Community engagement and power dynamics in conservation philanthropy grant making.

Funding decisions influence where, how, and by whom conservation is pursued globally. In the context of growing calls for more participatory, Indigenous-led, and socially just conservation, we undertook the first empirical investigation of how philanthropic foundations working in marine conservation globally engage communities in grant-making decisions. We paid particular attention to whether and how community engagement practices reinforce or disrupt existing power dynamics. We conducted semistructured remote interviews with 46 individuals from 32 marine conservation foundations to identify how conservation foundations engage communities in setting their priorities and deciding which organizations and projects to fund. We found that community engagement in foundation decision-making was limited in practice. Eleven of the 32 foundations reported some form of community engagement in funding decisions. Two of these foundations empowered communities to shape funding priorities and projects through strong forms of engagement. Many engagement practices were one way, one time, or indirect and confined to certain points in decision-making processes. These weaker practices limited community input and reinforced unequal power relations, which may undermine the legitimacy, equity, and effectiveness of conservation efforts. We suggest that foundations aim for stronger forms of community engagement and reflect on how their grant-making practices affect power relations between foundations and communities.

Participación comunitaria y dinámicas de poder en la concesión de subsidios para la filantropía de la conservación Resumen Realizamos la primera investigación empírica sobre la forma en que las fundaciones filantrópicas que trabajan con la conservación marina a nivel mundial involucran a las comunidades en las decisiones para la concesión de subsidios. Prestamos especial atención a cómo y si las prácticas de participación ciudadana refuerzan o interrumpen las dinámicas de poder existentes. Entrevistamos de forma remota a 46 individuos de 32 fundaciones de conservación marina para identificar cómo las fundaciones de conservación involucran a las comunidades para establecer sus prioridades y decidir cuáles organizaciones y proyectos financiar. Encontramos que la participación comunitaria en las decisiones de financiamiento estaba limitada en la práctica. Once de las 32 fundaciones reportaron algún tipo de participación ciudadana en sus decisiones de financiamiento. Dos de estas fundaciones empoderaron a las comunidades para que formaran las prioridades de financiamiento y a los proyectos por medio de una participación sólida. Muchas de las prácticas de participación eran de una manera, de una vez o indirectas y confinadas a ciertos puntos en el proceso de decisión. Estas prácticas más débiles limitaron la aportación comunitaria y reforzaron las relaciones desiguales de poder, lo que puede debilitar la legitimidad, equidad y eficiencia de los esfuerzos de conservación. Sugerimos que las fundaciones busquen maneras más sólidas de involucrar a la comunidad y reflexionen sobre el efecto de sus prácticas de concesión de subsidios sobre las relaciones de poder entre las fundaciones y las comunidades.

Nurse Managers Coping Strategies for Crisis Management: Qualitative Systematic Review.

Stressor-related disorders are a growing issue for both the individual and the organizations. The aim of the study was to analyze the strategies used by nurse managers to face crises. A systematic review of the literature, including qualitative studies was performed. Data were analyzed using framework-based synthesis and summarized into domains. Quality was evaluated using the JBI QARI Checklist. 10 studies met the inclusion criteria. Data collection was based on interviews, followed by questionnaires and focus groups. Good communication, organizational commitment and emotional support were the principal domains. Institutions should support nurse managers to cope with stress and make suggestions for adaptations.

Deductive Care Methodology: Describing and testing modes of care research.

OBJECTIVE: Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care. METHODOLOGY: Design and test of the DCM modes based on three phases: mapping of the MDC, generation of models from this methodology and testing of the models through studies in a clinical context. RESULTS: The MDC presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed. CONCLUSIONS: The MDC collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the MDC with an interdisciplinary orientation between Health Sciences and Computer Sciences.

Gestión del dolor agudo postoperatorio: condiciones para garantizar la seguridad y la efectividad de los tratamientos analgésicos / Management of acute postoperative pain: Conditions to guarantee the safety and effectiveness of analgesic treatments

La evidencia sobre la gestión del dolor postoperatorio presenta un grado de calidad bajo o insuficiente. El Grupo de Trabajo del Dolor Agudo SEDAR ha elaborado este documento-guía para aplicar la mejor evidencia científica disponible a la práctica clínica habitual, individualizándolo en función de factores propios del paciente y del procedimiento, y englobando las distintas opciones organizativas del control de dolor.El documento profundiza y actualiza conceptos y requisitos mínimos necesarios para una analgesia óptima postoperatoria, el abordaje multidisciplinar y la gestión del dolor agudo postoperatorio. Se definen y se describen líneas estratégicas y los distintos modelos de gestión. Se establece un plan de actuación general perioperatoria basado en la colaboración con los servicios quirúrgicos implicados, en la revisión conjunta de la evidencia y en la elaboración de protocolos por procedimiento. Finalmente, se presenta un plan de seguimiento y los indicadores mínimos necesarios para un control de calidad del dolor postoperatorio. (AU)

The evidence on postoperative pain management is of low or insufficient quality. The SEDAR Acute Pain Working Group has prepared this guideline-document to apply the best available scientific evidence to clinical practice, individualizing it based on factors specific to the patient and the procedure, and encompassing different organizational options, attempting to individualize it based on specific factors of the patient and the procedure, and encompassing the different organizational options for pain control.The document updates concepts and minimum requirements necessary for optimal postoperative analgesia, a multidisciplinary approach and the management of acute postoperative pain. Strategic lines and different management models are defined. A general perioperative action plan is established based on collaboration with the surgical departments involved, on the joint review of the evidence and on preparation of protocols by the procedure. Finally, a follow-up plan and a series of minimum indicators necessary for quality control of postoperative pain are presented. (AU)

Long COVID-19 and primary care: Challenges, management and recommendations / COVID-19 prolongado y atención primaria: desafíos, manejo y recomendaciones

Long COVID-19, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms after COVID-19 onset. This article explores the challenges, management strategies, and recommendations for addressing long COVID-19 in primary care settings. The epidemiology of long COVID-19 reveals significant variability, with a substantial portion of COVID-19 survivors experiencing post-acute symptoms. Pathophysiological mechanisms include viral persistence, endothelial dysfunction, autoimmunity, neurological dysregulation, and gastrointestinal dysbiosis. Multiple risk factors, including age, sex, pre-existing comorbidities, smoking, BMI, and acute COVID-19 severity, influence the development of long COVID-19. Effective management requires proactive measures such as vaccination, identification of high-risk populations, public awareness, and post-infection vaccination. Collaboration of primary care physicians with specialists is essential for holistic and individualized patient care. This article underscores the role of primary care physicians in diagnosing, managing, and mitigating the long-term effects of COVID-19. (AU)

La COVID-19 prolongada, también conocida como secuela postaguda de la infección por SARS-CoV-2, se caracteriza por síntomas persistentes después de la aparición de la COVID-19. Este artículo explora los desafíos, las estrategias de manejo y las recomendaciones para abordar la COVID-19 prolongada en entornos de atención primaria. La epidemiología de la COVID-19 prolongada revela una variabilidad significativa, y una parte sustancial de los supervivientes de la COVID-19 experimentan síntomas postagudos. Los mecanismos fisiopatológicos incluyen persistencia viral, disfunción endotelial, autoinmunidad, desregulación neurológica y disbiosis gastrointestinal. Múltiples factores de riesgo, como la edad, el sexo, las comorbilidades preexistentes, el tabaquismo, el IMC y la gravedad aguda de la COVID-19, influyen en el desarrollo de la COVID-19 prolongada. Una gestión eficaz requiere medidas proactivas, como la vacunación, la identificación de poblaciones de alto riesgo, la concienciación pública y la vacunación posterior a la infección. La colaboración de los médicos de atención primaria con los especialistas es esencial para una atención holística e individualizada al paciente. Este artículo subraya el papel de los médicos de atención primaria en el diagnóstico, el tratamiento y la mitigación de los efectos a largo plazo de la COVID-19. (AU)

Resumen ejecutivo del documento de consenso sobre el manejo de la anemia perioperatoria en España / Executive summary of the consensus document on the management of perioperative anemia in Spain

La anemia perioperatoria constituye un factor independiente de riesgo de morbimortalidad posoperatoria. Sin embargo, persisten barreras conceptuales, logísticas y administrativas que dificultan la implementación generalizada de protocolos para su manejo. El coordinador del proyecto convocó a un grupo multidisciplinar de ocho profesionales para elaborar un documento de consenso sobre el manejo de la anemia perioperatoria, con base a en serie puntos claves (PCs) relativos a su prevalencia, consecuencias, diagnóstico y tratamiento. Estos PCs fueron evaluados utilizando una escala Likert de 5 puntos, desde «totalmente en desacuerdo [1]» a «totalmente de acuerdo [5]». Cada PC se consideró consensuado si recibía una puntuación de 4 o 5 por al menos siete participantes (> 75%). A partir de los 36 PCs consensuados, se construyeron algoritmos diagnóstico-terapéuticos que pueden facilitar la implementación de programas de identificación precoz y manejo adecuado de la anemia perioperatoria, adaptados a las características de las instituciones hospitalarias de nuestro país.(AU)

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 9 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from “strongly disagree [1]” to “strongly agree [5]”. For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.(AU)

Medicolegal aspects of documentation and the electronic health record / Aspectos medicolegales de la documentación y la historia clínica electrónica

Introduction: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum.Methods: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. Results: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. Conclusion: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.(AU)

Introducción: Los momentos de mayor actividad en el hospital a menudo se enfrentan con los mayores desafíos en cuanto a la documentación completa y exhaustiva del evento de atención al paciente. La transición casi completa a la historia clínica electrónica (HCE) iba a ser la solución a una serie de preocupaciones sobre la documentación de los proveedores. Está claro que la HCE proporciona confiabilidad, reproducibilidad, integración, toma de decisiones basada en la evidencia y contribución multidisciplinaria en todo el espectro de la atención médica.Métodos: El uso de un consenso de opinión de expertos complementado con una revisión de la literatura enfocada permite una presentación equilibrada de los datos basada en la evidencia.Resultados: La documentación no es una herramienta perfecta, ya que se han planteado problemas de eficiencia, confiabilidad, uso de maniobras abreviadas y la posibilidad de un mayor riesgo medicolegal. La solución es la atención al detalle de la documentación y la creación de sistemas que faciliten la excelencia. El enfoque en los sistemas de documentación electrónica debe incluir evaluación continua, mejora continua, participación de un equipo multidisciplinario de atención al paciente y receptividad de los proveedores en el desarrollo y las operaciones de la HCE. Conclusión: El uso más eficaz de la HCE como herramienta de gestión de riesgos requiere conocimiento de la documentación, análisis específicos, mejora del producto y desarrollo conjunto de recursos clínico-comerciales.(AU)

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention / Primeros pasos en la desinstitucionalización de adultos mayores: protocolo para la implementación de una intervención compleja

Background: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. Objective: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. Methods: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. Discussion: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community.(AU)

Introducción: Las residencias de personas mayores cobran cada vez más importancia como centros de atención al final de la vida. Sin embargo, muchos adultos mayores desean permanecer en sus casas mientras envejecen. Objetivo: Se pretende evaluar la viabilidad de un proceso de desinstitucionalización en adultos mayores seleccionados que viven en las residencias y que expresen la voluntad para iniciar el proceso. Métodos: Este estudio, dividido en dos fases, se llevará a cabo durante 15 meses en 241 sujetos que viven en dos residencias de personas mayores en Navarra (España). La primera fase tiene un diseño transversal en donde se identificarán los factores y covariables asociadas a la viabilidad y voluntad para participar en un proceso de desinstitucionalización a través de un análisis bivariante, los recursos imprescindibles para el proceso y los residentes que quieran participar en él. La segunda fase tiene un diseño de intervención compleja en la que se implementa un proceso de desinstitucionalización. Se realizará un análisis exploratorio descriptivo y comparativo para caracterizar a los participantes, los servicios prescritos y el efecto de la intervención de desinstitucionalización a lo largo del tiempo (la calidad de vida será la variable principal; las secundarias serán las referentes a la salud, las psicosociales y de uso de recursos). Este estudio irá acompañado de un subestudio pseudocualitativo y emergente para identificar las barreras y los elementos facilitadores relativos a la implementación de este proceso y comprender cómo los componentes de la intervención y el contexto influyen en los resultados del estudio principal. Los componentes de la intervención y su ejecución serán de gran relevancia en el análisis. Discusión: Las alternativas a la institucionalización con viviendas adaptadas y apoyos comunitarios pueden permitir a las personas que así lo desean el retorno a la comunidad.(AU)

Medicolegal aspects of documentation and the electronic health record.

INTRODUCTION: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum. METHODS: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. RESULTS: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. CONCLUSION: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.

Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis.

INTRODUCTION: Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. MATERIALS AND METHODS: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. RESULTS: The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. CONCLUSION: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.

Approach to the care process by nurse case managers in a breast unit.

OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Retos y estrategias para recuperar y dinamizar la atención primaria. Metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades)-CAME (Corregir, Afrontar, Mantener y Explotar) en un departamento de salud / Challenges and strategies to recover and dynamize primary care: SWOT-CAME analysis in a Health Department

Objetivo: Identificar fortalezas, obstáculos, cambios en el entorno y capacidades de los equipos y unidades de apoyo en atención primaria, con el objetivo de proporcionar atención de alta calidad en un área de salud integrada. Diseño: Estudio de métodos mixtos basado en la matriz DAFO y el análisis CAME. Emplazamiento: Atención primaria, Comunidad Valenciana. Participantes: En total han participado 271 profesionales de los diferentes colectivos y representantes de asociaciones de pacientes, 99 en la fase de captura de ideas, 154 en la fase de elaboración de la matriz DAFO y 18 en la fase de elaboración del análisis CAME. Intervenciones: Se condujo un análisis DAFO-CAME a partir del cual se establecieron líneas de acción. La captura de información se realizó mediante grupos nominales, la fase de consenso integrando al conjunto de profesionales mediante Delphi y conferencia de consenso. Mediciones principales: Priorización de propuestas para mantener las fortalezas, afrontar las amenazas, explotar las oportunidades, corregir las debilidades en el marco de un plan de acción de un área de salud integrada. Resultados: Se propusieron un total de 82 ideas diferentes (20 fortalezas, 40 debilidades, 4 amenazas, 12 oportunidades y 6 amenazas-oportunidades). Este análisis condujo a un plan estratégico con 7 líneas y 33 acciones/intervenciones priorizadas. Conclusiones: Atención integrada buscando fórmulas colaborativas entre niveles asistenciales, redefinición de roles, soluciones digitales, capacitación del personal y mejoras en equipamientos y procesos de soporte, junto a medidas para afrontar el envejecimiento de la población y las necesidades de centros sociosanitarios constituyen los retos sobre los que actuar.(AU)

Objective: To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area. Design: Mixed methods study based on the SWOT matrix and CAME analysis. Location: Primary care, Valencian community. Participants: A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase. Interventions: A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques. Main measurements: Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan. Results: A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis). Conclusions: Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.(AU)

Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio / Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture

Introducción: Evaluar si, en pacientes con fractura de extremo distal del radio, los ejercicios domiciliarios realizados en una pantalla táctil de dispositivos tableta reducen el consumo de recursos presenciales y mejoran la recuperación clínica, comparado con el programa convencional de ejercicios domiciliarios prescrito en papel. Material y métodos: Ensayo clínico pragmático, multicéntrico, paralelo, de dos grupos y controlado, con evaluador cegado y análisis por intención de tratar. Reclutados cuarenta y seis pacientes con fractura de extremo distal del radio en dos hospitales del Sistema Sanitario Público de Andalucía (SSPA). Los participantes de los grupos experimental y control recibieron el mismo tratamiento de sesiones presenciales de fisioterapia. El grupo experimental recibió un programa de ejercicios domiciliario utilizando la aplicación para tableta ReHand y el grupo control recibió un programa de ejercicios domiciliario en papel. Variable principal: número de sesiones de fisioterapia registradas en la base de datos electrónica del SSPA. Variables secundarias: número de consultas de rehabilitación presenciales con un médico rehabilitador y variables clínicas como la funcionalidad, la fuerza de prensión, la destreza manual, el dolor y la amplitud de movimiento. Resultados: El grupo experimental necesitó menos sesiones de fisioterapia (DM: −16,94; IC del 95%: −32,5 a −1,38) y consultas de rehabilitación (DM: −1,7; IC del 95%: −3,39 a −0,02) en comparación con el grupo control. Conclusión: En pacientes con fractura de extremo distal del radio, la prescripción de ejercicios realizados en una pantalla táctil de dispositivos tipo tableta a través de ReHand redujo el número de sesiones de fisioterapia y de consultas de rehabilitación.(AU)

Introduction: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methods: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. Results: The experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. Conclusions: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.(AU)

Long COVID-19 and primary care: Challenges, management and recommendations.

Long COVID-19, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms after COVID-19 onset. This article explores the challenges, management strategies, and recommendations for addressing long COVID-19 in primary care settings. The epidemiology of long COVID-19 reveals significant variability, with a substantial portion of COVID-19 survivors experiencing post-acute symptoms. Pathophysiological mechanisms include viral persistence, endothelial dysfunction, autoimmunity, neurological dysregulation, and gastrointestinal dysbiosis. Multiple risk factors, including age, sex, pre-existing comorbidities, smoking, BMI, and acute COVID-19 severity, influence the development of long COVID-19. Effective management requires proactive measures such as vaccination, identification of high-risk populations, public awareness, and post-infection vaccination. Collaboration of primary care physicians with specialists is essential for holistic and individualized patient care. This article underscores the role of primary care physicians in diagnosing, managing, and mitigating the long-term effects of COVID-19.

Guía en redes sociales de radiología. ¿Hacia un nuevo paradigma en educación médica? / Social networks in radiology: Toward a new paradigm in medical education?

El sistema universalmente aceptado para la transmisión del conocimiento científico en medicina se basa desde hace mucho en las publicaciones científicas. Las redes sociales (RRSS) son una alternativa o complemento que puede ser útil. Las RRSS (Twitter, Instagram, Facebook, LinkedIn, YouTube, TikTok) tienen generadores de contenidos educativos que pueden proporcionar formación de calidad, a pesar de su informalidad. Cada una tiene sus puntos fuertes y sus debilidades, que conviene conocer. Son gratuitas y permiten discutir en vivo, incorporar contenidos ágilmente y contactar directamente con expertos o fuentes de conocimiento. Las editoriales son conscientes de su influencia y han incorporado métricas que miden el impacto en ellas de los artículos (Altmetrics). La estrategia formativa de cualquier servicio debe incorporarlas ya. Sin embargo, navegar en ellas es complejo y el sistema de búsqueda, basado en hashtags, es ineficiente, por lo que su uso en educación sigue siendo cosa de excéntricos. El conocimiento generado en las RRSS, a pesar de su informalidad, es una fuente cada vez más importante de conocimiento. Los servicios de radiología deben definir una estrategia de RRSS, no con fines de propaganda, sino educativos, creando grupos focales bien formados que busquen contenidos mediante revisión sistemática y filtros, repositorios digitales y sesiones de revisión y los compartan dentro y fuera del servicio. Igualmente, debe ser implementada una estrategia de comunicación a través de redes.(AU)

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.(AU)

Social networks in radiology: Toward a new paradigm in medical education?

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.

Diseño y validación del cuestionario de evaluación de la calidad percibida en la gestión deportiva del futbol femenil / Desenho e validação do questionário para avaliação da qualidade percebida na gestão esportiva do futebol feminino / Design and validation of the questionnaire for the evaluation of the perceived quality in sports management of women’s soccer

El objetivo del presente trabajo es diseñar y validar la creación del cuestionario de evaluación de la calidad percibida en la gestión deportiva del futbol femenil. El muestreo fue intencional por conveniencia, con un total de 332 jugadoras y un rango de edad de entre los 18 y 51 años (M= 20.92; DE= 3.59). Se llevaron a cabo análisis de validez de constructo por medio de un análisis factorial exploratorio (AFE) así como un análisis factorial confirmatorio (AFC) seguido de análisis de fiabilidad y varianzamedia extractada. El instrumento creado fue el GEDECAFF. Los resultados de los análisis factoriales mostraron 36 ítems divididos en 4 factores: (1) Interacción con el entrenador, (2) Instalaciones, (3) Servicio de personal e (4) Institucional; los indicadores de pertinencia fueron apropiados y explican el 76.25% de la varianza total. Los índices de ajuste, error y chi cuadrado son adecuados CFI = .90, TLI = .89 y RMSEA = .07, χ2/gl = 2.17. Los resultados muestran que Alfa de Cronbach y Omega de McDonald por factores está por encima de .90. En conclusión, el cuestionario GEDECAFF presenta las propiedades psicométricas satisfactorias y atiende las necesidades de los servicios ofrecidos por los distintos clubes, dando oportunidad a la mejora continua de la calidad del servicio en el futbol femenil.(AU)

The purpose of this study is to design and validate the creation of the questionnaire for the evaluation of theperceived quality in the sports management of women's soccer. The sampling was intentional for convenience, with a total of 332 soccer players and an age range between 18 and 51 years (M = 20.92; SD= 3.59). Construct validity analyses were carried out using an exploratory factor analysis (EFA) as well as a confirmatory factor analysis (CFA) followed by reliability analysis and extracted mean variance. The instrument created was the GEDECAFF. The result of the factor analysis showed 36 items divided into 4factors: (1) Interaction with a coach, (2) Facilities, (3) Personal service, and (4) Institutional; the relevance indicators were adequate, explaining 76.25% of the total variance. The fit and error indices are adequate CFI = .90, TLI = .89, and RMSEA = .07, regarding the χ2/df = 2.17. The results show that Cronbach's Alpha and McDonald's Omega by factors is above .90. In conclusion, the GEDECAFF questionnaire presents the appropriate psychometric properties and meets the needs of the services offered by the different women's soccer clubs, opening an opportunity for continuous improvement in the quality of service in women's soccer.(AU)

O objetivo deste estudo foivalidar a criação do questionário para avaliação da qualidade percebida na gestão desportiva do futebol feminino. A amostra foi intencional por conveniência, com um total de 332 jogadores de futebol e faixa etária entre 18 e 51 anos (M= 20.92; DP= 3.59). As análises de validade de construto foram realizadas por meio de uma análise fatorial exploratória (EFA), bem como uma análise fatorial confirmatória (CFA), seguida de análise de confiabilidade e variância média extraída. O instrumento criado foi o GEDECAFF. Os resultados das análises fatoriais mostraram 36 itens divididos em 4 fatores: (1) Interação com o formador, (2) Instalações, (3) Atendimento Pessoal e (4) Institucional; os indicadores de relevância foram adequados, explicando 76.25% da variância total. Os índices de ajuste e erro são adequados CFI = .90, TLI = .89 e RMSEA = .07, em relação ao χ2/df = 2.17. Os resultados mostram que o Alfa de Cronbach e o ômega do McDonald's por fatores estão acima de 0,90. Em conclusão, o questionário GEDECAFF apresenta as propriedades psicométricas adequadas e atende às necessidadesdos serviços oferecidos pelos diferentes clubes de futebol feminino, abrindo uma oportunidade de melhoria contínua na qualidade do serviço no futebol feminino.(AU)

[At the heart of care management, the relationship]. / Au cœur du management du soin, la relation.

The prevalence of management concerns in hospitals and a highly normative conception of health care are converging today in a standardization of care. The latter is undoubtedly at the root of the current malaise among caregivers. Indeed, the New Public Management approach is encouraging them, despite themselves, to carry out their missions to the detriment of the values of care. A more appropriate form of management would, on the contrary, be based on a continuity to be sought between care values and management values, around the notion of support. This would mean reinstating concern for interpersonal relationships at the heart of care management missions.

Complications related to unwitnessed magnet ingestion in paediatrics: Case series.

Foreign body inges tion is one of the mo s t common problems a mo ng chi ldren. There is a great te ndency among children between the age of six months to six years to p lace objects, such as coins, fish bone, pins, button batteri es, magnets and o th er hous ehold ite ms, in their m outh and often swa llow them. Magnet ingestion is not uncommon. Hazardous effects can occur owing to the fact that these are usually unwitnessed leading to disparity in histor y an d delayed presentation. Nowadays these m agnets are made of Neodymium which is a s trong element and can be moulded into various shapes and sizes, making them more attractive to children . Single magnet ingestion may pass with out complication, bu t multip le ingested magnets pose risk of severe complications such as obstruction, inter bowel fistulae, and perforation often requiring urgent intervention. Here, we present three cases who presented to the emergency d epartment with unusu al prese nt ation s an d ultimately under went exp loratory La parotomy with surprising intra- operative findings along with magnetic objects.