Effectiveness of foot orthosis in patients with rheumatoid arthritis related to quality of life and pain. A systematic review and meta-analysis

Foot pain and deformity is almost ubiquitous in RA and results in considerable physical and psychosocial impairment. Epidemiological studies consistently suggest a 90% prevalence of foot pain despite advances in pharmacological therapy. Mechanical and other non-pharmacological interventions such as orthoses and footwear, have an important role in managing foot pathology in patients with their systemic disease controlled. The effectiveness of treatment with insoles, especially in early periods, was studied in a randomized controlled trial, which results suggested an immediate clinical improvement, reducing foot pain, disability and limited functionality.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Effectiveness of advanced practice nursing interventions in older people and their description through the nursing interventions classification. A systematic review and qualitative study

The Association des Infirmières et Infirmiers du Canada (AIIC) (2008), defines Advanced Practice Nursing (APN), as “an advanced level of nursing practice that maximizes the use of specialized skills and nursing knowledge in order to respond to the customers’ needs in health’s sphere". APNs’ programs, were initially introduced in the 1960s to fulfil gaps both in services traditionally carried by physicians, in order to improve access to care particularly in under-served services and contexts by doctors (Delamaire & Lafortune 2010), and also as a consequence to the reduction of physicians’ and resident doctors hours internationally (Dowling et al. 2013; Olson & Chioffi 2005; Por 2008). Despite that, advanced practice is still being unclear due to the differences related to health settings and policies (Gardner et al. 2007). In the recent years, it has been introduced the concept of ‘complex chronic disease’, which is linked to the concept of aging and frailty, and determined by the presence of multiple and complex chronic conditions. The most differential characteristics of this group of people are the presence of several chronic diseases concurrently, multiple admissions in hospital emergency services in the same year, the presence of certain diseases such as heart failure or Chronic Obstructive Pulmonary Disease (COPD), polypharmacy and reduced personal autonomy. In addition, there are additional factors such as older age, living alone or not having enough family support and being in risk of falling, among others (Contel et al. 2012). In this sense, the APN is in an ideal position to cover the necessities of this population group. Case management and telemonitoring could be essential to the success in the developing of individualized care plans to improve chronic patients’ health status (Contel et al. 2012; Carroll et al. 2007; Clark et al. 2010). Moreover, several models of APN attention have been developed in a wide variety of heath contexts in the elderly population (Oeseburg et al. 2009; Low et al. 2011), with remarkable outcomes in terms of effectiveness. Examples of those models could be those in transitional care (Brand et al. 2004), case management (Leung et al. 2004) or heart diseases (Blaha et al. 2000; Duffy et al. 2010) to improve quality of life or reduce rehospitalizations. Also, APN carried out interventions in patients that suffered dementia (Callahan et al. 2006), with older people with low incomes and acute health problems (Counsell et al. 2007), or in the community, giving support to families and patients to manage resources (Thompson et al. 2008). However, there is a deficit of conceptual frameworks to characterize and describe the range of interventions and services by APNs in the older population (Morales Asencio 2010). In this sense, the availability of a standardized language to describe nursing interventions (Nursing Intervention Classification, NIC) (Bulecheck GM et al. 2008; Thoroddsen 2005) can provide an additional resource to classify the components of different APN models and could facilitate the description of APN in a universal language, available in a vast majority of health care record systems around the world. Aims: The aims of this thesis are: 1. To identify, assess and summarise available scientific evidence about the effect of interventions deployed by APNs when providing care to older people in different settings (hospital, home, outpatient, residential). 2. To describe the roles and components of the interventions developed by APNs in the contexts mentioned before. 3. To identify the interventions provided by APNs to older people in different contexts (acute and long-term care) with a Standardized Nursing Language, in the studies included in the Systematic Review. Design: The present study was divided in two parts: firstly, a systematic review, and secondly, a qualitative with mixed methods study. Methods: Systematic review: Data Sources: Sixteen electronic databases were consulted (1990-2010). The research also included reviews, papers, reports and evaluations from research health services centres and Health Technology Agencies. Review Methods: Studies that met inclusion criteria were reviewed for quality, using RevMan 5 application’s checklist of bias, together with the methodological quality criteria of the Cochrane COPD group. Qualitative study Quotes of the interventions carried out by advanced practice nurses were codified by experts into the Nursing Intervention Classification. A content analysis was carried out, followed by a Delphi technique Results: Systematic review: Eleven studies were included. They were classified depending on the follow-up period, and also on the scope of the advanced practice nursing services. In both cases, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, improved patients’ self-care and quality of life, as well as increased patients’ and caregivers’ satisfaction. Qualitative study: In total 73 different interventions codified in the Nursing Intervention Classification were extracted from the studies in different care contexts, with a clear predominance of interventions related to the Behavioural and Health care system domains, which could be explained due to the need of improving the psychosocial functioning and self-care of these patients to lead them to preserve their quality of life. Conclusion: Advanced practice nurses seems to be crucial to improve the health status of elderly people, which main characteristic is to bear with chronic diseases, in almost every care context. Moreover, Advanced Practice Nurses’ interventions could be considered as complex but with the use of standardized nursing languages as the Nursing Intervention Classification, they can be better described, reported and analysed along different contexts. Moreover, core elements of the APNs’ roles can be identified and they could be used for delineating or remodelling services. Further investigation will be needed to confirm that advanced practice nursing programs decreases health costs, to compare their effectiveness in both, the generalist and the specific model, and to analyse the pertinence of a mixed model. Bibliografía Morilla-Herrera, J.C. et al., 2012. Effectiveness of advanced practice nursing interventions in older people: protocol for a systematic review and qualitative study. Journal of advanced nursing

Competencias de seguridad clínica en la formación de los estudiantes de enfermería. Scoping revi

Introducción: En el ámbito de la seguridad clínica, la mera transmisión de conocimientos no parece ser garantía suficiente, ya que, aunque los estudiantes manifiestan conocer las precauciones estándar dentro de sus prácticas clínicas, en la práctica, dicho conocimiento no garantiza su aplicación posterior Objetivo: conocer métodos empleados para el desarrollo de estas competencias en seguridad clínica en los estudiantes de grado de Enfermería. Diseño: scoping review. Metodología: Se ha realizado una búsqueda bibliográfica en Pubmed, CINAHL, WOS, MEDES, OMS, Institute of Medicine, y el Ministerio de sanidad, utilizando la metodología propuesta por el Joanna Briggs Institute. Resultados: En el proceso de adquisición de las competencias en seguridad clínica en los estudiantes de enfermería, destaca la división entre conocimientos adquiridos por el alumnado, y la actitud que muestran ante el aprendizaje, que algunos autores sitúan como esencial para la adquisición de conocimientos. También es reseñable cómo la formación en habilidades más prácticas, como el cálculo de medicación, así como la creación de un entorno adecuado, supervisado y con buena comunicación con el tutor, merman o anulan el miedo a fallar de los alumnos en las prácticas clínicas, así como la creación de un entorno adecuado, supervisado y con buena comunicación con el tutor. Conclusiones: Los métodos empleados para la formación en seguridad clínica en estudiantes de enfermería, no deberían estar únicamente centrados en la mera adquisición de conocimientos, sino que son necesarias estrategias de enseñanza-aprendizaje orientadas a la modificación de conductas que afiancen el uso sistemático de estas medidas.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Satisfacción y fatiga por compasión en personal de enfermería de oncología: estudio descriptivo y correlacional

Objectives: (1) To determine the perception of Compassion Satisfaction and Fatigue of oncology nursing staff; (2) to study the correlation between Compassion Satisfaction and Fatigue and sociodemographic, professional and adaptive variables (resilience, attitudes toward death, personality); and (3) to identify predictors of the two dimensions. Method: Descriptive, correlational, cross-sectional study. 69 nurses (62.7%) and 41 auxiliary care technicians (37.3%) from the Oncology Services in Biscay (Basque Health Service) completed the ProQOL-V, CD-RISC-10, DAP-R, and NEO-FFI-3. Data were collected between September 2018 and March 2019. The statistical analysis with SPSS.22 included chi-square tests, comparison of means, Pearson´s correlation, and multivariate logistic regression. Results: 66.4% (n=73) showed high Compassion Satisfaction, and 41.8% (n=46) were at moderate levels of Compassion Fatigue. People with prior studies related to death and/or grief were more satisfied. Compassion Satisfaction had stronger correlations with resilience and extroversion, and Compassion Fatigue did so with neuroticism and resilience. Four predictor variables emerged for Compassion Satisfaction: age, prior learning, resilience, and agreeableness; and four for Compassion Fatigue: attitudes of avoidance and escape concerning death, neuroticism, and openness.Conclusions: The high relationship found between training and resilience with Compassion Satisfaction can serve as a guide for academic and health care institutions to orient training, preventive and interventional strategies to provide oncology nursing teams with resources that allow them to optimize their care role.Objetivos: (1) Conocer la percepción de Satisfacción y Fatiga por Compasión del personal de Enfermería de oncología; (2) estudiar la correlación entre variables sociodemográficas, profesionales y adaptativas (resiliencia, actitudes ante la muerte y personalidad) y la Satisfacción y Fatiga por Compasión y, (3) identificar variables predictoras para ambas dimensiones.Método: Estudio descriptivo, correlacional, de corte transversal. 69 enfermeras (62.7%) y 41 técnicos en cuidados auxiliares de Enfermería (37.3%) de los servicios de Oncología de Bizkaia (Servicio Vasco de Salud) dieron respuesta al ProQOL-V, CD-RISC-10, PRAM y NEO-FFI-3. Los datos se recogieron entre septiembre 2018 y marzo 2019. El estudio estadístico con el SPSS.22 implicó pruebas chi cuadrado, comparación de medias, correlación de Pearson y regresión logística multivariante. Resultados: El 66.4% (n=73) presentó alta Satisfacción, y el 41.8% (n=46) se situó en niveles moderados de Fatiga por Compasión. Las personas con estudios previos sobre la muerte y/o duelo se percibieron más satisfechas. La Satisfacción estableció correlaciones más fuertes con resiliencia y extroversión, y la Fatiga lo hizo con neuroticismo y resiliencia. Emergieron 4 variables predictoras para la Satisfacción: edad, formación, resiliencia, y amabilidad; y 4 para la Fatiga: evitación y aceptación de escape ante la muerte, neuroticismo y apertura.Conclusiones: La alta relación hallada entre la formación y la resiliencia con la Satisfacción por Compasión puede servir de guía a las instituciones académicas y asistenciales para orientar estrategias formativas, preventivas e interventivas que permitan dotar a los equipos de enfermería oncológica de recursos que les permitan optimizar la percepción sobre su rol de cuidado

Valoración del nivel de estrés relacionado con las prácticas clínicas en el Grado de Enfermería

Los estudiantes universitarios están sometidos a diferentes fuentes de estrés que pueden generarles problemas de ansiedad. En concreto, el estrés derivado de sus prácticas clínicas: el contacto con el paciente, la familia y otros profesionales sanitarios, la intervención en situaciones de emergencia o los procesos fin de vida, pueden generar un estrés que el estudiante no sea capaz de gestionar. El objetivo de este proyecto es implementar un programa de afrontamiento a la ansiedad en este colectivo, que les ayude en el desarrollo de competencias transversales, beneficiosas tanto personal como laboralmente. Principalmente se tratarán la inteligencia intrapersonal e interpersonal a lo largo de diferentes actividades a desarrollar en varias asignaturas de 3º y 4º de carrera. Se espera conseguir una disminución de la ansiedad del alumnado. Este programa podrá hacerse extensivo a otras titulaciones y centros universitarios.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Quality of Life, Physical and Mental Health, and Economic Evaluation of Family Caregivers of Chronic Dependent Children: INFAPRINT Cohort Study Protocol.

Background: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group. Methods: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group. Conclusions and implications: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.Funding for open access charge: Universidad de Málag

Perfusión tisular periférica en talones de sujetos sanos expuestos a presión continua

Objetivos: 1) Observar los cambios que se producen en el flujo microvascular periférico de talones de sujetos sanos expuestos a patrones de presión continuo, 2) Observar los cambios que se producen en la temperatura periférico de talones de sujetos sanos expuestos a patrones de presión continuo. Metodología: Estudio experimental no controlado, no aleatorizado en fase preclínica. La población diana fueron los alumnos sanos de la Facultad de Ciencias de la Salud. El procedimiento a seguir fue protocolizado y se llevó a cabo por igual en todos los sujetos: se evaluó el flujo capilar sanguíneo y la temperatura local de los talones de los sujetos, mediante láser Doppler. Los datos se analizaron con el software informático SPSS. Resultados: Los valores iniciales de flujo capilar sanguíneo y temperatura local obtenidos fueron: 5,06 UA (unidad arbitraria) y 26,24 ºC, respectivamente; después de las dos horas de medición los valores fueron: 6,91 UA y 26,84 ºC. Por tanto, el flujo vascular sanguíneo incrementó un 36,51% y la temperatura local un 2,29%. Discusión/ Conclusión: Los resultados obtenidos muestran un ligero aumento de los valores de la microcirculación capilar sanguínea y de la temperatura local después de una exposición continua a presión durante dos horas.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Spanish validation of the national league for nursing questionnaires for clinical simulation

Introduction Learning by clinical simulation enables students to experience the nuances often encountered in clinical settings before experiencing actual real-world patient scenarios. Valid and reliable assessment tools are required to measure clinical competence. The aim of this study was to validate the National League for Nursing satisfaction instruments for its use in the Spanish context. Methods Psychometric and cultural adaptation study. Student Satisfaction and Self-Confidence in Learning Scale, the Simulation Design Scale and the Educational Practices Questionnaire were adapted culturally, and their psychometric properties were tested empirically. Results Fourth-year undergraduate nursing students participated in the study (n = 173). The Cronbach's alpha scores obtained ranged from 0.90 to 0.95. Confirmatory factor analysis revealed adequate goodness of fit values (RMSEA: 0.04 to 0.08). Conclusions The Spanish-language version of the National League of Nursing instruments obtains satisfactory results. Further study is needed to determine the factorial invariance and whether any modifications in the instruments are needed.This research was supported in part by the University of Malaga within the framework of the financing program of educational innovation projects under number PIE 144-2015

Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure ?nished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant ?short term? result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.Ministerio de SanidadInstituto de Salud Carlos II

Competencias en enfermeras especialistas y en enfermeras de práctica avanzada

10 p.Objetivo: Analizar la distribución de competencias avanzadas en enfermeras especialistas y enfermeras de práctica avanzada y evaluar su asociación con algunas características de superfil profesional.Método: Estudio transversal analítico multicéntrico. Se incluyeron enfermeras que ejercían como Enfermeras de Práctica Avanzada y enfermeras Especialistas. Se midió su nivel de competencias avanzadas percibidas, así como variables de caracterización profesional.Resultados: Doscientas setenta y siete enfermeras participaron (149 ejercían práctica avanzada y 128 especialistas), con una media de 13,88 (11,05) años como especialista y 10,48 (5,32) años como Enfermera de Práctica Avanzada. Un 28,8% tenía nivel de máster o doctorado. El 50,2% ejercía en atención primaria, el 24,9% en hospitales y el 22,7% en salud mental. El nivel global autopercibido fue elevado en las distintas competencias, siendo las dimensiones más bajas las de investigación, práctica basada en la evidencia, gestión de la calidad y seguridad y liderazgo y consultoría. Las Enfermeras de Práctica Avanzada obtuvieron mayor nivel competencial de forma global y en las dimensiones de liderazgo y consultoría, relaciones interprofesionales, gestión de cuidados y promoción de salud. No hubo diferencias en función de la experiencia o la posesión de nivel de máster o de doctorado. En las Enfermeras de Práctica Avanzada el contexto de práctica no influía en los niveles competenciales, aunque en las enfermeras especialistas sí, a favor de las que ejercían en salud mental.Conclusiones: Las enfermeras especialistas y de práctica avanzada tienen competencias distintas que deberían ser gestionadas adecuadamente para el desarrollo de los servicios enfermeros avanzados y especializados