Impact of telenurse-led intervention in clinical trials on health literacy, empowerment, and health outcomes in patients with solid tumours: a pilot quasi-experimental study.

BACKGROUND: During the COVID-19 pandemic, decentralised clinical trials incorporated self-monitoring, self-reporting, and telenursing tools to address health literacy and health empowerment of patients enrolled in clinical trials. We aimed to determine the impact of an educational intervention using telenursing consultations on health literacy, health empowerment, and health-related quality of life in cancer patients enrolled in clinical trials by measuring the level of satisfaction with the care received and assessing the views of healthcare professionals concerning the advanced practice nurse (APN) role in oncology clinical trials. METHODS: In this pilot analytical, descriptive, longitudinal, quasi-experimental, and pre-post test study, an educational intervention was conducted by 5 visits with an APN using synchronous teleconsultation in patients starting cancer treatment for the first time in a clinical trial (n = 60), and health professionals working with the APN (n = 31). A descriptive analysis of the samples and questionnaires were utilised along with statistical comparisons. RESULTS: After the intervention, patients' health literacy (31.7%), health empowerment (18.3%), and health-related quality of life (33.3%) increased (p < 0.05), with a decrease and trend towards resolution of care needs (p < 0.05). Satisfaction with the quality and care received in terms of perceived convenience, transition, and continuity of care showed positive results in 64.9 ± 20.7, 77.6 ± 19.5, and 72.1 ± 20.4 of respondents, respectively. On the overall assessment of the APN role, healthcare professionals expressed a high level of agreement with the statements related to their work performance. CONCLUSIONS: The data indicates that a clinical trial APN-led telenursing educational intervention results in an overall increase in health literacy, an improvement in health empowerment and health-related quality of life, and a decrease in care needs of oncology clinical trials patients. Patients stated that they received a high quality of care and health professionals indicated high levels of acceptance with APNs. Based on these results, we suggest that the APN role should gain more recognition in the Spanish healthcare system and their professional competencies should be aligned with those of other countries.

Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis.

AIMS: To analyse the aspects involved in the care of individuals assessed as kidney transplant candidates and to identify the role of nurses in providing specialised care for this population. DESIGN: Scoping review. The results were summarised using a narrative synthesis technique. DATA SOURCES: A review of the literature published between 2001 and 2021 was conducted between October and November 2021 using PubMed, CINAHL and SciELO. REVIEW METHODS: The research team agreed on a search strategy based on clinical practice guidelines for assessing kidney transplantation candidates. Quantitative, qualitative and mixed methods studies published in peer-reviewed journals in English, Spanish, French and Portuguese were included. RESULTS: A total of 377 studies were identified, and 49 articles were included after the inclusion and exclusion criteria were applied. The narrative synthesis was structured into four themes: Physical needs; Psychological and quality of life needs; Education and adherence needs; and Nurses' role. CONCLUSION: Nursing assessment of kidney transplantation candidates should encompass physical, psychosocial and adherence aspects. A variety of methodologies and resources are available for this assessment. Nurses contribute to coordinating access to kidney transplantation, aiming to improve adherence to an appropriate lifestyle to prevent patients from being excluded from kidney transplantation or suffering from kidney transplantation-related complications. IMPACT: Based on our findings, we managed to design a nursing care map for kidney transplantation candidates combining the main elements of nursing care that should be incorporated into this process. Advanced practice nursing professionals play a crucial role in accessing renal transplant care.

Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study.

OBJECTIVES: To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. DESIGN: Descriptive, cross-sectional study. PARTICIPANTS AND MEASUREMENTS: All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development. RESULTS: Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. CONCLUSION: The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.

The role of Advanced Practice Nurses in creating the Kidney Transplant candidate care map (APN-preKT): a convergent-parallel mixed methods research protocol.

BACKGROUND: Waiting time for kidney transplants (KT) is an important health determinant for patients with chronic kidney disease (CKD). During this time, ongoing evaluation and participation is necessary in order to guarantee the quality and suitability of the proposed treatment. There is no existing literature on the potential impact of inclusion of an Advanced Practice Nurse (APN) role in the hospital setting on care for CKD patients who are candidates for KT. The main objectives of this protocol are: to analyse outpatient nursing activity in the care of individuals with KT in Spain; to identify the needs of individuals who are KT candidates; and to measure the impact of the APN role through patient outcomes and experiences. These objectives are fulfilled through 5 specific related substudies. METHODS: A convergent parallel mixed methods approach will be conducted between July 2021 and April 2024. Quantitative and qualitative data will be collected and analysed separately to ascertain whether the findings confirm or contradict one another. Each of the 5 substudies of the project require a specific design, sampling method, and data collection procedure in order to meet the overall objectives for the project. DISCUSSION: The results of the project are expected to inform the design of future nursing roles and contribute to future improvements in the quality of care provided. The data that may be obtained from this protocol are limited to the specific context of the study facility and may be extrapolated but not compared to other settings due to the variability of care pathways for KT candidates internationally. TRIAL REGISTRATION: This project was approved by the Clinical Research Ethics Committee (no.2020/9418/I). The study was supported by the "Strategic Plan for Health Research and Innovation" from the Generalitat de Catalunya, registration number SLT017/20/000001, with a contribution of 57,239 euros.

Necesidades asistenciales durante el estudio de personas candidatas a donantes de riñón “PREMIO SEDEN SOBRE DONACIÓN Y TRASPLANTE 2021” / Care needs during the study of kidney donor candidates

Objetivos: Describir las necesidades asistenciales del candidato a donante de riñón; sus características sociodemográficas y clínicas; y analizar los resultados desde una perspectiva de género.Material y Método: Estudio observacional descriptivo transversal. Se recogieron datos clínicos; sociodemográficos; y el número y tipo de visitas y pruebas realizadas durante el año 2020.Resultados: Se incluyeron 60 candidatos a donantes de riñón (n=37 mujeres; 61,67%) con una media de 51,98±14,50 años y una mediana de 2,5 [RIQ (0,69-5,29)] meses de estudio. 16 (26,67%) fueron aptos para la donación, correspondiendo al 14,16% de la actividad en Trasplante Renal (TR) del centro de referencia. Se requirieron 757 visitas (20,60% de la actividad) de las que 341 (45,05%) fueron visitas con la enfermera. Se requirieron 423 pruebas (19,60% de la actividad) durante el estudio. Se identificó una media de 1,87±1,35 factores de riesgo cardiovascular en la muestra analizada, siendo de 1,56±0,81 en los que finalmente fueron donantes. Más mujeres (n=12; 75%) que hombres (n=4; 25%) fueron finalmente donantes renales.Conclusiones: El estudio del candidato a donante de riñón es complejo e implica el doble de actividad que en el de los candidatos a receptores de trasplante renal. El proceso finaliza en donación en el 27% de los candidatos estudiados. La enfermera concentra el 45% de las visitas que se requieren. Es necesario explorar estrategias para optimizar el proceso de estudio. Hay diferencias de género en cuanto a la predisposición para estudiarse voluntariamente como candidata a donante renal. (AU)

Objetives: To describe the care needs of the kidney donor candidate; the socio-demographic and clinical characteristics; and to analyse the results from a gender perspective.Material and Method: Cross-sectional descriptive observational study. Clinical and socio-demographic data, number and type of visits and clinical tests performed during 2020 were collected.Results: Sixty kidney donor candidates (n=37 women; 61.67%) with a mean age of 51.98±14.50 years and a median of 2.5 [RIQ (0.69-5.29)] months of study were included. 16 (26.67%) were eligible for donation, corresponding to 14.16% of the Renal Transplant (RT) activity of the reference centre. 757 visits were required (20.60% of the activity) of which 341 (45.05%) were visits with a nurse. 423 tests (19.60% of the activity) were required during the study. A mean of 1.87±1.35 cardiovascular risk factors was identified in the sample analysed, being 1.56±0.81 in those who were donors. More women (n=12; 75%) than men (n=4; 25%) were ultimately renal donors.Conclusions: The study of kidney donor candidates is complex and involves twice as much activity as that of kidney transplant recipient candidates. The process ends in donation in 27% of the candidates studied. The nurse concentrates 45% of the visits required. Strategies need to be explored to optimise the study process. There are gender differences in the predisposition to be studied voluntarily as a kidney donor candidate. (AU)

Prevalencia de burnout en enfermeras de nefrología tras un año de pandemia por COVID-19 / Prevalence of burnout syndrome in nephrology nurses after one year of the COVID-19 pandemic

Introducción: La prevalencia de Enfermedad Renal Crónica, así como la complejidad de su manejo terapéutico, hace que las enfermeras de nefrología sean susceptibles a sufrir el síndrome de burnout. En este escenario, ha aparecido la pandemia por COVID-19. Esta nueva situación puede potenciar la aparición de burnout entre las enfermeras nefrológicas.Objetivo: Describir la prevalencia del síndrome de burnout entre las enfermeras de un servicio de nefrología de un hospital terciario.Material y Método: Estudio observacional, descriptivo, transversal y unicéntrico. La recogida de datos se efectuó en mayo de 2021 mediante un cuestionario ad-hoc con preguntas sociodemográficas y laborales. Se administró el cuestionario validado “Maslach Burnout Inventory Human Services Survey”, compuesto de preguntas sobre sentimientos y actitudes de profesionales hacia pacientes y compañeros de trabajo.Resultados: Se incluyó a 28 enfermeras, correspondiendo al 71,8% de la población a estudio, con una media de 18±12,2 años de experiencia; 11 (39,3%) tuvieron COVID-19; 24 (85,7%) estaban vacunadas; 18 (64,3%) no recibieron formación específica sobre el SARS-CoV-2; 13 (46,4%) enfermeras tenían miedo de transmitir la COVID-19 a su entorno; 5 (17,9%) tenían miedo a contagiarse y 19 (67,9%) se sentían mal anímicamente.Los resultados del “Maslach Burnout Inventory Human Services Survey”, destacaron a 15 enfermeras (58,6%) con al menos dos de las tres esferas afectadas.Conclusiones: Las enfermeras presentan un riesgo real de burnout en el contexto descrito y la implementación de programas de prevención y tratamiento sería lo apropiado según la literatura de referencia. La esfera con mayor afectación reportada es la de la realización personal. (AU)

Introduction: The high prevalence of chronic kidney disease and the complexity of therapeutic management make nephrology nurses susceptible to burnout syndrome. In this scenario, the COVID-19 pandemic has appeared. This new situation may increase the appearance of burnout among nephrology nurses.Objective: To describe the prevalence of burnout syndrome among nurses in a nephrology department of a tertiary hospital.Method: Observational, descriptive, cross-sectional, single-centre study. Data collection was carried out in May 2021 using an ad-hoc questionnaire with socio-demographic and occupational questions. The validated questionnaire “Maslach Burnout Inventory Human Services Survey” was administered, consisting of questions on feelings and attitudes of professionals towards patients and co-workers.Results: 28 nurses were included, being 71.8% of the study population, with a mean of 18±12.2 years of experience; 11 (39.3%) had COVID-19; 24 (85.7%) were vaccinated; 18 (64.3%) did not receive specific training on SARS-CoV-2; 13 (46.4%) nurses were afraid of transmitting COVID-19 to their environment; 5 (17.9%) were afraid of becoming infected and 19 (67.9%) felt bad mood.The results of the “Maslach Burnout Inventory Human Services Survey” showed that 15 nurses (58.6%) had at least two of the three spheres affected.Conclusions: Nurses present a real risk of burnout in the context described. The implementation of prevention and treatment programs is essential. The area with the greatest reported impact is that of self-fulfillment. (AU)

Efectividad de una intervención sobre el registro de la valoración enfermera al ingreso / Efficacy of an intervention about nursing assessment compliance at admission

Objetivo: evaluar la eficacia de una intervención sobre cumplimentación de la entrevista de valoración enfermera al ingreso.Método: estudio analítico cuasi-experimental pre-post de grupo único en el Hospital del Mar de Barcelona. La variable de interés principal fue el grado de cumplimentación, recogida según el Modelo de Patrones Funcionales de la Salud de Marjory Gordon. Se analizaron 60 historias clínicas antes de la intervención y 60 después. La intervención fue una sesión formativa en la que se compartieron los resultados del primer análisis, se abordó la fundamentación teórica del Proceso de Atención de Enfermería y la importancia de su registro. Se realizó un análisis descriptivo con frecuencias absolutas y relativas, y para el análisis de la efectividad se calcularon diferencias porcentuales.Resultados: la cumplimentación de la historia clínica al ingreso aumentó de un 66,9% a un 74,5% tras la intervención. En la valoración por patrones aumentó de un 64,9% a un 75,7%, aunque los patrones 6 (Cognitivo/perceptivo) y 11 (Valores/creencias) disminuyeron su grado de cumplimentación. Lo mismo sucedió con los ítems de antecedentes personales y el apartado de observaciones. Sin embargo, aumentó el grado de cumplimentación de la firma del informe de un 96,7% a un 98,3% y la asignación de la trayectoria de cuidados de un 95,0% a un 100%, siendo el único que aumentó a cumplimentación total.Conclusiones: la intervención fue efectiva de forma global aumentando el grado de cumplimentación de la historia clínica al ingreso, aunque no en todos los ítems ni patrones.(AU)

Objective: to assess the efficacy of an intervention on compliance with the nursing assessment interview at admission.Method: an analytical, quasi-experimental, pre-post study on a single arm at the Hospital del Mar of Barcelona. The primary variable of interest was the level of compliance, collected according to the Functional Health Patterns Model by Marjory Gordon. There was an analysis of 60 clinical records before the intervention, and 60 after the intervention. The intervention consisted in a training session, where the results of the first analysis were shared, and the theoretical basis of the Nursing Care Process was addressed, as well as the importance of its compliance. A descriptive analysis was conducted with absolute and relative frequencies, and percentage differences were calculated for the analysis of efficacy.Results: the completion of clinical record at admission increased from 66.9% to 74.5% after the intervention. In the assessment by patterns, there was an increase from 64.9% to 75,7%, though patterns 6 (Cognitive/perceptive) and 11 (Values/beliefs) reduced their level of compliance. The same occurred with the items for personal background and the Observations section. However, there was an increase in the level of compliance with signing the report, from 96.7% to 98.3%, and in the care path assignment, from 95.0% to 100%, which was the only one which increased up to total compliance.Conclusions: the intervention was effective in an overall way, increasing the level of compliance with clinical record at admission, although not in all items or patterns.(AU)

[Monitoring and telematic control of people with kidney transplant and suspected COVID-19 infection.] / Seguimiento y control telemático a personas con trasplante renal y sospecha de infección por COVID-19.

OBJECTIVE: People with Kidney Transplantation require immunosuppressant treatments and this classifies them as a population at risk for virus and/or bacterial infections. The objective of the study was to describe the follow-up of transplanted people with suspected COVID19 infection. METHODS: Descriptive, cross-sectional, observational study with prospective follow-up carried out between March and June 2020. Sociodemographic and clinical data were recorded for the assessment, control and follow-up of the cases. The results were expressed with means and standard deviation, median and interquartile range, or frequencies and percentages. The chi-square test was used to compare qualitative variables and the Student's T test to compare quantitative variables with normal distribution. If they did not follow a normal distribution, the Mann Whitney U test was used. The level of statistical significance was established at p<0.05. RESULTS: A total of 56 patients were included, with a mean of 62.73±13.01 years and a median of 39.5 [7.5; 93] months transplanted. 2.48±2.69 calls/patient were made during a period of 3.46±4.41 days. Virtual follow-up was performed with 100% (n=56) and 71.43% (n=40) required hospital admission at some point. 28.57% (n=16) of the people evaluated were managed at home. The PCR test was performed on 85.71% (n=48) of the study population, being positive in 48.21% (n=27). 29.62% (n=8) of the positive cases required invasive mechanical ventilation and 33.33% (n=9) died. The mortality rate in the study population is 4.17 times higher than that presented in the data from the registries in the general population. CONCLUSIONS: According to the mortality data, it is essential to maintain close contact with the main objective of referring the case to the hospital system at the slightest suspicion of complication. Remote monitoring is offered as a positive opportunity for the control of transplant recipients who require close monitoring by the nursing team.

OBJETIVO: Las personas con Trasplante Renal requieren tratamientos con inmunosupresores y esto los clasifica como población de riesgo para infecciones de virus y/o bacterias. El objetivo del estudio fue describir el seguimiento a personas trasplantadas con sospecha de infección por COVID-19. METODOS: Estudio observacional descriptivo de corte transversal con seguimiento prospectivo llevado a cabo entre marzo y junio de 2020. Se registraron datos sociodemográficos y clínicos para la valoración, control y seguimiento de los casos. Los resultados se expresaron con medias y desviación estándar, mediana y rango intercuartílico o frecuencias y porcentajes Se utilizó el test de chi-cuadrado para comparar variables cualitativas y la prueba T de student para comparar variables cuantitativas con distribución normal. Si no seguían una distribución normal se utilizó el test U de Mann Whitney. Se estableció el nivel de significación estadística en p<0,05. RESULTADOS: Se incluyó a un total de 56 pacientes con una media de 62,73± 13,01 años y una mediana de 39,5 [7,5; 93] meses trasplantados. Se realizaron 2,48±2,69 llamadas/paciente durante un periodo de 3,46±4,41 días. Se realizó seguimiento virtual con el 100% (n=56) y el 71,43% (n=40) requirió ingreso hospitalario en algún momento. El 28,57% (n=16) de las personas valoradas se logró controlar en domicilio. Se realizó el test PCR al 85,71% (n=48) de la población estudiada, siendo positivo en el 48,21% (n=27). El 29,62% (n=8) de los casos positivos requirió de ventilación mecánica invasiva y el 33,33% (n=9) falleció. La tasa de mortalidad en la población estudiada es 4,17 veces superior a la presentada en los datos de los registros en población general. CONCLUSIONES: Según el dato de mortalidad, se hace indispensable mantener el contacto estrecho con el objetivo principal de derivar el caso al sistema hospitalario a la menor sospecha de complicación. El seguimiento a distancia se ofrece como una oportunidad positiva para el control de las personas trasplantadas que requieran un seguimiento estrecho por parte del equipo de enfermería.

Analysis of experience of the use of plastic cannulas in Spanish haemodialysis units.

INTRODUCTION: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. OBJECTIVE: To analyse Spanish HD nurses' experience of using PC. DESIGN: Cross-sectional observational study. METHODS: An ad hoc questionnaire was administered on nurses' experience of PC use. RESULTS: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate-strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25 , 1; P75 , 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. CONCLUSIONS: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively. IMPLICATIONS FOR PRACTICE: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care.

Contribución de las redes sociales al crecimiento de las sociedades científicas / Contribution of social networks in the growth of scientific societies

FUNDAMENTOS: El uso de redes sociales (RS) se ha extendido exponencialmente en los últimos años, constituyéndose en una nueva herramienta de comunicación y divulgación. En la comunidad científica existe igualmente este impacto. MÉTODOS: El objetivo del estudio fue describir el uso que una asociación de enfermería nefrológica autonómica está haciendo de las RS y el impacto que está teniendo este uso en su número de socios. Retrospectivamente, se recogieron los datos mensuales de seguidores de cada RS utilizada, el número de publicaciones y el número de socios de la asociación. El periodo de observación fue desde mayo de 2015 hasta diciembre de 2017. RESULTADOS: Se analizaron las 5 RS utilizadas: Facebook (342 seguidores y 1004 publicaciones), Twitter (84 seguidores y 49 publicaciones), Instagram (77 seguidores y 39 publicaciones), Youtube (2 seguidores y 4 publicaciones) y Blogger (9 seguidores y 99 publicaciones). Los socios al final del periodo de estudio fueron 98. Existe una correlación positiva de 0,9 entre los seguidores y el número de publicaciones realizadas (p = 0,003). Se han encontrado correlaciones positivas entre socios y seguidores de Facebook (r=0,5;p = 0,001), Twitter (r=0,8;p = 0,002) y Blogger (r=0,7;p = 0,004). CONCLUSIONES: Utilizar RS es una buena estrategia de difusión y este uso se correlaciona con el número de socios logrado. A pesar de que la literatura científica advierte de que el potencial de las RS está por explotar y su utilidad se ha puesto en duda, es una vía de interés en cuanto a crecimiento y difusión de las sociedades científicas

BACKGROUND: The use of social networks (SN) has been expanded exponentially in recent years, becoming a new communication and dissemination tool. In the scientific community this impact exists equally. METHODS: The objective of the study was to describe the use that an autonomous nephrological nursing association is making of SN and the impact this use is having on the number of members. In retrospect, the monthly followers data of each SN used, the number of publications and the number of members of the association were collected. The observation period was from May 2015 to December 2017. RESULTS: The 5 SN used were analyzed: Facebook (342 followers and 1004 posts), Twitter (84 followers and 49 posts), Instagram (77 followers and 39 posts), YouTube (2 followers and 4 posts) and Blogger (9 followers and 99 publications). The members at the end of the study period were 98. There is a positive correlation of 0.9 between the followers and the number of publications made (p = 0.003). Positive correlations were found between Facebook partners and followers (r=0.5;p = 0.001), Twitter (r=0.8;p = 0.002) and Blogger (r=0.7;p = 0.004). CONCLUSIONS: Using SN is a good dissemination strategy and this use correlates with the number of members achieved. Although the scientific literature warns that the potential of SN is to be exploited and its usefulness has been questioned, it is a way of interest in terms of growth and dissemination of scientific societies

Traditional and complementary medicine in a nephrology department: practitioner knowledge and advice.

BACKGROUND: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. AIMS: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. METHODS: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. FINDINGS: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. CONCLUSION: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.

Déficit de actividades recreativas en hemodiálisis. Satisfacción y coste económico ante un proyecto lúdico terapéutico / Lack of leisure activities in hemodialysis. Satisfaction and economic cost before a therapeutic play project

INTRODUCCIÓN: Se ha documentado que implementar programas de actividades recreativas durante las sesiones de diálisis es una buena alternativa para mejorar no solo la percepción hacia el tratamiento, sino también otras alteraciones presentes en las personas con enfermedad renal crónica en tratamiento con hemodiálisis. OBJETIVOS: Analizar la satisfacción de los pacientes con el Proyecto Déficit de Actividades Recreativas, así como cuantificar el coste económico del mismo. MATERIAL Y MÉTODO: Estudio descriptivo transversal realizado en 2019. Se recogieron datos clínicos. Se valoró la satisfacción con el proyecto de actividades propuesto. Se recogieron datos de autopercepción sobre el estado de salud y el tratamiento. Se cuantificó el coste económico del proyecto. RESULTADOS: Evaluados 37 pacientes. La puntuación mediana de satisfacción para las actividades fue: Programa Pallapupas 8/10 (P25:6; P75:10), Celebraciones mensuales 10/10 (P25:8; P75:10), Ejercicio físico intradiálisis 7/10 (P25:5; P75:10), Conciertos en directo 7/10 (P25:5,5; P75:9,5). En la autopercepción, un 37,84% (n=14) percibía negativamente el tratamiento y un 29,73% (n=11) no estar satisfecho con la inversión de tiempo. El 91,89% (n=34) desea continuar participando en las actividades organizadas. El coste total teórico de las 4 actividades evaluadas es de 33.715,22 euros al año. CONCLUSIONES: Se ha hallado una alta satisfacción de los pacientes con el Proyecto déficit de actividades recreativas en hemodiálisis, pudiendo ser el coste anual de dicho proyecto asumible

INTRODUCTION: It has been documented that implementing leisure activity programs during dialysis sessions is a good alternative to improve not only the perception towards treatment, but also other alterations present in people with chronic kidney disease on hemodialysis. OBJECTIVES: To analyse patient satisfaction with the Lack of Leisure Activities Project, as well as quantify its economic cost. MATERIAL AND METHOD: Descriptive cross-sectional study conducted in 2019. Clinical data were collected. Satisfaction with the proposed activity project was assessed. Self-perception data on health status and treatment were collected. The economic cost of the project was quantified. RESULTS: 37 patients were evaluated. The median satisfaction score for the activities was: "Pallapupas" Program 8/10 (P25:6; P75:10), Monthly celebrations 10/10 (P25:8; P75:10), 7/10 intradialytic exercise (P25:5; P75:10), live concerts 7/10 (P25:5.5; P75:9.5). Regarding to self-perception, 37.84% (n=14) perceived the treatment negatively and 29.73% (n=11) were not satisfied with the time invested. 91.89% (n=34) wish to continue participating in organized activities. The total theoretical cost of the 4 activities evaluated is 33,715.22 euros per year. CONCLUSIONS: A high satisfaction of the patients with the Lack of Leisure Activities in hemodialysis Project was found, being the annual cost of the project acceptable

From physical to emotional pain in chronic kidney disease: Nurses' perceptions.

BACKGROUND: Changes in body image are a recurring theme in the literature on chronic kidney disease (CKD). There is insufficient evidence identifying nurses' perceptions of this topic. OBJECTIVE: To explore nurses' perceptions of changes in the bodies of persons with CKD. DESIGN: Phenomenological study. METHODS: Data were collected by semi-structured interviews with nephrology nurses selected through pragmatic sampling until data saturation. The interviews were transcribed and analyzed using the seven phases of Colazzi. FINDINGS: Information saturation was achieved with six nurses. Coexisting elements were found between the physical and emotional impact of CKD, and therefore the data were organised into a central theme: "From physical to emotional pain in the individual's body". This central theme was defined by seven subthemes that describe the coexistence of these two physical and emotional spheres, giving rise to the appearance of important meanings in the changes occurring in the bodies of individuals diagnosed with CKD. These meanings included stigma, dysfunctionality, emotional pain, the feeling of slavery, lack of information, taboo and hope. CONCLUSIONS: In the nurses' perspective, the changes occurring in the bodies of people with CKD can transcend the physical sphere and acquire more complex meanings. Nurses have a unique insight into these complex meanings, which include all the domains of the person, and which have important implications for daily practice. IMPLICATIONS FOR PRACTIC: Nurses should have specialised training in providing effective responses to patients' emotional needs. It is also important to incorporate professional profiles that support nursing interventions.

Análisis del uso y complicaciones del acceso vascular periférico en la técnica del recambio plasmático terapéutico mediante centrifugación / Analysis of the use and complications of peripheral vascular access in centrifuge-based therapeutic plasma exchange

Introducción: El recambio plasmático terapéutico es una técnica extracorpórea de depuración sanguínea. El recambio plasmático terapéutico mediante el método de centrifugación (plasmacentrifugación) requiere flujos de 50 ml/min lo que permite realizar el intercambio con accesos vasculares periféricos. El principal objetivo de este estudio fué el de analizar el uso y las complicaciones del acceso vascular periférico en las sesiones de plasmacentrifugación. Material y Método: Estudio observacional descriptivo longitudinal sobre el análisis de complicaciones del acceso vascular periférico de las sesiones de plasmacentrifugación realizadas entre enero de 2017 y marzo de 2018. Resultados: Inclusión de un total de 93 sesiones de plasmacentrifugación, estas sesiones fueron llevadas a cabo en 9 pacientes con una mediana de 7 (P25:6; P75:10,5) sesiones por paciente. El 66,66% (n=6) fueron mujeres. En el 89,24% (n=83) de las sesiones se usó la centrifugación y en el 10,75% (n=10) la fotoaféresis. La etiología de enfermedad para estos pacientes fue: renal en el 55,55% (n=5) de los casos, neurológica en el 33,33% (n=3) de los casos y dermatológica en el 11,11% (n=1). De las 93 sesiones totales hubo problemas relacionados con la canalización de un acceso vascular periférico en el 52,69% de las sesiones (n=49). Conclusiones: Debido a que en más de la mitad de las sesiones se presentaron complicaciones en el abordaje del acceso vascular periférico, se concluye que es necesario el estudio vascular ambulatorio del paciente antes de la primera sesión, pudiendo ser útil el uso de la punción ecoguiada

Introduction: Therapeutic plasma exchange is an extracorporeal blood purification technique. Centrifuge-based therapeutic plasma exchange (plasmacentrifugation) requires flows of 50 ml/min which allows the exchange with peripheral vascular accesses. The main objective of this study is to analyze the use and complications of peripheral vascular access in plasmacentrifugation sessions. Material and Method: Descriptive observational longitudinal study on the analysis of peripheral vascular access complications in plasmacentrifugtion sessions between January 2017 and March 2018. Results: A total of 93 plasmacentrifugation sessions were included. Sessions were carried out in 9 patients with a median of 7 (P25:6; P75:10.5) per patient. 66.66% (n=6) were women. Centrifugation was used in 89.24% (n=83) of the sessions and in 10.75% (n=10) photoaferesis. The etiologies of the disease for these patients were: renal in 55.55% (n=5) of cases, neurological in 33.33% (n=3) of cases and dermatological in 11.11% (n=1). There were problems related to the channeling of peripheral vascular access in 52.69% of the sessions (n= 49). Conclusions: Because in more than half of the sessions there were complications in the channeling of peripheral vascular access, it is concluded that ambulatory vascular study of the patient is necessary before the first session, the use of ultrasound guided puncture may be useful

Relación entre calidad del sueño, ansiedad y depresión en pacientes con enfermedad renal crónica en hemodiálisis / Relationship between sleep quality, anxiety and depression in patients with chronic kidney disease on hemodialysis

Introducción: Los trastornos de sueño tienen una alta prevalencia en los pacientes con Enfermedad Renal Crónica en Hemodiálisis. Un descanso insuficiente o de mala calidad influye negativamente en la actividad cotidiana siendo causa o consecuencia de estados depresivos o ansiosos. Objetivo: Evaluar la calidad del sueño en pacientes en hemodiálisis y su relación con los niveles de depresión y ansiedad. Material y Método: Estudio observacional descriptivo con inclusión de 28 pacientes en hemodiálisis durante febrero de 2017. Se recogieron datos sociodemográficos, se administró el test Pittsburg de Calidad del Sueño, y se valoró el estado cognitivo con el examen Minimental y la depresión y ansiedad con la Hospital Anxiety and Depression Scale (HADS). Resultados: El 82,14% (n=23) presentó insomnio según el test de Pittsburg. Los resultados obtenidos con el HADS fueron positivos para ansiedad en un 21% (n=6) y positivos para depresión en un 35% (n=10). Los resultados en el test Pittsburg se correlacionaron positivamente con los niveles de ansiedad (p=0,004) y depresión (p=0,049). El grado de depresión se correlacionó negativamente con ausencia de deterioro cognitivo (p=0,010). Conclusiones: La calidad del sueño en los pacientes examinados es mala y se pueden relacionar con los resultados de depresión y ansiedad encontrados. Según estos resultados, incluiremos información sobre hábitos de sueño saludables en el proceso de educación a pacientes en hemodiálisis, así como pretendemos mejorar la detección y tratamiento especializado de la ansiedad y depresión

Introduction: Sleep disorders have a high prevalence in patients with chronic kidney disease (CKD) on hemodialysis (HD). Insufficient or poor quality rest negatively influences daily activity, being the cause or consequence of depressive or anxious states. Objective: To evaluate the quality of sleep of patients on hemodialysis and the relationship with levels of depression and anxiety. Material and Method: Descriptive observational study including 28 HD patients during February 2017. Sociodemographic data were collected, the Pittsburg Sleep Quality test was administered, the cognitive status was assessed with the Mini-Mental test and anxiety and depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Results: According to the Pittsburg Sleep Quality test, 82.14% (n=23) presented insomnia. HADS was positively related to anxiety in 21% (n=6) of population and to depression in 35% (n=10). The results in the Pittsburgh test correlated positively with levels of anxiety (p=0.004) and depression (p=0.049). The degree of depression correlates negatively with the absence of cognitive impairment (p=0.010). Conclusions: The sleep quality in the examined patients is poor and can be related with the depression and anxiety results. According to that results, we will include information about healthy sleep habits in the HD patients' education process, as well as we intend to improve management and specialized treatment of anxiety and depression

Using Creative Activities to Improve Treatment Perceptions of Patients on Hemodialysis.

Hemodialysis (HD) has a significant impact on health-related quality of life (HRQoL). We performed an observational study to assess the mental and physical status of 41 patients on chronic HD treatment. We planned and launched a program of recreational and therapeutic intradialysis activities to reduce patients' boredom due to inactivity. Patients' mental and physical status was reassessed at 12 months. Our initial attempt to introduce these recreational activities as intradialysis therapy has been rated positively by all patients. After one year, anxiety decreased (without statistical significance) and willingness to participate in activities increased from 50.00% to 85.71% (p=0.019). No improvement was observed on the remaining studied variables. This preliminary initiative is promising. We plan to maintain these successful therapies and include others to help consolidate this program.

Análisis del estado psicofísico de los pacientes en hemodiálisis / Analysis of the psychophysical state of hemodialysis patients

Introducción: Los pacientes en hemodiálisis deben someterse a tratamientos no curativos y altamente invasivos, implicando importantes cambios en el estilo, hábitos y calidad de vida. Objetivo: Conocer el estado psíquico y físico de los pacientes en programa crónico de hemodiálisis y su opinión acerca de su experiencia personal en las sesiones de hemodiálisis. Material y Método: Estudio observacional descriptivo de corte transversal. Se utilizaron diferentes escalas de valoración para conocer en profundidad el estado psico-físico de la muestra seleccionada. Resultado: Inclusión de 35 pacientes, con una media de 67,43±14,82 años y estancia mediana en hemodiálisis de 20 meses [P25 4; P75 62,5]. El 71,43% presentaba algún grado de dependencia para las actividades básicas (Barthel) y el 85,71% para las actividades instrumentales (Lawton-Brody). El 71,43% presentaba algún grado de ansiedad (Hamilton) y el 77,14% la probabilidad de padecer depresión (Escala Goldberg). El 54,29% presentaba algún grado de deterioro cognitivo (Examen Minimental). El 88,57% percibe afectación en su calidad de vida en el aspecto físico y el 51,43% a nivel mental (SF-12). La experiencia en hemodiálisis fue valorada por el grupo como Regular, Mala o Muy Mala por el 51,43%, un 62,86% afirmó no hace nada durante las sesiones y un 57,14% se siente atraído por la idea de participar en un Programa de Actividades Recreativas (según cuestionario de elaboración propia). Discusión y Conclusiones: La mediana de los resultados en depresión, ansiedad, dependencia, deterioro cognitivo, percepción de calidad de vida y percepción del tratamiento está gravemente alterada. Según la bibliografía consultada, favorecer la realización de actividades lúdico-terapéuticas durante la hemodiálisis puede mejorar la actitud de los pacientes, ayudar a mantener un adecuado nivel de salud tanto físico como mental y mejorar la percepción del tratamiento (AU)

Introduction: Hemodialysis patients should undergo non-curative and highly invasive treatments, involving significant changes in style, habits and quality of life. Objective: To know the psychic and physical state of patients in a chronic hemodialysis program and their opinion about their personal experience in hemodialysis sessions. Material and Method: A cross-sectional observational descriptive study was carried out. Different rating scales were used to know in depth the psycho-physical state of the selected sample. Results: Thirty-five patients were included, with an average age of 67.43±14.82 years and a median hemodialysis time of 20 months [P25 4; P75 62.5]. 71.43% had some degree of dependency for basic activities (Barthel) and 85.71% for instrumental activities (Lawton-Brody). 71.43% presented some degree of anxiety (Hamilton) and 77.14% the probability of suffering depression (Goldberg Scale). 54.29% had some degree of cognitive deterioration (Minimental Exam). 88.57% perceive impairment in their quality of life in the physical aspect and 51.43% in the mental level (SF-12). The experience in hemodialysis was rated by the group as ‘Regular’, ‘Bad’ or ‘Very Bad’ by 51.43%. A 62.86% reported doing nothing during the sessions and 57.14% are attracted by the idea of participating in a recreational program (according to a self-created questionnaire). Discussion and Conclusions: The median of the results in depression, anxiety, dependence, cognitive deterioration, perception of quality of life and perception of the treatment is seriously altered. According to the consulted bibliography, favoring the performance of ludic-therapeutic activities during hemodialysis can improve the attitude of patients, helping maintain an adequate level of both physical and mental health and improving the perception of treatment (AU)

Measuring peritoneal absorption with the prolonged peritoneal equilibration test from 4 to 8 hours using various glucose concentrations.

BACKGROUND: Peritoneal fluid flows such as small-pore ultrafiltration and free water transport can now be calculated by means of the modified peritoneal equilibration test (PET). To calculate peritoneal fluid absorption, volume markers have been used, but that method is not easily applicable in clinical practice. Alternatively, absorption can be estimated using the personal dialysis capacity test. However, a method of measuring overall peritoneal absorption together with the PET is lacking. The aim of the present study was to assess whether overall peritoneal absorption was different when measured from the 4th to 8th hour in a prolonged PET using three different glucose solutions. METHODS: The study enrolled 32 stable peritoneal dialysis (PD) patients from a tertiary university hospital, who underwent three 8-hour prolonged PETs with 1.36%, 2.27%, and 3.86% glucose solution. The PETs were performed in random order over a period of less than 1 month. During the prolonged PET, the peritoneal volume was emptied and reinfused at 60 and 240 minutes and drained at 480 minutes. Peritoneal absorption was calculated as the volume difference between the 4th and the 8th hour. RESULTS: The dialysate-to-plasma ratio (D/P) of urea, the D/P creatinine, and the mass transfer area coefficient (MTC) of creatinine at 240 minutes were not significantly different with the three glucose solutions. The end-to-initial (D/D0) glucose, MTC urea, and MTC glucose were significantly different. All water transport parameters were significantly different, except for the 4- to 8-hour absorption volumes and rates. The peritoneal absorption rates were, for 1.36% solution, 1.03 ± 0.58 mL/min [95% confidence interval (CI): 0.83 to 1.24 mL/min]; for 2.27% solution, 0.86 ± 0.71 mL/min (95% CI: 0.61 to 1.11 mL/min); and for 3.86% solution, 1.05 ± 0.78 mL/min (95% CI: 0.77 to 1.33 mL/min). Peritoneal absorption volumes and rates from the 4th to the 8th hour showed good correlations for the various solutions. CONCLUSIONS: Using any glucose solution, the prolonged PET with voiding and reinfusion at the 4th hour could be a practical method for calculating overall peritoneal absorption from the 4th to the 8th hour in PD patients.