Valoración de un proyecto de “triage” de urgencias por enfermería en atención primaria / Evaluation of a primary care nursing emergencies triage project

Objetivo: Conocer la valoración, por parte de enfermeras y estudiantes de enfermería, sobre cambios organizativos para la instauración de un sistema de “triage” de urgencias en atención primaria. Diseño del estudio: Estudio cualitativo, tipo grupo focal. Emplazamiento: Atención primaria. Participantes: Enfermeras de atención primaria y estudiantes de tercer curso de enfermería. Método: Se constituyeron dos grupos, uno formado por siete enfermeras, pertenecientes a centros de salud urbano, rurales y SUAP; y un segundo grupo formado por cinco estudiantes de tercer curso de enfermería. Se realizó una videograbación de las reuniones y posteriormente se llevó a cabo un proceso de análisis y síntesis de la información. Resultados: Se constató un acuerdo en ambos grupos sobre la factibilidad de esta tarea y, en general, se consideraban con suficiente cualificación para su desempeño. Se subrayó asimismo la importancia de que no recaiga sobre el área administrativa la responsabilidad de decidir quién y cuándo debe atender a un paciente que requiere atención inmediata. En el grupo de enfermeras se hizo especial hincapié en que este proyecto no sería viable con las cargas de trabajo actuales, por lo que planteaban la necesidad de aumentar las plantillas o introducir cambios organizativos. Los estudiantes se mostraban interesados por asumir este tipo de tareas, aunque desearían una mayor formación específica en su currículo académico. Consideraban fundamental delimitar tareas y protocolizar actividades. Conclusiones: Enfermeras cualificadas en el trabajo en atención primaria y estudiantes de enfermería en la fase final de su formación coinciden en la factibilidad de implantar un sistema de “triage” para pacientes que requieren atención inmediata en un centro de salud (AU)

Objective: To ascertain the evaluation of nurses and nursing students on organisational changes for the establishment of a triage system for primary care emergencies. Design: Focus group qualitative study. Location: Primary Care. Participants: Primary health care nurses and third year nursing students. Method: Two groups were formed, one of seven nurses from city, rural and SUAP healthcare centres and a second group made up of five third year nursing students. A video recording was made of the meetings and later a process of analysis and synthesis of the information was carried out. Results: There was agreement between both groups on the feasibility of this task and, in general, they considered themselves sufficiently qualified to perform it. Likewise, importance was given to the fact that responsibility for deciding who should attend to a patient needing immediate care, and when, should not fall on the administrative area. In the nursing group, special emphasis was placed on the fact that this project would not be viable with current workloads and, for this reason, they put forward the need to increase the workforce or to bring in organisational changes. The students showed interest in taking on this kind of task, although they would wish for greater specific training in their academic curriculum. They considered definition of tasks and regulation of activities to be fundamental. Conclusions: Qualified nurses at work in primary care and nursing students nearing the end of their training agree on the feasibility of implementing a triage system for patients requiring immediate attention at a healthcare centre (AU)

[Variability in the control of oral anticoagulant therapy between primary care and hospital in Albacete (2009)]. / Variabilidad en los controles de la terapia anticoagulante oral entre atención primaria y hospital en Albacete (2009).

BACKGROUND: After taking control of oral anticoagulant therapy in our health center it became necessary to detect possible differences with regard to hospital monitoring. The aim of our study was to determine the variability in the International Normalized Ratio (INR) values of patients on oral anticoagulant therapy (OAT), and the possible relation to control in primary care or hospital. METHODS: We analyzed the last 6 controls of 291 patients in an urban health centre in routine control by OAT. In order to analyze the variability, we calculated the standard deviation (SD) of natural logarithm (ln) of INR values, comparing by Student t test their mean between patients whose treatment had been scheduled in primary care and those on some occasions ruled by them and others in hospital. We compared also the proportion of controls within range in each group (chi2). RESULTS: 153 (52.6%) patients were women, and the mean age was 73.8 years (SD: 11.3). We analyzed a total of 1710 INR controls, of which 1412 have been validated by family physicians and 298 by haematologists; there were no significant differences in INR values. Patients whose treatment had been scheduled by professionals of the health centre had mean values of the SD of the ln of the INR of 6 controls analyzed significantly lower (p <0.0001) than in those who had taken a mixed control. Also, a higher proportion of controls within range (68.0% vs 38.6%, p <0.0001). CONCLUSIONS: Patients who are followed only by professionals in the health centre have less variability and more appropriate INR control than those with a mixed control health centre / hospital.

Variabilidad en los controles de la terapia anticoagulante oral entre Atención Primaria y Hospital en Albacete (2009) / Variability in the control of oral anticoagulant therapy between primary care and Hospital in Albacete (2009)

Fundamento: Tras asumir el control de la terapia anticoagulante oral en nuestro centro de salud surgió la necesidad de detectar posibles diferencias con respecto al seguimiento hospitalario. El objetivo de nuestro trabajo fue conocer la variabilidad en los valores del Cociente Normalizado Internacional (INR) de los pacientes en tratamiento anticoagulante oral (TAO), y su posible relación con el control en centro de salud u hospital. Métodos: Se analizaron los 6 últimos controles de 291 pacientes de un centro de salud urbano en control rutinario por TAO. A fin de analizar su variabilidad, se ha calculado la desviación estándar (DE) de los logaritmos neperianos (ln) de los valores de INR, comparando por medio del test t de Student la media de las mismas entre aquellos pacientes cuyo tratamiento había sido pautado por profesionales del centro de salud y aquellos pautados en unas ocasiones por éstos y en otras en hospital. Se comparó asimismo la proporción de controles dentro de rango en cada grupo (chi2). Resultados: Eran mujeres 153 (52,6%) de los pacientes, y la media de edad era 73,8 años (DE: 11,3). Se han analizado un total de 1.710 controles de INR, de los que 1.412 han sido validados por médicos de familia y 298 por hematólogos, sin que existieran diferencias significativas en los valores de INR analizados por unos y otros. Los pacientes cuyo tratamiento había sido pautado siempre por profesionales del centro de salud presentaron unos valores medios de DE de los ln de los INR de los 6 controles analizados significativamente inferior (p<0,0001) al de aquellos que habían llevado un control mixto. Asimismo, presentaban una mayor proporción de controles dentro de rango (un 68,0% vs 38,6%; p<0,0001). Conclusiones: Los pacientes que son seguidos exclusivamente por los profesionales del centro de salud presentan una menor variabilidad y más adecuados controles de INR que aquellos con un control mixto centro de salud/hospital(AU)

Background: After taking control of oral anticoagulant therapy in our health center it became necessary to detect possible differences with regard to hospital monitoring. The aim of our study was to determine the variability in the International Normalized Ratio (INR) values of patients on oral anticoagulant therapy (OAT), and the possible relation to control in primary care or hospital. Methods: We analyzed the last 6 controls of 291 patients in an urban health centre in routine control by OAT. In order to analyze the variability, we calculated the standard deviation (SD) of natural logarithm (ln) of INR values, comparing by Student t test their mean between patients whose treatment had been scheduled in primary care and those on some occasions ruled by them and others in hospital. We compared also the proportion of controls within range in each group (chi2). Results: 153 (52.6%) patients were women, and the mean age was 73.8 years (SD: 11.3). We analyzed a total of 1710 INR controls, of which 1412 have been validated by family physicians and 298 by haematologists; there were no significant differences in INR values. Patients whose treatment had been scheduled by professionals of the health centre had mean values of the SD of the ln of the INR of 6 controls analyzed significantly lower (p <0.0001) than in those who had taken a mixed control. Also, a higher proportion of controls within range (68.0% vs 38.6%, p <0.0001). Conclusions: Patients who are followed only by professionals in the health centre have less variability and more appropriate INR control than those with a mixed control health centre / hospital(AU)

“Si llevas el Anillo conéctate a la Web”: Análisis de las opiniones encontradas en foros de Internet sobre el uso del Anillo Anticonceptivo Vaginal / “If you use the Ring get on line”: Analysis of the opinions on the use of the Vaginal Contraceptive Ring found on Internet forums

Objetivos. Conocer las opiniones acerca del uso del anillo anticonceptivo vaginal expresadas en foros de Internet. Diseño del estudio. Estudio cualitativo. Emplazamiento. Atención comunitaria. Participantes. Participantes en foros de Internet relacionados con el uso del anillo vaginal. Mediciones y Resultados. Por medio de una búsqueda en Google se identificaron foros en los que sehiciera referencia al uso del anillo vaginal. Se han revisado 85 foros, seleccionando opiniones de 246participantes. Seguidamente se clasificó y sintetizó la información recogida. Como ventajas más relevantes se han destacado: comodidad de administración, no suele haberolvidos, regula el ciclo menstrual, no produce aumento de peso, su eficacia no se afecta por vómitoso diarreas, y se evita el primer paso de metabolismo hepático. Entre los inconvenientes habría que resaltar: sensación de que se va a salir, precio, algunas mujeres se quejan de irregularidad menstrual ,irritación vaginal, sensibilidad mamaria, aumento de peso, cambios de humor, cefalea, menos flujovaginal, náuseas, cansancio, e interacciones medicamentosas. Se subrayan también inconvenientes en relación con la aplicación del dispositivo, el modo de conservación o cuándo empieza a ser efectivo. Las opiniones sobre cómo afecta a las relaciones sexuales oscilan entre quienes consideran que aumenta la libido y quienes refieren una disminución del deseo sexual, o bien molestias en las relaciones, debido a que la pareja o las usuarias lo notan. Conclusiones. El anillo vaginal es un método anticonceptivo fácil de utilizar, cómodo de aplicar y seguro, sin embargo, presenta frecuentes efectos adversos sobre todo a nivel local (AU)

“If you use the Ring get on line”: Analysis of the opinions on the use of the Vaginal Contraceptive Ring found on Internet forums Objectives. To learn the opinions on the use of the vaginal contraceptive ring expressed on Internet forums. Study design. Qualitative study Setting. Community healthcare. Participants. Participants on internet forums related to the use of vaginal rings. Measurements and Results. A search on Google identified forums that referred to the use of the vaginal ring. A total of 85 forums were reviewed, and opinions from 246 participants were selected. The information was then classified and summarised. The most significant advantages pointed out were: easy to use, not easily forgotten, regulates menstrual cycle, doesn’t cause weight gain, its effi cacy is not affected by vomiting or diarrhea, it avoids first pass hepatic metabolism. Amongst the disadvantages pointed out were: feeling that it is going to slip out, some women complained of irregular periods, vaginal irritation, breast tenderness, weight gain, nausea, mood swings, headache, vaginal dryness, nausea, tiredness and drug interactions. Other drawbacks related to the insertion of the ring, how to store it or when it becomes effective, were emphasised. Opinions on how it affected sexual relations ranged from increased libido to a decrease in sexual desire, or the user or user’s partner can feel it during sexual intercourse. Conclusions. The vaginal ring is an easy to use contraceptive method, easy to insert and safe. However there are frequent adverse effects especially local effects (AU)