[Efficacy of Physiotherapy Interventions on the Respiratory Musculature Through Respiratory Training Techniques in Post-operative Lung Transplant Recipients: Systematic Review]. / Eficacia de las intervenciones fisioterápicas sobre la musculatura respiratoria mediante técnicas de entrenamiento respiratorio en el postoperatorio de trasplantados pulmonares: una revisión sistemática.

Introduction: Respiratory muscles are a limiter of exercise capacity in lung transplant patients. It is necessary to know the effectiveness of specific respiratory muscle training techniques carried out in the management of adult lung transplant patients in the postoperative period. Methodology: A systematic review of clinical trials was carried out, which included adult lung transplant patients undergoing post-transplant respiratory training. A search was carried out in the databases PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library between January 2012 and September 2023, using the terms: "breathing exercise", "respiratory muscle training", "inspiratory muscle training", "respiratory exercise", "pulmonary rehabilitation", "lung rehabilitation"; in combination with "lung transplantation", "lung transplant", "posttransplant lung". No language limit. Results: Eleven trials were included with a total of 639 patients analyzed. Most training programs begin upon hospital discharge (more than one month post-transplant), few do so early (Intensive Care Unit). The duration varies from 1-12 months post-transplant. The interventions were based on aerobic training and peripheral muscle strength. Some of them included breathing exercises and chest expansions. The most used outcome variable was submaximal exercise capacity measured with the 6-minute walk test. Conclusions: Training the respiratory muscles of the adult transplant patient favors the improvement of exercise capacity and quality of life. Aerobic training, as well as strength training of the rest of the peripheral muscles, contribute to the improvement of respiratory muscles.

Resultados obstétricos y neonatales relacionados con la hidratación intraparto en mujeres atendidas de parto de bajo riesgo / Obstetric and neonatal results associated with intrapartum hydration for women with low-risk labour

Objetivo: determinar la influencia de la hidratación intraparto en los resultados obstétricos y neonatales en mujeres nulíparas atendidas por parto de bajo riesgo.Métodos: se realizó un estudio observacional prospectivo en el Hospital Universitario Puerta de Hierro Majadahonda (Madrid, España). Se incluyeron mujeres nulíparas con gestación única atendidas por parto de bajo riesgo. Se recogieron variables maternas (sociodemográficas, clínicas al ingreso, intraparto y en el puerperio inmediato, resultados obstétricos) y neonatales (datos al nacimiento, a las 24 y 48 horas). Se realizó análisis descriptivo y univariante con los test estadísticos correspondientes. Se valoró la influencia de la hidratación en los resultados obstétricos y neonatales estableciendo un punto de corte en la hidratación recibida intraparto (mediana volumen total administrado por hora: 300 mL/h).Resultados: se incluyeron 148 mujeres. Edad media (DE) 32 (4,4) años, edad gestacional media (DE) 39 (1,4) semanas. Al ingreso, la dilatación media fue de 2 cm. Parto inducido en 65,5% (n= 97). Los resultados obstétricos y neonatales fueron más favorables en las mujeres que recibieron un volumen mayor(> 300 mL/h), con diferencias significativas en la duración total del parto (mediana 526 vs. 735 min; p< 0,001), incidencia de parto por cesárea (14,3% frente 18,7%), fiebre (5,5% frente a 7,7%), incidencia de pérdida de peso neonatal superior al 7% a las 48 horas (28,6% frente a 39,8%), lactancia materna (94,6% frente a 82,4%).Conclusiones: la administración de un mayor volumen de líquidos a mujeres nulíparas durante el parto de bajo riesgo se asoció con mejores resultados obstétricos y neonatales.(AU)

Objective: to determine the influence of intrapartum hydration on obstetric and neonatal results in nulliparous women during low-risk labour.Methods: an observational prospective study was conducted at the Hospital Universitario Puerta de Hierro Majadahonda (Madrid, Spain). The study included nulliparous women with single pregnancy and low-risk labour. Maternal variables were collected (sociodemographic, clinical signs at admission, intrapartum and immediately post-partum, obstetric results) as well as neonatal variables (data at birth, at 24 and 48 hours). Descriptive and univariate analysis was conducted with the relevant statistic tests. The influence of hydration was assessed in obstetric and neonatal results, determining a cut-off point for the hydration received intrapartum (median total volume administered per hour: 300 mL/h).Results: the study included 148 women, with a mean age (SD) of 32 (4.4) years, and a mean gestational age (SD) of 39 (1.4) weeks. At admission, mean dilation was of 2 cm. There was induced labour in 65.5% of cases (n= 97). Obstetric and neonatal results were more favourable in those women who received a higher volume (≥ 300 mL/h), with significant differences in the total duration of labour (median 526 vs. 735 min; p< 0.001), incidence of Caesarean births (14.3% vs. 18.7%), fever (5.5% vs. 7.7%), incidence of neonatal weight loss >7% at 48 hours (28.6% vs. 39.8%), breastfeeding (94.6% vs. 82.4%).Conclusions: administration of a higher volume of fluids to nulliparous women during low-risk labour was associated with better obstetric and neonatal results.(AU)

Características clínicas y laborales de los trabajadores de un hospital universitario con signos y síntomas de COVID-19 durante la pandemia / Clinical and occupational characteristics of university hospital workers with COVID-19 signs and symptoms during the pandemic

Objetivo: conocer las características sociodemográficas, laborales y la exposición al riesgo en trabajadores de un hospital universitario que presentaron síntomas COVID-19 durante la primera ola de la pandemia. Métodos: estudio transversal (julio-septiembre 2020) a personal del Hospital Puerta de Hierro Majadahonda (Madrid, España) que trabajó en la primera ola de la pandemia. Se diseñó una encuesta ad hoc, que incluía: perfil del trabajador, síntomas COVID-19, exposición, curso clínico y atención sanitaria, entre otros. Se realizó un análisis descriptivo. Se usó Chi cuadrado y t de Student para el contraste de hipótesis. Resultados: 992 sujetos. El 34,3% (n= 340) presentó síntomas COVID-19. 283 (84,0%) eran mujeres. El 82,9% (n= 282), personal sanitario. El 36,8% (n= 125), enfermeras. El 63,5% (n= 216) trabajó en unidades de alto riesgo. El 36,2% (n= 123) tenía patología previa. El 83,3% (n= 194) reconoció haber trabajado previamente en unidades de alto riesgo. El 84,5% (n= 229) manifestó haberse sentido expuesto a la infección durante el trabajo. El 49,7% (n= 98) tuvo alguna incidencia de riesgo. El 73,7% (n= 202) presentó astenia. Hubo mayor prevalencia de personal sanitario con síntomas COVID-19 frente a no sanitario en función del trabajo asistencial (92,9% frente a 50,0%; p< 0,001), área de trabajo COVID-19 (74,2% frente a 48,1%; p< 0,001), actividad en Unidades de riesgo alto (73,4% frente a 15,5%; p< 0,001). Conclusiones: entre trabajadores con síntomas COVID hubo una mayor proporción de personal sanitario, mujeres, enfermeras, trabajadores en áreas COVID-19, unidades de riesgo, con exposición previa con pacientes infectados/sospecha. Las diferencias entre trabajadores sanitarios y no sanitarios vienen determinadas por el lugar de trabajo durante la pandemia y el riesgo de exposición a la COVID-19.(AU)

Objective: to understand the sociodemographic and occupational characteristics and risk exposure among workers of a university hospital who presented COVID-19 symptoms during the first wave of the pandemic. Methods: a cross-sectional study (July to September 2020), on staff from the Hospital Puerta de Hierro Majadahonda (Madrid, Spain) who were working during the first wave of the pandemic. An ad hoc survey was designed, which included the worker profile, COVID-19 symptoms, exposure, clinical course, and healthcare, among others. Descriptive analysis was conducted, and Chi-square and Student’s t-test were used for statistical hypothesis testing. Results: the study included 992 subjects; 34.3% (n= 340) presented COVID-19 symptoms; 283 (84.0%) were female; 82.9% (n= 282) of them were healthcare staff; 36.8% (n= 125) were nurses; 63.5% (n= 216) worked at high risk units; 36.2% (n= 123) had a previous medical condition. Of the participants, 83.3% (n= 194) admitted having worked previously at high risk units; 84.5% (n= 229) stated that they have felt exposed to the infection during work; 49.7% (n= 98) had some incidence of risk; and 73.7% (n= 202) presented asthenia. There was a higher prevalence of healthcare staff with COVID symptoms vs. non-healthcare staff, based on care activities (92.9% vs. 50.0%; p< 0.001), work at COVID areas (74.2% vs. 48.1%; p< 0.001), and activity in high risk Units (73.4% vs. 15.5%; p< 0.001). Conclusions: among the workers with COVID symptoms, there was a higher proportion of healthcare staff, women, nurses, workers at COVID areas, risk units, and previous exposure to patients with confirmed or suspected infection. Differences between healthcare and non-healthcare staff were determined by their place of work during the pandemic and their risk of exposure to COVID-19.(AU)

Factores asociados con los signos y síntomas de COVID-19 en los profesionales sanitarios de un hospital universitario español durante la pandemia / Factors associated with covid-19 signs and symptoms in healthcare professionals at a spanish university hospital during the pandemic

Objetivos: El objetivo del estudio fue identificar los factores asociados al desarrollo de COVID-19 en profesionales sanitarios de un hospital universitario al inicio de la pandemia. Material y Métodos: Estudio transversal mediante encuesta online validada en aspecto y contenido, pre-test cognitivo y pilotaje dirigida a los profesionales sanitarios. Se describieron las frecuencias absolutas y relativas para variables cualitativas y cuantitativas, se analizaron las asociaciones mediante la prueba chi-cuadrado para cualitativas y t de Student para cuantitativas. Se realizó una regresión logística para identificar los factores asociados a la COVID-19 en profesionales sanitarios. Resultados: Participaron 728 sujetos. Se observaron diferencias estadísticamente significativas en el tipo de trabajo (p=0,041), exposición relacionada con los espacios y la organización (p=0,001), patología previa (p=0,029) y asma (p=0,034). Los profesionales sanitarios que trabajaron en áreas asistenciales del hospital presentaron la mayor probabilidad de desarrollar COVID-19 (OR: 2,02; p=0,027) y también en aquellos con exposición relacionada con los espacios y organización (OR: 2,13; p≤0,001). Conclusión: Los profesionales sanitarios que trabajaron en áreas asistenciales del hospital presentaron el doble de probabilidad de desarrollar COVID-19. Lo mismo se observó para aquellos con exposición relacionada con los espacios. (AU)

Objectives: The aim of the study was to identify factors associated with the development of COVID-19 in healthcare professionals at a university hospital at the onset of the pandemic. Material and Methods: Cross-sectional study using an online survey validated in aspect and content, cognitive pre-test and piloting aimed at healthcare professionals. Absolute and relative frequencies were described for qualitative and quantitative variables, associations were analyzed using the chi-square test for qualitative variables and Student's t-test for quantitative variables. Logistic regression was performed to identify factors associated with COVID-19 in healthcare professionals. Results: 728 workers participated in the survey. Statistically significant differences were observed in type of work (p=0.041), exposure related to spaces and organisation (p=0.001), previous pathology (p=0.029) and asthma (p=0.034). Healthcare professionals working in care areas of the hospital were most likely to develop COVID-19 (OR: 2.02; p=0.027) and also in those with exposure related to space and organisation (OR: 2.13; p≤0.001). Conclusion: Healthcare professionals who worked in care areas of the hospital were twice as likely to develop COVID-19. The same was observed for those with space-related exposure. (AU)

Pain Behaviors Analyzed by Videorecording in Brain-Injured Patients Admitted to the Intensive Care Unit.

AIM: To describe and classify pain behaviors (facial and body) in brain-injured patients with a low level of consciousness before, during, and after the performance of painful and non-painful care procedures. METHODS: Facial behaviors and body movements in brain-injured patients were videotaped at rest, during the application of three care procedures (two painful and one non-painful), and 15 minutes after completion of these procedures. Each video recording was evaluated by expert evaluators blinded to each other. For each of the behaviors observed, all possible combinations between the three procedures and/or time were compared using the McNemar test. Effect size was measured by the difference in proportions using the Wilson score 95% confidence intervals. RESULTS: Twenty-seven patients were included. The mean (standard deviation) Glasgow Coma Score was 5.4 (1.9). A total of 33 behaviors (29 active, four neutral) were registered. Expression of behaviors was more common during the painful procedures compared with the other time points (non-painful procedures, baseline, and final evaluation). Inter-evaluator agreement was substantial (Kappa index >0.7) in more than 50% of the observed behaviors. CONCLUSIONS: In this study involving brain-injured patients with a low level of consciousness, facial, body, and ventilation-related behaviors were more common during painful procedures. Agreement between evaluators to detect the presence or absence of these behaviors was substantial. These findings underscore the need to develop pain assessment measures specific to this patient population.

Evaluación de las estrategias formativas digitales para profesionales sanitarios implementadas durante la pandemia por COVID-19 / Evaluation of the digital educational strategies for healthcare professionals implemented during the COVID-19 pandemic

Objetivo: evaluar la implementación de la estrategia educativa de microaprendizaje mediante el uso de una aplicación móvil para los profesionales sanitarios de un hospital universitario durante la pandemia por COVID-19. Método: se realizó una encuesta a trabajadores del hospital. Se monitorizaron las visualizaciones de las píldoras formativas. El cuestionario permitió recoger información del perfil sociodemográfico de los participantes, el uso de aplicaciones móviles formativas y el de las píldoras creadas ad hoc durante la pandemia por COVID-19. El número de usuarios registrados en la aplicación era de 4.572. Los datos obtenidos se analizaron mediante un análisis descriptivo, utilizándose la prueba T de Student y el test ANOVA para análisis bivariantes. Resultados: participaron 633 profesionales, edad media (DE) 44,8 (11,1) años. El 81,7% (n= 517) era mujer. El 93,5% (n= 592) era trabajador sanitario. Las enfermeras representaron el 41,2% (n= 261) y los médicos el 22,3% (n= 141). Durante la pandemia, el 55,8% (n= 353) de los sujetos del estudio había trabajado dando asistencia directa a pacientes COVID (+). El 94% (n= 595) utilizó la visualización de vídeos para formarse/informarse para su ámbito profesional. El 94,9% refirió conocer las píldoras formativas de la app Formación SanidadMadrid. Las 22 píldoras formativas recibieron 25.539 visualizaciones en total. Se registró alta satisfacción de los participantes en el uso de este método para su formación durante la pandemia. Conclusiones: la estrategia formativa de microlearning basada en píldoras formativas disponibles en una aplicación móvil demostró ser un elemento clave para el desarrollo de nuevas metodologías formativas digitales en el entorno hospitalario durante una situación pandémica.(AU)

Objective: to evaluate the implementation of the microlearning educational strategy through the use of a mobile application for the healthcare professionals of a university hospital during the COVID-19 pandemic. Methods: a survey was conducted on hospital staff. The visualizations of knowledge pills were monitored. The questionnaire allowed to collect information about the sociodemographic profile of participants, the use of educational mobile applications, and of the pills created ad hoc during the COVID-19 pandemic. The number of users registered in the application was of 4,572. The data obtained were analysed through descriptive analysis, using the Student’s T test and the ANOVA test for bivariate analyses. Results: the study included 633 professionals, with a mean age (SD) of 44.8 (11.1) years; 81.7% (n= 517) were female and 93.5% (n= 592) were healthcare professionals. Nurses represented 41.2% (n= 261) of the sample, and doctors 22.3% (n= 141). During the pandemic, 55.8% (n= 353) of the study subjects had worked providing direct assistance to COVID (+) patients; 94% (n= 595) visualized videos for training / getting information for their professional setting; and 94.9% reported awareness of the knowledge pills by the Formación SanidadMadrid App. The 22 knowledge pills received 25,539 visualizations in total. There was high satisfaction by participants regarding the use of this method for their training during the pandemic. Conclusions: the microlearning educational strategy, based on knowledge pills available at a mobile application, demonstrated being a key element for the development of new digital training methodologies in the hospital setting during a pandemics scenario.(AU)

[Risk perception, information received and occupational engagement of workers in a university hospital in the face of the COVID-19 pandemic.] / Percepción del riesgo, información recibida y participación laboral de los trabajadores de un hospital universitario ante la pandemia de la COVID-19.

OBJECTIVE: Hospital workers faced the pandemic with a lack of knowledge, procedures and resources, which generated different experiences based on the perceived risk of exposure. It was considered pertinent to conduct a study to learn about the risk perception, the information received and the occupational engagement of workers in a university hospital in the face of the pandemic. METHODS: A cross-sectional study (july-september 2020) was carried out by an ad hoc survey of workers in the Majadahonda Puerta de Hierro University Hospital with 20 items (Likert scale from 0=not at all agree to 5=totally agree). The sample size was set at 828 workers. The absolute frequency and percentage of agreement for each item were described. Chi-Square was used to assess the association of responses with sex, type of worker, work area and activity in COVID-19 units. RESULTS: 992 workers participated, with 80.7% being women, 79.8% healthcare personnel and 33.2% nurses. Workers perceived a high risk of exposure. Approximately half confirmed that they had received information on the use of masks, although not on PPE. More than half stated that they felt involved in teamwork, but not in COVID-19 unit planning. Statistically significant differences (p<0.05) were found in the risk perception by sex, between type of worker (healthcare vs. non-healthcare), work area (healthcare vs. non-healthcare) and working in COVID-19 Units vs. non-COVID-19 Units. CONCLUSIONS: Healthcare personnel who worked in care areas and COVID-19 units present greater perception of the risk of exposure, although they report a higher degree of agreement in the information received and in their work engagement in the face of the pandemic.

OBJETIVO: Los trabajadores del hospital afrontaron la pandemia con falta de conocimientos, procedimientos y recursos, lo que generó diferentes experiencias en base al riesgo de exposición percibido. Se consideró pertinente realizar un estudio para conocer la percepción del riesgo, la información recibida y la participación laboral de los trabajadores de un hospital universitario ante la pandemia. METODOS: Se realizó un estudio transversal (entre julio y septiembre de 2020) mediante una encuesta ad hoc con 20 ítems (Escala Likert de 0=nada de acuerdo a 5=totalmente de acuerdo) a los trabajadores del Hospital Universitario Puerta de Hierro Majadahonda, que desarrollaron su actividad laboral durante la primera ola pandémica de la COVID-19. El tamaño muestral se estableció en 828 sujetos. Se describieron la frecuencia absoluta y el porcentaje de acuerdo de cada ítem. Se usó la chi-cuadrado para valorar la asociación de las respuestas con el sexo, el tipo de trabajador, el área de trabajo y la actividad en unidades de COVID-19. RESULTADOS: Participaron 992 trabajadores, habiendo un 80,7% de mujeres, un de 79,8% personal sanitario y un 33,2% de enfermeras. Los trabajadores percibieron un alto riesgo de exposición. Aproximadamente la mitad afirmaron haber recibido información sobre el uso de mascarillas, aunque no de los equipos de protección individual (EPI). Más de la mitad afirmó sentirse partícipe del trabajo en equipo, pero no de la planificación de unidades de COVID-19. Se encontraron diferencias estadísticamente significativas (<0,05) en la percepción del riesgo por sexo, entre el tipo de trabajador (sanitario frente a no sanitario), el área de trabajo (asistencial frente a no asistencial) y trabajar en Unidades de COVID-19 frente a Unidades de no COVID-19. CONCLUSIONES: Los sanitarios que trabajaron en áreas asistenciales y unidades de COVID-19 presentan mayor percepción del riesgo de exposición, aunque refieren mayor grado de acuerdo en la información recibida y en su participación laboral ante la pandemia.

Notificación de agresiones por los trabajadores del Servicio Madrileño de Salud / Aggressions reported by the Madrid Health Service staff

Objetivo: conocer la prevalencia de agresiones notificadas por los trabajadores del Servicio Madrileño de Salud, saber la prevalencia de lesiones o alteraciones de la salud ocasionadas a los trabajadores por este motivo, e identificar los factores asociados a dichas agresiones. Método: estudio transversal en trabajadores del Servicio Madrileño de Salud (SERMAS) que notificaron una situación conflictiva/agresión en el periodo 2009-2018, a través de un registro habilitado por el SERMAS. Las variables estudiadas incluyeron datos del trabajador, del agresor, del incidente y sus consecuencias. Análisis descriptivo mediante el programa estadístico Stata. Resultados: se identificaron 5.587 notificaciones de situaciones conflictivas, el 89% correspondió a Atención Primaria (AP) y el 11% a Atención Especializada (AE). La prevalencia de alteraciones en el estado de salud sobre el total de notificaciones fue del 95% (IC 95%: 94-96), con un 97% (IC 95%: 95-98) en AE y un 95% (IC 95%: 94-95) en AP. En AE los trabajadores notificaron un 8% de agresiones físicas y 17% de coacciones, en AP fueron un 4% y un 25%, respectivamente. En Urgencias se notificaron un 12% de agresiones físicas frente al 4,6% del resto de servicios y un 13% de coacciones frente al 25%. En AE las enfermeras fueron los trabajadores que más agresiones notificaron y en AP fueron los facultativos. Conclusiones: en AP se notifican nueve veces más situaciones conflictivas que en AE. Las coacciones superan a las agresiones físicas. El personal de Enfermería y los trabajadores de urgencias son los profesionales que más agresiones notifican.(AU)

Objective: to understand the prevalence of aggressions reported by the Madrid Health Service staff, to learn about the prevalence of lesions or health alterations caused to workers for this reason, and to identify the factors associated with said aggressions. Method: a cross-sectional study conducted with workers of the Madrid Health Service (SERMAS) who reported a situation of conflict / aggression during the 2009-2018 period through a register provided by the SERMAS. The variables studied included: details of the worker, the aggressor, the incident and its consequences. There was descriptive analysis through the Stata statistical program. Results: in total, 5,587 reports of situations of conflict were identified: 89% from Primary Care (PC) and 11% from Specialized Care (SC). The prevalence of alterations in health status within all reports was 95% (CI 95%: 94-96), with 97% (CI 95%: 95-98) in SC and 95% (CI 95%: 94-95) in PC. Specialized Care staff reported 8% of physical aggressions and 17% of coercions; these were 4% and 25%, respectively, in PC. In the Emergency Unit, 12% of physical aggressions were reported vs. 4.6% in the rest of hospital units, and 13% of coercion vs. 25%. Nurses were the SC workers who reported more aggressions, vs. physicians in PC. Conclusions: nine times more situations of conflict are reported in Primary Care than in Specialized Care. Coercions are higher than physical agressions. Nursing staff and Emergency workers are the professionals reporting more aggressions.(AU)

Percepción del riesgo, información recibida y participación laboral de los trabajadores de un hospital universitario ante la pandemia de la COVID-19 / Risk perception, information received and occupational engagement of workers in a university hospital in the face of the COVID-19 pandemic

FUNDAMENTOS: Los trabajadores del hospital afrontaron la pandemia con falta de conocimientos, procedimientos y recursos, lo que generó diferentes experiencias en base al riesgo de exposición percibido. Se consideró pertinente realizar un estudio para conocer la percepción del riesgo, la información recibida y la participación laboral de los trabajadores de un hospital universitario ante la pandemia. MÉTODOS: Se realizó un estudio transversal (entre julio y septiembre de 2020) mediante una encuesta ad hoc con 20 ítems (Escala Likert de 0=nada de acuerdo a 5=totalmente de acuerdo) a los trabajadores del Hospital Universitario Puerta de Hierro Majadahonda, que desarrollaron su actividad laboral durante la primera ola pandémica de la COVID-19. El tamaño muestral se estableció en 828 sujetos. Se describieron la frecuencia absoluta y el porcentaje de acuerdo de cada ítem. Se usó la chi-cuadrado para valorar la asociación de las respuestas con el sexo, el tipo de trabajador, el área de trabajo y la actividad en unidades de COVID-19.RESULTADOS: Participaron 992 trabajadores, habiendo un 80,7% de mujeres, un de 79,8% personal sanitario y un 33,2% de enfermeras. Los trabajadores percibieron un alto riesgo de exposición. Aproximadamente la mitad afirmaron haber recibido información sobre el uso de mascarillas, aunque no de los equipos de protección individual (EPI). Más de la mitad afirmó sentirse partícipe del trabajo en equipo, pero no de la planificación de unidades de COVID-19. Se encontraron diferencias estadísticamente significativas (p<0,05) en la percepción del riesgo por sexo, entre el tipo de trabajador (sanitario frente a no sanitario), el área de trabajo (asistencial frente a no asistencial) y trabajar en Unidades de COVID-19 frente a Unidades de no COVID-19.(AU)

BACKGROUND: Hospital workers faced the pandemic with a lack of knowledge, procedures and resources, which generated different experiences based on the perceived risk of exposure. It was considered pertinent to conduct a study to learn about the risk perception, the information received and the occupational engagement of workers in a university hospital in the face of the pandemic. METHODS: A cross-sectional study (july-september 2020) was carried out by an ad hoc survey of workers in the Majadahonda Puerta de Hierro University Hospital with 20 items (Likert scale from 0=not at all agree to 5=totally agree). The sample size was set at 828 workers. The absolute frequency and percentage of agreement for each item were described. Chi-Square was used to assess the associationof responses with sex, type of worker, work area and activity in COVID-19 units.RESULTS: 992 workers participated, with 80.7% being women, 79.8% healthcare personnel and 33.2% nurses. Workers perceived a high risk of exposure. Approximately half confirmed that they had received information on the use of masks, although not on PPE. More than half stated that they felt involved in teamwork, but not in COVID-19 unit planning. Statistically significant differences(p<0.05) were found in the risk perception by sex, between type of worker (healthcare vs. non-healthcare), work area (healthcare vs. non-healthcare) and working in COVID-19 Units vs. non-COVID-19 Units.CONCLUSIONS: Healthcare personnel who worked in care areas and COVID-19 units present greater perception of the risk of exposure, although they report a higher degree of agreement in the information received and in their work engagement in the face of the pandemic.(AU)

Effectiveness of a healthcare-based mobile intervention on sedentary patterns, physical activity, mental well-being and clinical and productivity outcomes in office employees with type 2 diabetes: study protocol for a randomized controlled trial.

BACKGROUND: Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes significantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefits. The aim of this study is to evaluate the short-, medium- and long-term effectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in office staff with DM2. Secondary aims. To evaluate the effectiveness on glycaemic control and lipid profile at 6- and 12-month follow-up; anthropometric profile, blood pressure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12 months. METHODS: Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n = 110) or intervention group (n = 110), with post-intervention follow-ups at 6 and 12 months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18-65 years of age) diagnosed with DM2, who have sedentary office desk-based jobs. The control group will receive usual healthcare and information on the health benefits of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13 weeks to change occupational sedentary behaviour. VARIABLES: (1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sitting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well-being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Differences between groups pre- and post- intervention on the average value of the variables will be analysed. DISCUSSION: If the mHealth intervention is effective in reducing sedentary time and increasing physical activity in office employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092738. Registered September 17, 2019.

Programa ADAPTATEA para mejorar la atención de niños y niñas con autismo en la realización de un electroencefalograma / The adaptatea program to improve care for children with autism undergoing an electroencephalogram

Las dificultades socio-comunicativas que presentan los/as niños/as con trastorno del espectro autista (TEA), y las barreras del entorno sanitario, pueden complicar las pruebas diagnósticas y las intervenciones sanitarias hasta el punto de no poder realizarse. Pueden darse momentos muy complicados para estos niños/as y sus familias, que son vividos con gran ansiedad generándoles gran hostilidad hacia el entorno sanitario. A su vez, los profesionales se ven desbordados e impotentes ante estas situaciones, aumentando los recursos humanos y el tiempo necesarios para atenderles. El personal de Enfermería tiene un papel fundamental en la identificación de las dificultades y barreras, tanto las que presentan los/as niños/as y sus familias, como las del propio personal sanitario implicado, pudiendo actuar como facilitadores desde el primer momento.El Servicio de Neurofisiología realiza electroencefalogramas (EEG) a pacientes con TEA, ya que la epilepsia es un problema frecuentemente asociado al mismo. Las dificultades para efectuar con éxito la prueba han llevado a la creación del programa ADAPTATEA, cuyo objetivo general es mejorar la calidad de la atención y conseguir realizar el EEG en las mejores condiciones posibles, llevando a cabo las adaptaciones sanitarias necesarias. Se basa en el empleo de pictogramas y material audiovisual cuyo objetivo es anticipar al niño o niña y familia lo que se les va a hacer, transformando la prueba en algo más cercano y cotidiano para ellos. Además, propone recomendaciones para la preparación, ejecución de la prueba, y para el mejor manejo de las conductas desadaptativas del niño/a cuando acude al hospital.(AU)

The socio-communicative difficulties presented by children with autism spectrum disorder (ASD) and the healthcare environment barriers can complicate diagnostic tests and healthcare interventions even to the point where these cannot be performed. These can lead to very difficult times for these children and their families, experienced with high anxiety and generating major hostility towards the healthcare environment. At the same time, professionals will feel overwhelmed and powerless when faced with these situations, which require an increase in human resources and time. The Nursing staff plays an essential role in the detection of these difficulties and barriers, presented both by children and their families and by the healthcare staff involved, and they can act as facilitators since the first minute.The Neurophysiology Unit performs electroencephalograms (EEG) to ASD patients, because epilepsy is a problem often associated with this disorder. The difficulties to perform this test successfully have led to the creation of the ADAPTATEA program, with the overall objective to improve the quality of care and being able to perform the EEG in the best possible conditions, by conducting the healthcare adaptations required. This is based on the use of pictograms and audiovisual materials targeted to explaining the child and his/her family what will be done and transforming the test into something closer and more common to them. Besides, it proposes recommendations for the preparation and performance of the test, and for the best management of the maladaptive behaviours of the child when attending hospital.(AU)

[Nursing care for hospitalized patients in COVID-19 units]. / Cuidados enfermeros en el paciente adulto ingresado en unidades de hospitalización por COVID-19.

Since the SARS-CoV-2 was announced on March 11 in 2020, most of people, professional healthcare, scientists, technical personnel and managers included, have been developing protocols, procedures, guides, technical reports to orient an adequate attention in this health emergency due to the COVID-19. The shortage bibliography about nursing care in this pandemic is the reason to develop a useful clinical protocol to attend to the higher number of adult patients who were admitted at Hospitalization Units adapted to patient with COVID-19. For that reason, the aim of this document is to provide recommendations to the clinical practice and that way, helping to protocolize the care in adult patients admitted in COVID-19 Hospitalization Units, based in standards of the literature or the most current experience in front of this new pandemic.

Estrategias de formación durante la pandemia por covid-19 en un hospital universitario / Training strategies during the covid-19 pandemic in a university hospital

La pandemia causada por el SARS-CoV-2, declarada Emergencia de Salud Pública de Importancia Internacional por el director general de la Organización Mundial de la Salud (OMS) en marzo de 2020, originó una emergencia sanitaria impactando en todos los aspectos de la gestión, formación y asistencia en los hospitales. La pandemia supuso un reto en la formación de los profesionales sanitarios que se vieron obligados a adquirir conocimientos rápida y eficazmente para planificar, ejecutar y tomar decisiones sobre el diagnóstico y tratamiento de pacientes infectados por SARS-CoV-2. La formación tradicional se adaptó al contexto de la pandemia, teniendo en cuenta la distancia de seguridad obligatoria y la demanda de una formación de corta duración y eficaz, cuyo contenido variaba en poco tiempo. En este contexto, el Hospital Universitario Puerta de Hierro-Majadahonda (Madrid, España) implementó una estrategia de formación digital basada en la producción y publicación de píldoras formativas a través de una aplicación móvil desarrollada por la Unidad de Formación Continuada (app Formación SanidadMadrid). Durante la pandemia se crearon, produjeron y publicaron a través de la app, un total de 24 píldoras formativas en tres modalidades: vídeo de corta duración, acceso a websites con información actualizada y documentos breves sobre procedimientos. El diseño de las píldoras formativas se fundamentó en las metodologías de enseñanza-aprendizaje mobile learning y microlearning, como herramientas útiles y eficaces para dar respuesta a las necesidades formativas de un hospital universitario ante una emergencia sanitaria, dada la gran aceptación por parte de los profesionales sanitarios.(AU)

The pandemic caused by SARS-CoV-2 was declared a Public Health Emergency of International Concern by the Director General of the World Health Organization (WHO) in March, 2020. This created a health emergency with impact upon all aspects of management, training, and care in hospitals. The pandemic represented a challenge for the training of healthcare professionals, who were forced to acquire knowledge fast and effectively in order to plan, act, and make decisions about the diagnosis and treatment of patients infected by SARS-CoV-2. Traditional training was adapted to the pandemic setting, taking into account the compulsory safety distance and the demand for short-duration effective training, with contents changing within a short time. In this context, the Hospital Universitario Puerta de Hierro-Majadahonda (Madrid, Spain) implemented a strategy for digital training based on the creation and publication of educational pills through a mobile application developed by the Continuation Training Unit (Formación SanidadMadrid App). During the pandemic, 24 educational pills were created, produced and published through the app, in three forms: short-duration video, access to websites with updated information, and brief documents on procedures. The design of the educational pills was based on these teaching-learning methods: mobile learning and microlearning, considered useful and effective tools to give an answer to training needs in a university hospital when faced with a health emergency, given their wide acceptance by healthcare professionals.(AU)

Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol.

AIMS: To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme. DESIGN: Quasi-experimental, pre-/post-intervention study without a control group. METHODS: Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee. DISCUSSION: The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults. IMPACT: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complications.

Intervenciones enfermeras más prevalentes en la atención de adultos ingresados en unidades de hospitalización / The most prevalent Nursing interventions in patient care for adults admitted to hospitalization units

Objetivo: identificar las intervenciones enfermeras más prevalentes en la atención del paciente adulto en el contexto de las unidades de hospitalización.Método: diseño multimétodo y multicéntrico realizado en la Comunidad de Madrid. Para llevar a cabo el estudio se contó con un Equipo de Investigación formado por expertos en metodología de la investigación y metodología enfermera. El estudio se desarrolló en tres fases: primero se elaboró un listado con 80 intervenciones de Enfermería NIC, seleccionadas por consenso; en segundo lugar se diseñó una encuesta ad hoc que contenía las 80 NIC con varias opciones de respuesta en función de la frecuencia de realización en la práctica habitual; la tercera fase fue un estudio transversal dirigido a profesionales de Enfermería que trabajaban en unidades de hospitalización de adultos de los 10 hospitales participantes. La encuesta se distribuyó mediante correo electrónico. Se efectuó análisis descriptivo.Resultados: participaron 427 enfermeras. Años de antigüedad media (desviación estándar) 14 (7,74). Las NIC más prevalentes que se realizaban más de tres veces al día fueron: administración de medicación (n= 294; 68,9%); control de la medicación (n= 285; 66,7%); administración de medicación oral (n= 282; 66%); cuidados del dolor (n= 280; 65,6%); escucha activa (277; 64,9%); administración de analgésicos (272; 63,9%); cambio de posición (n= 262; 61,4%), entre otras.Conclusiones: se identificaron las intervenciones realizadas con mayor frecuencia, como primera línea de trabajo encaminado a obtener más información sobre intervenciones y tiempos de ejecución, que ayuden a mejorar la gestión de recursos humanos en función de las necesidades de los pacientes.(AU)

Objective: to identify the most prevalent Nursing interventions in adult patient care in the setting of hospitalization units.Method: a study with multi-method and multicenter design conducted at the Autonomous Community of Madrid. A Research Team participated in the study; the team was formed by experts on research methodology and nursing methodology. The study consisted of three phases: a list was prepared first with 80 NIC Nursing interventions, selected by consensus; secondly, an ad hoc survey was designed, containing the 80 NICs with different answer options based on the frequency they were carried out in daily practice; and the third phase was a cross-sectional study targeted to Nursing professionals working at hospitalization units for adult patients from the 10 hospitals involved. The survey was sent by e-mail. Descriptive analysis was conducted.Results: the study included 427 nurses; their mean years of seniority (standard deviation) was 14 (7.74). The most prevalent NICs that were done more than three times per day were: medication administration (n= 294; 68.9%); medication monitoring (n= 285; 66.7%); oral medication administration (n= 282; 66%); pain management (n= 280; 65.6%); active listening (277; 64.9%); administration of analgesics (272; 63.9%); change of position (n= 262; 61.4%), among others.Conclusions: the interventions most frequently carried out were identified, as a first line of work targeted to obtaining more information on interventions and times of performance, which will help to improve the management of human resources based on patient needs.(AU)

Grupo de Investigación en Enfermería y Cuidados de Salud. Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA) / Research Group in Nursing Care. Puerta de Hierro-Segovia de Arana Institute for Health Research (IDIPHISA)

Este artículo tiene como propósito dar a conocer la trayectoria del Grupo de Investigación en Enfermería y Cuidados de Salud del Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), así como sus líneas de investigación, producción científica y logros. El grupo cuenta con una reconocida trayectoria en investigación en el ámbito nacional. De los 22 institutos de investigación sanitaria acreditados por el Instituto de Salud Carlos III en el periodo 2009-2014, el IDIPHISA fue uno de los seis primeros que reconoció el Grupo de Investigación en Enfermería (mayo, 2014). Las líneas de investigación del grupo son: innovación en cuidados; seguridad del paciente; cuidados en parto, puerperio y recién nacido; cuidados en pacientes críticos; cuidados en procesos crónicos, dependencia y cuidado familiar; innovación docente y tecnológica; humanización de la atención; innovación en fisioterapia. En la actualidad, está integrado por 28 miembros, de los cuales 14 (50%) tienen el grado de doctor y ocho (28,6%) están realizando el doctorado. Entre 2015-2019 el grupo ha producido 105 publicaciones, con un factor de impacto acumulado de 119,89, y ha generado/contribuido con 17 tesis.(AU)

This article explains the historical trajectory of the Research Group in Nursing Care from the Puerta de Hierro-Segovia de Arana Institute for Health Research (IDIPHISA), as well as its lines of research, scientific output and achievements. The group has an acknowledged trajectory in research in the national setting. Of the 22 institutes for heath research certified by the Instituto de Salud Carlos III (ISCIII) during 2009-2014, the IDIPHISA was one of the six first to acknowledge the Research Group in Nursing Care (certified in May 2014). From 2015 on, additional groups have been acknowledged in the new certified institutes for research. The lines of research of the group are: innovation in care; patient safety; childbirth, post-partum and newborn care; critical patient care; care for chronic conditions; dependence and family care; educational and technological innovation; humanization in care; innovation in physiotherapy. Currently it includes 28 members; 14 (50%) have a doctor’s degree and eight (28,6%) are studying for their doctorate. In the past five years (2015-2019) the group has presented 105 publications, with an accumulated impact factor of 119.89; and they have generated / contributed with 17 theses.(AU)

Cuidados basados en terapias conductuales aplicados al paciente con incontinencia urinaria / Nursing care for patients with urinary incontinence based on behavioural therapies

La Incontinencia Urinaria es un problema de salud relevante con una prevalencia elevada en ancianos hospitalizados. El aumento de población anciana en la sociedad española justifica la actualización de cuidados y técnicas aplicables a pacientes geriátricos, dependientes y crónicos. Los procedimientos de cuidados de salud basados en la evidencia ayudan a los profesionales en la toma de decisiones y disminuyen la variabilidad en la práctica clínica. En este artículo se describe el procedimiento de cuidados al paciente con incontinencia urinaria del Hospital Guadarrama basado en el uso de terapias conductuales

Urinary Incontinence is a highly prevalent and important health problem in hospitalized elderly people. The increase in the elderly population in Spain requires the care and techniques that apply to geriatric, dependent and chronic patients to be updated. Evidence-based health care procedures assist professionals in decision-making and reduce variability in clinical practice. This article describes the care procedure for patients with urinary incontinence in the Guadarrama Hospital based on the use of behavioural therapies

Care of older people with Cognitive Impairment or Dementia Hospitalized in Traumatology Units (CARExDEM): a quasi-experiment.

BACKGROUND: In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia. METHODS: A quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia. DISCUSSION: Our aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes. TRIAL REGISTRATION: Registered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/ Protocol Record HCB/2017/0499. SPONSOR: Hospital Clinic Barcelona.

Nursing care for patients with urinary incontinence based on behavioural therapies. / Cuidados basados en terapias conductuales aplicados al paciente con incontinencia urinaria.

Urinary Incontinence is a highly prevalent and important health problem in hospitalized elderly people. The increase in the elderly population in Spain requires the care and techniques that apply to geriatric, dependent and chronic patients to be updated. Evidence-based health care procedures assist professionals in decision-making and reduce variability in clinical practice. This article describes the care procedure for patients with urinary incontinence in the Guadarrama Hospital based on the use of behavioural therapies.

Perineal repair of media-lateral episiotomies and 2nd degree tears by midwives: A randomised controlled trial comparing three suture techniques.

BACKGROUND: Perineal trauma pain is associated with perineal repair and its subsequent healing. New evidence is required concerning perineal repair techniques that cause less pain and favour healing. OBJECTIVE: To compare three perineal repair suturing techniques after episiotomy or second degree tearing during a normal birth with respect to reducing pain and improving the perineal healing process. DESIGN: A randomised controlled trial. SETTING: A large public university hospital in Madrid, Spain. PARTICIPANTS: Full term pregnant women older than 18 years-of-age, who required perineal repair after episiotomy or second degree tearing and were attended for normal birth by midwives. METHODS: One hundred and eighty-three women were randomly assigned to three groups: the Continuous Suture Group (n = 58), Interrupted Cutaneous Suture Group (n = 53), or the Interrupted Subcutaneous Suture Group (n = 57). The study participants and data collectors were blinded to group allocations. Principal outcome: perineal pain 10 days after birth. Other outcomes: short (2 and 48 h) and long term (3 and 6 months) perineal pain after birth; short term healing; suture time. RESULTS: At 10 days postpartum, the presence of spontaneous pain, pain when walking or moving in bed, was almost nonexistent in the 3 suture groups. The median (P25-P75) perineal pain on palpation was similar in the 3 groups, with values of 2 (1-4) in the Continuous Suture Group, 3 (2-5) in the Interrupted Cutaneous Suture Group and 2 (1-4) in the Interrupted Subcutaneous Suture Group; also were similar the perineal pain on sitting: 1 (0-3) in the Continuous Suture Group, 1 (0-2) in the Interrupted Cutaneous Suture Group and 1 (0-3) in the Interrupted Subcutaneous Suture Group. There were no statistically significant differences between the groups. Pain measurements throughout the follow-up period only showed statistically significant differences in 2 out of 22 evaluations: pain when sitting 48 h after birth and spontaneous pain at 3 months. The mean times (standard deviation) to carry out suturing were 12.86 (4.9) minutes in the Continuous Suture Group, 13.54 (5.6) in the Interrupted Cutaneous Suture Group, and 15.59 (6.9) minutes in the Interrupted Subcutaneous Suture Group (p < 0.05). CONCLUSIONS: The three suturing methods described for perineal repair after episiotomy or second degree tearing after normal birth are comparable with respect to short, medium and long term perineal pain and the healing process. Use of the continuous suturing technique involved less time than interrupted suture methods. Tweetable abstract: proper the suturing methods for perineal repair after episiotomy or second degree tearing prevent postpartum perineal pain.