Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Evaluación de los factores psicosociales en profesionales de Atención Primaria de Salud.

Introduction. Actually, quality focuses on user and is less important health professional as care giver. OMS´s definition as situation of full biopsychosocial welfare required that every person has needs, problems, concerns. So, the main objetive was evaluated psychosocial factors that decrease human quality of people are working there. Material and methods. By means of descriptive- cross study, with 43 workers of sample that we choose at random (stratified sampling by professional category). We gave them a self-administered questionary and the following items:mental workload, temporal autonomy, work content, supervision-participation, role definition, interest in worker and relationships. Using SPSS 19.0 to data analysis. Workers. Working conditions. Occupational health. Results To include the highest scores were to mental workload, with an average punctuation of 7,41. Conclusions. This item represents a priority in corrective actions, mainly in directors and attention to the public categories, emphasizing in pace of work and perceived fatigue by workers.Introducción. Actualmente la calidad, centrada en el usuario, deja atrás la importancia que tiene el profesional de enfermería como dador de cuidados. La "salud", definida por la OMS como situación de completo bienestar bio-psico-social, implica que toda persona tiene necesidades, problemas, inquietudes. Objetivo. Se planteó realizar una evaluación de los factores psicosociales en profesionales de atención primaria. Material y métodos. Se realizó un estudio descriptivo transversal, cuyo tamaño muestral fue de 43 trabajadores elegidos al azar, mediante un muestreo aleatorio estratificado por categoría profesional y se pasó un cuestionario siguiendo el método del INSHT. Las variables dependientes fueron: carga mental, autonomía temporal, contenido de trabajo, supervisión- participación, definición de rol, interés por el trabajador y relaciones personales. Para el análisis de datos se utilizó el programa informático SPSS 19.0. Resultados. Las puntuaciones medias más elevadas se registraron para la variable "carga mental", como situación nociva, con una puntuación media de 7,41. Conclusiones. Esta dimensión representa una prioridad en cuanto a las acciones correctoras a adoptar, principalmente en las categorías directivos y atención al público, haciendo hincapié en el ritmo de trabajo y en la fatiga percibida por los trabajadores

Proceso de atención de enfermería en un paciente geriátrico

We present the case of 78 year old man admitted to the Nursing Virgin of Africa, which will produce a standardized care plan, with the objective of maintaining functional independence, improve their quality of life, reduce mortality and increase life expectancy life, providing individualized care to the elderly and their environment. We will make a comprehensive geriatric assessment and thus will value, by nurse taxonomy NANDA, NIC, NOC and Nutritional Scale (MNA), altered their needs along the lines of Virginia Henderson. By presenting this case, we intend to give a series of recommendations for the preservation of health and functional independence, being the most important aspects of health promotion in older adults.Presentamos caso de varón de 81 años ingresado en una Residencia de ancianos, en el que elaboraremos un plan de cuidados estandarizados, con el objetivo de mantener su independencia funcional, mejorar su calidad de vida, disminuir la mortalidad y aumentar la esperanza de vida, proporcionando una atención individualizada al anciano y a su entorno. Realizaremos una valoración geriátrica integral y con ello valoraremos, mediante la taxonomía enfermera NANDA, NIC, NOC y la Escala Nutricional (MNA), sus necesidades alteradas siguiendo el modelo de Virginia Henderson. Con la presentación de este caso, pretendemos dar una serie de recomendaciones para la conservación de su salud e independencia funcional, por ser los aspectos más importantes de la promoción de la salud en los adultos de edad avanzada

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease