Experience of primary care nurses applying nurse-led management of patients with acute minor illnesses.

AIM: The aim of this study is to determine the experience of primary health care nurses regarding the application of nurse-led management in patients with acute minor illnesses. BACKGROUND: Nursing leadership of care for acute minor illnesses is a new challenge faced by nurses in Spain. DESIGN: Qualitative, hermeneutical, interpretive phenomenological approach is used. The Consolidated criteria for reporting qualitative research guidelines were applied. METHODS: Twenty primary care nurses participated; three focus group discussions and nine semi-structured interviews were conducted between November 2019 and October 2020. All the focus group discussions and interviews were recorded, transcribed verbatim and analysed using content analysis. RESULTS: Seven main themes emerged from the focus group discussions and interviews: concept, perception of the other actors, practice, history and social context, competencies, training, and legality. CONCLUSION: The study shows the diversity and complexity of nurses' experience when applying nurse-led management in acute minor illnesses. This work has helped to show the gaps perceived by nurses, including the lack of training in the treatment of conditions historically attended by physicians, the lack of definition of the legal framework and the limitations on nurse prescribing. It also highlighted the power of the nursing profession in terms of autonomy, competencies and role expansion.

Influence of Age and Cardiovascular Risk Factors in Vestibular Neuritis: Retrospective Cohort Study.

To analyze the influence of age and cardiovascular risk factors (CVRFs) in the evolution of vestibular neuritis (VN). METHODS: Retrospective cohort study. VN-diagnosed patients were included and divided into two groups: those with and without CVRFs. We analyzed the mean vestibular-ocular reflex (VOR) gain, measured through the video head impulse test (vHIT) at the diagnosis and one-year follow-up. We conducted a factorial analysis of variance (ANOVA) to evaluate the effect of age, sex, and CVRFs in the mean VOR gain. RESULTS: Sixty-three VN-diagnosed patients were included. There were no statistically significant differences in the mean VOR gain between both groups. However, in the subgroup analysis, there were statistically significant differences when comparing the mean VOR gain at the one-year follow-up between the group over 55 years of age 0.77 ± 0.20 and the group under 55 years 0.87 ± 0.15 (p = 0.036). Additionally, the factorial ANOVA demonstrated a significant main effect of age group on the mean VOR gain at the one-year follow-up (p = 0.018), and it also found a significant interaction between the factors of gender, age group, HTN (p = 0.043). CONCLUSIONS: CVRFs do not independently affect the mean VOR gain in VN patients' follow-ups. However, age significantly impacts VOR gain in VN and could be modulated by gender and hypertension.

Factors Impacting the Use or Rejection of Hearing Aids-A Systematic Review and Meta-Analysis.

PURPOSE: To examine the prevalence of adherence to hearing aids and determine their rejection causes. METHODS: This study was conducted according to the Preferred Reporting terms for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an electronic search using PubMed, BVS, and Embase. RESULTS: 21 studies that met the inclusion criteria were selected. They analyzed a total of 12,696 individuals. We observed that the most common causes for positive adherence to hearing aid use included having a higher degree of hearing loss, patients being aware of their condition, and requiring the device in their daily life. The most common causes for rejection were the lack of perceived benefits or discomfort with the use of the device. The results from the meta-analysis show a prevalence of patients who used their hearing aid of 0.623 (95% CI 0.531, 0.714). Both groups are highly heterogeneous (I2 = 99.31% in each group, p < 0.05). CONCLUSIONS: A significant proportion of patients (38%) do not use their hearing aid devices. Homogeneous multicenter studies using the same methodology are needed to analyze the causes of rejection of hearing aids.

Vértigo posicional paroxístico benigno y enfermedad de Menière: análisis retrospectivo / Benign paroxysmal positional vertigo and Menière's disease: retrospective analysis

Introducción y objetivo: El Vértigo Posicional Paroxístico Benigno (VPPB) es más frecuente dentro del subgrupo de pacientes con Enfermedad de Menière (EM). El presente estudio tiene como objetivo describir las características clínicas tanto del VPPB como de la EM cuando se encuentran asociados. Método: Realizamos un análisis retrospectivo de 22 pacientes con EM diagnosticados de VPPB entre el 1999 y el 2021 en el Complejo Asistencial Universitario de Salamanca. Se recogieron variables clínicas, tanto de las características del VPPB como de la EM. Resultados: En nuestra base de datos, el 66,66 % de los 22 pacientes eran mujeres con una edad media de 59,33 años. El canal semicircular afecto con más frecuencia fue el posterior derecho. En cuanto al VPPB, un 19% se trata de VPPB multicanal, en casi la mitad (47,62%) se tuvieron que realizar más de tres maniobras para solucionarlo y tardó más de un mes en resolverse en más de la mitad (57,14%). Por otro lado, la EM era bilateral en el 19% de los pacientes, con un tiempo de evolución desde el diagnóstico de más de tres años en el 71,42%. Un tercio de los pacientes había presentado más de 10 crisis en los últimos seis meses, y fluctuación en la audición. En base a estos resultados, parece que los pacientes con EM avanzada tienen más probabilidades de presentar VPPB y con peor resultado en su tratamiento. Conclusión: La aparición conjunta del VPPB y la EM podría afectar al pronóstico de ambas patologías por separado. (AU)

Introuction and objective: Benign Paroxysmal Positional Vertigo (BPPV) is more frequent within the subgroup of patients with Menière's Disease (MD). The present study aims to describe the clinical characteristics of both BPPV and MD, when they are associated. Method: We carried out a retrospective analysis of 22 patients with MD diagnosed with BPPV between 1999 and 2021 at the University Assistance Complex of Salamanca. Clinical variables were collected, both from the characteristics of BPPV and MD. Results: In our database, 66.66% of the 22 patients were women with a mean age of 59.33 years. The most frequently affected semicircular canal was the posterior right. Regarding BPPV, 19% are multichannel BPPV, in almost half (47.62%) more than three maneuvers had to be performed to solve it and it took more than a month to resolve it in more than half (57.14%). On the other hand, MD was bilateral in 19% of patients, with a time since diagnosis of more than three years in 71.42%. A third of the patients had presented more than 10 crises in the last six months, and fluctuation in hearing. Based on these results, it appears that patients with advanced MD are more likely to have BPPV and have a worse treatment outcome. Conclusion: The joint appearance of BPPV and MD could affect the prognosis of both pathologies separately. (AU)

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis.

BACKGROUND: Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. METHODS: Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). RESULTS: We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. DISCUSSION: There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. CONCLUSION: A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

Impacto de la enfermedad de pequeño vaso en la inestabilidad del anciano. Estudio descriptivo transversal / Vestibular Pathology and Instability in the Elderly and its Relationship with Small Vessel Disease. Cross-Sectional Descriptive Study

Introducción y objetivo: La elevada prevalencia de mareo e inestabilidad en los ancianos, su complejo diagnóstico e importantes consecuencias (caídas y lesiones derivadas) constituyen un grave problema sanitario. El presente estudio tiene como objetivo principal determinar si existe relación entre dichos síntomas y la presencia de enfermedad de pequeño vaso. Secundariamente intentaremos describir las causas más frecuentes de mareo e inestabilidad en los pacientes ancianos. Método: Se realiza un estudio descriptivo transversal con 214 pacientes mayores de 70 años remitidos por vértigo, mareo o inestabilidad. Se valoran los diagnósticos más frecuentes y se comparan tres grupos: 1) Patología vestibular periférica, 2) mareo o inestabilidad de causa desconocida y 3) grupo de control. Para ello se utiliza la escala de Fazekas que determina la magnitud de las lesiones de sustancia blanca por imágenes de resonancia magnética. Resultados: El vértigo posicional paroxístico benigno fue el diagnóstico más frecuente (17,3%), seguido de la enfermedad de Ménière (15%). Un 20% de los pacientes fueron clasificados como origen desconocido o multifactorial. La enfermedad de pequeño vaso se encontró con mayor frecuencia en el grupo con mareo de causas desconocidas (p=0,034). Conclusiones: se reafirma la asociación entre las lesiones de sustancia blanca, sugerentes de enfermedad de pequeño vaso, y la mayor aparición de mareo e inestabilidad en los ancianos; siendo la prevalencia de la enfermedad mucho menor en el grupo de control que en aquellos con mareo de causa desconocida. Asimismo, se determina que el vértigo posicional paroxístico benigno es el diagnóstico más frecuente de mareo e inestabilidad en el anciano. (AU)

Skull Vibration-Induced Nystagmus and High Frequency Ocular Vestibular-Evoked Myogenic Potentials in Superior Canal Dehiscence.

BACKGROUND: Although diagnostic criteria have been established for superior canal dehiscence syndrome, cases in which the diagnosis is not easy are frequent. On those occasions, some tests such as vibration-induced nystagmus or vestibular-evoked myogenic potentials can offer invaluable help due to their high sensitivity and specificity. METHODS: We studied 30 patients showing superior canal dehiscence or "near-dehiscence" in a CT scan. Skull vibration-induced nystagmus and high frequency ocular vestibular-evoked myogenic potentials are performed in each patient. The aim of the study is to determine how useful both tests are for detection of superior canal dehiscence or near-dehiscence. RESULTS: Of the 60 temporal bones studied, no dehiscence was the result in 22, near-dehiscence in 17 and a definite finding in 21. In 10/30 patients, there was no SVIN (Skull vibration induced nystagmus) during otoneurological testing, while in 6/30, induced nystagmus was mainly horizontal, and in 14/30 there was vertical up-beating. All patients had a positive oVEMP (Ocular vestibular evoked myiogenic potentials) at 0.5 kHz in both ears and the HFoVEMP (High frequency ocular vestibular evoked myiogenic potentials) response was positive in 25/60 (41.6%) of the ears studied and in 19/30 of the patients evaluated (in 6 it was positive in both ears). Up-beat SVIN will point to a SCD (Superior Canal Dehiscence) mainly when HFoVEMP are present, and when this is negative there is a high probability that it is not a SCD. CONCLUSIONS: When SVIN and HFoVEMP results are added (or combined), they not only improve the possibilities of detecting SCD, but also the affected side.

Hearing loss in vestibular schwannoma

Introducción y objetivo: La hipoacusia es uno de los síntomas más frecuentes en el debut de un schwannoma vestibular (SV). El objetivo de este estudio es analizar la pérdida auditiva en pacientes con SV y determinar en qué medida se relaciona con el tamaño tumoral. Método: Se lleva a cabo un estudio retrospectivo observacional en 291 pacientes diagnosticados de SV entre 1995 y 2017 en el servicio de Otorrinolaringología y Cirugía Cervicofacial del Hospital Clínico Universitario de Salamanca analizándose diferentes datos pre y postoperatorios de los pacientes así como hallazgos radiológicos y quirúrgicos.Resultados: El síntoma más frecuente de consulta es la hipoacusia unilateral progresiva (31.6%). La asociación entre el tamaño del SV y la hipoacusia no es estadísticamente significativa (p=0.099).Conclusiones: La pérdida auditiva producida por un SV no es patrimonio de ningún estadio, aunque las pérdidas severas y profundas son más indicativas de neurinomas grados III-IV, y ante una pérdida auditiva leve o audición normal tendremos con más probabilidad un neurinoma grado I-II. (AU)

The most common reason for consultation in patients suffering from Vestibular Schwannoma (VS) is progressive hearing loss. The main objective of this study is analyzing the hearing loss in patients with VS and determining the extent to which the tumor grade and the hearing loss are related. Methods: An observational retrospective study was conducted with a sample of 291 patients diag-nosed with VS between 1995 and 2017 in the Department of Otorhinolaryngology and Head and Neck Surgery of the Tertiary Care Primary Center of Salamanca. We analyzed preoperative and postoperative data from patients with VS as well as radiological and surgical findings. Results: The most common reason for consultation at diagnosis was progressive unilateral hearing loss (31.6%). The relationship between the size of the VS and hearing loss in the patients who reported progressive unilateral hearing loss as a reason for consultation was not statistically significant (p=0.099). Conclusion: The most common reason for consultation in VS is progressive unilateral hearing loss. The hearing loss caused by VS does not have a statistically significant association with any tumor grade, although severe and profound hearing loss is more commonly associated with grade III-IV neurinomas, whereas mild hearing loss or normal hearing are more likely in grade I-II tumors. (AU)

Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?

BACKGROUND: Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses' globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom. MAIN BODY: Nurses' health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses' workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health. CONCLUSION: The protection of nurses' health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work-life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses' health and monitor the progress towards nurses' health equity.