La comunicación con el familiar del paciente dependiente. Actuación de enfermería = Communication with the relative of the dependent patient. The Nursing intervention

Resumen: Introducción: Los profesionales sanitarios están en contacto permanente además de con los pacientes a tratar con los familiares que le acompañan, por lo que la comunicación tiene que ser adecuada tanto para el paciente como para quien lo cuida. Atender al familiar y/o cuidador principal durante el diagnostico de una enfermedad y las medidas a tratar para su recuperación son esenciales para una buena practica del equipo sanitario. Objetivos: Determinar cuáles son las necesidades de los cuidadores y /o familia de comunicación y conocer las características de los cuidadores/ familiares a tratar por enfermería. Metodología: Es una revisión bibliográfica a través de las principales bases de datos en salud: cuiden, crochane plus, lilacs. Realizaremos un recorrido en la bibliografía en la que vamos a encontrar diferentes aspectos importantes sobre el tema a tratar. Resultados: Durante la búsqueda de datos hemos observado que existen muchos artículos referenciando que tipo de comunicación dependiendo de el lugar en el que se encuentre el paciente dentro del hospital y el momento de su proceso patológico. Existen modernas formas de ver los cuidados a través de las nuevas tecnologías de la información (TIC), el concepto de teletrabajo se desarrolla en Europa a finales de los años setenta y resurge a partir de la década de los ochenta en los debates sobre flexibilidad de la jornada laboral. Conclusiones: La formación de los profesionales de enfermería en comunicación es muy importante, tanto como realizar un buen procedimiento de enfermería ya que el contacto con el paciente y la familia es esencial en el profesional. En la actualidad, gracias a las nuevas tecnologías existen métodos que nos pueden acercar al cuidador y facilitar el trabajo para enseñar una buena practica para el paciente.Palabras clave: Comunicación, Relaciones enfermero-paciente, Relaciones profesional-familiaAbstract: Introduction: Health professionals are in constant contact with patients in addition to dealing with family members who accompany him, so that the communication needs to be appropriate for both the patient and caregiver. To attend a family member and / or primary caregiver for the diagnosis of disease and measures to deal with recovery are essential for good health team practice. Objective: To determine what the needs of caregivers and / or family of communication are and know the characteristics of carers/family to be treated by nurses. Methodology: A literature review through the major databases in health: care, plus crochane, lilacs. Make a tour in the literature in which we will find many important aspects about the subject matter. Results: When searching for data, we have observed that there are many articles referencing that type of communication depending on the place where the patient within the hospital and the time of disease process are. There are modern ways of viewing care through new information technologies (ICT), the concept of telework is developed in Europe in the late seventies and reemerges from the eighties in discussions on flexibility the workday. Conclusions: The training of nurses in communication is very important, as well as make a good nursing procedure as contact with the patient and family is essential to the professional. Today, thanks to new technology there are ways that we can approach the caregiver and facilitate the work to teach good practice for the patient.Keywords: Communication, Nurse-patients relation, Professional-family relations doi: http://dx.doi.org/10.20318/recs.2016.345

La comunicación no verbal con el anciano y los profesionales sanitarios = Nonverbal communication with the elderly and health professionals

El ser humano lleva comunicándose continuamente desde sus orígenes, satisfaciendo de esta manera una necesidad humana básica. Esta comunicación no siempre es comprendida o asimilada de la forma deseada .Desde las profesiones sanitarias, el proceso comunicativo mediante el cual establecemos nuevas relaciones, es imprescindible para poder interactuar con los pacientes o clientes. Objetivo. Conocer las modificaciones que se suceden fisiológicamente con el envejecimiento en cuanto a la recepción, interpretación y emisión de mensajes no verbales con el fin de buscar una comunicación óptima con el anciano. Material y Método. Se ha realizado una revisión sistemática de aquellas publicaciones que han aparecido en los últimos diez años y que corresponden a comunicación no verbal con el mayor y los profesionales sanitarios.Las bases de datos utilizadas ha sido: Medline-Pubmed, Cuiden plus, Scielo, CINAHL, EMBASE e IME Resultados. Dos cambios relacionados con la edad que ocurren en la mayoría de los ancianos contribuyen en gran medida a tornar difícil la comunicación con ellos: los cambios en la visión y los cambios auditivos. Conclusiones. La vejez no es de por sí limitante; las limitaciones nacen al ignorar que muchas funciones orgánicas y mentales se modifican sin que por ello las facultades vitales de la persona desaparezcan. Nuestro deber es ofrecer la comprensión necesaria y proveer la interrelación con unas nuevas alternativas.Palabras clave: Anciano, comunicación no verbal, profesionales.Abstract: The human being has continually communicating from its origins, thus meeting a basic human need. This communication is not always understood or assimilated as desired .From the health professions, the communicative process by which we establish new relationships, it is essential to interact with patients or clients. Objective. Knowing the physiological changes that occur with aging in terms of reception, interpretation and nonverbal messages broadcast to find an optimal communication the elderly. Material and Methods. There has been a systematic review of publications that have appeared in the last ten years, corresponding to nonverbal communication with the largest and health professionals. The database used was: Medline-Pubmed, Cuiden plus, Scielo, CINAHL, EMBASE and IME results. Two age-related changes that occur in most elderly contribute greatly to render them difficult communication: changes in vision and hearing changes. Conclusions. Old age is not self-limiting; limitations are born to ignore that many organic and mental functions are modified without this vital powers of the person disappear. Our duty is to provide the necessary understanding and provide the interface with new alternatives.Keywords: Elderly, nonverbal communications, professionals

Comunicación y cambios del lenguaje en personas con enfermedad de Alzheimer = Communication and language changes in people with Alzheimer's disease

Resumen: Introducción: En la actualidad la enfermedad de Alzheimer está muy presente en la sociedad de ahí la importancia de su estudio. Es una patología que provoca numerosos cambios en la persona, tanto a nivel cognitivo, como físico y afectivo. Es de gran importancia el estudio y aprendizaje de los cambios y las necesidades de estos pacientes respecto a la comunicación, puesto que van perdiendo capacidad de relacionarse, al no poder expresarse, entender o relacionar conceptos. Debemos conocer los cambios a nivel del lenguaje y las necesidades que tienen estos enfermos. Objetivos: Analizar cuáles son los cambios en el leguaje en las personas con enfermedad de Alzheimer. Conocer qué medidas se deben tomar para la correcta comunicación con los enfermos de Alzheimer. Material y método: Se ha realizado una revisión bibliográfica sobre el tema de los cambios del leguaje en enfermos de Alzheimer en diferentes bases de datos. Resultados: los trastornos del lenguaje son unas de las primeras manifestaciones de la enfermedad de Alzheimer, apareciendo en el 40 % de los casos en las primeras fases de la enfermedad y en el 100% de los casos en demencia severa. Conclusiones: las alteraciones del lenguaje en el enfermo de Alzheimer son importantes porque producen un efecto negativo en el paciente y lleva a una incapacitación y aislamiento. Se deben buscar técnicas para ayudar a la comunicación de estos enfermos, hablando por ejemplo claro y conciso y no acabando las frases por ellos. Hay que mantener contacto visual y vocalizar muy bien y gesticular. La comunicación no verbal es realmente importante en este tipo de enfermos. Se debe de estar instruido como profesional en este tema para poder ayudar a los pacientes a una comunicación eficaz y poder enseñar a los cuidadores esas técnicas.Palabras clave: Comunicación, enfermedad de Alzheimer, LenguajeAbstract: Introduction: Currently, Alzheimer's disease is very present in society, for that reason its study is so important. It is a condition that causes numerous changes in the patient, both in physical and in the emotional cognitive level. It is of great importance to study and learn the changes and needs of these patients regarding communication, since they lost the ability to relate, unable to express themselves, understand or relate concepts. We know the changes at the language level and needs of these patients. To analyze what changes in language are in people with Alzheimer's disease. Knowing what steps to take to correct communication with Alzheimer's patients. Material and Methods: We carried out a literature review on the topic of changes in Alzheimer language in different databases. Results: Language disorders are one of the first signs of Alzheimer's disease, occurring in 40 % of cases in the early stages of the disease and in 100 % of cases in severe dementia. Conclusions: language disorders in Alzheimer's patient are important because they produce a negative effect on the patient and leads to disability and isolation. Techniques should be sought to assist the communication of these patients, talking on clear and concise example and not finishing their sentences for them. You have to keep eye contact and gesturing and vocalise well. Non-verbal communication is really important in these patients. They must be trained as a professional in this topic to help patients to effective communication and caregivers can teach these techniquesKeywords: Communication, Alzheimer´s disease, Language doi: http://dx.doi.org/10.20318/recs.2016.345

Micronuclei detection by flow cytometry as a high-throughput approach for the genotoxicity testing of nanomaterials

Thousands of nanomaterials (NMs)-containing products are currently under development or incorporated in the consumer market, despite our very limited understanding of their genotoxic potential. Taking into account that the toxicity and genotoxicity of NMs strongly depend on their physicochemical characteristics, many variables must be considered in the safety evaluation of each given NM. In this scenario, the challenge is to establish high-throughput methodologies able to generate rapid and robust genotoxicity data that can be used to critically assess and/or predict the biological effects associated with those NMs being under development or already present in the market. In this study, we have evaluated the advantages of using a flow cytometry-based approach testing micronucleus (MNs) induction (FCMN assay). In the frame of the EU NANoREG project, we have tested six different NMs-namely NM100 and NM101 (TiO2NPs), NM110 (ZnONPs), NM212 (CeO2NPs), NM300K (AgNPs) and NM401 (multi-walled carbon nanotubes (MWCNTs)). The obtained results confirm the ability of AgNPs and MWCNTs to induce MN in the human bronchial epithelial BEAS-2B cell line, whereas the other tested NMs retrieved non-significant increases in the MN frequency. Based on the alignment of the results with the data reported in the literature and the performance of the FCMN assay, we strongly recommend this assay as a reference method to systematically evaluate the potential genotoxicity of NMs

The impact of the COVID-19 pandemic in diabetes and dyslipidemia management in a Spanish region: a retrospective study of the Aragon population

IntroductionPrevious research has indicated that the COVID-19 outbreak had a negative impact on the diagnosis and management of cardiometabolic diseases. Our aim was to analyze the impact of the COVID-19 pandemic on the management of dyslipidemia and type 2 diabetes (T2D) in the Aragon region of Spain.MethodsWe conducted an observational retrospective study, which included data from all patients diagnosed with active T2D or dyslipidemia in Aragon during 2019–2021. Data was collected from the BIGAN platform, a big database that includes all healthcare data from the Aragon population. Clinical, biochemical, and pharmacological prescription information was obtained for each patient and for each year.ResultsOut of the total population of 1,330,000 in the Aragon region, 90,000 subjects were diagnosed with T2D each year, resulting in a prevalence of approximately 7%. The COVID-19 pandemic resulted in a decrease in the prevalence of this disease and a lower incidence during the year 2020. In addition, patients with T2D experienced a deterioration of their glucose profile, which led to an increase in the number of patients requiring pharmacological therapy. The prevalence of dyslipidemia was approximately 23.5% in both 2019 and 2020 and increased to 24.5% in 2021. Despite the worsening of the anthropometric profile, the lipid profile improved significantly throughout 2020 and 2021 compared to 2019. Moreover, the number of active pharmacological prescriptions increased significantly in 2021.DiscussionOur findings suggest that the overload of the health system caused by the COVID-19 pandemic has resulted in an underdiagnosis of T2D. Moreover, patients with T2D experienced a worsening of their glycemic profile, an increase in their pharmacological requirements, and lower performance of their analytical determinations. Dyslipidemic subjects improved their lipid profile although the value of lipid profile determination decreased between 2020 and 2021

Pulso de nanopartículas de plata (NPAg) en soluciones preservantes para tallos florales de Rosa cv Avalanche

Para evaluar la calidad floral de los cultivos de ornato se juzgan cualidades visuales, pero sobre todo la longevidad que alcancen en su vida postcosecha antes de marchitarse. Con el fin de retrasar la senescencia floral, se emplean soluciones preservantes. Las nanopartículas de plata (NPAg) han sido usadas para tratar flores de corte por su efecto biocida y el mejoramiento de variables físicas, por lo que el objetivo de este trabajo fue evaluar los cambios en el consumo de solución, peso y diámetro floral de tallos florales de Rosa cv. Avalanche durante su vida postcosecha. Se aplicó un pulso de 60 minutos con NPAg. Los resultados muestran que las NPAg favoreció un incremento de la apertura floral e índice de apertura floral con diferencias estadísticas. Sin embargo, la tasa de absorción de solución, así como la pérdida de peso no evidenciaron un efecto significativo entre los tratamientos.To evaluate the floral quality of ornamental crops, visual qualities are judged, but above all the longevity that they reach in their post-harvest life before withering. In order to delay floral senescence, preservative solutions are used. Silver nanoparticles (NPAg) have been used to treat cut flowers due to their biocidal effect and the improvement of physical variables, so the objective of this work was to evaluate changes in solution consumption, weight and floral diameter of stems. flowers of Rosa cv. Avalanche during its postharvest life. A 60-minute pulse with NPAg was applied. The results show that the NPAg favored an increase in flower opening and flower opening index with statistical differences. However, the rate of solution absorption, as well as weight loss, did not show a significant effect between treatments

Associations of hypomagnesemia in patients seeking a first treatment of alcohol use disorder

Introduction: Hypomagnesemia (hypoMg) has not yet been extensively studied in alcohol use disorder (AUD) . We hypothesize that chronic, excessive alcohol consumption favors oxidative stress and pro-inflammatory alterations that may be exacerbated by hypoMg. The objective of this study was to analyze the prevalence and associations of hypoMg in AUD.Patients and Methods: Cross-sectional study in patients admitted for a first treatment of AUD in six tertiary centers between 2013 and 2020. Socio-demographic, alcohol use characteristics, and blood parameters were ascertained at admission.Results: 753 patients (71% men) were eligible; age at admission was 48 years [IQR, 41-56 years]. Prevalence of hypoMg was 11.2%, higher than that observed for hypocalcemia (9.3%), hyponatremia (5.6%), and hypokalemia (2.8%). HypoMg was associated with older age, longer duration of AUD, anemia, higher erythrocyte sedimen-tation rate, gamma-glutamyl transpeptidase, glucose levels, advanced liver fibrosis (FIB-4 >= 3.25) and estimated glomerular filtration rate (eGFR) < 60 mL/min. In multivariate analysis, advanced liver fibrosis (OR, 8.91; 95% CI, 3.3-23.9) and eGFR < 60 mL (OR, 5.2; 95% CI, 1.0-26.2) were the only factors associated with hypoMg.Conclusions: Mg deficiency in AUD is associated with liver damage and glomerular dysfunction suggesting that both comorbidities should be assessed in the course of serum hypoMg

Urticarial vasculitis: a retrospective study of 20 cases and diagnostic-therapeutic protocol

La urticaria vasculitis es una enfermedad crónica que se caracteriza por episodios urticariales o de angioedema que puede asociarse a niveles bajos de complemento. Hemos realizado un estudio descriptivo retrospectivo que incluye a 20 pacientes con urticaria vasculitis diagnosticados en los últimos 5 años donde analizamos los síntomas más frecuentes y los tratamientos que se han empleado. A continuación se ha diseñado un protocolo diagnóstico-terapéutico de Urticaria Vasculitis para orientar el manejo de estos pacientes, en el que se incluye una breve definición de esta entidad así como las enfermedades y fármacos a los que se puede asociar.The urticarial vasculitis is a chronic disease characterized by urticarial or angioedema episodes that may be associated with low levels of complement. We conducted a retrospective study including 20 patients with urticaria vasculitis diagnosed in the last 5 years where we analyze the most common symptoms and treatments that have been used. Then there has been a diagnostic and therapeutic protocol Urticaria Vasculitis which helps the management of these patients which includes a brief definition of illness and disease and drugs that may be associated

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio