Applying the Modified Ten-Group Robson Classification in a Spanish Tertiary Hospital.

BACKGROUND: Caesarean section is necessary to save the lives of mothers and newborns at times, but it is important to perform it only when it is essential due to all the risks involved. This study aimed to examine the rate of caesarean sections performed at a tertiary hospital using the Robson classification to detect methods for the detection of and/or reduction in these caesarean section rates. METHODS: A descriptive, cross-sectional study of a retrospective database was carried out. RESULTS: A total of 10,317 births were assessed. The Robson classification was used to assess these interventions and verify whether the indication for performed caesarean sections was appropriate. In total, 2036 births by caesarean section were performed in the whole sample. The annual caesarean section rate varied between 18.67% and 21.18%. CONCLUSIONS: Caesarean sections increased by about 20% in 2021 compared to 2020 even though the trend over the years of study was decreasing. Vaginal delivery after caesarean section is a reasonable and safe option. Caesarean section rates could be improved, mostly in Robson's Group 2. The Robson classification facilitated progress in the implementation of measures aimed at improving care and adjusting caesarean section rates.

Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review.

"Postoperative delirium" is defined as delirium occurring in the hospital up to one week after a procedure or before discharge (whichever occurs first) that meets the DSM-5 diagnostic criteria. Objectives: To describe the risk factors related to this pathology and identify effective non-pharmacological forms of treatment. An integrative review of the available literature was performed. The search results considered included all quantitative studies published between 2011 and 2019 in both English and Spanish. A total of 117 studies were selected. Advanced age was identified as the principal risk factor for postoperative delirium. Nursing interventions appear to be the key to preventing or reducing the seriousness of delirium after an anaesthetic episode. The aetiology of postoperative delirium remains unknown, and no treatment exists to eliminate this pathology. The role of nursing staff is fundamental in the prevention, diagnosis, and management of the pathology.

Examination of the Brain-Dead Organ Donor Management Process at a Spanish Hospital.

The number of donors and organs available has not increased at the same rate as the inclusion of new patients in the waiting lists. The aim of the present study was to analyze the quality of the detection process of potential brain-dead organ donors at the Hospital of León. For this, a cross-sectional prospective study was developed on a retrospective cohort of patients who were admitted or died by catastrophic brain damage with the potential for organs donation. Data were collected for six months using hospital records of admissions and exitus. For the statistical analysis, the free distribution software Epi Info 3.5.4 was employed. A total of 627 patients were studied: 550 were discharged and 77 died as potential donors. Of the potential donors, 65 died in asystole, but 60 of them had an absolute contraindication to donation and 20 died after limitation of life support therapy. Five cases with donor criteria in controlled asystole were detected. The analysis found that the detection process conformed to the regulatory framework stablished by the National Transplant Organization. However, population aging leads to a high rate of absolute contraindications among detected potential donors. The donation capacity of the hospital could therefore be increased with the implementation of a donor protocol in controlled asystole.

Situación actual de la prescripción enfermera en España / Current situation of the nursing prescription in Spain

La prescripción enfermera es un tema que ha generado controversia en los últimos años. Desde hace tiempo, se viene reclamando un apoyo legal para esta tarea que las enfermeras asumen de manera habitual en su práctica clínica. Las enfermeras realizan tareas asistenciales relacionadas con pacientes crónicos, cuidados paliativos, de atención domiciliaria o de otros procesos y, en muchas ocasiones, deben tomar decisiones sin ningún respaldo legal. La primera regulación en España que hace referencia a la capacidad de las enfermeras para indicar, usar y dispensar determinados medicamentos y productos sanitarios de forma autónoma aparece en la Ley 28/2009, que modificaba la ley de garantías y uso racional de los medicamentos. En ella, también se hacía referencia a que el gobierno regularía esta competencia. El desarrollo de esta normativa no se produjo hasta el año 2015 con el Real Decreto 954/2015, que niega la posibilidad de la prescripción enfermera autónoma y genera de nuevo controversia. En los últimos meses se ha llegado a un acuerdo para modificar este real decreto, de manera que, una vez que se publique en el BOE, las enfermeras podrán prescribir en el ámbito de sus competencias, lo que supondrá el reconocimiento de sus competencias en la práctica profesional y un beneficio tanto para los pacientes como para el sistema sanitario

The nursing prescription is a subject that has generated controversy in recent years. For some time now, legal support has been demanded for this task which nurses usually assume in their clinical practice. The nurses perform care tasks related to chronic patients, palliative care, home care or other processes, and in many cases, they must make decisions without any legal backing. The first regulation in Spain that refers to the ability of nurses to indicate, use and dispense certain medicines and health products autonomously appears in Law 28/2009, which modified the law on guarantees and rational use of medicines. In it, reference was also made to the fact that the government would regulate this competence. The development of this regulation does not occur until 2015 with Royal Decree 954/2015, which denies the possibility of autonomous nurse prescription and generates new controversy. In recent months, an agreement has been reached to modify this royal decree so that, once it is published in the BOE, nurses may prescribe within the scope of their competences, which will mean the recognition of their skills in professional practice and a benefit for both patients and the health system

Is vitamin D deficiency being considered in the differential diagnosis of osteoporosis in routine practice? / ¿Está considerado el déficit de vitamina D en el diagnóstico diferencial de la osteoporosis en la práctica clínica habitual?

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Impact of the NOGG and NOF Guidelines on the Indication of Bone Mineral Density in Routine Clinical Practice.

The universal screening for osteoporosis by bone mineral density (BMD) is not feasible because of its unfavorable cost-benefit due to its low sensitivity. The aim of the present study was to estimate the population and economic impact of the diagnostic criteria of the National Osteoporosis Guideline Group (NOGG) and the National Osteoporosis Foundation (NOF) and assess the appropriateness of the BMD tests performed in routine clinical practice. A cross-sectional study was conducted in individuals referred for BMD testing who were not receiving antiresorptive therapy. The absolute risk of major and hip fracture was calculated using the British formula of the Fracture Risk Assessment Tool. NOGG and NOF guidelines diagnostic thresholds interventions were used. A total of 640 individuals were included, of which 95% were women, with a median age of 59.4 years (interquartile range = 14). When applying the NOGG criteria, BMD testing was recommended in 32.3% of the individuals, whereas this percentage increased to 75.6% with the NOF guidelines (p < 0.05). Regarding the appropriateness of the BMD tests performed, 31.9% were deemed appropriate according to both the NOGG and NOF guidelines, whereas 23.9% were considered inappropriate. In conclusion, the application of the NOGG and NOF guidelines led to a decrease in BMD indications, reducing costs and improving efficiency in the diagnostic management of osteoporosis, although variability exists between the guidelines.

Análisis de la utilización de anfotericina B liposomal / Analysis of the use of liposomal amphotericin B

Antecedentes. El aumento en los últimos años de pacientes inmunodeprimidos y el uso de fármacos citotóxicos e inmunosupresores ha aumentado la incidencia de infecciones fúngicas invasivas. Objetivos. Evaluar la utilización de anfotericina B liposomal de acuerdo con la indicación, la dosis, la efectividad y la nefrotoxicidad. Métodos. Estudio retrospectivo de un período de 8 años donde se tomaron como referencia las indicaciones y posología descritas en la ficha técnica. La efectividad se midió en función de la resolución de la infección, no recurrencia o aparición, supervivencia a los 7 días, no suspensión y no adición de otro antifúngico. La efectividad se analizó en función de indicación, dosis, duración del tratamiento, dosis acumulada y comorbilidad. La nefrotoxicidad fue medida como un aumento de la creatinina sérica por encima de 2 veces la basal. Resultados. Se trataron 47 episodios, de los cuales el 91,5% de los tratamientos se ajustaron a las indicaciones. Se logró efectividad en un 44,7% de los casos: 33% en neutropénicos, 50% de las aspergilosis, 60% de las candidiasis y 100% de las leishmaniasis. Las tasas de respuesta en los tratados durante ≤ 15 días y > 15 días fueron de 25 y 56,5% (p = 0,039), respectivamente. Las causas principales del fracaso fueron exitus (23%) y falta de efectividad (17%). Un 9% de los pacientes sufrió nefrotoxicidad. Conclusiones. Los datos de efectividad y nefrotoxicidad concuerdan con los obtenidos en otros estudios. Su efectividad se ha visto asociada con la duración del tratamiento. La anfotericina B liposomal es un fármaco seguro con efectividad moderada (AU)

Background. The increase in immunosuppressed patients and in the use of cytotoxic and immunosuppressive agents in the last few years has led to a rise in the incidence of invasive fungal infections. Aims. he objective of this study is to evaluate the use of liposomal amphotericin B according to its indication, dosage, effectiveness and nephrotoxicity. Methods. This is a retrospective study over a 8 year-period. Indications and dosage described in the Summary of Product Characteristics were taken as reference. Effectiveness was measured in terms of resolution of infection, no recurrence or emergence, survival at 7th day, no discontinuation and no addition of another antifungal. Effectiveness was also analysed in relation to indication, dosage, treatment duration, cumulative dose and comorbidity. Nephrotoxicity was defined as a doubled serum creatinine when compared with basal values. Results. A total of 47 episodes were analysed, with 91.5% of treatments being adequate for the indications. Effectiveness was achieved in 44.7% of cases: 33% in neutropenic patients, 50% of aspergillosis, 60% of candidiasis, and 100% of the leishmaniasis. Response rates in patients treated for 15 days or less and those for more than 15 days were 25 and 56.5% (P = .039), respectively. The main causes of failure were death (23%) and lack of effectiveness (17%), with 9% of patients suffering from nephrotoxicity. Conclusions. The effectiveness and nephrotoxicity data agree with those obtained in other studies. Liposomal amphotericin B is a safe drug with a moderate effectiveness that is associated with the duration of the treatment (AU)

[Analysis of the use of liposomal amphotericin B]. / Análisis de la utilización de anfotericina B liposomal.

BACKGROUND: The increase in immunosuppressed patients and in the use of cytotoxic and immunosuppressive agents in the last few years has led to a rise in the incidence of invasive fungal infections. AIMS: The objective of this study is to evaluate the use of liposomal amphotericin B according to its indication, dosage, effectiveness and nephrotoxicity. METHODS: This is a retrospective study over a 8 year-period. Indications and dosage described in the Summary of Product Characteristics were taken as reference. Effectiveness was measured in terms of resolution of infection, no recurrence or emergence, survival at 7th day, no discontinuation and no addition of another antifungal. Effectiveness was also analysed in relation to indication, dosage, treatment duration, cumulative dose and comorbidity. Nephrotoxicity was defined as a doubled serum creatinine when compared with basal values. RESULTS: A total of 47 episodes were analysed, with 91.5% of treatments being adequate for the indications. Effectiveness was achieved in 44.7% of cases: 33% in neutropenic patients, 50% of aspergillosis, 60% of candidiasis, and 100% of the leishmaniasis. Response rates in patients treated for 15 days or less and those for more than 15 days were 25 and 56.5% (P=.039), respectively. The main causes of failure were death (23%) and lack of effectiveness (17%), with 9% of patients suffering from nephrotoxicity. CONCLUSIONS: The effectiveness and nephrotoxicity data agree with those obtained in other studies. Liposomal amphotericin B is a safe drug with a moderate effectiveness that is associated with the duration of the treatment.