Mujeres colombianas viviendo con VIH/sida: contextos, experiencias y necesidades de cuidado de enfermería

The objective of this approach has been to ascertain the experiences of life and the nursing care needs of Colombian women who live with HIV/AIDS in order to obtain elements to focus programs and gender and rights based intervention processes led by nursing professionals. The study uses a qualitative design based on narratives obtained through in-depth interviews from 5 women diagnosed with HIV, aged between 30 and 55 years old, who come from different regions of the country assigned by the subsidized regime of the social security system for health to the infectology service at a clinic situated in Bogotá, Colombia, where they receive treatment.Analysis of the results establishes that this group of women is diverse, inasmuch as the subjects come from different areas and have different lifestyles. The relation of the women with their disease indicates that each case has its particularities and different forms of facing it. Notwithstanding the above, there are similarities between them: all women emphasize that the HIV/AIDS has had deep impact in their lives which have been changed by the disease. Several describe feelings of guilt, disappointment, social rejection and solitude. HIV has affected their life at the family, work, affective and sexual level. They all state that adherence to treatment is the main cause of their survival.Their needs are related to their psychosocial situation as well as to their health care. Recommendations suggested include, among others, activities of education for self care and gender centred workshops for the better understanding of the disease as well as for enhancing self-esteem, empowerment and self - acceptanceEl objetivo de este estudio ha sido conocer las experiencias vividas y las necesidades de cuidado de enfermería sentidas por mujeres colombianas que viven con VIH/SIDA, con el fin de contar con elementos para encaminar programas y procesos de intervención con perspectiva de género y de derechos, liderados por profesionales de enfermería. Se tuvo en cuenta un diseño cualitativo con base en testimonios narrados mediante entrevistas a profundidad realizadas a 5 mujeres diagnosticadas con VIH, con edades entre 30 y 55 años, provenientes de diferentes regiones del país, adscritas a través del régimen subsidiado del sistema de seguridad social en salud al servicio de infectología de una clínica de la ciudad de Bogotá, Colombia, donde reciben tratamiento.La caracterización de las participantes permite establecer que se trata de un grupo diverso en cuanto a los contextos de donde provienen y a sus estilos de vida. Cada caso posee sus particularidades y sus diferentes formas de afrontamiento. No obstante lo anterior, se presentan similitudes entre ellas: todas las mujeres destacan que el VIH/SIDA ha tenido profundo impacto en sus vidas las cuales cambiaron a partir de la enfermedad; varias describen sentimientos de culpa, decepción, rechazo social y soledad. El VIH ha afectado su vida a nivel familiar, laboral, afectivo y sexual. Coinciden todas en que adherirse al tratamiento constituye la principal opción que les ha permitido salvar sus vidas.Sus necesidades están en directa relación con su situación psicosocial así como con el cuidado de su salud. Como recomendaciones se sugieren, entre otras, actividades de educación para el autocuidado y talleres con enfoque de género para la mayor comprensión de la enfermedad así como para mejorar su autoestima, su empoderamiento y la aceptación de sí misma

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Colombian women living with hiv/aids: experiences and needs of nursing care

El objetivo de este estudio ha sido conocer las experiencias vividas y las necesidades de cuidado de enfermería sentidas por mujeres colombianas que viven con VIH/SIDA, con el fin de contar con elementos para encaminar programas y procesos de intervención con perspectiva de género y de derechos, liderados por profesionales de enfermería. Se tuvo en cuenta un diseño cualitativo con base en testimonios narrados mediante entrevistas a profundidad realizadas a 5 mujeres diagnosticadas con VIH, con edades entre 30 y 55 años, provenientes de diferentes regiones del país, adscritas a través del régimen subsidiado del sistema de seguridad social en salud al servicio de infectología de una clínica de la ciudad de Bogotá, Colombia, donde reciben tratamiento. La caracterización de las participantes permite establecer que se trata de un grupo diverso en cuanto a los contextos de donde provienen y a sus estilos de vida. Cada caso posee sus particularidades y sus diferentes formas de afrontamiento. No obstante lo anterior, se presentan similitudes entre ellas: todas las mujeres destacan que el VIH/SIDA ha tenido profundo impacto en sus vidas las cuales cambiaron a partir de la enfermedad; varias describen sentimientos de culpa, decepción, rechazo social y soledad. El VIH ha afectado su vida a nivel familiar, laboral, afectivo y sexual. Coinciden todas en que adherirse al tratamiento constituye la principal opción que les ha permitido salvar sus vidas. Sus necesidades están en directa relación con su situación psicosocial así como con el cuidado de su salud. Como recomendaciones se sugieren, entre otras, actividades de educación para el autocuidado y talleres con enfoque de género para la mayor comprensión de la enfermedad así como para mejorar su autoestima, su empoderamiento y la aceptación de sí mismas.ABSTRACT The objective of this approach has been to ascertain the experiences of life and the nursing care needs of Colombian women who live with HIV/AIDS in order to obtain elements to focus programs and gender and rights based intervention processes led by nursing professionals. The study uses a qualitative design based on narratives obtained through in-depth interviews from 5 women diagnosed with HIV, aged between 30 and 55 years old, who come from different regions of the country assigned by the subsidized regime of the social security system for health to the infectology service at a clinic situated in Bogotá, Colombia, where they receive treatment. Analysis of the results establishes that this group of women is diverse, inasmuch as the subjects come from different areas and have different lifestyles. The relation of the women with their disease indicates that each case has its particularities and different forms of facing it. Notwithstanding the above, there are similarities between them: all women emphasize that the HIV/AIDS has had deep impact in their lives which have been changed by the disease. Several describe feelings of guilt, disappointment, social rejection and solitude. HIV has affected their life at the family, work, affective and sexual level. They all state that adherence to treatment is the main cause of their survival. Their needs are related to their psychosocial situation as well as to their health care. Recommendations suggested include, among others, activities of education for self care and gender centred workshops for the better understanding of the disease as well as for enhancing self-esteem, empowerment and self - acceptance