Sistemas de evaluación de las competencias en la asignatura estancias clínicas II grado de enfermería: diseño de herramientas objetivas

Este trabajo describe un nuevo sistema evaluativo mas objetivo en la asignatura Estancias Clínicas II de Grado en Enfermería pero no por ello queremos desentendernos de los más avanzados sistemas que trabajan también con la intersubjetividad y la narrativa. Se ha modificado el sistema de evaluación introduciendo descriptores cualitativos diferentes para cada una de las actividades con la finalidad de objetivar los resultados e incrementar la evaluación cualitativa

La atención psicológica y la atención psiquiátrica de enfermería

En el siguiente articulo se definen operativamente los conceptos de cuidados. psicológicos y cuidados psiquiátricos de enfermería, desde la perspectiva de la enfermera psiquiátrica como asignatura de 3er Curso de D.E. Se analiza la existencia de las ciencias de la conducta en el currículum básico del estudiante de enfermería y se propone un ámbito de actuación determinado para cada tipo de cuidados

Actitudes de Enfermería que fomentan o impiden la asistencia adecuada a los pacientes

La finalidad de este articulo, es examinar las lineas de conducta apropiadas que debe observar el profesional de enfermería para proporcionar cuidados psicológicos dentro del marco general de su acción; es decir, en la concepción del ser humano como un individuo único, con sus propias características, que requiere cuidados globalizados e individualizados al mismo tiempo

Aspectos relacionales de los cuidados de enfermería

La comunicación verbal, en el contexto de enfermería, debe ser contemplada como una habilidad a ejercitar por las enfermeras, ya que, aplicada correctamente, permite una mejor y más completa consecución de los cuidados de enfermería. El presente articulo sugiere actitudes que facilitan la relación personal con el paciente, apoyadas en cinco estrategias conductuales: aceptación del enfermo como individuo, escucha, clarificación, es decir se intenta comprender los problemas y percepciones del paciente, información, para ayudar al paciente a ganar en comprensión de su enfermedad y análisis de los sentimientos e ideas del paciente

Evaluation of Safety and Efficacy of ReHub in Patients Who Underwent Primary Total Knee Arthroplasty: Study Protocol for a Randomized Controlled Trial

Background: Total Knee Arthroplasty (TKA) is an intervention that can significantly improve the quality of life of patients with advanced knee osteoarthritis. Early start of rehabilitation and its continuation at home once the patient is discharged are key factors for the success of the process.This study aims to assess the effectiveness of a home-based telerehabilitation solution (ReHub) on improving functional capacity and clinical outcomes for patients who underwent TKA. Methods/design: The study is a randomized, open-label with blinded outcome assessor, parallel assignment clinical trial with a sample size of 52 patients that is conducted according to the SPIRIT recommendations. After the TKA intervention, the patients are randomly allocated to the control group or the experimental group with a 1:1 ratio. Both groups follow a Fast Track recovery protocol which includes discharge after 2-3 days from surgery, a daily plan of 5 exercises for autonomous rehabilitation and domiciliary visits by a physiotherapist starting approximately 2 weeks after surgery. The experimental group uses the sensor-based telerehabilitation system ReHub to perform the exercises. The primary outcome measure is the range of motion of the knee. Secondary outcomes include physical performance, quality of life, pain intensity, muscle strength, treatment adherence and satisfaction with the ReHub system. The outcomes assessment is performed at hospital discharge (baseline), at stitch removal (2 weeks after baseline) and 2 weeks after stitch removal (4 weeks after baseline).The study conforms to the guidelines of the Declaration of Helsinki and was approved by the hospital's ethics committee. Discussion: The study will address an important gap in the evidence base by reporting the effectiveness of an affordable and low-cost home-based telerehabilitation solution in patients who underwent TKA. Ethics and dissemination: The study was approved by the hospital's ethics committee ("Comité Ético de Investigación Clínica del HCB", reg. HCB/2019/0571). The trial was registred at ClinicalTrials.gov (NCT04155957). The results of this study will be published in peer-reviewed journals as well as national and international conferences. Trial registration: NCT04155957 (ClinicalTrials.gov). Highlights: Assessing a home-based telerehabilitation solution effectiveness in knee surgery.In situations such as the CoVid-19 pandemic, it is a resolutive intervention method.Telerehabilitation is an alternative to conventional face-to-face physical therapy.This system is far less demanding in terms of human resources.Range of motion assessment is the primary outcome measure

Evaluation and Characterization of Post-Stroke Lung Damage in a Murine Model of Cerebral Ischemia

After stroke and other brain injuries, there is a high incidence of respiratory complications such as pneumonia or acute lung injury. The molecular mechanisms that drive the brain-lung interaction post-stroke have not yet been elucidated. We performed transient middle cerebral artery occlusion (MCAO) and sham surgery on C57BL/6J mice and collected bronchoalveolar lavage fluid (BALF), serum, brain, and lung homogenate samples 24 h after surgery. A 92 proteins-panel developed by Olink Proteomics ® was used to analyze the content in BALF and lung homogenates. MCAO animals had higher protein concentration levels in BALF than sham -controls, but these levels did not correlate with the infarct volume. No alteration in alveolar-capillary barrier permeability was observed. A total of 12 and 14 proteins were differentially expressed between the groups (FDR < 0.1) in BALF and lung tissue homogenates, respectively. Of those, HGF, TGF-α, and CCL2 were identified as the most relevant to this study. Their protein expression patterns were verified by ELISA. This study confirmed that post-stroke lung damage was not associated with increased lung permeability or cerebral ischemia severity. Furthermore, the dysregulation of HGF, TGF-α, and CCL2 in BALF and lung tissue after ischemia could play an important role in the molecular mechanisms underlying stroke-induced lung damage

Gestión del dolor en pacientes del programa Rapid Recovery (RR) en artroplastia total de rodilla (ATR)

La artroplastia total de rodilla (ATR) es una cirugía consisten­te en la sustitución artificial de la articulación, debido a una lesión traumática o bien a un proceso degenerativo o de ar­trosis, con un dolor importante asociado que en ocasiones afecta de forma negativa a la recuperación del paciente. La elección de la prótesis dependerá de las características ana­tómicas del paciente y del criterio del cirujano. El concepto de «cirugía de recuperación rápida» fue intro­ducido en 1997 por Khelet y significó el inicio del modelo Fast Track o de Rapid Recovery (RR), ligado a una rehabilitación acelerada, un alta precoz y la optimización de todos los as­pectos de la experiencia del paciente pre, intra y posoperato­ria. La recuperación rápida es un proceso quirúrgico que pre­tende conseguir la máxima autonomía del paciente mediante la educación, el control del dolor y la movilización precoz. El instrumento fundamental para la recuperación rápida es conseguir la implicación del paciente mediante el empodera­miento, es decir, por medio de la educación preoperatoria del paciente, que contribuirá a reducir la ansiedad y facilitará que se involucre en su propia recuperación. Así, será partícipe de una terapia física posoperatoria eficaz, utilizando todas aque­llas herramientas necesarias para aumentar su capacidad de gestionar los problemas de salud. El empoderamiento del paciente forma parte del modelo de enfermería del Hospital Clínic de Barcelona (HCB) adoptado por la Dirección de Enfer­mería en diciembre del año 2012. La cirugía convencional de ATR en Cataluña hasta el ini­cio de la cirugía RR ocasionó 14 132 intervenciones en el año 2008, con hospitalización convencional posterior. Este artículo describe los cuidados y los resultados de las intervenciones enfermeras, definidas en la vía clínica RR de ATR dirigidas a la minimización del dolor, y las repercusiones sobre la movilización de los pacientes. Se efectuó en una uni­dad monográfica de un hospital terciario de Barcelona en el año 2013

Blood Biomarker Panels for the Early Prediction of Stroke‐Associated Complications

Biomarkers; Stroke; Stroke‐associated infectionBiomarcadors; Ictus; Infecció associada a un ictusBiomarcadores; Ictus; Infección asociada a un ictusBackground Acute decompensated heart failure (ADHF) and respiratory tract infections (RTIs) are potentially life‐threatening complications in patients experiencing stroke during hospitalization. We aimed to test whether blood biomarker panels might predict these complications early after admission. Methods and Results Nine hundred thirty‐eight patients experiencing ischemic stroke were prospectively recruited in the Stroke‐Chip study. Post‐stroke complications during hospitalization were retrospectively evaluated. Blood samples were drawn within 6 hours after stroke onset, and 14 biomarkers were analyzed by immunoassays. Biomarker values were normalized using log‐transformation and Z score. PanelomiX algorithm was used to select panels with the best accuracy for predicting ADHF and RTI. Logistic regression models were constructed with the clinical variables and the biomarker panels. The additional predictive value of the panels compared with the clinical model alone was evaluated by receiver operating characteristic curves. An internal validation through a 10‐fold cross‐validation with 3 repeats was performed. ADHF and RTI occurred in 19 (2%) and 86 (9.1%) cases, respectively. Three‐biomarker panels were developed as predictors: vascular adhesion protein‐1 >5.67, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) >4.98 and d‐dimer >5.38 (sensitivity, 89.5%; specificity, 71.7%) for ADHF; and interleukin‐6 >3.97, von Willebrand factor >3.67, and d‐dimer >4.58 (sensitivity, 82.6%; specificity, 59.8%) for RTI. Both panels independently predicted stroke complications (panel for ADHF: odds ratio [OR] [95% CI], 10.1 [3–52.2]; panel for RTI: OR, 3.73 [1.95–7.14]) after adjustment by clinical confounders. The addition of the panel to clinical predictors significantly improved areas under the curve of the receiver operating characteristic curves in both cases. Conclusions Blood biomarkers could be useful for the early prediction of ADHF and RTI. Future studies should assess the usefulness of these panels in front of patients experiencing stroke with respiratory symptoms such as dyspnea.This project received funding from Instituto de Salud Carlos III (ISCIII) [DTS14/00004, PI17/02130], co‐financed by the European Regional Development Fund (FEDER), and from Fundació La Marató de TV3 [201706] and the European Union's Horizon 2020 research and innovation program [754517]. Neurovascular Research Laboratory takes part into the Spanish stroke research network INVICTUS+ (RD16/0019/0021). The funders had no role in the study design and conduction

Clinical results before and after implementation of a Fast - Track protocol for 507 patients who underwent total knee arthroplasty surgery: A retrospective, observational study.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. !is study aimed to assess the e'ects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: !is is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. !e variables studied were active knee #exion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. !e mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active #exion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. !e mean active extension was: -5.37º (SD = 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more signi$cant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in #exion and extension). However, the exact role of the Flexet device is still to be determined. Keywords: Total Knee Arthroplasty, Fast-Track, Rapid-Recovery, ROM, early mobilization, active physiotherapy

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. This study aimed to assess the effects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: This is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. The variables studied were active knee flexion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. The mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active flexion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. The mean active extension was: -5.37º (SD= 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more significant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in flexion and extension). However, the exact role of the Flexet device is still to be determined