Diferencias entre pacientes institucionalizados y pacientes en atención domiciliaria en la provincia de Sevilla / Differences between institutionalized patients and those included in a home care program in Seville

OBJETIVO: Conocer las características y las diferencias clínicas entre pacientes institucionalizados y los de programas de atención domiciliaria. DISEÑO: Estudio observacional descriptivo transversal multicéntrico. EMPLAZAMIENTO; Sevilla, 2016. PARTICIPANTES: Un total de 1.857 pacientes ancianos (1.441 institucionalizados y 416 en domicilio). MEDICIONES: Las variables estudiadas fueron: sexo, edad, estado civil, apoyo familiar, patologías, criterios de pluripatología y fármacos. Se valoraron el estado funcional y el cognitivo mediante las escalas de Barthel, Lawton-Brody y Pfeiffer. RESULTADOS: Un 71,40% fueron mujeres. Estadísticamente el hecho de estar institucionalizados o vivir en el domicilio se relaciona con las siguientes patologías y categorías: esquizofrenia (p < 0,001), HTA (p = 0,012), DM (p = 0,001), FA (p < 0,001) y neoplasias (p = 0, 012), A1 (p = 0,012), A2 (p < 0,001), B1 (p < 0,001), B2 (p = 0,002), C (p < 0,001), E1 (p < 0,001), E3 (p = 0,01), F2 (p < 0,01), G2 (p = 0,024) y H (p = 0,005). El promedio del índice de Barthel de la muestra fue de 49,1 ± 34,45 (IC 95%: 47,49-50,7), el de Lawton-Brody en domicilio fue de 2,33 ± 2,49 y en institucionalizados, de 1,59 ± 2,12. La media de la escala de Pfeiffer fue de 4,93 ± 3,53. CONCLUSIONES: Se asocia con la institucionalización el deterioro cognitivo, consecuencia de posibles patologías neurológicas (categoría E3) y psiquiátricas. Por el contrario, no se asocia con la comorbilidad del paciente, puesto que es muy elevada en pacientes en situación de atención domiciliaria con mejores estados de independencia funcional y cognitivo

OBJECTIVES: To describe the characteristics and clinical differences between institutionalised patients and those included in a home care program. DESIGN: A descriptive, observational, cross-sectional, and multicentre study. Site Seville, 2016. STUDY SUBJECTS: A total 1857 elderly patients of similar characteristics (1441 institutionalised and 416 at home) in Seville in 2016. MEASUREMENTS: The variables studied included gender, age, civil status, family support, pathologies, multiple pathology criteria, and medication prescriptions. Functional and cognitive status was evaluated using the Barthel index, and the Lawton-Brody and Pfeiffer scales. RESULTS: The majority of patients (71.40%) were women. The fact of being institutionalised or being included in a home care program were statistically related to the following pathologies and categories: schizophrenia (p < .001), arterial hypertension (p = .012), diabetes mellitus (p = .001), atrial fibrillation (p < .001), and neoplasia (p = .012), A1 (p = .012), A2 (p < .001), B1 (p < .001), B2 (p = .002), C (p < .001), E1 (p < .001), E3 (p = .01), F2 (p < .01), G2 (p = .024), and H (p = .005). The mean Barthel index of the sample was 49.1 ± 34.45 (95% confidence interval: 47.49-50.7). The mean Lawton-Brody scale in the case of patients included the home care program was 2.33 ± 2.49 and in those institutionalised 1.59 ± 2.12. The mean Pfeiffer scale was 4.93 ± 3.53. CONCLUSIONS: Cognitive impairment was related to institutionalisation, being a result of possible neurological (E3 category) and psychiatric diseases. On the other hand, patient comorbidity was not related to it, because it is very high in patients included in a home care program, in whom functional and cognitive independency status is better

Cierre de orejuela izquierda como alternativa a la anticoagulación en la fibrilación auricular / Left atrial appendage occlusion as an alternative to anticoagulation in patients with atrial fibrillation

No disponible

Relationship between Diet, Menstrual Pain and other Menstrual Characteristics among Spanish Students.

This study sought to describe and compare adherence to the Mediterranean diet and consumption of local foods from the Huelva region among Spanish university women in relation to menstrual pain and other menstrual characteristics. This cross-sectional study included 311 health science students. The study variables were sociodemographic and gynecologic characteristics, adherence to the Mediterranean diet using the KIDMED questionnaire, alcohol consumption (SDU) and consumption of local food. A descriptive bivariate analysis and multiple binary regression were performed for menstrual pain. Up to 55.3% of participants had moderate adherence to the Mediterranean diet and only 29.6% had high adherence. Women with low adherence had longer menstrual cycles (p < 0.01). Eating less than two pieces of fruit per day (OR = 3.574; 95%CI = 1.474-8.665; p < 0.05) and eating pulses more than one day a week (OR = 2.320; 95%CI = 1.006-5.348) raised the probability of suffering menstrual pain. A positive correlation between SDU and cycle length was identified (r = 0.119, p = 0.038), and menstrual bleeding was lower in women who consumed olive oil daily (p = 0.044). In conclusion, the Mediterranean diet, alcohol consumption and consuming typical foods from southern Spain appear to influence cycle length, menstrual flow and menstrual pain. Further research is necessary to confirm and expand these findings.

[Differences between institutionalized patients and those included in a home care program in Seville]. / Diferencias entre pacientes institucionalizados y pacientes en atención domiciliaria en la provincia de Sevilla.

OBJECTIVES: To describe the characteristics and clinical differences between institutionalised patients and those included in a home care program. DESIGN: A descriptive, observational, cross-sectional, and multicentre study. Site Seville, 2016. STUDY SUBJECTS: A total 1857 elderly patients of similar characteristics (1441 institutionalised and 416 at home) in Seville in 2016. MEASUREMENTS: The variables studied included gender, age, civil status, family support, pathologies, multiple pathology criteria, and medication prescriptions. Functional and cognitive status was evaluated using the Barthel index, and the Lawton-Brody and Pfeiffer scales. RESULTS: The majority of patients (71.40%) were women. The fact of being institutionalised or being included in a home care program were statistically related to the following pathologies and categories: schizophrenia (p<.001), arterial hypertension (p=.012), diabetes mellitus (p=.001), atrial fibrillation (p<.001), and neoplasia (p=.012), A1 (p=.012), A2 (p<.001), B1 (p<.001), B2 (p=.002), C (p<.001), E1 (p<.001), E3 (p=.01), F2 (p<.01), G2 (p=.024), and H (p=.005). The mean Barthel index of the sample was 49.1±34.45 (95% confidence interval: 47.49-50.7). The mean Lawton-Brody scale in the case of patients included the home care program was 2.33±2.49 and in those institutionalised 1.59±2.12. The mean Pfeiffer scale was 4.93±3.53. CONCLUSIONS: Cognitive impairment was related to institutionalisation, being a result of possible neurological (E3 category) and psychiatric diseases. On the other hand, patient comorbidity was not related to it, because it is very high in patients included in a home care program, in whom functional and cognitive independency status is better.

Disección coronaria espontánea e hipotiroidismo / Spontaneous coronary artery dissection and hypothyroidism

Introducción y objetivos: La hormona tiroidea afecta al metabolismo de todos los tejidos del organismo. El objetivo es analizar la prevalencia y las implicaciones de las alteraciones tiroideas en una cohorte de pacientes consecutivos con disección coronaria espontánea (DCE). Métodos: Se evaluó a 73 pacientes diagnosticados de DCE y se compararon las características y la evolución clínica de los pacientes eutiroideos frente a los hipotiroideos. Se comparó posteriormente la prevalencia de alteraciones tiroideas y las características clínicas de estos pacientes con las de 73 pacientes con síndrome coronario agudo pero sin DCE emparejados por edad, sexo y presentación clínica. Resultados: La media de edad fue 55 +/- 12 años y el 26% tenía hipotiroidismo. Los pacientes con DCE e hipotiroidismo eran todas mujeres (el 100 frente al 69%; p = 0,01), tenían disecciones más distales (el 74 frente al 41%; p = 0,03), en arterias en tirabuzón (el 68 frente al 41%; p = 0,03) y recibieron tratamiento más conservador (el 79 frente al 41%; p = 0,007). Durante un seguimiento medio de 4,1 +/- 3,8 años, la tasa de eventos adversos fue del 23%, sin diferencias según el estado de la función tiroidea. La prevalencia de hipotiroidismo fue significativamente mayor en los pacientes con DCE que en el grupo con síndrome coronario agudo sin DCE (el 26 frente al 8%; p = 0,004). Conclusiones: Hay una elevada prevalencia de hipotiroidismo en los pacientes con DCE. Los pacientes hipotiroideos con DCE son más frecuentemente mujeres, tienen disecciones más distales y en arterias en tirabuzón y reciben tratamiento más conservador

Introduction and objectives: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). Methods: A total of 73 patients with SCAD were analyzed. Baseline characteristics and clinical outcomes were compared between euthyroid and hypothyroid patients. Subsequently, the prevalence of thyroid function abnormalities and the clinical characteristics of SCAD patients were compared with those in 73 patients with acute coronary syndrome but without SCAD, matched by age, sex, and presentation. Results: Mean age was 55 +/- 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 +/- 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). Conclusions: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy

La entrevista clínica y el teléfono móvil / Clinical interview and mobile phone

No disponible

Spontaneous Coronary Artery Dissection and Hypothyroidism.

INTRODUCTION AND OBJECTIVES: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). METHODS: A total of 73 patients with SCAD were analyzed. Baseline characteristics and clinical outcomes were compared between euthyroid and hypothyroid patients. Subsequently, the prevalence of thyroid function abnormalities and the clinical characteristics of SCAD patients were compared with those in 73 patients with acute coronary syndrome but without SCAD, matched by age, sex, and presentation. RESULTS: Mean age was 55 ± 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 ± 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). CONCLUSIONS: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy.

Communication with patients and the duration of family medicine consultations.

OBJECTIVE: To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. DESIGN: Cross-sectional multicentre study. LOCATION: Primary Healthcare Centres in Andalusia, Spain. PARTICIPANTS: A total of 119 tutors and family medicine physician residents. PRINCIPAL MEASUREMENTS: Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. RESULTS: The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2=0.32). There was no correlation between physician or patient gender, or problem type. CONCLUSION: A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation.

Valoración del uso de retinografía como método de diagnóstico precoz de glaucoma crónico en atención primaria: validación para el cribado en población con factores de riesgo para glaucoma de ángulo abierto / Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors

Objetivo: Determinar la exactitud y el comportamiento de las retinografías realizadas en atención primaria como herramienta de diagnóstico precoz del glaucoma crónico (GAA) en población con factores de riesgo. Diseño: Estudio observacional, descriptivo y transversal con 2 observadores en paralelo de forma ciega: 2 médicos de atención primaria (MAP) y un oftalmólogo de atención especializada Emplazamiento: Centro de atención primaria urbano, consultas externas del servicio de oftalmología (hospitalario). Participantes: Ciento noventa y seis pacientes de ambos sexos, entre 40-70 años, diabéticos, hipertensos, no diagnosticados de glaucoma, captados mediante llamada telefónica tras revisión de listados de pacientes. Dos de los pacientes no acudieron a las citaciones para las pruebas oftalmológicas, considerándose como pérdidas. Mediciones: Para la variable cuantitativa diagnóstico de glaucoma por retinografía: exactitud calculada por la sensibilidad y especificidad, comportamiento por los valores predictivos positivo y negativo, cociente de probabilidad positivo y negativo, concordancia interobservador por índices kappa y cociente de correlación intraclase (CCI). Resultados: Se obtuvo una sensibilidad del 21% (IC 95%: 0-43%), especificidad del 93% (IC 95%: 89-97%), valor predictivo negativo del 94% (IC 95%: 90-97%) y positivo del 20% (IC 95%: 0-40%); cociente de probabilidad positivo de 3,07 (IC 95%: 0,98-9,62) y negativo de 0,84 (IC 95%: 0,64-1,11). El CCI fue de 0,653 (IC 95%: 0,495-0,769), y el índice kappa, de 0,140 (ET: 0,106). Conclusiones: La retinografía no presenta un comportamiento adecuado como herramienta de diagnóstico precoz de GAA desde atención primaria según el modelo planteado en nuestro estudio. Serían necesarios ajustes que subsanasen su baja sensibilidad, como usar otras pruebas combinadas y mejorar el entrenamiento de los MAP (AU)

Objective: The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG). Design: An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist. Location: Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic. Participants: A total of 196 patients of both genders, between 40-70 years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses. Measurements: For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC). Results: The retinography for OAG screening has a sensitivity of 21% (95% CI: 0-43%), a specificity of 93% (95% CI: 89-97%), a negative predictive value of 94% (95% CI: 90-97%), and positive of 20% (95% CI: 0-40%); positive probability ratio of 3.07 (95% CI: 0.98-9.62) and negative 0.84 (95% CI: 0.64-1.11). The IC was 0.653 (95% CI: 0.495-0.769) and kappa index of 0.140 (0.106 ET). Conclusions: According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved (AU)

[Assessment of the use of retinography as a screening method for the early diagnosis of chronic glaucoma in Primary Care: Validation for screening in populations with open-angle glaucoma risk factors]. / Valoración del uso de retinografía como método de diagnóstico precoz de glaucoma crónico en atención primaria: validación para el cribado en población con factores de riesgo para glaucoma de ángulo abierto.

OBJECTIVE: The aim of this study is to determine usefulness, validity of retinographies performed in Primary Care as a tool for early diagnosis of open-angle chronic glaucoma (OAG). DESIGN: An observational, descriptive and cross-sectional study with two blinded parallel observers: 2 general practitioners and 1 ophthalmologist. LOCATION: Urban Primary Care Health Centre, and the Ophthalmology Department outpatient clinic. PARTICIPANTS: A total of 196 patients of both genders, between 40-70years, with diabetes and hypertension, and undiagnosed with glaucoma, were recruited by phone call after checking patient lists. Two patients that did not arrive for their appointments for the ophthalmology tests were considered as losses. MEASUREMENTS: For the quantitative diagnostic variable of glaucoma: Accuracy calculated from the sensitivity and specificity, safety from the positive and negative predictive values and the positive and negative probability ratio; interobserver concordance by Kappa index ratio and the intraclass correlation (IC). RESULTS: The retinography for OAG screening has a sensitivity of 21% (95%CI: 0-43%), a specificity of 93% (95%CI: 89-97%), a negative predictive value of 94% (95%CI: 90-97%), and positive of 20% (95%CI: 0-40%); positive probability ratio of 3.07 (95%CI: 0.98-9.62) and negative 0.84 (95%CI: 0.64-1.11). The IC was 0.653 (95%CI: 0.495-0.769) and kappa index of 0.140 (0.106ET). CONCLUSIONS: According to this proposed model, retinography is not a useful tool for the early diagnosis of OAG in Primary Care, as it is not safe enough. Before it can be used, it would need adjustments for its low sensitivity, and the use other combined tests. The training of general practitioners would also need to be improved.

Communication skills of tutors and family medicine physician residents in Primary Care clinics / Habilidades comunicacionales de tutores y residentes de medicina de familia en las consultas de atención primaria

AIM: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient. DESIGN: A descriptive multicentre study. LOCATION: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva. PARTICIPANT:119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients. Principal measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed. RESULTS: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: −0.1). CONCLUSION: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patienT

OBJETIVO: Conocer el perfil comunicacional de los médicos de familia y las caracteristicas asociadas a una mejor comunicación con el paciente. DISEÑO: Estudio descriptivo multicéntrico. Emplazamiento. Centros de salud de atención primaria de Almería, Granada, Jaén y Huelva. PARTICIPANTES: Ciento diecinueve médicos de familia (tutores y residentes de 4. ° año) videograbados en consulta. MEDICIONES PRINCIPALES: Características demográficas y profesionales. Análisis de la comunicación médico-paciente mediante la escala Conectar, Identificar y Comprender, Acordar y Ayudar (CICAA). Se realizó un análisis descriptivo, bivariable y de regresión lineal múltiple. RESULTADOS: Se obtuvieron 436 entrevistas válidas. Casi el 100% se muestran corteses y amables, facilitan el discurso del paciente y permiten que exprese sus dudas. En cambio, pocos profesionales resumen la información, exploran el estado de ánimo del paciente, su entorno familiar, acontecimientos vitales estresantes o emplean preguntas abiertas. La puntuación media fue de 21.43±5.91 puntos (máximo 58). No existieron diferencias en la puntuación por sexo, ciudad o tipo de centro. Mediante regresión lineal múltiple se comprueba que una mayor puntuación se relaciona con ser tutor (B:2.98), el tiempo de consulta (B:0.63) y la edad del profesional (B: −0,1). CONCLUSIONES: Los médicos destacan por crear un clima cálido, buena escucha e informar al paciente; en cambio, deberían mejorarse la empatía, la exploración de la esfera psicosocial, realizar preguntas abiertas y la toma de decisiones compartidas. Ser tutor, mayor tiempo de consulta y ser más joven se relacionan con una mejor comunicación con el paciente (AU)

Prevalencia de la Lactancia Materna en Huelva, duración y factores relacionados / Prevalence of Breastfeeding in Huelva, duration and related factors

Objetivos: Conocer la prevalencia y duración de la Lactancia Materna (LM), así como la relación con las variables sociodemográficas, obstétricas y de educación materno infantil. Diseño: Estudio observacional descriptivo. Emplazamiento: siete centros de salud de Huelva capital. Participantes: 268 mujeres con niños de 1 a 2 años. La selección se hizo consecutiva, por orden de llegada. Mediciones principales: prevalencia y duración de LM, características sociodemográficas, características perinatales y alimentación complementaria. Resultados: Iniciaron la LM exclusiva un 52,9 % (IC:46,99-58,91). A los seis meses permanecen un 19,7% (IC:15,33-24,87). Un 63,4% (IC:57,54-69,04) comienzan lactancia materna total (exclusiva o mixta), un 47,7% (IC:41,82-53,75) continúa con ella a los 3 meses y un 26,1% (IC:21,12-31,63) a los 6 meses. La LM está relacionada con: la formación académica de la madre, el número de hijos, asistir a los talleres de preparación al parto, número de sesiones, nivel de satisfacción con respecto a la educación materno infantil, haber solicitado ayuda sobre LM, conocer el grupo de apoyo a la lactancia y haber asistido al mismo. Conclusiones: La prevalencia de LM es baja con respecto a lo esperado por los datos nacionales, la duración de la misma se aparta de las recomendaciones de la OMS y el nivel educativo de la madre favorece la prevalencia y duración de la LM. Los profesionales de la salud debemos continuar con su promoción y apoyo (AU)

Objective: To know the prevalence and duration of the breastfeeding, as well as the relation with the sociodemographic, obstetric and child and maternal education factors. Design: descriptive observational study. Site: seven health centers of Huelva city. Participants: 268 mothers of 1-2 y.o. children. The selection was made straight, in order of arrival. Main measurements: prevalence and duration of the breastfeeding, sociodemographic characteristics, perinatal characteristics and complementary feeding. Results: The 52,9 % (CI:46,99-58,91) of the sample initiated the exclusive breastfeeding. Six months later remained the 19,7 % (CI:15,33-24,87). The 63,4% (CI:57,54-69,04) initiated the total breastfeeding, 47,7% (CI:41,82-53,75) continue with it 3 months later and the 26,1% (CI:21,12-31,63) 6 months later. The breastfeeding is related with: the academic education of the mother, the number of children, to attend the workshops childbirth preparation, number of sessions, level of satisfaction with maternal and child education, to have requested assistance on reastfeeding, to know the breastfeeding support group and to have atended to it. Conclusions: The prevalence of the breastfeeding is less concerning than expected by the national data, the length of it is far from the recommendations of the WHO and the educational level of the mother, favors the prevalence and duration of breastfeeding. Health professionals must continue with their promotion and support (AU)

Communication skills of tutors and family medicine physician residents in Primary Care clinics.

AIM: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient. DESIGN: A descriptive multicentre study. LOCATION: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva. PARTICIPANTS: 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients. PRINCIPAL MEASUREMENTS: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed. RESULTS: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: -0.1). CONCLUSION: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient.

Satisfacción de las madres sobre la información recibida acerca de las vacunas infantiles / Satisfaction of mothers regarding the information received about infant vaccines

OBJETIVO: conocer la satisfacción de las madres de aquellos niños vacunados en Huelva acerca de la información recibida sobre las vacunas infantiles y la cobertura de vacunación. MÉTODO: estudio descriptivo transversal en los centros de salud de Huelva sobre madres de niños de edades comprendidas entre los 9 y los 28 meses de edad. Se empleó un cuestionario ad hoc que recogía información de variables sociodemográficas y del grado de vacunación de las vacunas sistemáticas y de la vacuna antineumocócica, contra el rotavirus y contra la varicela y los motivos para aceptarlas o no. Tratamiento de los datos: análisis bivariante a través de t de Student para muestras independientes. RESULTADOS: el total de madres estudiadas fue de 268. La media de la satisfacción de las madres fue de 6,6 (desviación estándar: 1,9) sobre 10. El porcentaje de vacunación para la vacuna conjugada antineumocócica fue de 64,4%, para la vacuna contra el rotavirus de 22,9% y para la vacuna contra el virus antivaricela del 21,4%, poniéndose de manifiesto una alta variabilidad entre las distintas zonas de salud. Los niños que participaron eneste estudio cumplieron con las vacunas sistemáticas del Programa de Vacunación Andaluz (PVA). CONCLUSIONES: el 100% de las madres vacuna a sus hijos de las vacunas gratuitas e incluidas en el PVA, sin embargo, no se le administraron las vacunas recomendadas como la antineumocócica, contra el rotavirus y contra la varicela, con coberturas aceptables

OBJECTIVE: children vaccinated in Huelva regarding the information received about infant vaccines and vaccination coverage. METHOD: transversal descriptive study conducted in health centres in Huelva with the mothers of 9-to-28-month-old children. An ad hoc questionnaire was used, which collected information on socio-demographic variables, and the level of vaccination for systematic vaccines and anti-pneumococcal vaccine, vaccines against rotavirus and chickenpox, and the reasons for accepting them or not. Data treatment: bivariate analysis through Student's t-test for independent samples. RESULTS: the total number of mothers included in the study was 268. The mean satisfaction of mothers was 6.6 (standard deviation: 1.9) out of 10. The percentage of vaccination for the pneumococcal conjugate vaccine was 64.4%; 22.9% for the rotavirus vaccine, and 21.4% for the chickenpox vaccine. High variability was evident between the different health areas. The children involved in this study received all systematic vaccines within the Andalusian Vaccination Program (PVA). CONCLUSIONS: 100% of mothers took their children to receive free vaccines which are included in the PVA. However, those recommended vaccines, such as anti-pneumococcal, against rotavirus, and against chickenpox, were not administered with an acceptable coverage

Perfil de los pacientes derivados desde la enfermera de emergencias a la enfermera gestora de casos comunitaria / Profile of patients referred by the emergency nurse to the community case management nurse

OBJETIVOS: describir el perfil del paciente derivado desde la enfermera de urgencias y emergencias a la enfermera gestora de casos comunitaria (EGCC) y la relación entre los criterios de derivación y la edad y el sexo de los pacientes, el centro al que son derivados y el servicio desde el que parte dicha derivación. MÉTODO: estudio descriptivo transversal sobre 79 pacientes que fueron atendidos en servicios sanitarios que dan cobertura a la zona sur de la provincia de Huelva. Variable principal: "criterios de derivación" desde los servicios de procedencia a su EGCC. Se calcularon índices de estadística descriptiva y se realizó un análisis bivariante a través de ji-cuadrado, t de Student y U de Mann-Whitney. RESULTADOS: el criterio más utilizado fue "pacientes que no siguen el plan terapéutico farmacológico" (37,97%). Eran cuidados mayoritariamente por sus familias (56,96%). El "índice de esfuerzo del cuidador>7" fue mayor en mujeres (p= 0,03); el "dolor crónico mal tolerado" era mayor en los pacientes derivados a zonas rurales (p= 0,026); el "no cumplimiento del régimen farmacológico" fue más elevado en los pacientes derivados desde la empresa pública de emergencias sanitarias. CONCLUSIONES: el perfil del paciente derivado desde los enfermeros de urgencias y emergencias hacia la EGCC es un paciente de avanzada edad, con un mal manejo de régimen farmacológico prescrito, con un alto nivel de dependencia y que es cuidado mayoritariamente por sus allegados. Ante esta realidad, la gestión de la EGCC de la intervención sobre el paciente y su familia, se hace imprescindible

OBJECTIVES: to describe the profile of the patient referred by the Emergency nurse to the Community Case Management Nurse (CCMN), and the relationship between referral criteria and patients' age and gender, the centre they are referred to, and the hospital unit which conducts said referral. METHOD: transversal descriptive study on 79 patients who were seen in healthcare centres which cover the Southern Area of the province of Huelva. Primary variable: "referral criteria" from the referring hospital units to their CCMN. Descriptive statistical indicators were calculated, and bivariate analysis was conducted through Chi-square test, Student's t, and Mann-Whitney's U. RESULTS: the criterion most frequently used was "patients who don't follow their pharmacological therapy schedule" (37.97%).The majority were looked after by their families (56.96%). The "caregiver strain index >7" was higher in women (p= 0.03); "poorly tolerated chronic pain" was higher in patients referred to rural areas (p= 0.026); "lack of compliance with pharmacological treatment" was higher in those patients referred by the public company for healthcare emergencies. CONCLUSIONS: the profile of the typical patient referred by Emergency nurses to the CCMN is an elderly patient, with poor management of their prescribed pharmacological treatment, with a high level of dependence, and mostly looked after by their family. Faced with this reality, management by the CCMN regarding the intervention on patient and family becomes essential

Protocolo de comunicación entre enfermera de urgencias y emergencias y enfermera gestora de casos comunitaria / Protocol for communication between emergency unit nurses and outpatient case management nurses

El propósito de este artículo es dar a conocer las características de un protocolo de derivación de pacientes, que ha sido elaborado con la intención de facilitarla comunicación de los profesionales de distintos niveles asistenciales y fomentar la coordinación de los mismos. El protocolo permite la comunicación entre la enfermera de urgencias y emergencias(EUE) y la enfermera gestora de casos comunitaria (EGCC), dos profesionales que ocupan posiciones muy distantes en el sistema sanitario público de Andalucía. Este procedimiento se ha planteado con una comunicación en doble sentido:- Desde la EUE a la EGCC para que esta gestione las intervenciones necesarias.- Desde la EGCC a la sala de coordinación de urgencias y emergencias, para tener disponible la información sobre cuidados especiales cuando los pacientes requieran atención de la EUE. Se han desarrollado criterios de derivación de enfermos en el primer sentido: desde EUE a EGCC, se ha creado una herramienta informática denominada "Derivación ENLA" y se han realizado sesiones formativas para los profesionales que son usuarios diana de esta herramienta. Se puso en marcha en junio de 2012, su primera evaluación fue en enero de 2013 y continuará desarrollándose en fases sucesivas (AU)

The purpose of this article is to make public the characteristics of a patientreferral protocol, which has been prepared in order to facilitate communication between professionals in different levels of care, and to encouragetheir coordination. This protocol allows the communication between the Emergency Unit Nurse(EUN) and the Outpatient Case Management Nurse (OCMN), two professional sholding very distant positions within the Andalusian public healthsystem. This procedure has been set out with a two-way communication:- From the EUN to the OCMN, for the latter to manage any necessary interventions.- From the OCMN to the Emergency Coordination Unit, in order to have information available about special care when patients require EUN care. Criteria for patient referral have been developed for the first pathway: from EUN to OCMN. A computing tool called "ENLA Referral" has been created ,and training sessions have been established for those professionals who are the target users for this tool. This was started on June, 2012, there was a first assessment on January, 2013, and its development will continue in consecutive stages (AU)

Relación entre médicos de familia y farmacéuticos: ¿podemos mejorarla? / Family doctor-pharmacist relationship: Can we improve it?

No disponible