Validez externa y convergencia de la escala INICIARE 2.0 y Care Dependency Scale: estudio multicéntrico

La enfermería basada en resultados es un campo en expansión que busca analizar los resultados finales de las intervenciones como garantía de la calidad sanitaria. En este sentido, numerosos estudios se han enfocado hacia la creación y desarrollo de herramientas que cuantifiquen diferentes aspectos relacionados con los resultados de la atención. El Inventario del Nivel de Cuidados mediante Indicadores de la Clasificación de Resultados de Enfermería (INICIARE) sigue esta línea y busca cuantificar las necesidades de cuidado de pacientes hospitalizados. Tras la validación interna, INICIARE quedó compuesta por 60 ítems con buenas puntuaciones en relación a su fiabilidad y validez. Para el diseño de INICIARE se utilizó la estructura del modelo conceptual de Virginia Henderson y la formulación de sus ítems se realizaron a partir de indicadores de resultados de la Nursing Outcomes Classification (NOC). Objetivo: Evaluar la validez externa de la herramienta INICIARE-60 en pacientes ingresados en hospitales del Sistema Sanitario Público Andaluz con diferentes modelos de gestión y diferentes grados de complejidad. Metodología: Estudio de validación clinimétrica en pacientes ingresados en once hospitales públicos con diferentes modelos de gestión y diferente nivel de complejidad, a través de un muestreo consecutivo y estratificado. Resultados: La muestra estuvo compuesta por 1165 pacientes. INICIARE obtuvo muy buenas puntuaciones en cuanto a fiabilidad (Alfa de Crobach=0,98) y validez (76,8% varianza explicada), una convergencia muy fuerte con Care Dependency Scale, escala patrón oro (rho=0,9), y una alta sensibilidad (86,4%), especificidad (88%) y precisión diagnóstica (87%). Conclusiones: INICIARE es una herramienta que sirve para medir necesidades de cuidado de pacientes en hospitales con diferentes modelos de gestión y diferentes grados de complejidad. Aporta un nuevo formato de valoración, con apoyo en lenguaje estandarizado enfermero, que la hacen compatible con la historia digital de salud. Por tanto, podría ser un instrumento que aporte grandes oportunidades para ser aplicado en gestión hospitalaria en la redistribución y priorización de recursos enfermeros.Nursing based in outcomes is an area in expanding whose aim is to analyze the end outcomes of interventions for sanitary quality. In this sense, different studies has been focused to building and developing of instruments that measure care outcomes. The Inventario del Nivel de Cuidados mediante Indicadores de la Clasificación de Resultados de Enfermería (INICIARE) had been built to measure needs care in patients. INICIARE are composed by 60 items after internal validity. The instrument got a good score of reliability and validity. INICIARE was designed with Henderson’s theory structure and the items are formulated by Nursing Outcomes Classification (NOC). Aim: To evaluate the external validity of the INICIARE scale in a multicentre study conducted in hospitals of varying complexity of the Andalusian Public Healthcare System. Methods: Validation study in patients of eleven public hospitals with different management models and varying complexity. Consecutive and stratified sampling. Results: Sample was composed by 1165 patients. INICIARE got a good scores of reliability (Cronbach’s alpha=0.98) and validity (76.8% explained variance), a convergence very strong with Care Dependency Scale like Gold Standard (rho=0.9), and high sensitive (86.4%), specificity (88%) and diagnostic accuracy (87%). Conclusions: INICIARE is an instrument to measure dependency in care in hospitals with different management models and varying complexity. INICIARE support a new structured form of assessment to patients, developed from standardized nursing language. INICIARE is compatibility with digital systems enables it to serve as support, as a structured system for patient assessment and revaluation and, in hospital management, for the prioritisation and redistribution of nursing resources

Caring for the caregiver: The emotional impact of the coronavirus epidemic on nurses and other health professionals

Objetivo La crisis sanitaria provocada por la pandemia del virus COVID-19 ha vuelto a destacar el papel de los profesionales sanitarios como elemento clave para su contención, que sufren una alta tensión marcada por la presión asistencial y la falta de medios de protección. Ante esta tensión, resulta relevante analizar el impacto emocional en los profesionales sanitarios de la pandemia de coronavirus y los recursos de afrontamiento para disminuir o atenuar este impacto. Destacan el estrés, los trastornos del sue˜no y los síntomas depresivos. Se ofrecen algunas estrategias que han sido utilizados por profesionales que anteriormente han sufrido la presión del COVID-19 y les han sido de utilidad. Por último, se se˜nalan algunas recomendaciones cuya eficacia es conocida para el manejo del impacto emocional.The health crisis caused by the COVID-19 virus pandemic has once again highlighted the role of health professionals as a key element for their containment, who suffer from high tension marked by healthcare pressure and the lack of means of protection. Given this tension, it is relevant to analyze the emotional impact on health professionals of the coronavirus pandemic and the coping resources to reduce or mitigate this impact. Stress, sleep disorders and depressive symptoms stand out. Some strategies are recommended that have been used by professionals who have previously been under pressure from COVID-19 and have been helpful to them. Finally, some recommendations whose efficacy is known for managing emotional impact are pointed out

Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4

Implementing Holistic Care in Isolated Patients During COVID-19 Pandemic A Case Study Using Nursing Outcomes (NOC) and Interventions (NIC) Classifications

The most effective strategy against SARS-Cov-2 virus spread is therapeutic isolation. Consequences of this measure are the presence of anxiety and depression. Therefore, it is the nurse's responsibility to identify strategies to implement humanized and holistic care in order to avoid physical and mental consequences of isolation

Elderly people, dependency and vulnerability in the coronavirus pandemic: an emergency for a social and health integration

La pandemia actual por SARS-CoV-2 (COVID-19) afecta con mayor incidencia y gravedad a las personas mayores en todo el mundo. En Espa˜na, el 68% del total de hospitalizaciones por coronavirus, corresponden a mayores de 60 a˜nos. Este trabajo tiene como objetivo incrementar la evidencia sobre las medidas a implementar con directrices actuales y futuras en diferentes escenarios. Destaca la necesidad de prepararnos para la acción mediante la implementación de protocolos de carácter internacional. Existe una tendencia hacia la atención biopsicosocial de las personas mayores en todos los entornos donde se encuentran, adecuando la atención y personalizando decisiones de ingresos hospitalarios, cuidados paliativos, atendiendo, entre otros criterios, a los a˜nos ajustados a la calidad de vida, así como alternativas para el monitoreo y tratamiento de la patología por COVID-19 y otras ya existentes. Son necesarias medidas de reducción de la transmisión del virus a través de la higiene y el distanciamiento, atendiendo a la salud biopsicosocial de los mayores aislados. Como alternativas innovadoras se propone la comunicación intersectorial, y el uso de herramientas tecnológicas, acompa˜nado de una adecuada alfabetización digital en salud. Las líneas futuras se centran en garantizar los derechos sociales y sanitarios, equiparando al mismo nivel el sistema social y de salud, y consiguiendo una coordinación real. Un nuevo marco de atención centrada en la persona podría ser un gran aliado para conseguir una atención integrada a los mayores, guiada por un aumento de los recursos destinados a la financiación de proyectos de investigación sobre longevidad

Insomnia Interventions in the Workplace: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to identify and evaluate the impact of interventions to improve or reduce insomnia in the workforce through randomized clinical trials. Following the recommendations of the PRISMA and MARS statement, a systematic literature search was carried out on the PubMed, Web of Science, CINHAL, and PsycINFO databases, with no restrictions on the language or publication date. For the meta-analysis, a random-effects model and theInsomnia Severity Indexwere used as outcome measures. To assess the risk of bias and the quality of evidence, the Cochrane Collaboration tool and the GRADE method were used, respectively. Twenty-two studies were included in the systematic review and 12 studies in the meta-analysis, making a total of 14 intervention groups with a sample of 827 workers. Cognitive behavioral therapy was the most widely used intervention. According to the estimated difference between the means, a moderate effect for the reduction of insomnia symptoms after the intervention (MD -2.08, CI 95%: [-2.68, -1.47]) and a non-significant degree of heterogeneity were obtained (p= 0.64; I-2= 0%). The quality of the evidence and the risk of bias were moderate. The results suggest that interventions on insomnia in the workplace are effective for improving workers' health, and that improvements in the quality of sleep and a decrease in the symptoms of insomnia are produced, thanks to an increase in weekly sleeping hours and a reduction in latency at sleep onset. As regards work, they also led to improvements in productivity, presenteeism, and job burnout

Obesity-associated metabolic disturbances reverse the antioxidant and anti-inflammatory properties of high-density lipoproteins in microglial cells

High-density lipoproteins (HDLs) play an important role in reverse cholesterol transport and present antioxidant properties, among others. In the central nervous system (CNS), there are HDLs, where these lipoproteins could influence brain health. Owing to the new evidence of HDL functionality remodeling in obese patients, and the fact that obesity-associated metabolic disturbances is pro-inflammatory and pro-oxidant, the aim of this study was to investigate if HDL functions are depleted in obese patients and obesity-associated microenvironment. HDLs were isolated from normal-weight healthy (nwHDL) and obese men (obHDL). The oxHDL level was measured by malondialdehyde and 4-hydroxynoneal peroxided products. BV2 microglial cells were exposed to different concentrations of nwHDL and obHDL in different obesity-associated pro-inflammatory microenvironments. Our results showed that hyperleptinemia increased oxHDL levels. In addition, nwHDLs reduced pro-inflammatory cytokines’ release and M1 marker gene expression in BV2 microglial cells. Nevertheless, both nwHDL co-administered with LPS+leptin and obHDL promoted BV2 microglial activation and a higher pro-inflammatory cytokine production, thus confirming that obesity-associated metabolic disturbances reverse the antioxidant and anti-inflammatory properties of HDLs in microglial cells.Junta de Andalucía US-126345

Consequences of chronic pain in childhood and adolescence

Objetivo: Examinar y mapear las consecuencias del dolor crónico en la infancia y la adolescencia. Método: Se realizó una revisión sistemática exploratoria (scoping review) de bases de datos internacionales (PubMed, SCOPUS, WOS y CINAHL, Cochrane Library) y de literatura gris. Se incluyeron documentos que abordaban aspectos psicosociales que influyen en el dolor crónico, publicados en inglés entre los anos ˜ 2010 y 2016. Se excluyeron los documentos que abordaban tratamientos farmacológicos o dolor crónico derivado de intervenciones quirúrgicas, y aquellos sin acceso al texto completo. Se incluyeron 34 documentos de los 716 revisados. Resultados: Los estudios muestran que el dolor se relaciona con altas tasas de discapacidad funcional y de trastornos del sueno˜ y del espectro ansiedad-depresión. Los/las jóvenes experimentan mayores tasas de victimización y estigmatización, lo que contribuye al aislamiento social, mayor dificultad para atender las exigencias académicas y menor oportunidad de consumo de sustancias ilegales. Con respecto a la familia, el dolor crónico se ha asociado con un peor funcionamiento familiar y una inversión considerable de recursos económicos. Conclusiones: Esta revisión pone de manifiesto que la capacidad funcional, el sueno, ˜ el desarrollo personal, el apoyo de iguales y el funcionamiento familiar son líneas de interés en los trabajos publicados. Sin embargo, se detectan lagunas de conocimiento en áreas como las conductas de riesgo, las consecuencias que puede ocasionar el dolor en la edad adulta y las desigualdades de géneroObjective: Our aim was to examine and map the consequences of chronic pain in children and adolescents. Method: A scoping review was carried out in the international databases (PubMed, SCOPUS, WOS and CINAHL, Cochrane Library) and gray literature. We included documents that addressed psychosocial aspects that influence chronic pain, published in English between 2010 and 2016. We excluded the documents that dealt with pharmacological treatments, chronic pain derived from surgical interventions or where there was no access to full text. 34 of the 716 documents reviewed were included. Results: Studies show that pain is associated with high rates of functional disability, sleep disorders and spectrum depression-anxiety. Young people experience higher rates of victimization and stigmatization, contributing to social isolation, difficulty in meeting academic demands and less opportunity to consume illegal substances. With respect to the family, chronic pain has been associated with poorer family functioning and considerable investment of economic resources. Conclusions: This Scoping Review shows that functional capacity, sleep, personal development, peer support and family functioning are interesting lines in published works. However, gaps in knowledge are detected in areas such as risk behaviours, the consequences that pain can cause in adulthood and gender inequalities

Cuidar al que cuida: el impacto emocional de la epidemia de coronavirus en las enfermeras y otros profesionales de la salud.

The health crisis caused by the COVID-19 virus pandemic has once again highlighted the role of health professionals as a key element for their containment, who suffer from high tension marked by healthcare pressure and the lack of means of protection. Given this tension, it is relevant to analyze the emotional impact on health professionals of the coronavirus pandemic and the coping resources to reduce or mitigate this impact. Stress, sleep disorders and depressive symptoms stand out. Some strategies are recommended that have been used by professionals who have previously been under pressure from COVID-19 and have been helpful to them. Finally, some recommendations whose efficacy is known for managing emotional impact are pointed out