Efectividad de una superficie especial de manejo de presión sustituto en la prevención de las lesiones por presión / Effectiveness of a Special Substitute Pressure Management Surface in Preventing Pressure Ulcers

Introducción: El alto índice de lesiones por presión en la Atención Primaria de Salud del municipio San José, generó la necesidad de utilizar una superficie especial de manejo de presión sustituto para su prevención. Objetivo: Evaluar la efectividad de una superficie especial de manejo de presión sustituto en la prevención de lesiones por presión. Métodos: Intervención cuasi-experimental con grupo control en pacientes encamados con lesiones por presión estadíos I y II en consultorios del Policlínico "Luis A. Turcios Lima", Mayabeque, durante 2018. Universo de 57 pacientes, se conformaron dos grupos por muestreo aleatorio simple. El grupo experimental con 27 pacientes (medidas generales de prevención y superficie especial de manejo de presión sustituto) y grupo control (medidas generales de prevención) 30 pacientes. Se calculó media aritmética y desviación estándar, se estimó Odds Ratio a través de modelo multivariado de regresión logística, con intervalo de confianza del 95 por ciento y un nivel de significancia p < 0.05. Resultados: Predominó el sexo femenino (66,67 por ciento grupo experimental, 73,33 por ciento grupo control). La edad media fue mayor en el grupo control (74,3 años), prevalecieron las lesiones estadio I (50,88 por ciento) y las regiones sacra y calcánea las más afectadas (45,61 por ciento y 24,56 por ciento, respectivamente), el tiempo de tratamiento promedio fue 10 días 8 horas. Se constató la efectividad de la superficie especial de manejo de presión sustituto en grupo experimental (92,59 por ciento), frente a la efectividad de medidas preventivas del grupo control (26,67 por ciento). Conclusiones: La utilización de una superficie especial de manejo de presión sustituto, diseñada con materiales de fácil acceso fue efectiva en la prevención de las lesiones por presión(AU)

ABSTRACT Introduction: The high rate of pressure injuries in primary health care of San José Municipality generated the need to use a special substitute pressure management surface for its prevention. Objective: To assess the effectiveness a special surrogate pressure management surface in preventing pressure injuries. Methods: Quasiexperimental intervention with a control group in bedridden patients with pressure injuries at stages I and II, carried out, during 2018, in family medical offices of Luis A. Turcios Lima Polyclinic, Mayabeque Province. The universe was 57 patients. Two groups were formed by simple random sampling. The experimental was made up of 27 patients (general preventive measures and special surrogate pressure management surface) and the control group was made up of 30 patients (general preventive measures). Arithmetic mean and standard deviation were calculated and odds ratio was estimated through multivariate logistic regression model, with a 95 percent confidence interval and a significance level of p < 0.05. Results: The female sex predominated (66.67 percent from the experimental group and 73.33 percent from the control group). The mean age was higher in the control group (74.3 years). Stage I lesions prevailed (50.88 percent), while the sacral and calcaneal regions were the most affected (45.61 percent and 24.56 percent, respectively). Average treatment time was ten days and eight hours. Effectiveness of the special surrogate pressure management surface was found in the experimental group (92.59 percent), compared to the effectiveness of preventive measures in the control group (26.67 percent). Conclusions: The use of a special surrogate pressure management surface, designed with easily accessible materials, was effective in preventing pressure injuries(AU)

Impact of clinical pharmacy interventions on health and economic outcomes in type 2 diabetes: A systematic review and meta-analysis.

AIM: To examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of people with type 2 diabetes in hospital settings. METHODS: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, COCHRANE Library and citations and reference lists of key articles. We included randomized and non-randomized controlled trials, cohort and controlled before-after studies. Primary outcomes were glycosylated haemoglobin (HbA1c ), all-cause mortality, major cardiovascular events, adverse events (AEs), health-related quality of life and economic outcomes. RESULTS: We retrieved 11,853 studies, of which 44 studies were included in the review (n = 8623). We included 29 randomized controlled studies in the meta-analyses (n = 4055). Clinical pharmacy interventions significantly reduced HbA1c levels compared to usual care (standardized mean difference: -0.52, p < 0.001). The interventions significantly reduced AEs compared to usual care. No studies were reported on the effectiveness of clinical pharmacy interventions on major cardiovascular events. In one study that examined the impact of clinical pharmacy interventions on all-cause mortality, a non-significant reduction was observed compared with usual care. There was significant improvement in quality of life and significant reduction in costs of type 2 diabetes care compared to usual care. CONCLUSIONS: Clinical pharmacy interventions were effective in improving glycaemic control, quality of life and reducing the rate of AEs and costs of type 2 diabetes care.

The low fresh gas flow anesthesia and hypothermia in neonates undergoing digestive surgeries: a retrospective before-after study.

BACKGROUND: Based on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high. Since September 1st, 2019, the recommendation had been launched to utilize ≤1 L/min fresh gas flow during the neonates' surgical procedure. We therefore intended to evaluate the association between low fresh gas flow anesthesia and the occurrence of hypothermia in neonates undergoing digestive surgeries. METHODS: A retrospective chart review, before-after study was conducted for neonates who underwent digestive surgeries. The primary outcomes were the incidence of hypothermia. The secondary outcomes included hospital mortality, the value of lowest temperature, blood loss, mean body temperature during the surgery, the length of hypothermia during the surgery and postoperative hospital length-of- stay (PLOS). RESULTS: 249 neonates fulfilled the eligibility criteria. The overall incidence of intraoperative hypothermia was 81.9%. The low fresh gas flow anesthesia significantly reduced the odds of hypothermia [routine group: 149 (87.6%) versus low flow group: 55 (69.6%); p < 0.01]. Moreover, the low fresh gas flow anesthesia could reduce the length of hypothermia [routine group: 104 mins (50, 156) versus low flow group: 30 mins (0,100); p < 0.01], as well as elevate the value of lowest temperature for neonates [routine group: 35.1 °C (34.5, 35.7) versus low flow group: 35.7 °C (35.3, 36); p < 0.01]. After adjustment for confounding, low fresh gas flow anesthesia and the length of surgical time were independently associated with intraoperative hypothermia. CONCLUSIONS: Low fresh gas flow anesthesia is an effective way to alleviate hypothermia in neonates undergoing open digestive surgery.

Aplicación de un programa de ejercicios con atención focalizada en 2 pacientes afectados por síndrome de Parkinson-plus / Application of a focused-attention exercise program in two patients affected by Parkinson-plus syndrome

Antecedentes y objetivo: El síndrome de Parkinson-Plus, también conocido como síndrome parkinsoniano atípico, es clínicamente muy heterogéneo y presenta una mala respuesta a los tratamientos farmacológicos antiparkinsonianos. Además, tiene peor pronóstico y una progresión más rápida comparado con la enfermedad de Parkinson. Dada la poca evidencia existente en la aplicación de terapia por ejercicio en este síndrome, y con la intención de ir formando un cuerpo de conocimiento sobre el uso de dichas terapias en estos pacientes, se presenta la intervención realizada en 2 pacientes. Material y métodos: Se intervino en 2 pacientes con síndrome de Parkinson-plus mediante un programa de ejercicios de atención focalizada, concebido específicamente para este colectivo y con la finalidad de atenuar o detener la vertiginosa pérdida de las capacidades físicas y mentales. Se realizaron 2 controles (pre y postintervención) y las escalas empleadas fueron la versión española del 39-item Parkinson's Disease Questionnaire y la Escala de Tinetti, así como el Mini-Mental State Exam para descartar trastorno cognitivo que impidiese seguir la sesión. Resultados y conclusiones: Se objetiva una leve mejoría en los valores absolutos de equilibrio, marcha y calidad de vida. Los hallazgos sugieren una probable utilidad del programa de ejercicios implementado, como una estrategia rehabilitadora válida, ya que podría mejorar y/o evitar la rápida pérdida de capacidades funcionales que afectan al equilibrio, la marcha y la calidad de vida. Se hacen necesarios estudios más apropiados para refrendar estas conclusiones

Background and objective: Parkinson-plus syndrome, also known as atypical Parkinsonian syndrome, is very heterogeneous clinically and responds poorly to antiparkinsonian (drug) therapies. It is characterized by worse prognosis and faster clinical progression compared to Parkinson's Disease. Evidence supporting the application of exercise therapy in this syndrome is lacking, we present here a therapeutic approach to these subjects with the aim of proposing a framework for therapists. Material and methods: Two patients with Parkinson-plus syndrome were treated through a programme of focused-attention exercises, specifically designed for this group and with the aim of decreasing or stopping the loss of physical and mental abilities. Two controls were carried out (pre and post intervention) and the scales used were the Spanish version of the 39-item Parkinson's Disease Questionnaire and the Tinetti Scale, as well as the Mini Mental State Exam to rule out cognitive disorder that would prevent the subjects following the sessions. Results and conclusions: A slight improvement was observed in the absolute values of balance, gait and quality of life. The findings suggest probable utility of the exercise programme implemented, as a valid rehabilitative strategy, since it could improve and/or prevent the rapid loss of functional capacities that affect balance, gait and quality of life. More appropriate studies are necessary to endorse these conclusions

Efectividad de 6 sesiones de biofeedback manométrico en la incontinencia urinaria y la calidad de vida: estudio prospectivo tipo antes-después, 67 casos / Effectiveness of 6 manometric biofeedback sessions on urinary incontinence and quality of life: A before-after study of 67 patients

Objetivo: demostrar si un protocolo reducido de 6 sesiones de ejercicios tónicos y fásicos es capaz de mejorar la calidad de vida y la fuerza muscular en los pacientes con incontinencia urinaria (IU). Material y métodos: se realizó un estudio prospectivo tipo antes y después a 67 pacientes con IU remitidos al Departamento de Rehabilitación del Hospital Universitario de Santa Cristina, Madrid, España. El estudio se realizó de enero del 2016 a diciembre del 2018. En la evaluación inicial, se registraron los datos de filiación, los factores predisponentes y el tipo de IU. Los pacientes recibieron recomendaciones de estilo de vida y los cuestionarios/escalas ICIQ-SF/I-QOL que debían rellenarse al inicio/final del tratamiento. La evaluación manométrica fue registrada en la evaluación inicial/final por el equipo MYOMED(R) 932 ENRAF NONIUS (CE 0197). El protocolo consistió en una sesión de 30 min de ejercicios tónicos/fásicos (15 min cada uno) 2 veces a la semana durante un máximo de 6 sesiones, supervisadas por un fisioterapeuta. Resultados: la edad media fue de 52,1±12,7 años. Mujeres 94% (n=63). La fuerza máxima y media de la contracción del suelo pélvico fue de 26,4±15,6 y 5,3±3,9mmHg, respectivamente, y aumentó significativamente después del tratamiento a 35,5±19,6 y 7,6±4,4mmHg (p<0,0001). El ICIQ-SF fue de 10,1±5 y disminuyó significativamente a 6,6±4,6 (p<0,0001). La I-QOL aumentó significativamente de 66,1±21,9 a 77,9±18,1 puntos (p<0,0001). La subescala I-QOL limitación de actividad se elevó de 63,7±22,6 a 77,3±17,8 (p<0,0001); la subescala I-QOL efecto psicosocial aumentó de 73,8±23,9 a 82,5±18,7 (p=0,0004); y la subescala I-QOL vergüenza social se incrementó de 56,5±23,7 a 70,5±22,1 (p<0,0001). Conclusión: el biofeedback manométrico es capaz de disminuir la IU y mejorar la calidad de vida y los valores manométricos. Este protocolo reducido de 6 sesiones podría aplicarse a otras instituciones públicas y privadas y podría tener un impacto económico en el sistema de salud y en la economía de los pacientes

Objective: to determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). Material and methods: a prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED(R) 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. Results: the mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). Conclusion: manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients

Unplanned readmission prevention by a geriatric emergency network for transitional care (URGENT): a prospective before-after study.

BACKGROUND: URGENT is a comprehensive geriatric assessment (CGA) based nurse-led care model in the emergency department (ED) with geriatric follow-up after ED discharge aiming to prevent unplanned ED readmissions. METHODS: A quasi-experimental study (sequential design with two cohorts) was conducted in the ED of University Hospitals Leuven (Belgium). Dutch-speaking, community-dwelling ED patients aged 70 years or older were eligible for enrolment. Patients in the control cohort received usual care. Patient in the intervention cohort received the URGENT care model. A geriatric emergency nurse conducted CGA and interdisciplinary care planning among older patients identified as at risk for adverse events (e.g. unplanned ED readmission, functional decline) with the interRAI ED Screener© and clinical judgement of ED staff. Case manager follow-up was offered to at risk patients without hospitalization after index ED visit. For inpatients, geriatric follow-up was guaranteed on an acute geriatric ward or by the inpatient geriatric consultation team on a non-geriatric ward if considered necessary. Primary outcome was unplanned 90-day ED readmission. Secondary outcomes were ED length of stay (LOS), hospitalization rate, in-hospital LOS, 90-day higher level of care, 90-day functional decline and 90-day post-hospitalization mortality. RESULTS: Almost half of intervention patients (404/886 = 45.6%) were categorized at risk. These received on average seven advices. Adherence rate to advices on the ED, during hospitalization and in community care was 86.1, 74.6 and 34.1%, respectively. One out of four at risk patients without hospitalization after index ED visit accepted case manager follow-up. Unplanned ED readmission occurred in 170 of 768 (22.1%) control patients and in 205 of 857 (23.9%) intervention patients (p = .11). The intervention group had shorter ED LOS (12.7 h versus 19.1 h in the control group; p < .001), but higher rate of hospitalization (70.0% versus 67.0% in the control group; p = .003). CONCLUSIONS: The URGENT care model shortened ED LOS and increased the hospitalization rate, but did not prevent unplanned ED readmissions. A geriatric emergency nurse could improve in-hospital patient management, but failed to introduce substantial out-hospital case-management. TRIAL REGISTRATION: The protocol of this study was registered retrospectively with ISRCTN ( ISRCTN91449949 ; registered 20 June 2017).

Cortical surface area variations within the dorsolateral prefrontal cortex are better predictors of future cognitive performance than fluid ability and working memory / Las variaciones de superficie cortical en la corteza dorsolateral prefrontal predicen mejor el futuro desempeño cognitivo que la inteligencia fluida y la memoria operativa

Background: Are cognitive and biological variables useful for predicting future behavioral outcomes?. Method: In two independent groups, we measured a set of cognitive (fluid and crystallized intelligence, working memory, and attention control) and biological (cortical thickness and cortical surface area) variables on two occasions separated by six months, to predict behavioral outcomes of interest (performance on an adaptive version of the n-back task) measured twelve and eighteen months later. We followed three stages: discovery, validation, and generalization. In the discovery stage, cognitive/biological variables and the behavioral outcome of interest were assessed in a group of individuals (in-sample). In the validation stage, the cognitive and biological variables were related with a parallel version of the behavioral outcome assessed several months later. In the generalization stage, the validation findings were tested in an independent group of individuals (out-of-sample). Results: The key finding revealed that cortical surface area variations within the right dorsolateral prefrontal cortex predict the behavioral outcome of interest in both groups, whereas the cognitive variables failed to show reliable predictive validity. Conclusions: Individual differences in biological variables might predict future behavioral outcomes better than cognitive variables concurrently correlated with these behavioral outcomes

Antecedentes: ¿Predicen las variables cognitivas y biológicas el futuro desempeño cognitivo? Método: en dos grupos independientes de participantes se miden variables cognitivas (inteligencia fluida y cristalizada, memoria operativa y control atencional) y biológicas (grosor y superficie cortical) en dos ocasiones separadas por seis meses, para predecir el desempeño en la tarea n-back valorado doce y dieciocho meses después. Se completan tres etapas: descubrimiento, validación y generalización. En la de descubrimiento se valoran en un grupo de individuos las variables cognitivas/biológicas y el desempeño a predecir. En la de validación, se relacionan las mismas variables con una versión paralela de la n-back completada meses después. En la de generalización, los resultados de la validación se replican en un grupo independiente de individuos. Resultados: las variaciones de superficie cortical en la corteza dorsolateral prefrontal derecha predicen el desempeño cognitivo en los dos grupos independientes de individuos, mientras que las variables cognitivas no contribuyen a la predicción del desempeño futuro. Conclusiones: las diferencias individuales en determinadas variables biológicas predicen el desempeño cognitivo mejor que las variables cognitivas que correlacionan concurrentemente con ese desempeño

Cortical surface area variations within the dorsolateral prefrontal cortex are better predictors of future cognitive performance than fluid ability and working memory.

BACKGROUND: Are cognitive and biological variables useful for predicting future behavioral outcomes? METHOD: In two independent groups, we measured a set of cognitive (fluid and crystallized intelligence, working memory, and attention control) and biological (cortical thickness and cortical surface area) variables on two occasions separated by six months, to predict behavioral outcomes of interest (performance on an adaptive version of the n-back task) measured twelve and eighteen months later. We followed three stages: discovery, validation, and generalization. In the discovery stage, cognitive/biological variables and the behavioral outcome of interest were assessed in a group of individuals (in-sample). In the validation stage, the cognitive and biological variables were related with a parallel version of the behavioral outcome assessed several months later. In the generalization stage, the validation findings were tested in an independent group of individuals (out-of-sample). RESULTS: The key finding revealed that cortical surface area variations within the right dorsolateral prefrontal cortex predict the behavioral outcome of interest in both groups, whereas the cognitive variables failed to show reliable predictive validity. CONCLUSIONS: Individual differences in biological variables might predict future behavioral outcomes better than cognitive variables concurrently correlated with these behavioral outcomes.

Intervención de Enfermería en cuidados domiciliarios a los adultos mayores con diabetes mellitus / Nursing intervention in home care for the elderly with diabetes mellitus

Fundamento: la diabetes mellitus es un problema de salud pública, por ser una de las enfermedades crónicas más prevalentes asociada a una elevada morbilidad y mortalidad. En la actualidad más de 382 millones de personas en el mundo padecen esta enfermedad y se estima que alcance los 592 millones para el 2035. La actividad de enfermería con el paciente en la atención domiciliaria es determinante para la modificación de este hecho. En este sentido, la atención ambulatoria del paciente diabético adquiere un valor determinante en este propósito. Objetivo: diseñar una intervención de enfermería en cuidados domiciliarios a los adultos mayores con diabetes mellitus. Métodos: estudio de intervención y desarrollo contextualizado en el Policlínico Dr. Rudesindo Antonio García del Rijo de la provincia Sancti Spíritus, del 2016 a 2017. Variables de estudio: nivel de conocimientos de enfermeras, cuidado de los adultos mayores con diabetes mellitus y estado de salud. Se utilizó entrevista estructurada a los adultos mayores, para conocer la mejoría del estado de salud, después de aplicada la intervención se compararon las proporciones poblacionales mediante Prueba de McNemar. Resultados: el nivel de conocimiento de las enfermeras al finalizar el programa de capacitación obtuvo 80,49, el 92,85 porciento del estado de salud de los adultos mayores con diabetes mellitus alcanzaron un buen estado de salud; el cuidado de los adultos mayores se pudo constatar que recibieron un cuidado aceptable, el 80,61 porciento, obedeció a cambios de conductas. Conclusiones: se caracterizó el estado actual de los adultos mayores con diabetes mellitus se evidenció el predominio del sexo masculino, así como el grupo de edad de 60-69 años y el nivel de conocimientos del personal de enfermería. Se diseñó una intervención para el cuidado domiciliario de los adultos mayores con diabetes mellitus(AU)

Background: diabetes mellitus is a public health problem, as it is one of the most prevalent chronic diseases associated with high morbidity and mortality. Currently, more than 382 million people in the world suffer from this disease and it is estimated that it will reach 592 million by 2035. Nursing activity with the patient in home care is crucial for the modification of this fact. In this sense, the ambulatory care of the diabetic patient acquires a determining value in this purpose. Objective: to design a nursing intervention in home care for the elderly with diabetes mellitus.Methods: intervention study and development contextualized at Dr. Antonio García del Rijo Polyclinic in the municipality and province of Sancti Spiritus, from 2016 to 2017. Study variables: level of knowledge of nurses, care of the elderly with diabetes mellitus and state of health. A structured interview to the elderly was used to know the improvement of the state of health, after the intervention was applied the population, the proportions were compared through McNemar test. Results: the level of knowledge of the nurses at the end of the training program obtained 80.49, the 92.85 percent of the health status of the elderly with diabetes mellitus reached a good state of health; the care of the elderly was able to confirm that they received acceptable care, the 80.61percent due to behavioral changes. Conclusions: the current status of the elderly with diabetes mellitus was characterized and it showed the male dominance as well as the age group of 60-69 years and the level of knowledge of nurses. An intervention was designed for the home care of the elderly with diabetes mellitus(AU)

Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study.

BACKGROUND: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. OBJECTIVE: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. METHODS: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. RESULTS: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. CONCLUSIONS: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times.

Results of the modification of an acute pancreatitis management protocol in Intensive Care medicine. / Resultados de la modificación de un protocolo de manejo para la pancreatitis aguda en Medicina Intensiva.

OBJECTIVE: To determine whether the implementation of a protocol for the management of patients with acute pancreatitis (AP) in an Intensive Care Unit (ICU) improves the clinical outcomes. DESIGN: A retrospective, before-after observational case series study was carried out. STUDY PERIOD: 1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016). SCOPE: An ICU with 48 beds and a recruitment population of 700,000 inhabitants. PARTICIPANTS: AP patients admitted to the ICU, with no exclusion criteria. INTERVENTIONS: The recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period. MAIN VARIABLES OF INTEREST: Patient age, sex, APACHE II, SOFA, study period, pre-ICU hospital stay, nutrition, surgery, antibiotic prophylaxis, hospital mortality, ICU length of stay, hospital length of stay, determinant-based classification. RESULTS: The study comprised 286 patients (94 in the pre-protocol period, 192 in the post-protocol period), with a global in-hospital mortality rate of 23.1% (n=66). Application of the protocol decreased the pre-ICU hospital stay and the use of antibiotic prophylaxis, and increased the use of enteral nutrition. Hospital mortality decreased in the second period (35.1 vs. 17.18%; P=.001), with no significant changes in ICU and hospital stays. In the multivariate logistic regression analysis, the variable period of treatment remained as a variable of statistical significance in terms of hospital mortality (OR 0.34 for the period 2008-2016, 95% CI 0.15-0.74). CONCLUSIONS: The implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU.

ABCs of Hospitalized Patients: A Simple Before-After Study of a Communication Tool to Improve Quality of Inpatient Care.

OBJECTIVES: Within the past several years, innovative communication tools have been established as viable quality improvement mechanisms in health care. Meanwhile, the economic and societal burdens of hospital-acquired conditions (HACs) continue to rise. Various interventions have been attempted to reduce HACs. This study evaluated the effectiveness of a communication tool in reducing risk factors for HACs. METHODS: A communication tool aimed at reducing HAC risk factors was developed by an interdisciplinary team of physicians and nurses and tested in a simple before-after quality improvement study. It included 8 components: ambulation/fall risk, blood glucose greater than 200 mg/dL, central venous catheters, deep venous thrombosis prophylaxis, erosions of the skin/dermal ulcers, Foley/urinary catheters, got communication, and heart monitor/telemetry. This communication tool facilitated multidisciplinary communication. The nurses completed it nightly, and the physicians reviewed the communication tool each morning and, when appropriate, addressed components of care that were out of compliance with best practices. RESULTS: The use of the ABCs of Hospitalized Patients Communication Tool led to daily improvements with reduction in the percentage of patients with blood glucose greater than 200 mg/dL from 43.3% to 35.1%, reduction in the use of central venous catheters from 8.2% to 1.0% of patients, increase in the use of chemical deep venous thrombosis prophylaxis from 45.4% of patients to 56.7%, reduction in the use of urinary catheters from 27.6% to 13.2%, and decrease in use of telemetry from 67.5% to 55.1%. All of the results have P < 0.05. These improvements were sustained over time. CONCLUSIONS: Implementation of a multidisciplinary communication tool serves as a simple, resource-conscious, and customizable instrument to reduce the risk factors for developing HACs. This communication tool can be easily disseminated and used by other institutions.

Eficacia clínica de la bupivacaína al 0, 5 por ciento asociada a dosis de fentanilo en la anestesia espinal para cesárea / Clinical efficacy of 0, 5 percent bupivacaine associated with doses of fentanyl in spinal anesthesia for caesarean section

Introducción: la anestesia obstétrica proporciona alivio del dolor quirúrgico y seguridad a la gestante, objetivos que se logran preferentemente con técnicas regionales. Objetivo: evaluar la eficacia clínica de la bupivacaína al 0,5 por ciento con dosis diferentes de fentanilo para anestesia espinal en gestantes que se someterán a cesárea.Método: se realizó un estudio experimental controlado y aleatorizado en el Hospital General Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila desde marzo hasta noviembre de 2015, con la finalidad de evaluar la eficacia clínica de 10 mg de bupivacaína al 0,5 por ciento asociada a 25 μg y a 50 μg de fentanilo para anestesia espinal en operación cesárea. La muestra estuvo constituida por 150 pacientes asignadas de forma aleatoria a dos grupos.Resultados: no se encontraron diferencias significativas entre los grupos en cuanto a las variables de tiempo estudiadas y al nivel de bloqueo. Presentaron hipotensión arterial 66 pacientes, temblores 48, y prurito 38.Conclusiones: la bupivacaína al 0,5 por ciento asociada a diferentes dosis de fentanilo es de gran utilidad en la cesárea debido a su rápido inicio de acción, período de latencia breve y tiempo de anestesia prolongado(AU)

Introduction: obstetric anesthesia provides surgical pain relief and safety to the pregnant woman, objectives that are achieved preferably with regional techniques. Objective: to evaluate the clinical efficacy of 0,5 percent bupivacaine with different doses of fentanyl for spinal anesthesia in pregnant women who undergo caesarean section.Method: a controlled and randomized experimental study was carried out in the General Provincial Teaching Hospital Dr Antonio Luaces Iraola from Ciego de Ávila from March to November 2015, in order to evaluate the clinical efficacy of 10 mg of 0,5 percent bupivacaine associated with 25 μg and 50 μg of fentanyl for spinal anesthesia in cesarean section. The sample consisted of 150 patients randomly assigned to two groups.Results: no significant differences were found between the groups in terms of the time variables studied and the block level. 66 patients presented hypotension, tremors 48, and pruritus 38.Conclusions: the 0,5 percent bupivacaine associated with different doses of fentanyl is very useful in caesarean section due to its rapid onset of action, short latency period and prolonged anesthesia time(AU)

Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study.

BACKGROUND: Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium. METHODS: A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data. RESULTS: No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 ± SD 4.8 days versus 4.9 ± SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate - 1.59; p = 0.08) was noted for delirious IC patients in a linear mixed model. No effect on patient mortality and on nurses' delirium knowledge (p = 0.43) and recognition (p = 1.0) was found. CONCLUSION: Our study, the first in its area to investigate effects of delirium e-learning on patient outcomes, demonstrated no benefits on both geriatric patients and nurses. Further research is needed to determine whether delirium e-learning nested within a larger educational approach inclusive of enabling and reinforcing strategies, would be effective. TRIAL REGISTRATION: ISRCTN ( 82,293,702 , 27/06/2017).

Intervención educativa sobre violencia intrafamiliar y maltrato infantil en familias disfuncionales / Educative intervention about intrafamily violence and children abuse in dysfunctional families

Introducción: la familia es la célula elemental de la sociedad, donde sus integrantes satisfacen sus intereses afectivos y sociales, pero a menudo se ve afectada por la presencia de violencia. Objetivo: evaluar los conocimientos que sobre violencia intrafamiliar y maltrato infantil tienen las familias disfuncionales antes y después de una estrategia de intervención. Métodos: se realizó una investigación tipo cuasi experimental antes y después sin grupo control de las familias disfuncionales pertenecientes al consultorio número 11 del Policlínico Docente Marta Martínez Figuera ubicado en Güines, Mayabeque, en el periodo comprendido entre el mes de febrero del año 2015 a mayo del año 2017. El universo de estudio estuvo conformado por 245 familias, la muestra fue de 178 familias disfuncionales. Resultados: antes de la intervención los resultados encontrados evidenciaron que la ingestión de alcohol fue la condición en el medio familiar más asociada a violencia, los golpes y/o castigos físicos fueron la principal manifestación de maltrato infantil, la persona del núcleo que más propició el maltrato fue la madre, los niños hipercinéticos fueron los más vulnerables y reconocieron el maltrato físico como forma más frecuente. Después de la intervención, se evidenciaron los gritos y/o amenazas verbales como principal manifestación de maltrato infantil, los niños rebeldes a la disciplina son los más afectados y la forma más relevante fue el maltrato psicológico y/o emocional. Conclusiones: antes de la intervención existían escasos conocimientos relacionados con la violencia intrafamiliar y el maltrato infantil, ganándose estos, después de la estrategia de intervención(AU)

Introduction: the family is the main cell of the society, where its members satisfy the affective and social interests, but sometimes it is affected by the presence of violence. Objective: to evaluate knowledge about intrafamily violence, and children abuse that dysfunctional families have before and after an intervention strategy.Methods: a cuasi experimental investigation before and after without control group of dysfunctional families from Doctor's Office # 11 at "Marta Martinez Figuera" teaching policlinic located in Güines, Mayabeque, was performed from February, 2015 to May, 2017. The universe was formed by 245 families; the sample was of 178 dysfunctional families. Results: before the intervention, the found results evidenced that alcohol ingestion was the most associated condition to violence within the families, bumps and physical punishments were the main manifestations of children abuse, the person from the household that most favored the abuse was their mothers, hyperactive children were the most vulnerable and recognized the physical abuse as the most frequent cause. After the intervention, shouts and verbal intimidations resulted as the main manifestations of children abuse, rebelled children to discipline are the most affected and the most relevant were the psychological and/or emotional abuse. Conclusions: before the interventions there were insufficient knowledge related to intrafamily violence and children abuse, and they were improved after the intervention strategy(AU)

Intervención educativa para incrementar el nivel de conocimientos sobre infección vaginal en gestantes / Intervenção educativa para aumentar o nível de conhecimento sobre a infecção vaginal em mulheres grávidas / Educational intervention to increase the level of knowledge about vaginal infection in pregnant women

Introducción: las infecciones vaginales afectan a mujeres de todas las edades, que en su mayoría han presentado la enfermedad en algún momento de su vida, no se refieren diferencias en relación con la raza u origen étnico. Objetivo: diseñar una intervención educativa que permita incrementar el nivel de conocimientos sobre infección vaginal en gestantes del consultorio médico "El Gremio No. 1", municipio Baracoa, Guantánamo, en el período de octubre de 2015 a mayo de 2017. Método: se realizó un estudio pre-experimental de intervención educativa en una muestra no probabilística intencionada de 16 gestantes. El estudio se realizó en tres etapas: etapa de diagnóstico, etapa de intervención y etapa de evaluación. El dato primario se obtuvo de la encuesta aplicada antes y después de la intervención. Los resultados se presentaron en tablas de contingencia y la medida de resumen el porcentaje. Se utilizó el porciento de variación para medir la efectividad de la intervención. Resultados: antes de la intervención se evidenció bajo conocimiento sobre los tipos de infección vaginal, factores de riesgos y métodos de prevención de la infección vaginal en el embarazo y aplicación de la técnica del aseo y el uso de agua hervida. El estudio permitió incrementar el nivel de conocimientos acerca de la infección vaginal después de la intervención. Conclusiones: se incrementó el nivel de conocimiento, aspecto que demuestra la efectividad de la propuesta de inter vención(AU)

Introduction: vaginal infections affect women of all ages, who have mostly presented the disease at some point in their lives; no differences are related to race or ethnic origin. Objective: to design an educational intervention that increase the level of knowledge about vaginal infection in pregnant women of the medical office "El Gremio No. 1", Baracoa, Guantanamo, from October 2015 to May 2017. Method: it was carried out a pre-experimental study of educational intervention in an intentional non-probabilistic sample of 16 pregnant women. The study was carried out in three stages: diagnostic stage, intervention stage and evaluation stage. The primary data was obtained from the survey applied before and after the intervention. The results were presented in contingency tables and the summary measure the percentage. The variation percentage was used to measure the effectiveness of the intervention. Results: before the intervention, there was evident knowledge about the types of vaginal infection, risk factors and methods of prevention of vaginal infection in pregnancy and application of the technique of cleanliness and the use of boiled water. The study permited to increase the level of knowledge about the infection after the intervention. Conclusions: the level of knowledge was increased, an aspect that demonstrates the effectiveness of the intervention proposal(AU)

Introdução: as infecções vaginais afetam mulheres de todas as idades, que em sua maioria apresentam a doença em algum momento de suas vidas, não havendo diferenças relacionadas à raça ou origem étnica. Objetivo: projetar uma intervenção educacional para aumentar o nível de conhecimento sobre a infecção vaginal no escritório do doutor generalista "El Gremio No. 1", município Baracoa, Guantanamo, no período de outubro de 2015 até maio de 2017. Método: foi realizado um estudo pré-experimental de intervenção educativa em uma amostra intencional não probabilística de 16 gestantes. O estudo foi realizado em três etapas: estágio de diagnóstico, estágio de intervenção e estágio de avaliação. Os dados primários foram obtidos a partir do inquérito aplicado antes e após a intervenção. Os resultados foram apresentados em tabelas de contingência e o resumo mede a porcentagem. A porcentagem de variação foi usada para medir a eficácia da intervenção. Resultados: antes da intervenção, não havia conhecimento evidente sobre os tipos de infecção vaginal, fatores de risco e métodos de prevenção da infecção vaginal na gravidez e aplicação da técnica de limpeza e uso de água fervida. O estudo permitiu aumentar o nível de conhecimento sobre a infecção após a intervenção. Conclusões: o nível de conhecimento foi aumentado, aspecto que demonstra a efetividade da proposta de intervenção(AU)

Heterogeneity in application, design, and analysis characteristics was found for controlled before-after and interrupted time series studies included in Cochrane reviews.

OBJECTIVES: The aim of the study was to examine the application, design, and analysis characteristics of controlled before-after (CBA) and interrupted time series (ITS) studies and their use in Cochrane reviews. STUDY DESIGN AND SETTING: We searched the Cochrane library for reviews including these study designs from May 2012 to March 2015 and purposively selected, where available, two reviews each across 10 prespecified intervention types. We randomly selected two CBA and two ITS studies from each review. Two researchers independently extracted information from the studies and the respective reviews. RESULTS: Sixty-nine reviews considered CBA and ITS studies for inclusion. We analyzed 21 CBA and 16 ITS studies from 11 to 8 reviews, respectively. Cochrane reviews inconsistently defined and labeled CBA and ITS studies. Many studies did not meet the Cochrane definition or the minimum criteria provided by Cochrane Effective Practice and Organisation of Care. The studies present a heterogeneous set of study features and applied a large variety of analyses. CONCLUSION: While CBA and ITS studies represent important study designs to evaluate the effects of interventions, especially on a population or organizational level, unclear study design features challenge unequivocal classification and appropriate use. We discuss options for more specific definitions and explicit criteria for CBA and ITS studies.

Diagnóstico y tratamiento de la leucorrea según la Medicina Tradicional / Diagnosis and treatment of leucorrhoea according to Traditional Medicine

Se realizó un estudio de intervención, prospectivo, longitudinal en el Hospital Universitario Ginecobstétrico Mariana Grajales de Santa Clara, con el objetivo de demostrar la utilidad de las técnicas tradicionales en el tratamiento de la leucorrea. La muestra quedó integrada por 64 pacientes, a las cuales se les aplicó acupuntura, auriculopuntura y tratamiento con fitoterapia; estas presentaron, como factor de riesgo, la inestabilidad en la pareja sexual. El 90,6 por ciento de las enfermas, al finalizar el estudio, se encontraban sin leucorrea, lo que demuestra que la medicina tradicional brinda una alternativa de diagnóstico y tratamiento para esta enfermedad(AU)

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study.

BACKGROUND: Detection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals. METHODS: A before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences. RESULTS: Forty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group. CONCLUSIONS: We found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral. TRIAL REGISTRATION: NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.