Discursive analysis of nursing care toward childhood fever and its contextual differences: An ethnomethodological study.

Fever is the most common clinical sign during infancy. Nurses deal with fever in children most directly and it is an integral aspect of their role as pediatric nurses. The objective of this study is to analyze the perceptions, knowledge and attitudes toward childhood fever of nurses in three health contexts: pediatric hospitalization, pediatric emergency and primary care. To respond this objective, a qualitative study with ethnomethodological approach has been carried out. In-depth interviews were conducted and theoretical clinical cases were presented to nurses working in pediatrics in the three settings studied. After the analysis of the discourses, the codes were classified into three categories: static and number-centric knowledge, dependent nursing attitude, and unconscious model nurses. On the one hand, when we analyze and compare the perceptions, attitudes and knowledge of the nurses between the different contexts, we find differences that consist mainly of what the context requires of them. On the other hand, in general and regardless of the context, the nurses interviewed place themselves in a traditional framework when faced with the phenomenon of fever in children.

Discursive Analysis of Pediatrician's Therapeutic Approach towards Childhood Fever and Its Contextual Differences: An Ethnomethodological Study.

Introduction: Fever stands out as the predominant clinical indicator in infancy. Pediatricians encounter fever routinely in their daily practice, playing a crucial role in their interactions with children and families. Objective: The aim is to examine pediatricians' viewpoints, understanding, and approaches regarding childhood fever in two healthcare settings: pediatric hospitalization (emergency and inpatient ward) and primary care. Methods: A qualitative study was conducted using an ethnomethodological approach. Pediatricians working in the specified pediatric settings participated in in-depth interviews where theoretical clinical cases were presented for analysis. Results: Following the examination of the discourses, the codes were organized into eight categories: Understanding of fever, Significance ascribed to fever, Therapeutic strategies, Engagement with the evidence, Family apprehensions regarding fever, Influence of the COVID-19 Pandemic, Inter- and intra-professional relationships, and Suggestions for change: Conclusions: Pediatricians acknowledge the importance of addressing discomfort in the treatment of fever, but express challenges in implementing these recommendations. Pediatricians in inpatient settings emphasize the need for enhanced parental education from primary care, while those in primary care recognize the potential for improvement. Inpatient pediatricians are open to implementing changes in their daily practices, particularly concerning the administration of antipyretics.

Pain assessment tools in adults with communication disorders: systematic review and meta-analysis.

BACKGROUND: Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS: A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS: Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS: While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION: This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses.

AIM: To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND: Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN: A qualitative phenomenological approach was used. METHODS: Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS: Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS: The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE: The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.

Analysis of the perceptions, knowledge and attitudes of parents towards fever in children: A systematic review with a qualitative meta-synthesis.

Fever is the most common symptom in childhood. Despite its prevalence and decades of education and research, the treatment of fever and febrile illnesses continues to cause concern and anxiety in parents. The objective of this systematic review with meta-synthesis is to analyse parents' perceptions, knowledge and attitudes towards the febrile child and how they influence the construction of the concept of fever. The PRISMA international standards and PRISMA checklist, as well as the Cochrane recommendations, were followed. Articles with qualitative methodology have been selected that analyse what fever means to parents, what their concerns about this sign are, where they get their information and what their expectations are of healthcare professionals during treating their feverish child. Finally, 17 articles that met the inclusion criteria were added in the qualitative meta-synthesis. The concept of fever has been represented as a non-harmful sign in and of itself, an aspect that emerges in fathers and mothers' discourse. Meanwhile, the perceived need to lower the temperature still appears to be the main aim of their approach, with attitudes implying an emergency to reach normothermia, focusing on temperature as the primary indicator of severity.

Conocimientos y actitudes de los profesionales sanitarios en Cantabria e Islas Baleares sobre voluntades previas / What do health professionals know about living wills in Cantabria and the Balearic Islands

Objetivo: Explorar los conocimientos y actitudes de los profesionales sanitarios con relación a las voluntades previas en dos regiones de España: Cantabria e Islas Baleares. Metodología: Estudio descriptivo transversal mediante cuestionario autoadministrado online. Se analizaron variables sociodemográficas, conocimientos y actitudes relacionados con las voluntades previas. El estudio se aprobó por el Comité Ético de Investigación Clínica de Cantabria. Resultados: Respondieron al cuestionario 274 profesionales sanitarios, de Cantabria 222 y de Islas Baleares 52. Un 75,6% respondió que otorgaría documento de voluntades previas y un 86,6% que lo recomendarían a sus pacientes crónicos. Un 15,5% expresó sentirse preparado para informar, un 95,2% que desearía recibir formación. Las enfermeras tuvieron más conocimientos concretos que otros profesionales con relación al procedimiento, validez y consulta del documento. Cantabria y Baleares presentaron diferencias estadísticamente significativas en intención de otorgar (p = 0,005) y en haber consultado o propuesto consultar el Registro de Voluntades Previas durante la práctica profesional (p = 0,000), en ambos casos con mayor porcentaje en Cantabria. Conclusiones: La percepción de los profesionales acerca de sus conocimientos relacionados con las voluntades previas es escasa, y su actitud es de respeto a estas, y las consideran útiles para todos los implicados. Su especial relevancia en la población de mayor edad constituye a las enfermeras especialistas en enfermería geriátrica-gerontológica principales beneficiarias e impulsoras de las voluntades previas (AU)

Objective: To explore knowledge and attitudes towards advance directives in health professionals from Cantabria and the Balearic Islands. Methodology: Cross-sectional study using an online validated questionnaire. Main measurements were sociodemographic variables, knowledge and attitudes towards Advance directives. The study was approved by the Cantabrian Ethics Committee. Results: 274 health professionals, from Cantabria 222 and the Balearic Islands 52, responded to the questionnaire. 75.6% of professionals would grant their own Living Will Declaration, and 86.6% would tell their chronic patients to. 15.5% felt prepared enough to inform their patients, 95.2% would like to receive training. Nurses have higher knowledge about procedure, validity and consulting the living will than other health professionals. Cantabria and the Balearic Islands show statistical significance in two items: intending to grant (p = 0.005) and had consulted or proposed to consult the living will of a patient during professional practice (p = 0.000), being higher for Cantabria for both items. onclusions: Health professionals have low knowledge about Advance Directives. They think it is a useful instrument for patients and for themselves. They would respect them. Professionals have little training in living wills and do not feel they could inform their patients properly. They would like to receive training irrespective of age, time working, current job, or experience. Specially important in elderly people, advance directives turn capital for geriatric specialized nurses both as receptors and as developers of this issue (AU)

Validation of Content for an App for Caregivers of Stroke Patients through the Delphi Method.

The aim of this study was to reach a consensus among experts (using the Delphi technique) to validate the informative content that should be included in an App to be used by informal caregivers of stroke patients in order to improve their quality of life, facilitating access to the health care system and involving them in their own health. This technique was developed between June and December 2021. The group of experts was selected on the basis of previously established criteria, and the coefficient of variation (v) was used as a measure of consensus. In addition, the concordance index was calculated to determine the stability of the different rounds. In the first round, the preliminary content, previously elaborated by the research group, was evaluated as very appropriate for the objectives set (N-P < 1.07). In addition, averages of 4.5 out of five and a coefficient of variation of less than 0.5 were obtained, confirming the consensus. In the second round, suggestions were made by the experts on how to improve the content of the information, obtaining 100% agreement with the results obtained in the first round. The results obtained allow a positive evaluation of the use of the Delphi method for the elaboration of the information to be housed in an App.

Injuries, Pain, and Catastrophizing Level in Gymnasts: A Retrospective Analysis of a Cohort of Spanish Athletes.

Physical and psychological demands from gymnastics increase the occurrence of injuries and pain among athletes, whose consequent level of catastrophizing could affect rehabilitation and performance. Although the characteristics of each gymnastics discipline may be key factors, they remain unclear. This study aimed to describe injuries, pain, and catastrophizing levels of gymnasts, according to their discipline and training characteristics. A total of 160 gymnasts fulfilled an online survey at the end of the 2021 season. Eighty gymnasts sustained 106 injuries (mainly ankle), and 128 had current pain (mainly low back). Although results were similar among disciplines, rhythmic gymnasts had a higher prevalence of low back pain (p = 0.003) and artistic wrist pain (p = 0.011). Gymnasts who sustained an injury displayed higher hours of training (p = 0.026), and those with current pain had more sports experience (p = 0.001) and age (p < 0.001). A higher catastrophizing level was observed in injured gymnasts and correlated with pain level (p < 0.001). No other differences were found (p > 0.05). Pain and injury prevalence is extremely high among gymnasts, being specific to the gymnastics discipline and increasing catastrophizing experience. Hours of training, age, and sports experience are key related factors, regardless of discipline.

Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis.

Background: /Objective: Combining blood flow restriction (BFR) with endurance training is exponentially increasing although the benefits are unclear in trained athletes. We aimed to describe the effects of aerobic and/or anaerobic training programmes combined with BFR on the aerobic capacity and related sport performance of trained athletes. Methods: Databases used were MEDLINE, SPORTDiscus, LILACS, IBECS, CINHAL, COCHRANE, SCIELO and PEDro, through October 2021. For study selection, criteria included (a) clinical trials that recruited trained healthy athletes, that (b) proposed BFR in combination with aerobic/anaerobic training programmes (≥8 sessions) and that (c) evaluated either aerobic capacity or related sport performance. For data extraction, a reviewer extracted the data, and another reviewer independently verified it. The tool RoB 2 (Risk of bias 2) was used to assess risk of bias. Results: Ten studies met the eligibility criteria, capturing a total of 207 participants. Although it did not reveal any significant effects from training with BFR on aerobic capacity compared to the same training without BFR, effect sizes were extremely high. Subgroup analyses according to the intensity of the training programmes found similar results for low-to-moderate or high-intensity training compared to the same sessions without BFR. Conclusion: Although adding BFR to training sessions always produce benefits from baseline in aerobic capacity and sport performance of trained athletes, these results are not better than those observed after the same training sessions without BFR. The reduced number of studies, small sample sizes and some concerns regarding risk of bias should be highlighted as limitations. Registration number: CRD42021248212.

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it.

Background: Although the emotional and psychological impact of nurses' work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health. Aim: The objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors. Design: A cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021. Methods: Sociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates. Findings: About 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses. Conclusion: Given the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated. Impact: Given these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.

Comparison between attention and experiences of chronic complex patients: A multicentric study.

The aim of this research is to explore and analyse the functional status and experiences of complex patients located at levels 3-4 of the risk pyramid of the chronic care model in primary care, within the hospital system of two regions in Spain. The design was a mixed design (COREQ). The participants were enrolled in programs for chronic complex patients and their caregivers. Sociodemographic variables were gathered, together with the following measures: the Barthel test, the Mini mental test, the Zarit questionnaire, the IEXPAC scale and the Braden scale. A semi-structured interview was conducted individually with patients in order to explore their experiences and narrative on the process of their illness and the support they had received. The sample comprised 206 chronic pluripathological patients, of whom 103 were from Cantabria and a further 103 were from Mallorca. The patient profile in both regions was very similar. There was an equal distribution across both gender and the patients were over 78 years old. They all had a basic (primary) education, an average income and required moderate physical dependence, receiving assistance primarily from their children. The qualitative analysis highlighted patients' awareness of the illness and their concern for the future, noting that, overall, patients were satisfied with the care provided by their caregivers and the health system. We can conclude that is the first multicentric study of these characteristics conducted in Spain, despite it being the country with the second largest ageing population in the world. It is important to test new organisational models with differentiating areas of advanced clinical practice in primary care, whereby both patients and their caregivers can be co-responsible within the care process.

Knowledge and attitudes towards living wills among healthcare professionals, residents and relatives in nursing homes: A qualitative study.

Living wills are a tool to support the principle of autonomy in end-of-life situations, when the person does not have the capacity to make decisions. The aim was to explore the knowledge and attitudes of residents, relatives and healthcare professionals in nursing homes in Cantabria regarding living wills. A qualitative phenomenological design was conducted. Two focus groups were held with seven participants in each group. A sample of 14 people participated in this study: four residents, five relatives and five professionals. This study was approved by the Clinical Research Ethics Committee of Cantabria. Two main categories were found, with six subcategories each: death, with six subcategories-as a social taboo, as a natural process, facing death, accompanying uncertainties, unnecessary lengthening of life and guilt-and living wills, with six subcategories-knowledge, unknowingness or misconceptions, usefulness, strategies to promote dissemination, intention of granting a living will and the professional's role in restricting or promoting autonomy. Unknowingness or misconceptions and uncertainties in relation to death were the most represented subcategories of each category. Although the attitudes among the study participants were mostly positive, there is a lack of knowledge concerning living wills, which is enhanced by the social taboo related to death.

Analysis of Nurses' and Physicians' Attitudes, Knowledge, and Perceptions toward Fever in Children: A Systematic Review with Meta-Analysis.

CONTEXT: Fever is a common symptom in children that nurses and pediatricians treat. Although it is a common sign in clinical practice, fever instills irrational fears in parents that health professionals share. OBJECTIVE: To investigate whether doctors' and nurses' knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children's fever. DATA SOURCES: A systematic review with meta-analysis was conducted with PRISMA international standards and the Cochrane recommendations. STUDY SELECTION: Articles examining health professionals' (doctors and/or nurses) knowledge, perceptions, and/or attitudes toward fever in children and the use of antipyretics were selected for the study. DATA EXTRACTION: The qualitative analysis was carried out by classifying the articles according to the applied educational programs for nurses related to fever care for children that evaluated different outcomes to determine their efficacies. RESULTS: For the qualitative synthesis, 41 articles were included, and 5 of these were taken in meta-analysis, which measured the effectiveness of educational programs for fever management in nurses. LIMITATIONS: All of the included studies generally had a high risk of bias. CONCLUSION: According to the evidence reviewed, nurses' and physicians' perceptions and attitudes regarding fever management in children indicate an overtreatment of this sign. We can give a recommendation grade of D on the use of educational programs to modify attitudes, perceptions, and knowledge about fever in children and improve clinical practice in nurses.

Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting.

This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships, patient-professional relationships, and moral ethics critique. Foucault tried to break loose from the self, which is merely the result of a biopolitical subjectivation and constituted an interpersonal level. From this, different elements involved in the decision-making capacity of patients in a clinical setting were analysed. Firstly, the context in which decision-making occurs has been explained, distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations. Secondly, an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called "techniques of the self". Finally, the ethical framework for a subject's "self-creation", insisting more on the exercises of self-subjectivation, reinforcing the ethics of the self by itself, the "care of the self", has been explained. The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient's autonomy in the clinical environment is constituted. All these elements could generate grounded theory on the qualitative methodology of this phenomenon. The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making, relegating to the background their opinions and beliefs. Consequently, a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

Therapeutic exercise to improve pelvic floor muscle function in a female sporting population: a systematic review and meta-analysis.

BACKGROUND: Despite the high prevalence of pelvic floor dysfunction (PFD) among women who participate in sports, and the efforts made to affect these pathologies through pelvic floor muscle (PFM) training, its effects on PFM function remain unclear. OBJECTIVE: To evaluate the effects of therapeutic exercise programmes on PFM function and quality of life in female athletes and physically active women. DATA SOURCES: The following databases were searched: MEDLINE, SCIELO, LILACS, SPORTDiscus, SCOPUS, CINHAL, SCIELO, PEDro, ScienceDirect and COCHRANE from January 2010 to May 2020. STUDY SELECTION: Study selection criteria included clinical trials that recruited either female athletes or physically active women, and evaluated the effects of therapeutic exercise programmes on PFM function. DATA SYNTHESIS: Ten studies met the eligibility criteria, capturing a total of 246 participants, of which 180 were apparently healthy individuals and 66 suffered from PFD. RESULTS: Meta-analysis revealed significant improvements in maximal voluntary contraction of the PFMs and reduction of urine leakage after the exercise programmes, although no effects were found for vaginal resting pressure. LIMITATIONS: Most of the studies reviewed had a small sample size and a high risk of bias. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Data suggest the benefits of therapeutic exercise on PFM function, PFD symptoms and quality of life after therapeutic exercise programmes in women who participate in sports. Incorporating therapeutic exercises designed to increase PFM function into physical activity routines could be beneficial for both healthy women and those suffering from PFD. However, due to the stated limitations, firm conclusions cannot be made. Systematic Review Registration Number PROSPERO CRD42020167243.

Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos / I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial

Objetivo: Comparar la vía aérea básica y la vía aérea avanzada con el dispositivo supraglótico I-Gel®, por medio de la capnografía durante la RCP intermedia. Diseño: Estudio piloto experimental aleatorizado por grupos. Emplazamiento: Asistencia extrahospitalaria en unidades de soporte vital básico en la isla de Mallorca. Participantes: Adultos atendidos tras parada cardiorrespiratoria de origen no traumático. Intervenciones: Manejo de la vía aérea avanzado durante la RCP instrumental con I-Gel® o básica con bolsa-válvula-mascarilla, bajo monitorización capnográfica. Mediciones principales: Niveles capnométricos obtenidos según dispositivo empleado, número de inserciones de la I-Gel®, casos sin conseguir una correcta inserción/ventilación por ramas, consecución de ROSC en la RCP y número de ingresos vivos hospitalarios. Resultados: Se reclutaron 23 casos para su análisis. La tasa de éxito de inserción de la I-Gel® fue 92,9% al primer intento, los valores capnométricos medios fueron de 16,3mmHg en grupo control y de 27,4% en el grupo intervención. El 34,8% (n=8) de los pacientes alcanzó recuperación, circulación espontánea en algún momento y el 26,1% (n=6) ingresaron vivos en el hospital. El análisis de supervivencia, atendiendo a la llegada de la unidad y el primer minuto de ventilaciones registrados junto a la variable ingreso vivo hospitalario sugiere una cierta tendencia hacia una mayor supervivencia en la rama intervención (P=0,066). Conclusiones: El uso de la I-Gel® suscita una mejora en la ventilación de los pacientes en PCR, evidenciado por los valores capnométricos medios en el grupo intervención, no encontrándose correlación con variables de resultado de la RCP.(AU)

Objective: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. Design: Randomized experimental pilot study by groups. Setting: Out-hospital care basic life support units on the Island of Mallorca. Participants: Adults attended after cardiorespiratory arrest of non-traumatic origin. Interventions: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. Main measurements: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. Results: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). Conclusions: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.(AU)

e-Health as a tool to improve the quality of life of informal caregivers dealing with stroke patients: Systematic review with meta-analysis.

OBJECTIVE: The objective of this review was to elucidate the evidence related to utilizing e-Health as a tool in improving the quality of life of informal caregivers of dependent patients due to cerebrovascular accident (CVA). METHODS: This systematic review with meta-analysis includes 13 studies. For these studies, seven databases were searched between 2009 and 2019. A random-effects model was adopted for overall estimation and to explain the heterogeneity. RESULTS: A random-effects model was adopted for overall estimation and to explain heterogeneity. The results did not demonstrate statistical significance (p<0.05) and low heterogeneity (I2  = 0). CONCLUSIONS: There is a tendency toward improvement in psychological health, solving care-related problems, as well as better prevention of problems arising from the burden. Therefore, new studies with larger sample size and primarily to conduct them for more than 6 months for the accuracy. CLINICAL RELEVANCE: This study reflects a trend toward improving psychological health, solving care-related problems, as well as improved the prevention of problems arising from the burden.

Educational intervention: Improving the knowledge and attitudes of health professionals on living wills.

BACKGROUND: Health professionals have limited knowledge of advanced directives or living wills, which may hamper understandings among the general population. This could impact on the current low registration rates for advanced directives. OBJECTIVE: To evaluate a single-group educational intervention to improve the knowledge and attitudes concerning advanced directives in the short and medium term among health professionals working in nursing homes for older adults. DESIGN: An educational intervention was carried out. SETTINGS: Fourteen nursing homes in Cantabria, Spain. PARTICIPANTS: 201 healthcare professionals. METHODS: A theoretical presentation, questions and debates took place between November 2018 and May 2019. Baseline, post-intervention, and follow-up measurements were made to evaluate knowledge and attitudes towards advanced directives. Descriptive and inferential statistical analyses were performed using the Student's t-test and the one-factor ANOVA. ETHICAL CONSIDERATIONS: This study was approved by the Clinical Research Ethics Committee of Cantabria. FINDINGS: No statistically significant differences were found for any of the socio-demographic variables at baseline, post-intervention, or follow-up. In relation to the baseline questionnaire, knowledge and attitudes increased after the intervention (p = .000 for both blocks of questions) as well as in the follow-up questionnaire (p = .000 for both blocks). DISCUSSION: A single-group educational intervention increases knowledge and improves attitudes towards advanced directives. Educated professionals can become health agents in this area, which can lead to an increase in the registration of advanced directives. CONCLUSIONS: Educational interventions represent a cost-effective measure that may provide benefits at the end of life for patients and their families, as well as for the healthcare team.

[I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial]. / Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos.

OBJECTIVE: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. DESIGN: Randomized experimental pilot study by groups. SETTING: Out-hospital care basic life support units on the Island of Mallorca. PARTICIPANTS: Adults attended after cardiorespiratory arrest of non-traumatic origin. INTERVENTIONS: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. MAIN MEASUREMENTS: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. RESULTS: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). CONCLUSIONS: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.

Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review.

BACKGROUND: Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography. OBJECTIVE: The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices. REVIEW METHODS USED: This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols. DATA SOURCES: A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019. REVIEW METHODS: Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme. RESULTS: Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation. CONCLUSIONS: The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.