Vaginal packing after vaginal hysterectomy: systematic review and recommendations.

INTRODUCTION AND HYPOTHESIS: Vaginal packing is often used after vaginal hysterectomy to reduce the risk of haemorrhagic and infectious complications, but the procedure may impair spontaneous bladder emptying and necessitate permanent bladder catheterization, which itself increases the risk of urinary infection, patient bother, delayed discharge, and increased costs. This systematic review was aimed at assessing the complications and outcomes associated with vaginal packing after vaginal hysterectomy. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, using the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework to define eligibility. Following data synthesis and subgroup analyses, we assessed the certainty of evidence according to GRADE guidance and formulated a clinical recommendation. RESULTS: The review included four clinical trials (involving 337 participants). These provided no clear evidence that vaginal packing led to clinically meaningful reductions in adverse effects, such as vaginal bleeding, hematoma formation, or postoperative vaginal cuff infection. Overall, the intervention produced no clear benefit regarding the predefined outcomes. CONCLUSIONS: Routine vaginal packing after vaginal hysterectomy had no clear benefit on outcomes. We therefore advise against this procedure.

Adverse events associated with the use of recommended vaccines during pregnancy: An overview of systematic reviews.

INTRODUCTION: Maternal immunization is aimed at reducing morbidity and mortality in pregnant women and their newborns. Updated evidence synthesis of maternal-fetal outcomes is constantly needed to ensure that the risk-benefit of vaccination during pregnancy remains positive. METHODS: An overview of systematic reviews (OoSRs) was performed. We searched The Cochrane Library, MEDLINE and EMBASE for SRs including recommended vaccines for maternal immunization reporting the following: abortion, stillbirth, chorioamnionitis, congenital anomalies, microcephaly, neonatal death, neonatal infection, preterm birth (PTB), low birth weight (LBW), maternal death and small for gestational age (SGA) from 2010 to April 2019. Quality and overlap of SRs was assessed. RESULTS: Seventeen SRs were identified, eight of them included meta-analysis; quality was high in three SRs, moderate in six SRs, low in two SRs, and critically low in six SRs. Stillbirth and PTB were the most frequently reported outcomes by 15 and 13 SRs, respectively, followed by abortion (9 SRs), congenital anomalies (9 SRs), SGA (8 SRs), neonatal death (8 SRs), LBW (4 SRs), chorioamnionitis (3 SRs), maternal death (1 SR). SRs included mainly observational evidence for influenza and Tdap vaccines (11 SRs and 4 SRs, respectively); limited evidence was found for hepatitis (1 SR), yellow fever (1 SR), and meningococcal (1 SR) vaccines. Most of the SRs found no effect. Eight SRs found benefit/protection of influenza vaccine (for stillbirth, neonatal death, preterm birth, LBW), or Tdap vaccine (for preterm birth and SGA); one found a probable risk (chorioamnionitis/Tdap). The SRs for Hepatitis B, meningococcal and yellow fever vaccines were inconclusive. CONCLUSIONS: Definite risks were not identified for any vaccine and outcome; however better evidence is needed for all outcomes and vaccines. The available evidence in the SRs to support vaccine safety was based mainly on observational data. More RCTs with adequate reporting of maternal-fetal outcomes and larger high-quality observational studies are needed.

Guía de práctica clínica de atención en el embarazo y puerperio / Clinical practice guide for pregnancy and puerperal care

El objetivo de esta guía es establecer un conjunto de recomendaciones basadas en la evidencia científica de mayor calidad disponible para mejorar la salud de las mujeres embarazadas y puérperas, así como la salud de los y las recién nacidos.

Guía de práctica clínica sobre prevención primaria y secundaria del ictus / Primary and secondary prevention of stroke: A guideline

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Calidad de los estudios que relacionan los instrumentos y los resultados en salud / Quality of the studies that relate measurement instruments with quality outcomes

En este artículo, final de la serie en la que se han presentado los resultadosde la revisión sistemática de los instrumentos que miden laactividad enfermera y su repercusión sobre los resultados en salud,se describen aspectos metodológicos de la revisiones sistemáticasdestacando la importancia de la valoración de la calidad de los trabajosincluidos y se analiza la calidad de los estudios que relacionanlos instrumentos y los resultados en salud de los pacientes. Las conclusionesde dichos estudios ya se han descrito en un artículo previo

This is the last of a series of articles that have presented the resultsof a systematic review of instruments used to measure nursing workand its repercussion on health outcomes. A description of themethodological aspects from the systematic reviews is presented,highlighting the importance of quality assessment in the studies includedand analysing the quality of those studies that relate such instrumentswith patient health outcomes. The results of these studies have been described in a previous article (AU)

Estudios que relacionan los instrumentos y los resultados en salud / Studies relating instruments to health outcomes

Los resultados en salud constituyen el producto final de todo el procesoasistencial. Es por este motivo que identificar los estudios publicadosen la literatura que relacionan los instrumentos presentadosa lo largo de esta serie con los resultados en salud, constituyóun punto clave de la revisión sistemática sobre los instrumentos quemiden cargas de Enfermería. En este artículo, se describen los artículosidentificados que relacionan instrumentos y resultados en salud.En el próximo artículo, último de la serie, se analizará la calidadmetodológica de los estudios aquí presentados

Health outcomes constitute the final product of the entire healthcareprocess. This is why the identification of studies published inthe literature relating the instruments presented throughout theseseries to healthcare outcomes, constituted a key aspect of the systematicreview on the instruments that measure nursing loads. Thisarticle describes the papers identified in the review that relate instrumentsto health outcomes. Our next paper will analyse the qualityof the methodology employed in the studies herein depicted

Instrumentos basados en medidas indirectas: Medicus, Exchaquet, Método Montesinos, IPSI y DNS / Instruments based on indirect measures: Medicus, Exchaquet, Montesinos method, IPSI and DNS

En este artículo, octavo de la serie de instrumentos para medir cargas de trabajo de Enfermería, se describen cuatro instrumentos que presentan como denominador común el basarse en medidas indirectas para la estimación de la carga de trabajo y el haber sido desarrollados para aplicarse en el contexto general de hospitalización. Los instrumentos identificados que reúnen estas características son los siguientes: Medicus (1974, LLOC), Exchaquet, Método Montesinos, IPSI y DNS

This article, 8th in a series of instruments used to measure working loads in nursing, describes four instruments. These four instruments share that they have all been based on indirect measures of working loads and that they have been developed to be applied within the general concept of hospitalisation. The identified instruments that meet these characteristics include: Medicus (1974, LLOC), Exchaquet, Montesinos method, IPSI and DNS

Estudios que relacionan los instrumentos y los resultados en salud / Studies relating instruments to health outcomes

Los resultados en salud constituyen el producto final de todo el proceso asistencial. Es por este motivo que identificar los estudios publicados en la literatura que relacionan los instrumentos presentados a lo largo de esta serie con los resultados en salud, constituyó un punto clave de la revisión sistemática sobre los instrumentos que miden cargas de Enfermería. En este artículo, se describen los artículos identificados que relacionan instrumentos y resultados en salud. En el próximo artículo, último de la serie, se analizará la calidad metodológica de los estudios aquí presentados

Health outcomes constitute the final product of the entire healthcare process. This is why the identification of studies published in the literature relating the instruments presented throughout these series to healthcare outcomes, constituted a key aspect of the systematic review on the instruments that measure nursing loads. This article describes the papers identified in the review that relate instruments to health outcomes. Our next paper will analyse the quality of the methodology employed in the studies herein depicted

Instrumentos basados en medidas indirectas para UCI II: SAF, NISS, Omega,Crew System y NCR / Instruments based on indirect measures for ICU II: SAF, NISS, Omega, Crew System and NCR

En este artículo, séptimo de la serie de instrumentos para medir cargas de trabajo de Enfermería, se describen cinco de los ocho instrumentos, creados para ser aplicados en las unidades de cuidados intensivos, basados en medidas indirectas, el SAF Nursing Care System, el Nursing Intervention Scoring System (NISS), el Sistema Omega, el Crew System y el Nursing Care Recording (NCR). De los instrumentos descritos sólo se validan mediante correlación el sistema Omega y el NCR. El sistema Omega se compara con las puntuaciones del PRN 87 y el NCR con los valores de TISS

This article, the seventh in a series of instruments designed to measure nursing loads, described five of the eight instruments created to be applied at intensive care units. The instruments are based on indirect measures, the SAF Nursing Care System, the Nursing Intervention Scoring System (NISS), the Omega System, the Crew System and the Nursing Care Recording (NCR). Of the described instruments, only the Omega system and the NCR system are validated by means of correlation. The Omega system is compared against the PRN 87 scores and the NCR against the TISS values

Instrumentos basados en medidas indirectas para UCI: TISS y NEMS / Instruments based on indirect measures for ICU: TISS and NEMS

En este artículo, sexto de la serie de instrumentos para medir cargas de trabajo de Enfermería, se describen dos de los ocho instrumentos creados para ser aplicados en las unidades de cuidados intensivos, basados en medidas indirectas, el Therapeutic Intervention Scoring System (TISS) y el Nine Equivalents for Nursing Manpower Use (NEMS). El TISS, descrito por primera vez en 1974, se diseñó para clasificar a los pacientes críticos en función de la gravedad de su enfermedad. El primer estudio que cuantifica cargas de Enfermería a partir de la puntuación TISS, es de Cullen y se publica en 1977. Una de las mayores críticas que recibe el TISS está relacionada con la multiplicidad de versiones hechas a partir del instrumento original. El NEMS se puede considerar una evolución del TISS ya que es un instrumento diseñado para medir cargas de trabajo en Enfermería a partir de una simplificación del TISS 28. La primera publicación es de 1997

This article, the sixth in a series describing instruments used to measure workload in nursing care, depicts two of the eight instruments created for application in intensive care units. These instruments: Therapeutic Intervention Scoring System (TISS) and the Nine Equivalents for Nursing Manpower Use (NEMS) were based on indirect measures. TISS, described for the first time in 1974, was designed to classify critical patients according to the severity of their condition. The first study quantified nursing workloads using the TISS score, was written by Cullen and published in 1977. One of the major criticisms of the TISS is related to the multiplicity of versions elaborated using the original instrument as a start point. NEMS can be considered as an evolution of the TISS, as it is an instrument designed to measure workloads in nursing based on a simplification of the TISS 28. The first publication dates back to 1997

Instrumentos basados en medidas directas para UCI II: NAS (Nursing Activities Score) / Instruments based on direct measures for ICY II: NAS (Nursing Activities Score)

Este artículo, quinto de una serie de diez, describe el NAS (Nursing Activities Score) que junto con el GRASP (Grace Reynolds Application and Study of PETO) y el TOSS (Time Oriented Score System), que se presentaron en el número anterior, son instrumentos basados en medidas directas creados para ser aplicados en las unidades de cuidados intensivos. El NAS se diseña a partir de la identificación de aquellas actividades de Enfermería que mejor reflejan la carga de trabajo en las Unidades de Cuidados Intensivos (UCI) y de la atribución a estas actividades, de una puntuación específica basada en el tiempo de Enfermería empleado en su realización. Es importante destacar que se trata siempre de medidas centradas en aquella parte del cuidado de Enfermería que es cuantificable, la relacionada con el conocimientoempírico y en esta línea es como se deben considerar los resultados obtenidos de la aplicación de estos instrumentos de medida

This article, the fifth in a series of ten, describes the NAS (Nursing Activities Score), which together with the GRASP (Grace Reynolds Application and Study of PETO) and the TOSS (Time Oriented Score System), presented in the last issue, are instruments based on direct measures created to be applied at intensive care units. The NAS measure is designed from the identification of thosenursing activities that best reflect the work load at Intensive Care Units (ICUs) and the assignment of activities, using a specific score based on the time the nurse takes to carry out the assigned task. It is important to point out that these are always measures focusing on that part of nursing care that is quantifiable, that is, that part of nursing relating to the empiric knowledge. It is thus from this line, how the results obtained from the application of such measurement instruments must be considered (AU)

Instrumentos basados en medidas directas para UCI I: GRASP y TOSS / Instruments based on direct measurements of ICU I: GRASP and TOSS

Este artículo, cuarto de una serie de diez, describe el GRASP (Grace, Reynolds Application and Study of PETO) y el TOSS (Time Oriented Score System), que junto con el NAS (Nursing Activities Score) que se presentará en el número siguiente, son instrumentos basados en medidas directas creados para ser aplicados en las Unidades de Cuidados Intensivos. El GRASP es un sistema de gestión de recursos enfermeros centrado en las necesidades de cada paciente y surge con el objetivo de planificar de una forma adecuada la plantilla de Enfermería necesariay así, garantizar la calidad del cuidado. El TOSS se basa en la medida del tiempo de las actividades de Enfermería en pacientes de cuidados intensivos realizadas durante las 24h previas al registro y sobre ello se establece el cálculo directo de la ratio enfermera-paciente

This article, the fourth of the series, describes the GRASP instrument (Grace, Reynolds, Application and Study of PETO) and the TOSS instrument (Time Oriented Score System), which together with the NAS (Nursing Activities Score) to be presented in our next issue, are instruments based on direct measurements created to be applied at the Intensive Care Units. The GRASP instrument is a nursing resource management system focusing on the needs of each patient that was created in response to a need to plan the nursing staff needed appropriately and, in this way, ensure the quality of care. The TOSS instruments is based on a measurement of the time nursing activities take inpatients admitted into the ICU performed in the 24 hours before the actual recording, with subsequent calculation of patient/ratio time ratio (AU)

Instrumentos basados en medidas directas II: SIIPS y SIGNO II / Instruments based on direct measures II: SIIPS and SIGN II

Este artículo tercero de una serie de diez, describe el SIIPS (SoinsIndividualisés à la Personne Soignée), y el Proyecto Signo II, quejunto con el PRN (Projet de Recherche en Nursing) descrito en elnúmero anterior, constituyen los tres instrumentos basados enmedidas directas del tiempo consumido en el cuidado de lospacientes, enmarcados en un ámbito de atención hospitalaria noespecializada. El SIIPS analiza los requerimientos de cuidados porparte del paciente basándose en las necesidades básicas descritaspor Virginia Henderson. Las necesidades requeridas, se agrupan entres actos de cuidado dispensados por las enfermeras (actos de cuidadosbásicos, de cuidados de relación y educación, y de cuidadostécnicos). El proyecto Signo II tiene como propósito definir un catálogode productos de Enfermería, determinar los criterios y nivelesde homologación de la Enfermería moderna y establecer los criteriosbásicos para diseñar un soporte informático de gestión

This is the third article of a series of ten describing the SIPPS(Soins Individualisés à la Personne Soignée) and the SIGN II project,which together with the PRN project (Project de Rechercheen Nursing), described in the last issue, constitute the threeinstruments based on direct measures of the time used in patientcare in a non-specialised hospital care setting. SIPPS analysespatient care requirements on the basis of the needs described byVirginia Henderson. The required needs are grouped in threecare actions carried out by the nurses (basic care actions, relationaland educational actions and technical care actions). TheSIGN II project is intended to define a catalogue of nursing productsand to establish basic criteria to design a management softwaresupport system

Instrumentos basados en medidas directas I: Projet Recherche in Nursing (PRN) / Instruments based on direct measurements I: Projet Recherche in Nursing (PRN)

Este artículo, segundo de una serie de diez, cuyo objetivo es difundirlos resultados de una revisión sistemática sobre los sistemas de medidade las cargas de Enfermería, describe el PRN (Projet Recherche inNursing) como instrumento de medición directa. Los instrumentosbasados en medidas directas del tiempo consumido en el cuidado delos pacientes se basan en una descripción exhaustiva de las actividadesde cuidado, ponderadas de acuerdo con el tiempo de ejecuciónde la acción. Estos instrumentos miden el tiempo de cuidado a partirde las actividades de cuidado que se han realizado o se prevé realizara un paciente durante un periodo de tiempo determinado.El enfoque de medición de la carga de trabajo en el PRN se basaen la medida de varios componentes: los cuidados directos e indirectosrequeridos, las transmisiones o comunicaciones referentesal paciente, las actividades administrativas y de mantenimiento ylos desplazamientos no relacionados con el paciente en el interiorde una unidad de cuidados

This article, second of a series of ten, the objective of which is todisseminate the results of a systematic revision on the systemsthat measure the nursing load, describes the PRN project (ProjectRecherche in Nursing) as a direct measurement tool. Instrumentsbased on direct measurement of the time consumed in the care ofpatients are based on an exhaustive description of the care activitiesundertaken, weighted according to the execution time of theaction. These instruments measure the care time from the care activitiesthat were performed or are to be performed on a given patientduring a given period of time.The approach to measure the work load in the PRN system isbased on the measurement of several components: direct and indirectcare required, transmissions or communications referring topatients, administrative duties, maintenance duties, and the goingfrom place to place within the care unit for things unrelated withthe patient