Enfermagem, pandemia e fadiga por compaixão: uma reflexão geral sobre 2020

La actual pandemia por COVID-19 ha significado para los profesionales de la enfermería un escenario en el que se ha hecho evidente el impacto que el ejercicio profesional puede tener sobre su calidad de vida. Justo cuando el 2020 fue escogido por la Organización Mundial de Salud como el año de la enfermería, se ha evidenciado un panorama poco favorecedor para el ejercicio del cuidado, en el que no sólo se han visto afectados pacientes, familias, sistemas de salud, sino también los propios profesionales que prestan atención a pacientes diagnosticados con el nuevo virus.  En el presente artículo de reflexión se realizó un análisis de uno de los efectos de las condiciones actuales de trabajo de los profesionales de enfermería: la fatiga por compasión, la cual constituye una afectación de la calidad de vida; también se presentan las recomendaciones actuales disponibles, para hacer frente a este fenómeno en Colombi

Gestão de Enfermagem no Santander: autoconhecimento ou administração de saúde?

In Santander, there are important healthcare institutions with a high level of complexity. Nursing is professionally represented and organized in these institutions through care management sub-directorates, units, or departments. In almost all these entities, teaching and care processes are developed to improve the quality of management of care through different strategies. However, there is still evidence of adherence to administrative practices of other disciplines to implement and evaluate the functions performed by nursing professionals. Some approaches to applying nursing knowledge at the level of care have been reported, such as evidence-based nursing and the nursing process. However, it is important to point out that there are few published experiences, and many of the publications are more than 10 years old, so there is a need to know the current panorama of care management in Santander. It is necessary to strengthen the definition, implementation, and evaluation of care management, which, according to the different experiences found, has limitations such as time and low adherence of some professionals, among others, which would lead to strengthening nursing leadership. How to cite this article: Cáceres Rivera, Diana Isabel; Rincón Romero, Mayerli Katherine. Gestión en Enfermería en Santander: ¿conocimiento propio o administración en salud?. Revista Cuidarte. 2023;14(2):e3067.  http://dx.doi.org/10.15649/cuidarte.3067Highlights: La gestión en Enfermería enfoca su atención a las necesidades de cuidado de la persona sana o enferma, familiares, cuidadores y la comunidad, que requiere la gestión e integración entre las relaciones interpersonales, liderazgo, comunicación asertiva y trabajo en equipo. El gremio enfermero ha realizado múltiples esfuerzos por implementar estrategias propias de la disciplina con el ánimo de planear, controlar y evaluar el cuidado para favorecer la calidad de mismo. Existe la necesidad del fortalecimiento de la definición, ejecución y evaluación de la gestión del cuidado desde el liderazgo de enfermería, la cual, desde las diferentes experiencias analizadas, tiene limitantes como el tiempo, la baja adherencia por parte de algunos profesionales, entre otros. Se debe desarrollar estrategias a la luz de un nuevo panorama en el cual la gestión del cuidado con enfoque en la transdisciplinariedad, la inclusión de la familia y la comunidad en la planeación y la evaluación de atención prestada a la persona enferma o sana en cualquier ciclo vital. En Santander existen importantes instituciones prestadoras de salud de alto nivel de complejidad. En dichas instituciones, Enfermería tiene una representación y organización profesional a través de las subgerencias, unidades o departamentos de dirección asistencial. En casi todas estas entidades, se desarrollan procesos docentes asistenciales que buscan mejorar la calidad en la gestión del cuidado a través de diferentes estrategias. Sin embargo, aún se evidencia la adherencia a prácticas administrativas propias de otras disciplinas para implementar y evaluar las funciones desarrolladas por los profesionales de enfermería. Se han descrito algunos acercamientos en la aplicación del conocimiento propio de enfermería a nivel asistencial como lo son la enfermería basada en la evidencia y el proceso de enfermería. Sin embargo, es importante resaltar que son pocas las experiencias publicadas y que muchas de las publicaciones tienen más de 10 años, por lo que surge la necesidad de conocer el panorama actual de la gestión del cuidado en Santander. Es necesario un fortalecimiento de la definición, ejecución y evaluación de la gestión del cuidado de enfermería, la cual, desde las diferentes experiencias encontradas, tiene limitantes como el tiempo, la baja adherencia por parte de algunos profesionales, entre otros, lo cual conduciría a fortalecer el liderazgo en enfermería. Como citar este artículo: Cáceres Rivera, Diana Isabel; Rincón Romero, Mayerli Katherine. Gestión en Enfermería en Santander: ¿conocimiento propio o administración en salud?. Revista Cuidarte. 2023;14(2):e3067.  http://dx.doi.org/10.15649/cuidarte.3067Em Santander, há importantes instituições de saúde com alto nível de complexidade. Nessas instituições, a enfermagem está representada e organizada profissionalmente por meio de subgerências, unidades de gestão de cuidados ou departamentos. Em quase todas essas instituições, são desenvolvidos processos de ensino e assistência que buscam melhorar a qualidade da gestão do cuidado por meio de diferentes estratégias. Entretanto, ainda há evidências de adesão às práticas administrativas de outras disciplinas para a implementação e avaliação das funções desempenhadas pelos profissionais de enfermagem. Foram descritas algumas abordagens para a aplicação do conhecimento de enfermagem em nível assistencial, como a enfermagem baseada em evidências e o processo de enfermagem. No entanto, é importante destacar que poucas experiências foram publicadas e que muitas das publicações têm mais de 10 anos, razão pela qual é necessário conhecer o panorama atual da gestão do cuidado em Santander. É necessário fortalecer a definição, a implementação e a avaliação do gerenciamento do cuidado de enfermagem, que, a partir das diferentes experiências encontradas, apresenta limitações como tempo, baixa adesão por parte de alguns profissionais, entre outras, o que levaria ao fortalecimento da liderança de enfermagem. Como citar este artigo: Cáceres Rivera, Diana Isabel; Rincón Romero, Mayerli Katherine. Gestión en Enfermería en Santander: ¿conocimiento propio o administración en salud?. Revista Cuidarte. 2023;14(2):e3067.  http://dx.doi.org/10.15649/cuidarte.306

Fatores associados ao início da atividade sexual em adolescentes: Estudo analítico transversal

Highlights Sexual activity onset during adolescence was common in the study population, with a higher prevalence in men than in women. The use of psychoactive substances poses a greater risk in terms of the onset of sexual activity, as well as for family and criminal problems. Educational and health institutions can re-direct actions if they recognize the risk factors related to the onset of sexual activity and can identify individual and collective awareness strategies. Public health interventions in educational institutions regarding comprehensive sexual education are needed to prevent the problems of sexually transmitted diseases and teenage pregnancy. Introduction: Different physical, social, affective, and sexual changes take place during adolescence, such as the sexual debut. Objective: To explore the factors associated with the onset of sexual activity in adolescents attending school (12–16 years) in Bucaramanga. Materials and Methods: This analytical cross-sectional study included 440 adolescents from a public school. An instrument developed by Latin American Center for Perinatology - History of Adolescents was applied, and descriptive and bivariate analyses were conducted using a binomial regression model adjusted by age and sex, with sexual activity onset as the outcome and possible associated factors as exposures. Results: The prevalence of the onset of sexual activity was 22.27% (95% CI: 18.56–26.46). Factors associated with greater prevalence of sexual activity onset were having a criminal record and partner PR=3.24, (95%CI: 2.60–4.05) and PR=2.00, (95%CI: 1.42–2.82), respectively. Male gender PR=1.19, (95% CI: 0.84–1.67), using tobacco PR=1.23 (95% CI: 0.73–2.06), alcohol consumption PR=1.23, (95% CI: 0.73–2.06), and other psychoactive substance use PR=1.78, (95% CI: 0.99–3.19) were risk factors; meanwhile, socializing with friends was a protective factor PR=0.27, (95% CI: 0.20–0.36). Discussion: Follow-up by parents and school support decrease the risk of adolescent sexual activity onset. Furthermore, interventions in the family and school settings are important. Conclusion: There are conditions that could promote the beginning of sexual activity in adolescence such as being male, having a partner, having a criminal record, smoking, and consuming alcohol or other substances could promote adolescent sexual activity onset, while socializing with friends was found to be a protective factor. How to cite this article: Sepúlveda Sepúlveda Nancy Milena; Cáceres Rivera Diana Isabel; López Romero Luis Alberto; Díaz Wandurraga Martha Jeannette. Factors associated with the onset of sexual activity in adolescents: Analytic cross-secctional. Revista Cuidarte. 2024;15(1):e3304.   http://dx.doi.org/10.15649/cuidarte.3304Highlights La prevalencia de inicio de actividad sexual durante la adolescencia fue representativa en la muestra observada, siendo mayor en hombres comparado con las mujeres. El uso de sustancias psicoactivas está relacionado con mayor riesgo de inicio de actividad sexual, al igual que los problemas familiares y judiciales. Conocer los factores de riesgo relacionados con el inicio de actividad sexual, así como la identificación de estrategias de promoción individuales y colectivas, podrían reorientar acciones en instituciones educativas y de salud. Se necesitan intervenciones de salud pública en las instituciones educativas sobre la educación sexual integral, para prevenir problemas asociados a las infecciones de transmisión sexual y embarazo adolescente. Introducción: En la adolescencia se producen cambios físicos, sociales, afectivos, sexuales, entre otros; sobre los cambios sexuales, el debut sexual. Objetivo: Explorar factores asociados al inicio de actividad sexual en adolescentes escolarizados (12 - 16 años) en Bucaramanga. Materiales y métodos: Estudio de corte trasversal analítico, incluyó 440 adolescentes de un colegio público. Se aplicó el instrumento Centro Latinoamericano de Perinatología - Historia del adolescente. Se realizó un análisis descriptivo de la información y análisis bivariado, empleando un modelo de regresión binomial ajustadas por edad y sexo empleando como desenlace el inicio de actividad sexual, y como exposiciones los posibles factores asociados. Resultados: La prevalencia del inicio de actividad sexual fue 22,27% (IC 95%: 18,56-26,46). Tener antecedentes judiciales y tener pareja, estaban asociados a mayor prevalencia de inicio de actividad sexual, RP=3,24, (IC 95%: 2,60-4,05) y RP=2,00 (IC 95%: 1,42-2,82), respectivamente. El ser hombre RP=1,19, (IC 95%: 0,84-1,67), consumir tabaco RP=1,23, (IC 95%: 0,73-2,06), alcohol RP= 1,23, (IC 95%: 0,73-2,06) y otras sustancias RP=1,78, (IC 95%: 0,99-3,19) se comportan como factores de riesgo; relacionarse con amigos fue un factor protector RP=0,27, (IC 95%: 0,20-0,36). Discusión: El acompañamiento de los padres y el apoyo del colegio, disminuyen el riesgo de inicio de actividad sexual en la adolescencia; intervenciones familiares y en el colegio son importantes. Conclusiones: Existen condiciones que podrían promover el inicio de actividad sexual en la adolescencia tales como, ser hombre, tener pareja, antecedentes personales judiciales, fumar, consumir alcohol y otras sustancias, mientras que, el relacionarse con amigos es un factor protector. Como citar este artículo: Sepúlveda Sepúlveda Nancy Milena; Cáceres Rivera Diana Isabel; López Romero Luis Alberto; Díaz Wandurraga Martha Jeannette. Factores asociados al inicio de actividad sexual en adolescentes: Estudio transversal analítico. Revista Cuidarte. 2024;15(1):e3304.  http://dx.doi.org/10.15649/cuidarte.3304Introdução: Durante a adolescência ocorrem alterações físicas, sociais, emocionais e sexuais, entre outras; sobre mudanças sexuais, estreia sexual. Objetivo: Explorar fatores associados ao início da atividade sexual em adolescentes escolares (12 - 16 anos) em Bucaramanga.   Materiais e métodos:   Estudo transversal analítico que incluiu 440 adolescentes de uma escola pública. Foi aplicado o instrumento Centro Latino-Americano de Perinatologia - História do adolescente. Foi realizada análise descritiva das informações e análise bivariada, utilizando modelo de regressão binomial ajustado por idade e sexo, tendo como desfecho o início da atividade sexual e como exposições os possíveis fatores associados. Resultados: A prevalência de início da atividade sexual foi de 22,27% (IC 95%: 18,56-26,46). Ter antecedentes judiciais e ter companheiro estiveram associados a maior prevalência de início da atividade sexual, RP=3,24, (IC 95%: 2,60-4,05) e RP=2,00 (IC 95%: 1,42-2,82), respectivamente. Ser homem RP= 1,19, (IC 95%: 0,84-1,67), consumir tabaco RP=1,23, (IC 95%: 0,73-2,06), álcool RP= 1,23, (IC 95%: 0,73-2,06) e outros substâncias RP=1,78, (IC 95%: 0,99-3,19) comportam-se como fatores de risco; interagir com amigos foi fator de proteção RP=0,27; (IC 95%: 0,20-0,36). Discussão: O acompanhamento parental e o apoio escolar reduzem o risco de início da atividade sexual na adolescência; as intervenções familiares e escolares são importantes. Conclusões: Existem condições que podem favorecer o início da atividade sexual na adolescência como ser homem, ter companheiro, antecedentes criminais pessoais, fumar, consumir álcool e outras substâncias, sendo o relacionamento com amigos um fator de proteção. Como citar este artigo: Sepúlveda Sepúlveda Nancy Milena; Cáceres Rivera Diana Isabel; López Romero Luis Alberto; Díaz Wandurraga Martha Jeannette. Factores asociados al inicio de actividad sexual en adolescentes: Estudio transversal analítico. Revista Cuidarte. 2024;15(1):e3304.  http://dx.doi.org/10.15649/cuidarte.330

Factors associated with the onset of sexual activity in adolescents: Analytic cross-sectional

Introduction: Different physical, social, affective, and sexual changes take place during adolescence, such as the sexual debut. Objective: To explore the factors associated with the onset of sexual activity in adolescents attending school (12–16 years) in Bucaramanga. Materials and Methods: This analytical cross-sectional study included 440 adolescents from a public school. An instrument developed by Latin American Center for Perinatology - History of Adolescents was applied, and descriptive and bivariate analyses were conducted using a binomial regression model adjusted by age and sex, with sexual activity onset as the outcome and possible associated factors as exposures. Results: The prevalence of the onset of sexual activity was 22.27% (95% CI: 18.56–26.46). Factors associated with greater prevalence of sexual activity onset were having a criminal record and partner PR=3.24, (95%CI: 2.60–4.05) and PR=2.00, (95%CI: 1.42–2.82), respectively. Male gender PR=1.19, (95% CI: 0.84–1.67), using tobacco PR=1.23 (95% CI: 0.73–2.06), alcohol consumption PR=1.23, (95% CI: 0.73–2.06), and other psychoactive substance use PR=1.78, (95% CI: 0.99–3.19) were risk factors; meanwhile, socializing with friends was a protective factor PR=0.27, (95% CI: 0.20–0.36). Discussion: Follow-up by parents and school support decrease the risk of adolescent sexual activity onset. Furthermore, interventions in the family and school settings are important. Conclusion: There are conditions that could promote the beginning of sexual activity in adolescence such as being male, having a partner, having a criminal record, smoking, and consuming alcohol or other substances could promote adolescent sexual activity onset, while socializing with friends was found to be a protective factor

Calidad de vida en adultos mayores con enfermedad pulmonar obstructiva crónica

Introduction. Chronic obstructive pulmonary disease is one the most significant causes of mortality and morbidity worldwide. It has psychosocial and pathophysiological effects that impact in a significant way to those who suffer from it. Objective. To evaluate quality of life from patients suffering from chronic obstructive pulmonary disease through the SF-36 survey (Spanish version for Colombia (SF-36 v2)) made during an external medical appointment made in Floridablanca, Colombia in 2015. Methodology. Descriptive cross sectional study performed to 40 patients diagnosed with chronic obstructive pulmonary disease. These patients attended to external pulmonology medical appointments between February and November of 2015 and filled out the short form SF-36 v2 after signing informed consent. The database was created under license using QualityMetric Health Outcomes™ Scoring Software 4.0. Results. 40 patients, with an average age of 73 years (DE ± 8.4), participated in this study. When analyzing data, it was found that the physical functioning dimensions were values lower than 50. On the other hand, it was found that dimensions related to social functioning and emotional role had higher values and close to the ones reported by healthy population. Conclusions. Patients diagnosed with chronic obstructive pulmonary disease showed a decrease in quality of life, in both of its dimensions: physical and mental, compared to healthy population’s reference values. It is ratified that this disease impacts all sub-scales of this construct, specially the ones related to the physical component. [Cáceres-Rivera DI, Roa-Díaz ZM, Domínguez CL, Carreño-Robayo JH, Orozco-LeviMA. Quality of life in older adults with chronic obstructive pulmonary disease. MedUNAB. 2018;21(1):46-58. doi: 10.29375/01237047.2512].Introducción. La enfermedad pulmonar obstructiva crónica es una importante causa de mortalidad y morbilidad a nivel mundial y tiene efectos psicosociales y fisiopatológicos que repercuten de manera significativa en la calidad de vida de quienes la padecen. Objetivo. Evaluar la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica a través del instrumento SF-36, versión en español para Colombia (SF-36 v2), en un servicio de consulta externa de Floridablanca, Colombia, durante el año 2015. Metodología. Estudio de corte transversal descriptivo realizado en 40 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que asistieron al servicio de consulta externa por Neumología entre los meses de febrero y noviembre de 2015. El cuestionario SF-36 v2 fue diligenciado por todos los participantes; previamente, se firmó el consentimiento informado. La base de datos fue digitada, bajo licencia, en QualityMetric Health Outcomes™ Scoring Software 4.0. Resultados. Participaron 40 pacientes, con una edad media de 73 (DE ± 8.4) años. En las dimensiones de funcionamiento físico se encontraron valores inferiores a 50; por otra parte, las dimensiones Funcionamiento Social y Rol Emocional presentaron valores superiores y cercanos a los reportados por población sana. Conclusiones. Los pacientes con enfermedad pulmonar obstructiva crónica mostraron una disminución en la calidad de vida comparado con los valores de referencia en población en general en sus dos componentes: físico y mental. Se ratifica el impacto que tiene esta enfermedad en todas las subescalas que componen este constructo, especialmente en el componente físico. [Cáceres-Rivera DI, Roa-Díaz ZM, Domínguez CL, Carreño-Robayo JH, Orozco-Levi MA. Calidad de vida en adultos mayores con enfermedad pulmonar obstructiva crónica. MedUNAB. 2018;21(1):46- 58. doi: 10.29375/01237047.2512]

Métodos utilizados para quantificar a carga de trabalho de enfermagem em unidades de terapia intensiva: uma revisão da literatura

Introduction: Nursing workload in intensive care units (ICUs) is related to efficiency and quality of care; however, there are no methods to quantify the nurses needed per shift in ICUs. Objective: To identify the most used tools to measure ICU nursing workload. Methods: An integrative literature review was performed using original articles in English, Spanish or Portuguese, published between 1991 and 2017 in the databases ScienceDirect, BVS, Scopus, and Embase. The search strategy was “nursing and workload and intensive critical or ICU and measure.” Duplicate articles or articles about intermediate care units were excluded. The quality of the articles was assessed using the Strobe checklist. Results: Thirty-six articles with a total of 19,036 patients were included; 50% (n=18) used NAS, 27.7% (n=10) used a combination of methods such as NAS, NEMS, TISS-28 or VACTE; 13.8% (n=5) used TISS-28, 5.6% (n=2) used video camera recording, and 2.7% (n=1) used NEMS to quantify the time spent by nurses in care. Discussion: There is currently no consensus on workload measurement methods in nursing. In this sense, more validation and comparison studies are needed to improve nursing care management in the ICUs. Conclusion: The most used tool to quantify workload in nursing is the Nursing Activities Score (NAS). Other tools identified were NEMS, TISS-28, and VACTE.  How to cite this article: Cáceres Rivera Diana Isabel, Ruiz Sandoval Jessica Paola, Cristancho Zambrano Luisa Yaneth, Pulido Montes Maria Andreina, López Romero Luis Alberto. Métodos empleados para cuantificar la carga de trabajo en Enfermería en las unidades de cuidados intensivos: Una revisión de la literatura. Revista Cuidarte. 2022;13(3):e2301. http://dx.doi.org/10.15649/cuidarte.2301Introducción: La carga de trabajo de Enfermería en unidades de cuidado intensivo está relacionada con la eficiencia y calidad de la atención, sin embargo, no existen métodos para cuantificar las enfermeras necesarias por turno en UCI. Objetivo: Identificar las herramientas más utilizadas para medir la carga de trabajo de Enfermería en UCIs. Materiales y métodos: Se realizó una revisión de literatura tipo integradora, utilizando artículos originales en inglés, español o portugués, publicados entre 1991 hasta 2017 en las bases de datos: Science@direct, BVS, Socupus y Embase, empleando la estrategia de búsqueda: Nursing and workload and intensive critical or ICU unit and measure, se excluyeron artículos duplicados y/o desarrollados en UCIs de cuidado intermedio, la calidad de los artículos fue valorada usando la lista de chequeo Strobe. Resultados: Se incluyeron 36 artículos con un total de 19.036 pacientes; el 50% (n=18) empleo el NAS, 27.7%(n=10) utilizó una combinación de métodos como el NAS, NEMS, TISS-28 o el VACTE, el 13.8%(n=5) empleo el TISS-28, el 5.6%(n=2) empleo registro de cámaras de video y un 2.7%(n=1) empleo el NEMS para cuantificar el tiempo empleado por enfermería en el cuidado. Discusión: actualmente no existe un consenso sobre métodos de medición de carga de trabajo en enfermería, en este sentido, es necesario realizar más estudios de validación y comparación que permitan mejorar la gestión del cuidado de enfermería en UCI.  Conclusión: La herramienta más utilizada para cuantificar la carga de trabajo en enfermería es el Nursing Activities Score (NAS), otras herramientas identificadas fueron: NEMS, TISS-28 y VACTE. Cómo citar este artículo: Cáceres Rivera Diana Isabel, Ruiz Sandoval Jessica Paola, Cristancho Zambrano Luisa Yaneth, Pulido Montes Maria Andreina, López Romero Luis Alberto. Métodos empleados para cuantificar la carga de trabajo en Enfermería en las unidades de cuidados intensivos: Una revisión de la literatura. Revista Cuidarte. 2022;13(3):e2301. http://dx.doi.org/10.15649/cuidarte.2301Introdução: A carga de trabalho de enfermagem em unidades de terapia intensiva está relacionada à eficiência e qualidade da assistência, entretanto, não existem métodos para quantificar  o número de enfermeiros necessários por turno na UTI. Objetivo: Identificar os instrumentos mais utilizados para mensurar a carga de trabalho de Enfermagem nas UTIs. Metodologia: Foi realizada uma revisão integrativa da literatura, utilizando artigos originais em inglês, espanhol ou português, publicados entre 1991 e 2017 nas bases de dados: Science@direct, BVS, Socupus e Embase, utilizando a estratégia de busca: Nursing and workload and intensivo critical ou unidade e medida de UTI, artigos duplicados e/ou desenvolvidos nas UTIs de cuidados intermediários foram excluídos, a qualidade dos artigos foi avaliada por meio do Strobe checklist. Resultados: foram incluídos 36 artigos com um total de 19.036 pacientes; 50% (n=18) utilizaram o NAS, 27,7%(n=10) utilizaram uma combinação de métodos como NAS, NEMS, TISS-28 ou VACTE, 13,8%(n=5) utilizaram o TISS-28, 5,6% (n=2) utilizaram registros de câmeras de vídeo e 2,7%(n=1) utilizaram o NEMS para quantificar o tempo gasto pela enfermagem no cuidado. Discussão: atualmente não há consenso sobre métodos de mensuração da carga de trabalho em enfermagem, nesse sentido, faz-se necessária a realização de mais estudos de validação e comparação para melhorar o gerenciamento do cuidado de enfermagem em UTI. Conclusão: O instrumento mais utilizado para quantificar a carga de trabalho de enfermagem é o Nursing Activities Score (NAS), outros instrumentos identificados foram: NEMS, TISS-28 e VACTE. Como citar este artigo: Cáceres Rivera Diana Isabel, Ruiz Sandoval Jessica Paola, Cristancho Zambrano Luisa Yaneth, Pulido Montes Maria Andreina, López Romero Luis Alberto. Métodos empleados para cuantificar la carga de trabajo en Enfermería en las unidades de cuidados intensivos: Una revisión de la literatura. Revista Cuidarte. 2022;13(3):e2301. http://dx.doi.org/10.15649/cuidarte.230

Evaluation of the efficacy and safety of text messages targeting adherence to cardiovascular medications in secondary prevention: the txt2heart Colombia randomised controlled trial protocol.

INTRODUCTION: Anti-platelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers and statins are cost-effective in patients with atherosclerotic cardiovascular diseases (ASCVD) for reducing the risk of ASCVD events. Unfortunately, there is abundant evidence that adherence to these cardiovascular medications is far from ideal. A recent Cochrane review showed a potential beneficial effect of Short Message Service (SMS) interventions on adherence to medication in ASCVD patients. METHODS AND ANALYSIS: The txt2heart study is a pragmatic randomised single-blind controlled trial. The objective is to evaluate the efficacy and safety of an intervention with SMS messages delivered by mobile phones to improve adherence to cardiovascular medications in patients with ASCVD. The intervention consists of behavioural techniques delivered via SMS. The primary outcome is change in blood serum low-density lipoprotein cholesterol levels as an indicator of adherence to statins. Secondary outcomes will include systolic blood pressure as an indicator of adherence to blood-lowering therapies and heart rate as an indicator of adherence to beta-blockers, urine levels of 11-dehydrothromboxane B2, self-reported adherence to cardiovascular medications and rates of cardiovascular death or hospitalisation due to cardiovascular disease. ETHICS AND DISSEMINATION: The study will be performed in compliance with the protocol, regulatory requirements, Good Clinical Practice and ethical principles of the Declaration of Helsinki. The Ethics Committee of Fundación Cardiovascular de Colombia evaluated and approved the trial. The txt2heart Colombia trial aims to provide robust evidence to evaluate whether SMS messages delivered through mobile telephones change the behaviour of Colombian patients who have suffered a cardiovascular event. Trial results will be presented to the local health authorities, and if the intervention is effective and safe, we hope this strategy will be implemented quickly because of its low cost and wide-reaching impact on the population. TRIAL REGISTRATION NUMBER: NCT03098186

Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. OBJECTIVE: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. METHODS: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. RESULTS: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. CONCLUSIONS: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028017

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Disfunción muscular respiratoria en pacientes llevados a cirugía cardiovascular.

Evaluar la presencia de las alteraciones en la fuerza muscular respiratoria en pacientes programados para la cirugía cardiovascular, el impacto de la cirugía sobre la función muscular respiratoria y su relación con las alteraciones ventilatorias