Visita de los menores de edad en una unidad de cuidados intensivos. ¿Qué opina el personal sanitario? / Visit of minors in an intensive care unit. What is the opinion of health staff?

OBJETIVO: Determinar las opiniones del equipo asistencial (EA) ante la visita de menores en una unidad de cuidados intensivos de adultos. MÉTODO: Estudio descriptivo transversal en una unidad de cuidados intensivos de adultos con un EA de 62 personas, entre septiembre-diciembre 2017. Se utilizó el cuestionario de Knutsson con 10 preguntas cerradas con espacio para comentarios y 2 abiertas. Selección de los encuestados mediante muestreo de conveniencia. Estadística descriptiva con frecuencias absolutas y porcentajes. Prueba de Chi2 o Fisher. Significación p < 0,05. RESULTADOS: Se recogieron 61 cuestionarios: 70,5% correspondían a personal de enfermería (PE). El 50% de profesionales médicos (PM) restringiría la entrada de menores de 0-6 años frente al 76,2% de PE (p = 0,04). Entre 7-12 años, el 16,7% de PM la limitaría frente al 46,5% del PE (p = 0,02). El 75% del EA opinó que la entrada podía significar riesgo de infección para el menor. El 60% creyó que el entorno podía intimidarlo y el 66,7% que podía impresionarlo el estado del paciente. Permitirían la entrada de menores de 0-6 años, si el paciente se estuviera muriendo (70,6% PM y 41% PE) p = 0,04), despierto (77,8% PM y 57,5% PE) o parentesco cercano (padre/madre) (66,7% PM y 60% PE). CONCLUSIONES: El EA es partidario de la visita con una edad > 6 años. En circunstancias especiales: parentesco cercano, paciente despierto o muerte son más permisivos independientemente de la edad. Los motivos de restricción son: entorno, estado y riesgo de infección. El PE es más restrictivo ante la visita

AIM: To determine the opinion of healthcare staff (HS) on the presence of minors in an adult intensive care unit. METHOD: Transversal descriptive research study in an adult intensive care unit with 62 people, between September/December 2017. The Knutsson questionnaire was used with 10 closed questions with space for comments, and 2 open questions. Selection of the respondents was by means of convenience sampling. Descriptive statistics with absolute frequencies and percentages. Chi-squared-test or Fisher. Significance p < .05. RESULTS: 61 questionnaires were collected: 70.5% nursing staff (NS). Fifty percent of medical staff (MS) would restrict the entry of 0 to 6-year old minors versus 76.2% NS (p = .04). Of the MS, 16.7% would restrict the visits of minors between the ages of 7 and 12 versus 46.5% NS (p=.02). Seventy-five percent of HS thought that minors' access could entail a risk of infection for the children. Of the survey respondents, 60% believed that the environment could intimidate the minor, and 66.7% thought that the patient's condition could affect the child. They would permit 0-6-year-old minors to access the ICU if the patient was dying (70.6% MS/41% NS, p = .04), awake and alert (77.8% MS/57.5% NE) and close relatives (parents) (66.7% MS/60% NS). CONCLUSIONS: HS support minors visiting an adult adult intensive care unit if they are > 6 years old. HS show a more positive attitude towards visits in special circumstances such as close relatives, awake patient, and death regardless of their age. The reasons for restriction of visits are: environment, patient's condition and risk of infection. NS show a less positive attitude in relation to visits

Visit of minors in an intensive care unit. What is the opinion of health staff? / Visita de los menores de edad en una unidad de cuidados intensivos. ¿Qué opina el personal sanitario?

AIM: To determine the opinion of healthcare staff (HS) on the presence of minors in an adult intensive care unit. METHOD: Transversal descriptive research study in an adult intensive care unit with 62 people, between September/December 2017. The Knutsson questionnaire was used with 10 closed questions with space for comments, and 2 open questions. Selection of the respondents was by means of convenience sampling. Descriptive statistics with absolute frequencies and percentages. Chi-squared-test or Fisher. Significance p<.05. RESULTS: 61 questionnaires were collected: 70.5% nursing staff (NS). Fifty percent of medical staff (MS) would restrict the entry of 0 to 6-year old minors versus 76.2% NS (p=.04). Of the MS, 16.7% would restrict the visits of minors between the ages of 7 and 12 versus 46.5% NS (p=.02). Seventy-five percent of HS thought that minors' access could entail a risk of infection for the children. Of the survey respondents, 60% believed that the environment could intimidate the minor, and 66.7% thought that the patient's condition could affect the child. They would permit 0-6-year-old minors to access the ICU if the patient was dying (70.6% MS/41% NS, p=.04), awake and alert (77.8% MS/57.5% NE) and close relatives (parents) (66.7% MS/60% NS). CONCLUSIONS: HS support minors visiting an adult adult intensive care unit if they are>6 years old. HS show a more positive attitude towards visits in special circumstances such as close relatives, awake patient, and death regardless of their age. The reasons for restriction of visits are: environment, patient's condition and risk of infection. NS show a less positive attitude in relation to visits.

Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos / Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units

Objetivos: Determinar el grado de conocimientos de las enfermeras sobre el uso de contenciones mecánicas en las unidades de críticos y los factores relacionados. Método: Estudio multicéntrico, observacional, en 12 unidades de críticos de 8 hospitales en España (n = 354 enfermeras). Se elaboró una encuesta ad-hoc de conocimientos cuyo contenido fue validado por expertos. La encuesta obtuvo una estabilidad test-retest de CCI = 0,71 (IC 95%: 0,57-0,81) en un estudio piloto previo. El instrumento final quedó conformado por 8 ítems. Se recogieron datos sociodemográficos y profesionales de los participantes, así como variables estructurales y clínicas de las unidades a estudio. Se llevó a cabo un análisis descriptivo y de asociación entre variables. Se consideró estadísticamente significativo un valor de p < 0,05. Resultados: Respondieron 250 enfermeras (70,62%), con una edad media de 36,8 (DE 9,54) años y una media de 10,75 (DE 8,38) años de experiencia profesional en unidades de críticos. El 73,6% no había recibido formación previa sobre contenciones mecánicas. La media de conocimientos fue de 4,21 (DE 1,39) (rango 0-8). El grado de conocimientos se asoció al hospital de referencia (p < 0,001). Las enfermeras con mayor grado de conocimientos es más probable que trabajen en unidades con consentimiento informado para el uso de contenciones mecánicas (p < 0,001); visita familiar flexible (p < 0,001); y que dispongan de protocolo de analgosedación (p = 0,011), o que la enfermera tenga autonomía en el manejo de la analgosedación (p < 0,001). Ningún dato sociodemográfico ni profesional individual se asoció al grado de conocimientos. Conclusiones: Es necesaria una mayor formación de las enfermeras sobre el uso de contenciones mecánicas. El entorno de trabajo donde se desarrollan los cuidados tiene una gran influencia en el grado de conocimientos de las enfermeras sobre esta intervención

Objectives: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. Method: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n = 354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. Results: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p < .001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p < .001); flexible family visiting (p < .001); analgo-sedation protocol (p = .011), and units in which nurses had autonomy to manage analgo-sedation (p < .001). Individual sociodemographic and professional data was not associated with knowledge level. Conclusions: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention

Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units. / Análisis de una encuesta sobre conocimientos en contenciones mecánicas de las enfermeras de unidades de críticos.

OBJECTIVES: To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. METHOD: A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n=354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. RESULTS: Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p<.001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p<.001); flexible family visiting (p<.001); analgo-sedation protocol (p=.011), and units in which nurses had autonomy to manage analgo-sedation (p<.001). Individual sociodemographic and professional data was not associated with knowledge level. CONCLUSIONS: Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention.

Effects of polymorphism rs3123554 in the cannabinoid receptor gene type 2 (CB2R) on metabolic and adiposity parameters after weight loss with two hypocaloric diets.

BACKGROUND: The role of CB2R gene variants on weight loss after a dietary intervention remained unclear. OBJECTIVE: Our aim was to analyze the effects of rs3123554 of CB2R receptor gene on metabolic and adiposity parameters after two different hypocaloric diets in obese subjects. DESIGN: A Caucasian population of 280 obese patients was enrolled. Patients were randomly allocated during 3 months to one of two diets (Diet I - moderate in carbohydrate. Vs Diet II - normal in carbohydrate). RESULTS: In both genotype groups (GG vs GA + AA), body weight, body mass index (BMI), fat mass, waist circumference and systolic blood pressure decreased after diet I and II. The decrease of these parameters was higher in non A allele carriers than A allele carriers. Pre- and post-dietary intervention, body weight, BMI, fat mass and waist circumference were higher in A allele carriers than non A allele carriers. In non A allele carriers, the decrease of glucose, insulin, HOMA-IR and Interleukin-6 levels was higher than A allele carriers after both diets. CONCLUSION: Carriers of the minor allele of rs3123554 variant of CB2R gene loose less body weight during two different hypocaloric diets. The improvement of metabolic parameters was better in no A allele carriers than A allele carriers.

Incidencia de lesiones cutáneas asociadas a la humedad en una unidad de cuidados intensivos / Incidence of moisture-associated skin damage in an intensive care unit

Objetivos: Determinar la incidencia de las lesiones cutáneas asociadas a la humedad (LESCAH) en el área del pañal, identificar los factores predisponentes y conocer las medidas preventivas y registros realizados. Metodología: Estudio descriptivo longitudinal (junio de 2014-abril de 2015) en una UCI polivalente. Se incluyeron pacientes con estancia > 48 h y sin lesiones cutáneas. Se valoró diariamente la piel hasta la aparición de LESCAH, alta o un máximo de 14 días. Se registraron datos demográficos, estancia, tipo de LESCAH, incontinencia, consistencia y número de deposiciones, obesidad, escala Braden y prevención. Resultados: Se estudiaron 145 pacientes (66,2% hombres), la mediana de edad fue 69 (P25 = 56,5-P75 = 76) años y la estancia de 5(P25 = 3-P75 = 11,25) días, el 29,9% presentó obesidad. Se detectó un 26,2% de dermatitis asociada a la incontinencia (DAI) y un 15,9% dermatitis intertriginosa (DI). Se registró el 23,8% de las LESCAH. Las variables relacionadas con la DAI fueron la incontinencia fecal, número de deposiciones, heces líquidas y estancia. Para la DI fueron la obesidad y la puntuación en la escala Braden. El análisis multivariable seleccionó la incontinencia fecal (OR = 5,4; IC 95%:1,1-26) y el número de deposiciones (OR = 1,1; IC:1,0-1,2) como variables independientes para desarrollar DAI y la obesidad (OR=2,8; IC95%:1,0-8,2) y escala Braden (OR =0,8; IC95%:0,7-1,0) para desarrollar DI. Se realizó prevención al 23,8% de los obesos y al 42,9% de los incontinentes. Conclusiones: Existe una elevada incidencia en LESCAH. Tener incontinencia fecal y mayor número de deposiciones son factores de riesgo para desarrollar DAI. La obesidad y una puntuación menor en la escala Braden predisponen a sufrir DI. El registro de las LESCAH y la prevención en pacientes de riesgo es insuficiente

Objectives: To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records. Method: Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48 hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded. Results: 145 patients (66.2% male) were studied, median age was 69 (P25 = 56.5, P75 = 76) and median length of stay was five days (P25 = 3, P75 = 11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR = 5.4, CI95%: 1.1-26) and the number of stools (OR = 1.1, CI 95%:1.0-1.2) as independent variables for developing IAD and obesity (OR = 2.8, CI 95%:1.0-8.2) and Braden (OR = 0.8, CI 95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed. Conclusions: There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient

Incidence of moisture-associated skin damage in an intensive care unit. / Incidencia de lesiones cutáneas asociadas a la humedad en una unidad de cuidados intensivos.

OBJECTIVES: To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records. METHOD: Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded. RESULTS: 145 patients (66.2% male) were studied, median age was 69 (P25=56.5, P75=76) and median length of stay was five days (P25=3, P75=11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR=5.4, CI95%: 1.1-26) and the number of stools (OR=1.1, CI95%:1.0-1.2) as independent variables for developing IAD and obesity (OR=2.8, CI95%:1.0-8.2) and Braden (OR=0.8, CI95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed. CONCLUSIONS: There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient.