Intervención enfermera “círculos de diálogo” para la disminución del nivel de sobrecarga de cuidadores de pacientes crónico complejos y con enfermedad crónica avanzada

Introduction. The increase in life expectancy has led to an aging population and a higher prevalence of chronic diseases. This has generated the need for informal caregivers of the elderly to face caregiving situations. On the other hand, there has been a change in the epidemiological profile of the last 50 years, where there is a decrease in infectious diseases and a higher prevalence of non-communicable diseases of chronic course such as, which increase the demand of caregivers relatives. Caring for a dependent family member can negatively affect the health of the caregiver in their emotional and working life. Objectives. In the first phase, the general objective is to describe the sociodemographic characteristics of the study sample, as specific, to analyze the relationship between the level of caregiver burden and the sociodemographic variables of the main caregivers, to analyze the relationship between the level of caregiver burden and the clinical characteristics of the patient. In a second phase, it is to determine the effectiveness of the dialogue circles nurse intervention, to reduce the level of burden perceived by the main caregivers of patients identified as complex chronic patients and advanced chronic disease. As specific they are, comparing the level of overload perceived by the main caregivers before and after the intervention between the experimental group and the control group and the degree of satisfaction about the intervention nurse dialogue circles. Methodology. Quantitative study in two phases. In the first a descriptive cross-sectional study and in the second an experimental study, a randomized clinical trial with simple masking. The study will be carried out in Catalonia, in the towns of the metropolitan area of Barcelona, belonging to the Baix Llobregat Center Primary Care Service.Introducción. El aumento de la esperanza de vida ha originado el envejecimiento de la población y una mayor prevalencia de enfermedades crónicas. Esto ha generado la necesidad de cuidadores informales de adultos mayores para enfrentar situaciones de cuidado de estos. Por otra parte, se ha evidenciado un cambio en el perfil epidemiológico de los últimos 50 años, donde se observa un descenso de las enfermedades de tipo infeccioso y una mayor prevalencia de enfermedades no trasmisibles de curso crónico, las cuales aumentan la demanda de los cuidadores familiares. El cuidado de un familiar dependiente puede afectar negativamente en la salud del cuidador/a, en su vida afectiva y laboral. Objetivos. Primera fase, el objetivo general es describir las características sociodemográficas de la muestra de estudio, como específicos son: analizar la relación entre nivel de sobrecarga del cuidador y las variables sociodemográficas de los cuidadores principales, analizar la relación entre nivel de sobrecarga del cuidador y las características clínicas del paciente. Segunda fase, determinar la eficacia de la intervención de la enfermera en círculos de diálogo, para reducir el nivel de sobrecarga percibido por los cuidadores principales de pacientes identificados como paciente crónico complejo y enfermedad crónica avanzada. Como específicos son: comparar el nivel de sobrecarga percibido por los cuidadores principales antes y después de la intervención entre el grupo experimental y el grupo control, y grado de satisfacción sobre la intervención enfermera círculos de diálogos. Metodología. Estudio cuantitativo en dos fases. Primera, estudio descriptivo transversal y segunda, un estudio experimental, ensayo clínico aleatorizado con enmascaramiento simple. El estudio se realizará en Cataluña, en las poblaciones del área metropolitana de Barcelona pertenecientes al Servicio de Atención Primaria Baix Llobregat Centre

Nurse intervention “dialogue circles” to reduce the level of burden perceived by the main caregivers of complex chronic patients and advanced chronic disease’s patients

Introducción: el aumento de la esperanza de vida ha originado el envejecimiento de la población y una mayor prevalencia de enfermedades crónicas. Esto ha generado la necesidad de cuidadores informales de adultos mayores para enfrentar situaciones de cuidado de estos. Por otra parte, se ha evidenciado un cambio en el perfil epidemiológico de los últimos 50 años, donde se observa un descenso de las enfermedades de tipo infeccioso y una mayor prevalencia de enfermedades no trasmisibles de curso crónico, las cuales aumentan la demanda de los cuidadores familiares. El cuidado de un familiar dependiente puede afectar negativamente en la salud del cuidador/a, en su vida afectiva y laboral. Objetivos: primera fase, el objetivo general es describir las características sociodemográficas de la muestra de estudio, como específicos son: analizar la relación entre nivel de sobrecarga del cuidador y las variables sociodemográficas de los cuidadores principales, analizar la relación entre nivel de sobrecarga del cuidador y las características clínicas del paciente. Segunda fase, determinar la eficacia de la intervención de la enfermera en círculos de diálogo, para reducir el nivel de sobrecarga percibido por los cuidadores principales de pacientes identificados como paciente crónico complejo y enfermedad crónica avanzada. Como específicos son: comparar el nivel de sobrecarga percibido por los cuidadores principales antes y después de la intervención entre el grupo experimental y el grupo control, y grado de satisfacción sobre la intervención enfermera círculos de diálogos. Metodología: estudio cuantitativo en dos fases. Primera, estudio descriptivo transversal y segunda, un estudio experimental, ensayo clínico aleatorizado con enmascaramiento simple. El estudio se realizará en Cataluña, en las poblaciones del área metropolitana de Barcelona pertenecientes al Servicio de Atención Primaria Baix Llobregat Centre

A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism

Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant ≥6 months before the study and had an eGFR>30 ml/min per 1.73 m2. The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism

A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism

Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant ≥6 months before the study and had an eGFR>30 ml/min per 1.73 m2. The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism