failure on CRRT. STUDY DESIGN: An observational, longitudinal, prospective study. This study was carried out in a tertiary referral hospital over 2 years. Data collected included the following variables: TMP, filter or FP, effluent pressure, venous and arterial pressure, filtration fraction, and ultrafiltration constant of each circuit. Means and their trends over time were collected, for both diffusive and convective therapy and for two membrane types. RESULTS: A total of 151 circuits (24 polysulfone and 127 acrylonitrile) were analysed, from 71 patients (n = 22 [34%] women; mean age, 66.5 [36-84] years). Of the total treatments, 80 were diffusive, and the rest were convective or mixed. In the diffusive circuits, a progressive rise in FP was observed without an increase in TMP and with an increasing trend in effluent pressure. Circuit lifespan was between 2 and 90 h. In 11% (n = 17) of the cases, the blood could not be returned to the patient. CONCLUSION: These findings allowed the creation of graphs that indicate the appropriate point to return blood to the patient. FP was a major determinant in this decision; in most cases, TMP was not a reliable parameter. Our findings are applicable to convective, diffusive, and mixed treatments as well as both types of membranes used in this acute setting. RELEVANCE TO CLINICAL PRACTICE: This study provides two clear reference graphs showing risk scales for the assessment of circuit pressures in CRRT. The graphs proposed here can be used to evaluate any machine on the market and the two types of membranes used in this acute setting. Both convective and diffusive circuits can be assessed, allowing safer evaluation in patients who change treatment.

Implementation of advanced triage in the Emergency Department of high complexity public hospital: Research protocol.

AIM: To evaluate the efficacy of advanced nurse triage based on the quality of care outcomes of patients attending the Emergency Department of a high-complexity hospital. To analyse the concept of advanced triage and the essential elements of the construct. DESIGN: Mixed longitudinal study, divided into 4 steps; which will include an initial qualitative step, two observational studies and finally, a quasi-experimental study. CLINICAL TRIAL REGISTRATION NUMBER: NCT05230108. METHODS: Step 1 will consist of a concept analysis. Step 2 will include a mapping of advanced practice protocol terminologies. Step 3 will analyse the opinion of health professionals on advanced triage. In step 4: in the retrospective phase (n = 1095), sociodemographic and clinical variables and quality indicators such as waiting time will be analysed. After that, in the prospective phase (n = 547), advanced triage will be implemented and the two cohorts will be compared. The whole study will be carried out from January 2022 to January 2024. DISCUSSION: Patients classified as low complexity at triage are more vulnerable to emergency department overcrowding. The implementation of advanced triage would make it possible to respond to patient needs by offering equitable and quality healthcare, facilitating accessibility, safety and humanization of the emergency department.

El catéter como elemento fundamental en las terapias de depuración renal / The catheter as a fundamental element in renal cleansing therapies

El término “catéter” es muy conocido para las enfermeras, sin embargo, el manejo de las vías para los pacientes con fallo renal es un tema que ofrece cierta dificultad.Las facetas específicas con relación a este tipo de catéteres y el tratamiento depurativo renal son el objetivo de este capítulo. Se analiza cómo hacer el cálculo del flujo de sangre, cómo elegir un buen catéter según su morfología, cuál es la técnica mejor para conservarlo y de qué forma sellarlo cuando se deje en reposo, sin tratamiento depurativo.Estos y otros conocimientos fundamentales se describirán, a partir de la evidencia hallada en la literatura. (AU)

The word catheter is well known to nurses, however, its management for patients with renal failure is a subject that offers some difficulty.The problems with this specific catheter and the renal purifying treatment are the objective of this paper. It analyses how to calculate the blood flow, how to choose a good catheter according to its morphology, what is the best technique to preserve it and how to lock it when it is left at rest, without any purifying treatment.These and other fundamental knowledge will be described, based on the evidence founded in the literature. (AU)

Empleo y resolución de la Gestión Enfermera de la Demanda en Cataluña / Use and resolution of Nurse Demand Management in Catalonia

Introducción: la gestión enfermera de la demanda (GED) es la atención a los problemas agudos leves liderada por la enfermera y llevada a cabo en los centros de atención primaria de Cataluña desde el 2009. El objetivo del estudio es evaluar el grado de implantación y resolución de la GED en los centros del Institut Català de la Salut. Métodos: estudio observacional descriptivo transversal. El ámbito de estudio ha sido el de atención primaria del Institut Català de la Salut de Cataluña. Análisis de datos secundarios. Los datos han sido extraídos de la plataforma Longview. Las variables de estudio han sido en cuanto a la GED: el número de visitas, la resolución, los motivos de consulta y protocolos implantados en los equipos. Resultados: la GED en el territorio catalán presenta variabilidad en los porcentajes de resolución entre las diferentes gerencias territoriales. Los protocolos pediátricos presentan mayor resolución que los de adultos. Los protocolos con mayor resolución son los relacionados con la práctica usual de la enfermera, y los menos, los que históricamente resolvía el médico. Por último, existe correlación positiva entre los protocolos implementados y el número de usuarios visitados por la enfermera. Conclusiones: el liderazgo enfermero en la atención a enfermedades agudas leves es una práctica afianzada por las enfermeras de atención primaria; aunque existe heterogeneidad en la resolución de los motivos de consulta especialmente entre los que habitualmente atendía la enfermera y los que históricamente resolvía el médico. (AU)

Introduction: Nursing leadership in users with acute minor illnesses (NLAMI) is the attention given by nurse to people with acute problems carried out in primary care centers in Catalonia since 2009. The aim of the study is to evaluate the degree of resolution of the NLAMI in the centers of the Institut Català de la Salut. Methods: cross-sectional descriptive observational study. The scope of the study was the primary care of the Institut Català de la Salut in Catalonia. Secondary data analysis. The data were extracted from the Longview platform. The study variables were related with NLAMI: number of visits, resolution, reasons for consultation and protocols implemented in the health centers. Results: The NLAMI is implemented in the Catalonia and there is variability in the percentages of resolution between territories. Pediatric protocols have higher resolution than adult protocols. The most resolved protocols are those related to the usual practice of the nurse, and the least resolved protocols are those historically resolved by the physician. Finally, there is a positive correlation between the protocols implemented and the number of users visited by the nurse. Conclusions: the leadership in the care of acute minor illnesses is an established practice of primary care nurses and there is heterogeneity in the resolution of the reasons for consultation, especially between those usually attended by the nurse and those historically resolved by the physician. (AU)

Quality of professional life of primary healthcare nurses: A systematic review.

AIMS: To identify and critically appraise the available evidence on the overall quality of professional life of primary care nurses worldwide and its main influencing factors. BACKGROUND: Quality of professional life of healthcare workers is a keystone that influences the quality of healthcare services provided by healthcare organisations. Nurses have a key role as healthcare services providers given the growing shortage of doctors in primary care. DESIGN: A systematic review design in accordance with the PRISMA statement. METHODS: The search was conducted through MEDLINE (PubMed), CINAHL, SCOPUS, Scientific Electronic Library Online (SciELO) and Web of Science databases. The grey literature was reviewed at OpenGrey. The search was limited to human studies published from April 2010-April 2020. No limit of original language publication was applied. Three independent reviewers analysed the methodological quality of the studies. RESULTS: Ten studies were included from five countries. Five studies reported nurses were satisfied with their quality of professional life and the influencing factors identified were Workload, Job autonomy, Demographic variables, Management support, Recognition, Intrinsic motivation, Interpersonal relations, Compassion fatigue, Burnout, Turnover intention, and work was reported as a component of Quality of life. CONCLUSION: Primary healthcare nurses reported a high level of quality of professional life, but the scarce studies found do not provide solid consistency to assess the overall quality of professional life. Perception of high workload was the most frequently identified factor to negatively influence the quality of professional life of nurses. RELEVANCE TO CLINICAL PRACTICE: Quality of professional life of primary care nurses is a key issue because of nurses' important relation with patient's care and satisfaction. Healthcare organisations should strive to address primary care nurses' quality of professional life to enhance their well-being and consequently patients' safety and high-quality healthcare services.

Older Adults With Complex Chronic Conditions Who Receive Care at Home: The Importance of Primary Care Assessment.

The current study aimed to describe the characteristics of older adults with complex chronic conditions cared for at home. One hundred thirty-eight participants were recruited. Participants' average age was 85.9 years and 69.6% were female. Poly-pharmacy was present in 89.9% of participants. Participants who presented with polypharmacy had a worse self-perception of health (p = 0.002), and the worst fall rate. A total of 22.5% had experienced a fall during the past 6 months. Approximately one half of participants rated their self-perceived quality of life as bad or very bad. The percentage who used emergency services (54.3%) was greater than the percentage who needed to be admitted (43.5%). A worse self-perception of physical health was significantly associated with hospital admissions (p = 0.01). Geriatric assessment by nurses can provide information to improve care in situations in which frailty, dependency, and chronic conditions occur together. Obtaining information on the needs of individuals with frailty is important in designing successful nursing interventions. [Journal of Gerontological Nursing, 47(11), 31-38.].

Paediatric nursing clinical competences in primary healthcare: A systematic review.

AIMS: To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide. DESIGN: A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement. DATA SOURCES: The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search. REVIEW METHODS: Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies. RESULTS: Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks. CONCLUSION: Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care. IMPACT: Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.

Analysis of the evolution of competences in the clinical practice of the nursing degree.

OBJECTIVE: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions.Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management. RESULTS: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%). CONCLUSION: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future.

Analysis of the evolution of competences in the clinical practice of the nursing degree / Análise da evolução de competências da prática clínica no curso de enfermagem / Análisis de la evolución de las competencias en la práctica clínica del grado en enfermeira

Objective: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions. Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management. Results: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%). Conclusion: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future.

Objetivo: analisar a progressão de estudantes na aquisição de competências específicas e transversais em relação às dimensões de competência. Método: este estudo transversal descritivo foi realizado no contexto das disciplinas de prática clínica do curso de enfermagem. O desenvolvimento de competências de 323 alunos foi analisado usando um questionário ad-hoc com quatro dimensões: provisão e gerenciamento do cuidado; comunicação terapêutica; desenvolvimento profissional; e gerenciamento do cuidado. Resultados: os resultados acadêmicos obtidos no segundo e terceiro anos apresentaram melhora nas habilidades referentes à provisão do cuidado e comunicação terapêutica (Práticas Clínicas I: 12%-29%; Práticas Clínicas II: 32%-47%) e uma piora no desenvolvimento profissional e gerenciamento do cuidado (Práticas Clínicas I: 44%-38%; Práticas Clínicas II: 44%-26%). Conclusão: as correlações entre estes dois anos foram altas em todas as dimensões analisadas. A avaliação da progressão de competências no contexto da prática clínica do curso de enfermagem nos permite otimizar estas práticas ao máximo e estabelecer perfis profissionais com maior grau de adaptação para o futuro profissional.

Objetivo: analizar la progresión del alumno en la adquisición de competencias específicas y transversales en relación con las dimensiones de competencia. Método: el estudio descriptivo transversal se realizó en los sujetos de práctica clínica incluidos en la licenciatura de Enfermería. Incluimos 323 estudiantes y contemplamos el desarrollo de competencias a través de un cuestionario ad hoc con 4 dimensiones: suministro y gestión del cuidado; comunicación terapéutica; desarrollo profesional; y, gestión del cuidado. Resultados: los resultados académicos entre la práctica del segundo y tercer año mostraron una mejora en la provisión del cuidado y en las habilidades de comunicación terapéutica: (Colocaciones clínicas I: 12% -29%; Colocaciones clínicas II: 32% -47%) y empeoraron en el desarrollo profesional y en la gestión del cuidado (Colocaciones clínicas I: 44%-38%; Colocaciones clínicas II: 44%-26%). Conclusión: las correlaciones entre estos dos años fueron altas en todas las dimensiones analizadas. La evaluación de la progresión de competencias, en el contexto de la práctica clínica, en los estudios universitarios de enfermería, nos permite optimizar estas prácticas al máximo y establecer perfiles profesionales con un mayor grado de adaptación al futuro profesional.

Impacto de las consultas y triajes telefónicos pediátricos en el uso del servicio de urgencias hospitalario / Pediatric televisits and telephone triage: impact on use of a hospital emergency department

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres

Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit

Pediatric televisits and telephone triage: impact on use of a hospital emergency department. / Impacto de las consultas y triajes telefónicos pediátricos en el uso del servicio de urgencias hospitalario.

OBJECTIVES: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. MATERIAL AND METHODS: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. RESULTS: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. CONCLUSION: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit.

OBJETIVO: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. METODO: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. RESULTADOS: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. CONCLUSIONES: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres.

Satisfacción de la carpeta de aprendizaje y agentes que intervienen en la práctica clínica en el grado de enfermería / Satisfaction of the learning portfolio and training staff involved in the clinical practice of a bachelor nursing degree

Objetivo. Evaluar las percepciones de los diferentes agentes que intervenían en la utilización de la carpeta de aprendizaje, y determinar el nivel de satisfacción de los estudiantes durante la práctica clínica. Metodología. Se incluyeron 33 profesores y 185 estudiantes matricula-dos durante el curso 2016-2017 en las asignaturas de Estancias Clínicas I y II, correspondientes al segundo y tercer curso de Grado de Enfermería de la Escuela de Enfermería de la Universidad de Barcelona. Se elaboraron dos cuestionarios ad-hoc: uno para evaluar la percepción de los agentes sobre la carpeta de aprendizaje, con 4 dimensiones relacionadas con el uso de la herramienta, la vinculación competencial, los problemas y las limitaciones en el manejo; y un segundo cuestionario sobre el nivel de satisfacción realizado sólo a los estudiantes. Resultados. Según los estudiantes, la utilidad de la carpeta de aprendizaje fue elevada con un 89% (n = 81) y un 71% (n = 67), en segundo y tercer curso respectivamente, pero esta utilidad disminuyó al asociarla con la ayuda que proporcionaba en la adquisición de sus competencias, 37% (n = 37) y 26% (n = 24). La dificultad en su utilización fue del 41% (n = 37) en segundo curso y del 28% (n=26) en tercero. Respecto a la opinión de los tutores de prácticas, tanto la idonei-dad como la utilidad de la carpeta obtuvieron valores elevados con un 91% (n = 30) y un 94% (n = 31), respectivamente. Conclusiones. La utilidad de la car-peta de aprendizaje es alta tanto para estudiantes como para profesores, pero representó un instrumento complejo en su uso, que nos obligará a unificar diseños en el sistema de evaluación para que el estudiante y tutores optimicen esta herramienta

Objective. To evaluate the perceptions of the students in relation to the usefulness of the Learning Portfolio, and to determine the level of students’ satisfaction during clinical practice. Methodology. 33 assistant professors and 185 students of Clinical Practice I and II at Nursing School in University of Barcelona during the 2016-2017 academic year were enrolled. Two ad-hoc questionnaires were elaborated: the first made reference to the usefulness of the Learning Portfolio related to the use of the tool, the competence liaison, the problems and the limitations in the handling of the same; the second questionnaire was about the level of satisfaction made only to students. Results. According to the students, the usefulness of the learning portfolio was high with 89% (n = 81) and 71% (n = 67), at second and third year, respectively. This utility decreased when portfolio was associated with the help provided in the acquisition of students’ competences, 37% (n = 37) and 26% (n = 24). Difficulty in using Portfolio was 41% (n = 37) in second academic year and 28% (n = 26) in the third. Regarding the tutors, both the suitability and the usefulness of the folder obtained high values with 91% (n = 30) and 94% (n = 31), respectively. Conclusions. The usefulness of the learning portfolio is high for both students and teachers. The portfolio re-presents a complex instrument in its use, an aspect that forces us to unify designs in the evaluation system so that the student and tutors optimize this tool

Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial.

AIM: To evaluate the association of a new nursing intervention on the adherence to antituberculosis treatment in a paediatric cohort (<18 years). BACKGROUND: Tuberculosis remains a public health problem worldwide. The risk of developing tuberculosis after primary infection and its severity are higher in children. Proper adherence to antituberculosis treatment is critical for disease control. DESIGN: Nonrandomized controlled trial; Phase 1, retrospective (2011-2013), compared with Phase 2, prospective with intervention (2015-2016), in a referral centre for paediatric tuberculosis in Spain (NCT03230409). METHODS: A total of 359 patients who received antituberculosis drugs after close contact with a smear-positive patient (primary chemoprophylaxis) or were treated for latent tuberculosis infection or tuberculosis disease were included, 261 in Phase 1 and 98 in Phase 2. In Phase 2, a new nurse-led intervention was implemented in all patients and included two educational steps (written information in the child's native language and follow-up telephone calls) and two monitoring steps (Eidus-Hamilton test and follow-up questionnaire) that were exclusively carried out by nurses. RESULTS: Adherence to antituberculosis treatment increased from 74.7% in Phase 1% to 87.8% in Phase 2 (p = 0.014; Chi-square test), after the implementation of the nurse-led intervention. In Phase 2, nonadherence was only associated with being born abroad (28.6% vs. 7.8%; p = 0.019; Chi-square test) and with foreign origin families (27.3% vs. 0%; p < 0.0001; Chi-square test). CONCLUSION: The nurse-led intervention was associated to an increase in adherence to antituberculosis treatment. Immigrant-related variables remained major risk factors for sub-optimal adherence in a low-endemic setting.

Implantación de la telemedicina, eSalud y atención telefónica de enfermería en España / Implementing telemedicine, ehealth and telephonic nursing assistance in Spain

Introducción. Los términos «telesalud» o «eSalud» definen los servicios sanitarios diversificados prestados a distancia por un equipo de profesionales usando las TIC para mejorar la salud de un usuario o una población. Desarrollo. El desarrollo de las TIC en las décadas del 2000 y del 2010 hizo posible una mayor aplicabilidad. Aparecieron técnicas de telerradiología y telepatología. Mediante las teleconsultas se empezó a practicar la teleenfermería. Los inicios prácticos de la teleenfermería, surgieron a partir de consultorías enfermeras telefónicas en Reino Unido y Canadá. La OMS estableció, en 2005, el Observatorio Mundial de eSalud para revisar los beneficios de las TIC. Actualmente, en España, 061 Cat Salut Respon, gestionado por enfermeras, da cobertura a Cataluña a través de su página web, teléfono, correo electrónico o chat. En Andalucía, Salud Responde es un centro de información y servicios para dar atención sanitaria a la ciudadanía. Conclusiones. Los sistemas de salud ofrecen servicios a través de sistemas multicanal y aplicaciones específicas (apps) que permiten mejorar la accesibilidad, en cualquier momento, desde cualquier punto con conexión a Internet. La implicación de las enfermeras en programas de eSalud, como las tele-nurses, está cada vez más extendida en España, tal y como ocurre a nivel internacional (AU)

Introduction. Tele-Health or eHealth are defined as diversified health services provided remotely by a team of professionals using ICT (Information and Communication Technology) to improve the health of a user or population. Development. The development of ICT during the 2000 and 2010 decades allowed for a wider applicability of these services. Techniques like teleradiology and telepathology appeared. Tele-nursing began to be practiced through teleconsultations. Tele-nursing emerged from consulting telephone nurses in the United Kingdom and Canada. In 2005, the WHO established the Global eHealth Observatory to review the benefits of ICT. Currently in Spain, 061 Cat Salut Respon, managed by nurses, gives coverage to Catalonia through its website, telephone, email or chat. In Andalusia, Salud Responde is a service and information center providing citizens with remote healthcare. Conclusions. Health systems offer services through multichannel schemes and specific applications (apps) improving accessibility anytime, anywhere, provided with internet connection. The involvement of nurses in eHealth programs, such as telenurses, is increasingly spreading in Spain, mirroring the trend at an international level (AU)

[Implementing Telemedicine, EHealth and Telephonic Nursing Assistance in Spain]. / Implantación de la telemedicina, eSalud y atención telefónica de enfermería en España.

Introduction: Tele-Health or eHealth are defined as diversified health services provided remotely by a team of professionals using ICT (Information and Communication Technology) to improve the health of a user or population. Development: The development of ICT during the 2000 and 2010 decades allowed for a wider applicability of these services. Techniques like teleradiology and telepathology appeared. Tele-nursing began to be practiced through teleconsultations. Tele-nursing emerged from consulting telephone nurses in the United Kingdom and Canada. In 2005, the WHO established the Global eHealth Observatory to review the benefits of ICT. Currently in Spain, 061 Cat Salut Respon, managed by nurses, gives coverage to Catalonia through its website, telephone, email or chat. In Andalusia, Salud Responde is a service and information center providing citizens with remote healthcare. Conclusions: Health systems offer services through multichannel schemes and specific applications (apps) improving accessibility anytime, anywhere, provided with internet connection. The involvement of nurses in eHealth programs, such as telenurses, is increasingly spreading in Spain, mirroring the trend at an international level.

Adherence to Antituberculosis Drugs in Children and Adolescents in A Low-Endemic Setting: A Retrospective Series.

Adherence to antituberculosis drug regimens is critical for the prevention and treatment of tuberculosis in pediatrics. In a large retrospective series of children and adolescents in Barcelona, Spain, completion of treatment was worse among patients treated for latent infection, compared with those treated for active tuberculosis or receiving primary chemoprophylaxis. Toxicity and cultural and language barriers were identified as predictors of nonadherence.

La integración de la información de salud del paciente / Integration of health information patient

Las tecnologías de la información y la comunicación (TIC) están implementadas en los sistemas de salud. Sin embargo, la actual situación socioeconómica plantea algunos interrogantes respecto a cómo evolucionará el sistema de salud en un contexto de uso generalizado de las TIC, pero con dificultades de sostenibilidad. Además de la sostenibilidad y la consolidación, ahora el reto planteado es la integración de la información y en qué ámbito asistencial y qué profesionales de la salud deberán liderar este paso adelante en la atención de salud de las personas de la comunidad. Todo ello supone un importante cambio de mentalidad para los usuarios de los sistemas de salud, y la necesidad de integrar todos los cuidados de salud, trabajando de manera más transversal, con el objetivo de dar continuidad asistencial y propiciando más calidad en la atención de salud del ciudadano (AU)

Information and communications technology (ICT) is implemented in health systems. However, the current economic situation raises questions regarding how the health system will evolve in a context of widespread use of ICT, but with sustainability problems. Beside sustainability and consolidation, now a days, the challenge is the integration of information and in which care level and who among health professionals should lead this step forward in health care. All this represents a major change of mindset for users of health systems, and the need to integrate all health care, working more transversely, with the aim of achieve more health care continuity and provide better quality in health care of citizen (AU)

Analysis of University Postgraduate Nursing Education in Spain.

BACKGROUND: The nursing education program framework in Spain has recently been adapted and modified. This study aimed to analyze university postgraduate master'slevel nursing education during the past 21 years in Spain in terms of educational supply and demand. METHOD: A retrospective, longitudinal, descriptive, and observational design was used. The educational offerings at 15 university nursing schools in Spain were examined. The target population was 7,871 registered and licensed nurses who had completed postgraduate education. RESULTS: Among the 211 programs offered, public universities' educational offerings focused on two areas-public health and emergency care-whereas most courses in private universities were in surgery. Regarding demand, 1,235 nurses were enrolled. The most frequently requested educational areas were surgery, emergency and urgent care, and public health. CONCLUSION: Although the postgraduate nursing education situation has changed, supply and demand for this type of education in Spain are well balanced at both public and private universities. [J Nurs Educ. 2016;55(11):615-622.].