Carga de trabalho em três grupos de pacientes em uma UTI espanhola segundo Nursing Activites Score

The purpose of this study was to assess the nursing workload at admission to and discharge from intensive care of three groups of patients (i.e., acute coronary syndrome, acute respiratory failure, and sepsis). A prospective, descriptive study was performed over a 27-month period and included 563 patients. The workload was assessed using the Nursing Activities Score scale. Significant differences in the workload were determined on the days of admission and discharge: the workload was higher in both cases for patients with acute respiratory failure and sepsis compared with patients diagnosed with acute coronary syndrome. This difference was maintained over the first seven days of their hospital stay. From day 8 on, the difference disappeared, and a workload balance was achieved in the three groups. Good staffing requires adequate tools for measuring care needs and understanding the workload required in the groups of patients who are most frequently admitted to intensive care.Se objetivó valorizar la carga de trabajo al ingreso y al alta en tres grupos de pacientes (síndrome coronario agudo, insuficiencia respiratoria aguda y sepsis) en terapia intensiva. Estudio descriptivo, prospectivo, de 27 meses, incluyéndose 563 pacientes, valorando carga de trabajo según Nursing Activities Score. Existieron diferencias significativas en la carga de trabajo al ingreso y en el alta entre los grupos de pacientes, siendo superior en ambos momentos la de pacientes con insuficiencia respiratoria aguda y sepsis frente a pacientes coronarios. Durante los siete primeros días de estancia se mantuvo esta diferencia, desapareciendo a partir del octavo día, equilibrándose la carga de trabajo para los tres grupos. Para conseguir una adecuada dotación de personal es fundamental contar con instrumentos para medir las necesidades de cuidados y conocer la carga de trabajo de los distintos grupos de enfermos que ingresan con mayor frecuencia en las unidades de terapia intensiva.O objetivo deste estudo foi avaliar a carga de trabalho na admissão e alta dos pacientes de três grupos (síndrome coronária aguda, insuficiência respiratória aguda e sepsis) em cuidados intensivos. Trata-se de estudo prospectivo, descritivo, que decorreu durante 27 meses, incluindo 563 pacientes. Para a avaliação da carga de trabalho utilizou-se a escala Nursing Activities Score. A partir dos resultados do estudo parecem existir diferenças significativas na carga de trabalho no dia da admissão e alta entre os grupos de pacientes, sendo a carga maior em ambos os tempos a dos pacientes com insuficiência respiratória aguda e sepsis. Durante os primeiros sete dias de internamento essa diferença manteve-se, desaparecendo no oitavo dia, o que equilibrou a carga de trabalho para os três grupos. Conclui-se que para se conseguir os recursos adequados é essencial dispor de instrumentos para medir as necessidades de cuidados e conhecer a carga de trabalho dos diferentes grupos de pacientes que passam com mais frequência pelas unidades de cuidados intensivos

Trends in hip fracture in patients with rheumatoid arthritis: Results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study

Purpose T o analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). Methods T his observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. Results Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The ageadjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). Conclusion I n Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.This work has a help for the research provided by the Society of Rheumatology of the Community of Madrid (SORCOM)

Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall

Background and aim: Hyponatraemia is the most common electrolyte disorder. Some studies have found that it increases morbidity and mortality. There are new lines of research that are investigating the link between hyponatraemia and patient falls. Aim: To determine if hyponatraemia is associated with falls in elderly hospitalised patients. Methods: Design observational, analytical, case-control study. Study population: Patients older than 65 years who had fallen during their hospitalisation at Gregorio Marañón Hospital (Madrid) were considered cases. Patients who did not fall were considered to be controls, paired according to the following variables: hospital ward, age, length of hospital stay, gender and Downton fall risk index. The sample size was 206 subjects. Data collection: Socio-demographic factors, variables included in the falls record sheet, Downton fall risk index and sodium levels were studied (hyponatraemia was considered Na+&lt; 135 mmol/l). Analysis: A descriptive analysis was performed to determine the sample homogeneity. The OR was calculated, and an analytical analysis using Chi-square test and a multivariate logistic regression analysis were also performed. Results: Of 103 cases recruited, 61 were men (50.4%) and 42 were women (49.4%). Hyponatraemia was detected in 29 cases with an association with falls of P: 0.002. The adjusted OR was 3.708 (1.6-8.3), 95% CI. Risk factors for falls were identified as hyponatraemia and limb sensory deficits. Conclusions: Given that hyponatraemia could be considered a risk factor for falls, the inclusion of the determination of sodium level would be important for fall prevention strategies in the elderly.Fundamento y objetivo: La hiponatremia es el trastorno electrolítico más frecuente. Algunos estudios afirman que aumenta la morbimortalidad. Existen nuevas líneas de investigación que buscan la relación entre hiponatremia y caídas. Objetivo: Determinar si la hiponatremia es un factor relacionado con las caídas en ancianos hospitalizados. Método: Disen˜ o observacional analítico de casos y controles. Población de estudio: Se consideraron casos los pacientes mayores de 65 an˜ os que experimentaron una caída durante su ingreso en unidades de hospitalización del Hospital General Universitario Gregorio Maran˜ ón de Madrid. Los controles fueron pacientes que no wxperimentaron caída, pareados según las variables: unidad, edad, periodo de ingreso, género y Downton. El taman˜ o fue de 206 sujetos. Recogida de datos: Se estudiaron factores sociodemográficos, las variables incluidas en la ficha de registro de caídas y escala de Downton, y el sodio sérico. Se consideró hiponatremia Na+ < 135 mmol/l. Análisis: Se realizó un análisis descriptivo para valorar la homogeneidad de la muestra, un análisis analítico utilizando el test chi cuadrado, calculando la OR y un análisis multivariante con regresión logística. Resultados: De 103 casos, 61 eran hombres (50,4%) y 42 mujeres (49,4%). En 29 se detectó hiponatremia; la relación con las caídas fue p: 0,002. La OR ajustada fue de 3,708 (1,6-8,3), IC 95%. Se identificaron como factores de riesgo para las caídas: hiponatremia y déficits sensoriales en extremidade

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Nursing workload in an intensive care unit and its relation with nosocomial infection incidence

Nosocomial infection is one of the most common causes of adverse events and complications related to health care. Development of nosocomial infection is associated with an increase in hospital stay and mortality and an overall increase in health care costs. Knowing the incidence of nosocomial infection is an effective way of controlling and preventing it. Identifying the relationship between nursing workload and nosocomial infections in critical care may be helpful to adjust the staff to the real requirements of the intensive care unit and may help reducing costs. The aim of the present study is to analyze the influence of nursing workload in the development of nosocomial infections in patients admitted to an intensive care unit. A longitudinal correlational research will be performed. The sample will be comprised of the patients admitted in the intensive care unit of the Hospital Universitario Fundación Alcorcón.Data regarding sociodemographical variables, ventilador-associated pneumonia, intravascular catheter location and duration, urinary catheter type and duration, and all pertinent cultures will be obtained from the medical records. Nursing Activities Score scale will be used to assess daily nursing workload in the unit. The number of patients admitted daily, as well as the number of nursing professionals working in each shift will also be taken into account

Nursing workload measurement scales in Intensive Care Units. Correlation between NAS and NEMS

The high costs of intensive care and the importance of patient safety and quality of care highlight the need to develop instrument to measure, as precisely as possible, nursing workload and staffing levels in intensive care. To assess the ideal staff number, we need instruments to measure the real nursing workload. The aim of this research is to compare two nursing workload measurement scales in Intensive Care Units, the Nursing Activities Score (NAS) and Nine Equivalents of Nurse Manpower Use Score (NEMS). We also want to assess the staffing needs of our ICU. A descriptive correlational study will be performed in a mixed medical ICU. The sample will be composed of of a minimum of 70 patients. Data regarding individual patients and unit global workload will be recorded, measured both with the NEMS and NAS scales. The required nursing staff will be calculated according to the measured workload. Nursing staffing needs using both scales will be calculated and compared to the actual staff. A descriptive analysis of the variables will be performed, and the existing correlation between both scales will be assessed using the Pearson correlation coefficient. A Student-t test will be performed to determine the differences between the calculated staffing requirements and the actual nursing staff. All data analyses will be done using a statistical software

Escalas de medida de carga de trabajo de enfermería en unidades de cuidados críticos. Correlación entre NAS y NEMS

The high costs of intensive care and the importance of patient safety and quality of care highlight the need to develop instrument to measure, as precisely as possible, nursing workload and staffing levels in intensive care. To assess the ideal staff number, we need instruments to measure the real nursing workload. The aim of this research is to compare two nursing workload measurement scales in Intensive Care Units, the Nursing Activities Score (NAS) and Nine Equivalents of Nurse Manpower Use Score (NEMS). We also want to assess the staffing needs of our ICU. A descriptive correlational study will be performed in a mixed medical ICU. The sample will be composed of of a minimum of 70 patients. Data regarding individual patients and unit global workload will be recorded, measured both with the NEMS and NAS scales. The required nursing staff will be calculated according to the measured workload. Nursing staffing needs using both scales will be calculated and compared to the actual staff. A descriptive analysis of the variables will be performed, and the existing correlation between both scales will be assessed using the Pearson correlation coefficient. A Student-t test will be performed to determine the differences between the calculated staffing requirements and the actual nursing staff. All data analyses will be done using a statistical software.Los altos costes de los cuidados intensivos, así como la calidad de los mismos y la seguridad de los pacientes ponen de relieve la necesidad de disponer de sistemas de medición de carga de trabajo que determinen de manera precisa los requerimientos de personal de enfermería. Para realizar el cálculo de la plantilla ideal, se necesitan instrumentos que midan carga de trabajo de enfermería real. El objetivo de esta investigación es comparar dos escalas de medición de carga de trabajo de enfermería en UCI, la escala NAS y la escala NEMS. También queremos comprobar si nuestra dotación de personal es la apropiada para atender al tipo de pacientes que tenemos en la unidad. Se realizará un estudio descriptivo correlacional en una unidad de cuidados intensivos de adultos polivalente. La muestra estará compuesta por un mínimo de 70 pacientes. Se recogerán datos de carga de trabajo individual y datos de carga de trabajo global de la unidad, todos ellos medidos con las escalas NAS y NEMS. Se calculará la dotación de personal necesaria y el ratio enfermera-paciente con ambas escalas. Se realizará un análisis descriptivo de todas las variables y se estudiará la correlación existente entre los valores obtenidos en cada escala usando el coeficiente de correlación de Pearson. También se realizará una comparación de las medias de personal de enfermería necesario calculado mediante ambas escalas utilizando la prueba t de Student. El análisis de datos se realizará con un paquete estadístico

Carga de trabajo de enfermería en una unidad de cuidados intensivos y su relación con la incidencia de infecciones nosocomiales

Nosocomial infection is one of the most common causes of adverse events and complications related to health care. Development of nosocomial infection is associated with an increase in hospital stay and mortality and an overall increase in health care costs. Knowing the incidence of nosocomial infection is an effective way of controlling and preventing it. Identifying the relationship between nursing workload and nosocomial infections in critical care may be helpful to adjust the staff to the real requirements of the intensive care unit and may help reducing costs. The aim of the present study is to analyze the influence of nursing workload in the development of nosocomial infections in patients admitted to an intensive care unit. A longitudinal correlational research will be performed. The sample will be comprised of the patients admitted in the intensive care unit of the Hospital Universitario Fundación Alcorcón. Data regarding sociodemographical variables, ventilador-associated pneumonia, intravascular catheter location and duration, urinary catheter type and duration, and all pertinent cultures will be obtained from the medical records. Nursing Activities Score scale will be used to assess daily nursing workload in the unit. The number of patients admitted daily, as well as the number of nursing professionals working in each shift will also be taken into account.La infección nosocomial es una de las causas más frecuentes de efectos adversos y complicaciones en los sistemas sanitarios. El desarrollo de infecciones nosocomiales se asocia con un aumento de la estancia hospitalaria y de la mortalidad relacionándose con un aumento de los costes. Conocer la incidencia de las infecciones nosocomiales mediante su vigilancia nos ayuda a su prevención y control. Relacionar la tasa de infección nosocomial con la carga de trabajo puede ayudar al ajuste de la plantilla en una Unidad de Cuidados Intensivos y a la reducción de costes. El objetivo de la presente investigación es analizar la influencia de la carga de trabajo de enfermería en la aparición de infecciones nosocomiales en los pacientes ingresados en una Unidad de Cuidados Intensivos. Se llevará a cabo un estudio descriptivo transversal correlacional. La muestra estará compuesta por todos los pacientes ingresados en la Unidad de Cuidados Críticos del Hospital Universitario Fundación Alcorcón. Se obtendrá de la historia clínica los datos sociodemográficos, los episodios de neumonía asociada a ventilación mecánica, los tipos y localizaciones de catéteres intravasculares, la duración de los catéteres, los tipos y el tiempo que permanece en el paciente las sondas vesicales y los cultivos pertinentes. Se empleará la escala Nursing Activities Score para medir la carga de trabajo de enfermería diariamente. También, se tendrá en cuenta el número de pacientes diarios en la unidad y el número de enfermeras en cada turno