ABSTRACT
La atención a pacientes con comorbilidad y pluripatología supone un reto para cualquier sistema sanitario. Las guías de práctica clínica (GPC) presentan limitaciones cuando se aplican a esta población. El objetivo de este trabajo es realizar una propuesta terminológica y metodológica sobre el abordaje de la comorbilidad y la pluripatología en las GPC. De acuerdo a la revisión bibliográfica efectuada, se sugieren algunas propuestas para su abordaje en las diferentes fases de elaboración de las GPC, con especial atención a la inclusión de los clusters de comorbilidad en las preguntas clínicas iniciales, la incorporación de la evidencia indirecta, el peso de la carga de gestionar la enfermedad para el paciente y su entorno en la formulación de recomendaciones, así como las estrategias de difusión e implementación. Estas propuestas deben desarrollarse en mayor profundidad con la participación de más agentes para disponer de herramientas válidas y útiles en esta población (AU)
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population (AU)
Subject(s)
Humans , Male , Female , Comorbidity/trends , Morbidity , Evidence-Based Medicine/methods , Evidence-Based Medicine/trends , Terminology as Topic , Chronic Disease/epidemiology , Chronic Disease/prevention & control , Primary Health Care/methods , Primary Health Care/trends , Prognosis , National Health SystemsABSTRACT
La atención a pacientes con comorbilidad y pluripatología supone un reto para cualquier sistema sanitario. Las guías de práctica clínica (GPC) presentan limitaciones cuando se aplican a esta población. El objetivo de este trabajo es realizar una propuesta terminológica y metodológica sobre el abordaje de la comorbilidad y la pluripatología en las GPC. De acuerdo a la revisión bibliográfica efectuada, se sugieren algunas propuestas para su abordaje en las diferentes fases de elaboración de las GPC, con especial atención a la inclusión de los clusters de comorbilidad en las preguntas clínicas iniciales, la incorporación de la evidencia indirecta, el peso de la carga de gestionar la enfermedad para el paciente y su entorno en la formulación de recomendaciones, así como las estrategias de difusión e implementación. Estas propuestas deben desarrollarse en mayor profundidad con la participación de más agentes para disponer de herramientas válidas y útiles en esta población
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population
Subject(s)
Humans , Male , Female , Terminology as Topic , Current Procedural Terminology , Chronic Disease/epidemiology , Chronic Disease/prevention & control , Comorbidity , Primary Health Care/legislation & jurisprudence , Primary Health Care/methods , Primary Health Care/trends , Chronic Disease/classification , Chronic Disease/mortality , PrognosisABSTRACT
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.
Subject(s)
Chronic Disease , Practice Guidelines as Topic , Chronic Disease/epidemiology , Chronic Disease/therapy , Comorbidity , HumansABSTRACT
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.
ABSTRACT
The authors make a detailed presentation about the steps to follow to ensure the patient is comfortable and that the execution of this technique is correct. The authors review the most important aspects, including asepsis and anesthesia, to prepare a wound for suturing and to make preparations for surgery. They also provide a brief description of the necessary surgical instruments and their characteristics.
Subject(s)
Dermatologic Surgical Procedures , Skin/injuries , Suture Techniques , Humans , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/nursingABSTRACT
Among the procedures in minor surgery, to suture wounds is a technique which nursing professional frequently perform as part of their normal work load, especially those nurses who work in Primary Health Care Centers and Emergency Wards. This article in the first in a series of three articles which enables the reader to review his/her knowledge about how to repair superficial skin lesions. After citing the legal aspects, the authors shall review each step in this procedure. We will check to see if the indication for suture is correct, evaluating a wound adequately. Afterwards, we review the procedure to clean the wound and to apply an anti-tetanus prophylaxis. We will mention how to adequately select the technique, the suture material and the instrument to be used. We will show the manner to use to avoid complications derived from an inadequate technique and we will continue with the follow up procedure for cicatrisation after first treatment, which includes informing the patient and a precocious treatment of complications, assuring the patient's welfare and the defense of his/her rights at all times; all of which will make possible an intervention which guarantees quality and is satisfactory to both the patient and the nursing professional who employs it.
Subject(s)
Dermatologic Surgical Procedures , Skin/injuries , Wounds, Penetrating/nursing , Wounds, Penetrating/surgery , HumansABSTRACT
En este tercer artículo se cierra la serie sobre cirugía en lesiones dérmicas superficiales. Se describe la realización de la técnica de sutura (suturas discontinuas y continuas), así como la técnica de anudado. También se tratan los aspectos de seguimiento de la herida y educación al paciente y la retirada de la sutura. El artículo finaliza con la bibliografía correspondiente a toda la serie (AU)
Subject(s)
Humans , Operating Room Nursing/methods , Suture Techniques/nursing , Patient Education as Topic/methods , Surgical Wound Infection/prevention & controlABSTRACT
Se detallan los pasos a seguir para conseguir que el paciente esté tranquilo y la ejecución de la técnica sea correcta. Se repasan los aspectos más importantes de la preparación de la herida (asepsia, anestesia...) y de la preparación del campo quirúrgico, con una breve descripción del instrumental quirúrgico necesario y sus características (AU)
Subject(s)
Asepsis/methods , Operating Room Nursing/methods , Operating Room Nursing/standards , Operating Room Nursing/organization & administration , Perioperative Nursing/methods , Perioperative Nursing/standards , Skin Diseases/nursing , Skin/injuries , Nursing Care/methods , Nursing Care/standards , Nursing Care/organization & administrationABSTRACT
Dentro de los procedimientos de cirugía menor, la sutura de heridas es una técnica que con frecuencia realizan en su labor asistencial los profesionales de enfermería, especialmente aquellos que trabajan en Atención Primaria de Salud y en Servicios de Urgencias. Este artículo es el primero de una serie de tres que ofrece al lector la posibilidad de revisar sus conocimientos sobre la reparación quirúrgica de lesiones dérmicas superficiales. Tras referenciar el marco legal, revisaremos cada uno de los pasos del procedimiento. Comprobaremos si la indicación de sutura es correcta, valorando adecuadamente la herida. Posteriormente procederemos a su limpieza y a la aplicación del protocolo de profilaxis antitetánica. Elegiremos adecuadamente tanto la técnica como el material de sutura y el instrumental a utilizar. Mostraremos la forma de evitar complicaciones derivadas de una técnica inadecuada y continuaremos con el seguimiento del proceso de cicatrización por primera intención, que incluye la educación al paciente y el tratamiento precoz de las complicaciones, asegurando en todo momento el bienestar del cliente y la defensa de sus derechos, que darán lugar a una intervención que garantice la calidad y sea satisfactoria tanto para el usuario como para el profesional que la practica (AU)
Subject(s)
Skin Transplantation , Suture Techniques/nursing , Sutures , Antibiotic Prophylaxis/nursing , Wound Healing/physiology , Nursing Care/methods , Nursing Care/standards , Nursing Care/organization & administration , Nurse Clinicians/organization & administration , Skin Diseases/nursing , Minor Surgical Procedures/methods , Skin/injuries , Skin Care/nursing , Skin Care/methods , Nurses/organization & administration , Nurses/trends , NursesABSTRACT
This third article closes a series about surgery in superficial skin lesions. The authors describe how to perform the technique of suture, both continuous and discontinuous suture, as well as the technique of knotting. The authors also describe the follow up procedures for treating a lesion, how to inform a patient about this procedure and the removal of the suture. At the end of this article, the authors include a bibliography for the entire series.
