ABSTRACT
ntroducción y objetivo: La educación por enfermería es una pieza clave en todo programa de insuficiencia cardíaca (IC), pero existen modelos muy heterogéneos y faltan instrumentos de medida. Nuestro objetivo ha sido evaluar un cuestionario propio y su utilidad como guía de la educación.Métodos: Estudio de cohortes prospectivo de pacientes tras el diagnóstico de IC seguidos en una unidad especializada. El grupo expuesto recibió sesiones educativas guiadas por evaluación del conocimiento mediante el cuestionario, y se comparó con un grupo con educación estándar. Se evaluó la validez y la fiabilidad del cuestionario. La utilidad del modelo educativo se determinó por la variable combinada principal de muerte y/o ingreso hospitalario o atención en urgencias por IC.Resultados: Se incluyeron 152 pacientes, 88 con educación guiada y 64 estándar, con un seguimiento medio de 16±4 meses. En el grupo guiado, la puntuación del cuestionario de evaluación (pc) subió del 59 al 78,5% (p=0,018) y se asoció con un mayor autocuidado (28,5-0,6*pc; p=0,04) y una tendencia a mejor calidad de vida (51,1-1,1*pc; p=0,09) y adherencia (5,02+0,04*pc; p=0,06), con una fiabilidad aceptable (Alfa de Cronbach: 0,75). La variable combinada principal ocurrió en 12 pacientes (13,6%) con educación guiada frente a 19 (29,7%) con la estándar (hazard ratio: 0,46; intervalo de confianza del 95%: 0,24-0,88; p=0,019), aunque en el análisis multivariante, solo fueron predictores: el nivel educativo, la edad, NT-proBNP y la fibrilación auricular.Conclusión: El cuestionario de conocimientos en IC propuesto es una herramienta válida y fiable, y permite cuantificar el aprendizaje. Su utilidad para guiar la educación precisa de cierta habilidad del paciente que determina un grupo con mejor pronóstico. (AU)
Introduction and objective: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention.Methods: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF.Results: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (P=0.018), which was associated with greater self-care (28.5-0.6*qs, P=0.04), a tendency toward better quality of life (51.1-1.1*qs, P=0.09), and adherence (5.02+0.04*qs, P=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; P=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis.Conclusion: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Heart Failure/diagnosis , Surveys and Questionnaires , Health Education , Prospective Studies , Cohort Studies , PrognosisABSTRACT
Identification of the emerging multidrug-resistant yeast Candida auris is challenging. Here, we describe the role of the Mexico national reference laboratory Instituto de Diagnóstico y Referencia Epidemiológicos Dr. Manuel Martínez Báez (InDRE) and the Mexican national laboratory network in the identification of C. auris. Reference identification of six suspected isolates was done based on phenotypic and molecular laboratory methods, including growth in special media, evaluation of isolate micromorphology, and species-specific PCR and pan-fungal PCR and sequencing. The four C. auris isolates identified were able to grow on modified Sabouraud agar with 10% NaCl incubated at 42 °C. With one exception, isolates of C. auris were spherical to ovoid yeast-like cells and blastoconidia, with no hyphae or pseudohyphae on cornmeal agar. C. auris isolates were resistant to fluconazole. Species-specific and pan-fungal PCR confirmed isolates as C. auris. Sequence analysis revealed the presence of two different C. auris clades in Mexico, clade I (South Asia) and clade IV (South America).
Subject(s)
Candida , Candidiasis , Agar , Antifungal Agents/pharmacology , Candida auris , Candidiasis/diagnosis , Mexico , Microbial Sensitivity TestsABSTRACT
INTRODUCTION AND OBJECTIVE: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention. METHODS: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF. RESULTS: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (p=0.018), which was associated with greater self-care (28.5-0.6*qs, p=0.04), a tendency toward better quality of life (51.1-1.1*qs, p=0.09), and adherence (5.02+0.04*qs, p=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; p=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis. CONCLUSION: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis.
