Experiencia del Sistema Nacional de Salud Mexicano en el desarrollo de guías de práctica clínica

ResumenAntecedentesLas guías de práctica clínica son herramientas que han demostrado hacer más racionales las decisiones en salud y disminuir la brecha entre la acción clínica y la evidencia científica.ObjetivoEl estudio tiene como objetivo compartir la experiencia en el desarrollo y actualización de guías por el Sistema Nacional de Salud de México.Material y métodosLa metodología en el desarrollo de guías consta de 5 fases: priorización, conformación de grupos de trabajo, desarrollo por adopción de guías internacionales o de novo, validación e integración en el Catálogo maestro de guías de práctica clínica para su difusión.ResultadosEl Catálogo maestro de guías de práctica clínica aloja 664 guías, distribuidas de la siguiente forma: 42% son de Medicina Interna, 22% de Cirugía, 24% de Pediatría y el 12% de Ginecología y Obstetricia. Del total de las guías, se da cobertura al 85% del Catálogo universal de servicios de salud, al 84% del Fondo de protección contra gastos catastróficos y al 61% del Seguro Médico Siglo XXI de la Comisión Nacional de Protección Social en Salud.DiscusiónEl resultado es la suma de un esfuerzo de coordinación y cooperación de las instituciones del Sistema Nacional de Salud, de las voluntades políticas y del compromiso de 3,477 profesionales de la salud que participan en el desarrollo y actualización de las guías.ConclusionesLa integración, difusión e implantación de las guías del Catálogo maestro mejora la calidad de la atención y seguridad de los usuarios del Sistema Nacional de Salud.AbstractBackgroundClinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence.ObjectiveThe objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico.Material and methodsThe methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination.ResultsThe Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health.DiscussionThe result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines’ development and update.ConclusionMaster catalogue guidelines’ integration, diffusion and implantation improve quality of attention and security of the users of the National Health System

Emotional Intelligence Components as Predictors of Engagement in Nursing Professionals by Sex

Engagement of nursing professionals is related to their psychological wellbeing, and therefore, emotional intelligence acts as a predictor. The purpose of this study was to analyze the explanatory value of the dimensions of emotional intelligence in engagement in both sexes, as well as the conditional effect of interaction of sex as a moderating variable. The sample was comprised of 2126 nurses with a mean age of 31.66 years. The Utrecht Work Engagement Scale and the Brief Inventory of Emotional Intelligence for Senior Citizens (EQ-i-20M) were used for their evaluation. The results revealed the existence of significant differences in engagement depending on the sex of the nursing professionals. Furthermore, this study showed that the interpersonal component of emotional intelligence is the predictor of engagement of female professionals, while mood and the interpersonal dimensions have a higher predictive value of engagement in males. Finally, this study was able to emphasize the sex differences found along with the importance of the role emotional intelligence dimensions have in engagement levels, which must be taken into account when designing intervention programs to improve engagement and promote participation of nursing professionals in their workplace

Mindfulness in Family Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis

Social and healthcare problems associated with dementia not only affect those who suffer from this disease, but their caregivers as well. The purpose of this study was to analyze the efficacy of mindfulness intervention on psychological variables of caregivers of persons with dementia. A search for scientific articles published from 2000 to 2019 in the PubMed, Web of Science and PsycINFO databases found a total of 282 articles. After screening with preestablished inclusion criteria, ten studies with participation of 161 caregivers remained for the meta-analysis. The results were significant in favor of mindfulness intervention for the variables studied with a standardized difference of mean of 0.71 at a 95% CI, 0.71 (0.52, 0.89); p ≤ 0.00001. Heterogeneity of the studies included was moderate (I2 = 40%). The main conclusion suggested by empirical evidence was that mindfulness intervention seems to be effective for the variables analyzed. However, continued in-depth study of this subject is recommended

Five microRNAs in Serum Are Able to Differentiate Breast Cancer Patients From Healthy Individuals

Breast cancer is the cancer with the most incidence and mortality in women. microRNAs are emerging as novel prognosis/diagnostic tools. Our aim was to identify a serum microRNA signature useful to predict cancer development. We focused on studying the expression levels of 30 microRNAs in the serum of 96 breast cancer patients vs. 92 control individuals. Bioinformatic studies provide a microRNA signature, designated as a predictor, based on the expression levels of five microRNAs. Then, we tested the predictor in a group of 60 randomly chosen women. Lastly, a proteomic study unveiled the overexpression and downregulation of proteins differently expressed in the serum of breast cancer patients vs. that of control individuals. Twenty-six microRNAs differentiate cancer tissue from healthy tissue, and 16 microRNAs differentiate the serum of cancer patients from that of the control group. The tissue expression of miR-99a, miR-497, miR-362, and miR-1274, and the serum levels of miR-141 correlated with patient survival. Moreover, the predictor consisting of miR-125b, miR-29c, miR-16, miR-1260, and miR-451 was able to differentiate breast cancer patients from controls. The predictor was validated in 20 new cases of breast cancer patients and tested in 60 volunteer women, assigning 11 out of 60 women to the cancer group. An association of low levels of miR-16 with a high content of CD44 protein in serum was found. Circulating microRNAs in serum can represent biomarkers for cancer prediction. Their clinical relevance and the potential use of the predictor here described are discussed

Interpersonal Support, Emotional Intelligence and Family Function in Adolescence

Background: During adolescence, although the peer group exerts a strong influence on how the individual thinks and feels and on personal social values, the family still exerts a sustaining and supporting role. This study analyzed the relationships established between family function, emotional intelligence and perceived interpersonal support in adolescence. Method: The sample was made up of 1287 high school students aged 14 to 18 (M = 15.11; SD = 0.91) in the province of Almeria (Spain). Results: The results showed moderate correlations between the intrapersonal emotional intelligence dimension and perceived availability of support (advice or orientation), and between the mood dimension of emotional intelligence and the three interpersonal support dimensions (appraisal, belonging and tangible). In addition, significant positive correlations were found between family function and the intrapersonal and mood dimensions of emotional intelligence, with medium and large effect sizes, respectively. Apart from that, the data revealed that students who could count on a more functional family referred to high empathy and acceptance by others and greater support in material or financial matters, followed by those with moderate family function. In addition, students from homes with severely dysfunctional families perceived less available support. Finally, students who said they could count on strong family function also scored higher on the intrapersonal factor of emotional intelligence. Conclusions: The implications of these findings for the development of emotional intelligence in early adolescence are discussed from the family context, considering the relationship between emotional intelligence and social support

Emotional Intelligence Profiles and Mobbing in Nursing: The Mediating Role of Social Support and Sensitivity to Anxiety

The prevalence of mobbing among nurses in various countries is around 17–20%. Some researchers have attempted to explain the success or failure of adaptation to the work environment and teamwork and to buffer the effects of psychological harassment in the workplace by incorporating emotional intelligence into the mobbing context. As its main objectives, this quantitative, observational, cross-sectional study analyzed the relationship between emotional intelligence and mobbing as perceived by nurses and sought to establish the mediating roles of other variables involved, such as social support and sensitivity to anxiety. The final sample consisted of 1357 Spanish, self-selected nurses aged 22–58 from multiple healthcare institutions. The questionnaires (Perceived Psychological Harassment Questionnaire, The Brief Emotional Intelligence Inventory, Brief Perceived Social Support Questionnaire, Anxiety Sensitivity Index-3) were implemented on a web platform, which enabled the participants to complete them online. Descriptive analyses and mediation models were estimated. Personal characteristics related to high sensitivity to anxiety and low emotional intelligence implied greater presence of mobbing at work. This mobbing may be buffered if the person perceives enough support from family, friends or significant others. Our results recommend reinforcing the social support network of nursing personnel to improve the work climate and training them in emotional intelligence in university and on-the-job program

Health alliance for prudent prescribing and yield of antibiotics in a patient-centred perspective (HAPPY PATIENT): a before-and-after intervention and implementation study protocol

Background Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections. Methods/design HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 individuals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit. Discussion HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics.publishedVersio

IgG Responses to Porins and Lipopolysaccharide within an Outer Membrane-Based Vaccine against Nontyphoidal Develop at Discordant Rates

Antibodies acquired after vaccination or natural infection with Gram-negative bacteria, such as invasive Salmonella enterica serovar Typhimurium, can protect against disease. Immunization with naturally shed outer membrane vesicles from Gram-negative bacteria is being studied for its potential to protect against many infections, since antigens within vesicles maintain their natural conformation and orientation. Shedding can be enhanced through genetic modification, and the resulting particles, generalized modules for membrane antigens (GMMA), not only offer potential as vaccines but also can facilitate the study of B-cell responses to bacterial antigens. Here we show that the response to immunization with GMMA from S. Typhimurium (STmGMMA) provides B-cell-dependent protection and induces antibodies to two immunodominant antigens, lipopolysaccharide (LPS) and porins. Antibodies to LPS O antigen (O-Ag) markedly enhance protection in the spleen, but this effect is less marked in the liver. Strikingly, IgG responses to LPS and porins develop with distinct kinetics. In the first week after immunization, there is a dramatic T-cell-independent B1b-cell-associated induction of all IgG isotypes, except IgG1, to porins but not to LPS. In contrast, production of IgG1 to either antigen was delayed and T cell dependent. Nevertheless, after 1 month, cells in the bone marrow secreting IgG against porins or LPS were present at a similar frequency. Unexpectedly, immunization with O-Ag-deficient STmGMMA did not substantially enhance the anti-porin response. Therefore, IgG switching to all antigens does not develop synchronously within the same complex and so the rate of IgG switching to a single component does not necessarily reflect its frequency within the antigenic complex