Prognostic value of defining characteristics in frail elderly syndrome: Hospital readmission and mortality outcomes.

OBJECTIVE: To identify the most relevant clinical characteristics of the nursing diagnosis frail elderly syndrome (FES) in hospitalized patients aged 65 or older and analyze their impact on 9-month mortality and hospital readmission. METHODS: A prospective and prognostic accuracy study was conducted in patients aged 65 or older, who were admitted to hospital more than 24 h. A consecutive convenience sampling process was used. Assessment included defining characteristics (DCs) of FES, clinical fraility scale (CFS), frail scale (FS), and 9-month mortality and hospital readmission. Statistical tests were used to verify associations between variables. Binary logistic regression analysis and area under the curve were used, to identify significant predictors for the outcomes and evaluate the prognostic accuracy of the DCs. FINDINGS: This study involved 150 patients. CFS scored 65 patients (43.3%, confidence interval 95% 35.2% a 51.6) as frail and proved a prognostic value of mortality at 9 month from pre-frail state (p = 0.020). The mean number of DCs for FES nursing diagnosis was 6.35 (SD = 3.14). Validated tools for measuring frailty were associated with all DCs, excepting nutritional imbalance: below body needs. The hospital readmission during the following 9 months was only statistically related to memory impairment (p = 0.07). CONCLUSION: Clinical frailty scale showed good results as a predictor of mortality. The study suggests exploring including it, in clinical manifestations of elderly frail syndrome. This study found that only memory impairment defining characteristic was predictive of hospital readmission. Further research should identify other relevant and prognostic clinical manifestations. IMPLICATION FOR NURSING PRACTICE: These findings highlight the importance of being vigilant on cognitive decline during hospital admissions. The most prevalent and determinant DCs identified in this study indicate that clinical should focus on preserving functional and mental abilities as well as mobility.

Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta-analysis.

AIMS: To determine adverse effects of ventrogluteal intramuscular injections versus dorsogluteal intramuscular injections. DESIGN: A systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, CINHAL, CENTRAL, LILACS(BVS), BDENF (BVS), WoS, IRCTP(WHO), ClinicalsTrials.gov and PROSPERO databases were searched with no restriction on year or language. Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS: A total of 1429 participants from 17 studies were included. The meta-analysis found that ventrogluteal injection site had significant relation to lower pain in 9 studies (SMD = -0.63, 95% CI = -0.87, -0.39), bleeding in 4 studies (SMD = -3.46, 95% CI = -6.07, -0.86) and hematoma in 2 studies; after 48 h (SMD = -0.25, 95% CI = -0.39, -0.11), and after 72 h (SMD = -0.16, 95% CI = -0.26, -0.06), if it was compared with dorsogluteal site injection. No differences were found when comparing the possibility of intramuscular injections given into de subcutaneous tissue. In three studies, ventrogluteal site did not significantly reduce the risk of subcutaneous injection (OR 0,62, 95% CI = 0.16, 2.41).

Bienestar de la mujer durante el proceso de parto: comparación de dos herramientas de evaluación / Women's welfare during the process of childbirth: a comparison of two evaluation tolos

OBJETIVO: Describir la experiencia y el bienestar de las mujeres durante el proceso de parto atendido en el Área de Salud 2-Cartagena, del Servicio Murciano de Salud, y relacionarlos con las características ociodemográficas y obstétricas de la muestra y discutir la adecuación de las escalas utilizadas CEQ-E y BMSP2 en el entorno donde se emplean. MÉTODO: Estudio descriptivo de corte transversal realizado sobre 120 mujeres con parto eutócico. Los datos fueron recogidos mediante las encuestas CEQ-E y BMSP2. RESULTADOS: El bienestar y la experiencia durante el parto fueron valorados entre adecuados y óptimos por un 83,8% de las participantes (120 mujeres) con la escala BMSP2, y con una puntuación media de 3,19 sobre 4 puntos con la herramienta CEQ-E. Los resultados de las subescalas indican que el apoyo profesional y el contacto madre-hijo fueron las dimensiones mejor valoradas. El bienestar y la satisfacción no se relacionaron con la edad, la fórmula obstétrica, el tipo de inicio de parto, la duración del parto y el desgarro durante el expulsivo. Únicamente la nacionalidad y el tipo de anestesia se relacionaron de forma estadísticamente significativa con algunas de las subescalas de las herramientas utilizadas. Entre las dos escalas de nuestro estudio existe una correlación positiva moderada (R = 0,557) que contribuye a la validez de criterio de la escala BMSP2. CONCLUSIONES: La correlación positiva entre las dos herramientas nos indica que ambas pueden ser útiles en contextos culturales como el mediterráneo, en el que son valoradas tanto la autoeficacia (dimensión que enfatiza la herramienta CEQ-E elaborada en Suecia) como la participación de la familia (dimensión incluida en la herramienta chilena BMSP2)

OBJECTIVE: Describe the experience and well-being of women in Area II of the Murcian Health Service during the birth process, and relate them to the sociodemographic and obstetric characteristics of the sam-ple, and discuss the adequacy of the scales used CEQ-E and BMSP2 in the environment where they are used. METHOD: Descriptive crosssectional study performed on 120 women with eutocic delivery. The data was collected through the CEQ-E and BMSP2 surveys. RESULTS: The level of well-being was assessed as adequate and optimal in 83.8% of the participants (120 women), with the BMSP2 scale, and with an average score of 3.19 over 4 points with the CEQ-E tool. The results of the subscales indicate that the professional support and the contact mother-newborn were the most valued dimensions. Well-being was not related to age, the obstetric formula, type of onset of labor, the duration of delivery and the tear during the expulsive period. Only the nationality and the type of anesthesia were related in a statistically significant way with some of the subscales of the tools used. Between the two scales of our study, there is moderate positive correlation (R = 0.557) that contributes to the criterion validity of the BMSP2 scale. CONCLUSIONS: The positive correlation between the two surveys indicates that both can be useful in cultural contexts such as the Mediterranean, in which both self-efficacy (dimension that emphasizes the CEQ-E scale developed in Sweden) and family participation are valued (dimension included in the Chilean questionary BMSP2)

Validación del cuestionario CTM-3-modificado sobre satisfacción con la continuidad de cuidados: un estudio de cohortes / Validation of the CTM-3-Modified Questionnaire on Satisfaction with Continuity of Care: A Cohort Study / Validação do questionário CTM-3-modificado sobre a satisfação com a continuidade de cuidados: um estudo de coortes

RESUMEN Objetivos: validar el contenido y constructo de la encuesta CTM-3 (Care Transitions Measure- 3 preguntas) modificada. Determinar el nivel de satisfacción de los usuarios con la continuidad de cuidados de enfermería interniveles y relacionarlo con la presencia de Informe de Cuidados de Enfermería tras su última hospitalización. Material y método: estudio de cohortes retrospectivo, con 131 pacientes hospitalizados en el Complejo Hospitalario de Cartagena (España).La satisfacción con la continuidad de cuidados se valoró con el cuestionario CTM-3-modificado, resultado de un proceso de validación realizado sobre el mismo. Resultados: un 94% de los encuestados presenta una satisfacción aceptable con el proceso de continuidad de cuidados. Los pacientes con Informe de Cuidados tienen un nivel alto de satisfacción con la continuidad de cuidados, RR= 0,90 (IC 95%: 0,831-0,990). Conclusiones: La validez de contenido y constructo realizadas, han permitido medir la satisfacción de los usuarios con la continuidad y su correlación con la presencia de informe, obteniendo como resultado que la realización de Informe de Cuidados influye ligeramente en la satisfacción con el proceso de continuidad de cuidados. Sin embargo, el hecho de que el informe se entregue en mano y/o se explique no parece afectar a la misma.

ABSTRACT Objectives: validate the content and construction of the modified CTM-3 survey (Care Transitions Measure - 3 questions). Determine the level of user satisfaction with the continuity of intermediate-level nursing care and relate it to the presence of a nursing care report after the most recent hospitalization. Material and method: A retrospective cohort study was conducted with 131 patients hospitalized at the Cartagena Hospital Complex (Spain). Satisfaction with the continuity of care was assessed with the CTM-3-modified questionnaire, which is the result of an earlier validation process. Results: Ninety-four percent (94%) of those who responded to the questionnaire indicated acceptable satisfaction with the continuity-of-care process. Patients with a care report have a high level of satisfaction with the continuity of care: RR = 0.90 (95% CI: 0.831-0.990). Conclusions: The content and construct validity of the questionnaire make it possible to measure user satisfaction with the continuity of care and its correlation to the presence of a care report, the result being that preparation of a care report slightly influences the level of satisfaction with the continuity-of-care process. On the other hand, the fact that the report is delivered by hand and/or explained appears to have no effect.

RESUMO Objetivos: validar o conteúdo e constructo do questionário CTM-3 (Care Transitions Measure - três perguntas) modificado. Determinar o nível de satisfação dos usuários com a continuidade de cuidados de enfermagem interníveis e relacioná-lo com a presença de relatório de cuidados de enfermagem após sua última hospitalização. Material e método: estudo de coortes retrospectivo, com 131 pacientes hospitalizados no Complexo Hospitalar de Cartagena (Espanha). A satisfação com a continuidade de cuidados foi avaliada com o questionário CTM-3-modificado, resultado de um processo de validação realizado sobre este. Resultados: 94 % dos entrevistados apresentam satisfação aceitável com o processo de continuidade de cuidados. Os pacientes com relatório de cuidados têm nível alto de satisfação com a continuidade de cuidados, RR= 0,90 (IC 95 %: 0,831-0,990). Conclusões: a validade de conteúdo e constructo realizada permite medir a satisfação dos usuários com a continuidade e sua correlação com a presença de relatório, obtendo como resultado que a realização de relatório de cuidados influencia levemente na satisfação com o processo de continuidade de cuidados. Contudo, o fato de que o relatório seja entregue em mãos e/ou seja explicado não parece afetá-la.

Influencia de la infusión contínua de insulina subcutánea en el control de la diabetes tipo 1 en niños / Influence of continuous subcutaneous insulin infusion in the control of type 1 diabetes in children

La diabetes mellitus tipo 1 es la enfermedad crónica endocrinológica más frecuente en la edad pediátrica. El autocuidado y el conocimiento sobre la enfermedad están relacionados con la reducción en costes en salud y con una mejora en la calidad de vida. La bomba de infusión s continua de insulina subcutánea (ICIS) imita la fisiología normal y elimina la necesidad de inyecciones repetidas, quedando por determinar si este tratamiento favorece el autocontrol de la diabetes. Material y Métodos: Estudio de Cohortes retrospectivo.La recogida de datos se realiza a través de un cuestionario basado en los NOC «Conocimiento: control de la diabetes» y «Autocontrol diabetes» a todos los niños con ICIS del área II de salud de la Región de Murcia, así como a sus homólogos de inyecciones múltiples. Para la determinación de resultados se utilizó el programa estadístico SPSS v.21. Resultados: Los sujetos del estudio tienen una edad media de 11 años, siendo 60% hombres y el 40% mujeres. No se obtuvieron diferencias estadísticamente significativas con respecto al nivel de conocimientos, autocontrol y valores de HbA1c entre el grupo de expuestos (ICIS) y no expuestos (inyecciones múltiples), excepto en el siguimiento de la dieta, donde si se obtuvo relación con el tratamiento con ICIS (p=0.037) . La edad también se relacionó con un aumento en los conocimientos (p=0.001). Conclusión: Las unidades familiares con menores de 7 años con inyecciones múltiples, deberán tener una formación más intensa sobre todo dirigida a disminuir la ansiedad y dudas de los padres (AU)

Diabetes mellitus type 1 is the most frequent endocrinological chronic disease during childhood. Self-care and the knowledge about this disease are the facts that are directly related to the reduction of health costs as well as the improvement of the life quality. The continuous subcutaneous insulin infusion pump (CSII) emulates the normal physiology and eliminates the need of continuous injections, remaining to determinate if this treatment contributes positively to the self-control of the diabetes. Didactic Materials and Methods: Retrospective cohort study. The data collection is made by a survey based on the NOC’s «Conocimiento: control de la diabetes» (Knowledge: diabetes control) and «Autocontrol diabetes» (Diabetes self-care) of all the children with continuous subcutaneous insulin infusion pump (CSII) at the health area number 2 from the Region of Murcia, as well as to their homologous with multiple injection. To draw the results, the statistic program SPSS v21, was the one used. Results: The study subjects have an average age of 11 years, being the 60% male and 40% female. Statistical significance was not obtained concerning to the level of knowledge, self-control and HbA1c values between the exposed group (CSII) and nonexposed group (multiple injection), except for the diet monitoring, where there was obtained a connection with the CSII treatment (p=0.037). The age was also related to a knowledge increasement (p=0.001). Conclusion: Households units with children under 7 years with multiple injections should have a more intense training in order to reduce the anxiety and doubts of the parents (AU)

Migración internacional de retiro. Procesos de autocuidado grupales entre inmigrantes británicos jubilados / International migration retirement. Self-care group processes among british immigrants retirees

Objetivo: Identificar prácticas autogestionarias grupales de atención a la dependencia, entre extranjeros británicos residentes en la Región de Murcia. Metodología: Diseño de investigación de carácter cualitativo con enfoque metodológico etnográfico. Población: inmigrantes británicos jubilados residentes en Mazarrón (Murcia). Las estrategias para recoger datos fueron las entrevistas en profundidad y la observación no participante. Resultados principales: Emergieron cinco categorías 'Prácticas de autocuidado en red', 'Los amigos y la familia', 'Sociabilidad y espacios identitarios', 'Percepción del sistema sanitario en España' y 'Expectativas de futuro y planificación de cuidados al final de la vida'. Conclusión principal: El análisis de las prácticas de autocuidado de los inmigrantes jubilados británicos nos muestra un colectivo que gestiona, en parte, la dependencia a través de 'sistemas de cuidado colaborativos' y que contrasta con el escaso asociacionismo de la tercera edad en España

Objective: Identify group self-managed dependence care practices between British immigrants residents in Region de Murcia. Methods: Qualitative research with ethnographic methodological approach. Population: retired British immigrants resident in Mazarrón (Murcia). Strategies for collecting data were in-depth interviews and nonparticipant observation. Results: The data is structured into 5 categories 'Practice selfcare network', 'Friends and Family', 'Sociability and identity spaces', 'Perception of the health system in Spain' and 'Expectations of future care planning at the end of life'. Conclusions: The analysis of self-care practices of immigrant British retirees, shows us a group that manages, partly, dependence through 'collaborative care systems' which contrasts with the poor elderly associations in Spain

Características de la escala Downton en la valoración del riesgo de caídas en pacientes hospitalizados / Characteristics of the Downton fall risk assessment scale in hospitalised patients

Objetivo: Describir las características de las valoraciones del riesgo de caídas y el perfil de los pacientes que sufrieron caídas en un hospital público del Sistema Nacional de Salud y determinar si existió asociación entre la «presencia de caídas» y la puntuación previa en la escala Downton, con el objeto de calcular algunas de las características de esta herramienta: sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, odss ratio y razón de verosimilitud. Metodología: diseño descriptivo retrospectivo sobre la incidencia de caídas registradas en el Complejo Hospitalario de Cartagena, realizando un análisis de las posibles causas y consecuencias de las mismas durante el período 2010-2015 (marzo). Un total de 576 pacientes sufrieron caídas durante el periodo analizado, de los cuales 107 no tenían ningún registro de «riesgo de caídas». La muestra final de pacientes fue de 469. El análisis estadístico de datos se realizó con el programa SPSSv.19. Resultados: En el contexto en el que se utiliza, la escala de Downton tiene una sensibilidad del 0,58; una especificidad de 0,62; una razón de verosimilitudes positiva del 1,55 y una razón de verosimilitudes negativa del 0,67. La odss ratio calculada fue de 2,31. Conclusiones: Los datos sobre incidencia de caídas (0,51%) son parecidos a los encontrados en otros trabajos. Los pobres resultados obtenidos en las características de la Escala Downton deberían ser una llamada de atención para las Instituciones Sanitarias. Una herramienta de valoración que clasifique a un paciente de riesgo debe ser incluida en los protocolos de seguridad del paciente si tiene una validez adecuada, y si permite evaluaciones rápidas y fiables que capten los cambios en la situación del paciente, con mejor criterio que el propio profesional de Enfermería (AU)

Objective: To describe the risk of falls assessments properties and profiles of the patients who fell in a public hospital of the National Health System, and to determine the relationship between the «presence of a fall» and the previous score using the Downton scale, in order to calculate some of the features of this tool: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, and odss ratio. Materials and methods: a study with a descriptive retrospective design was conducted on the incidence of falls recorded in Cartagena Hospital. An analysis was made of possible causes and effects of falls during the period from March 2010 to March 2015. A total of 576 patients fell during the period of the study, of whom 107 were recorded in the no «fall risk» registry, leaving a sample of 469 patients in the study. Data analysis was performed using the SPSSv.19 Statistics Package. Results: In the context in which the assessment was made, the Downton scale had a sensitivity of 0.58, specificity 0.62, a positive likelihood ratio of 1.55, and negative likelihood ratio of 0.67. The odds ratio calculated was 2.31. Conclusions: The data on the incidence of falls (0.51%) are similar to those found in other studies. Poor scores obtained on the Downton Index should serve as a wakeup call for the healthcare institutions. An assessment tool that classifies the at-risk patient should be included in patient safety profiles, provided it is of relevant validity to cover any changes in the patient’s situation, and acts as a better yardstick than the nurses' own assessment (AU)

Culture-bound syndromes in migratory contexts: the case of Bolivian immigrants.

Objective: to describe the culture-bound syndromes maintained by Bolivian immigrants in the new migratory context and analyze the care processes of these health problems. Method: qualitative research with an ethnographic methodological approach. Sample: 27 Bolivian immigrants. In-depth interviews and participatory observation were the strategies used for data collection. Data were classified and categorized into logical schemes manually and using the ATLAS-ti program v.5. Results: susto, "wayras", amartelo, pasmo de sol, pasmo de luna and pasmo de sereno are some of the folk illnesses that affect the Bolivian immigrants and that they have to treat in the new migratory context. Conclusions: in the new environment, the group under study preserves culture-bound syndromes that are common in their country of origin. The care strategies used for these health problems are adapted to the resources of the new context and based on interactions with the domestic environment, biomedicine and traditional medicine. It was observed the need for the health professionals to realize that the efficacy of certain therapies occurs within the scope of cultural beliefs and not in that of the scientific evidence.

Characteristics of the Downton fall risk assessment scale in hospitalised patients. / Características de la escala Downton en la valoración del riesgo de caídas en pacientes hospitalizados.

OBJECTIVE: To describe the risk of falls assessments properties and profiles of the patients who fell in a public hospital of the National Health System, and to determine the relationship between the "presence of a fall" and the previous score using the Downton scale, in order to calculate some of the features of this tool: Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio, and odss ratio. MATERIALS AND METHODS: A study with a descriptive retrospective design was conducted on the incidence of falls recorded in Cartagena Hospital. An analysis was made of possible causes and effects of falls during the period from March 2010 to March 2015. A total of 576 patients fell during the period of the study, of whom 107 were recorded in the no "fall risk" registry, leaving a sample of 469 patients in the study. Data analysis was performed using the SPSSv.19 Statistics Package. RESULTS: In the context in which the assessment was made, the Downton scale had a sensitivity of 0.58, specificity 0.62, a positive likelihood ratio of 1.55, and negative likelihood ratio of 0.67. The odds ratio calculated was 2.31. CONCLUSIONS: The data on the incidence of falls (0.51%) are similar to those found in other studies. Poor scores obtained on the Downton Index should serve as a wakeup call for the healthcare institutions. An assessment tool that classifies the at-risk patient should be included in patient safety profiles, provided it is of relevant validity to cover any changes in the patient's situation, and acts as a better yardstick than the nurses' own assessment.

Culture-bound syndromes in migratory contexts: the case of Bolivian immigrants / Síndromes vinculadas à cultura nos processos migratórios: o caso dos imigrantes bolivianos / Síndromes culturalmente definidos en los procesos migratorios: el caso de los inmigrantes bolivianos

ABSTRACT Objective: to describe the culture-bound syndromes maintained by Bolivian immigrants in the new migratory context and analyze the care processes of these health problems. Method: qualitative research with an ethnographic methodological approach. Sample: 27 Bolivian immigrants. In-depth interviews and participatory observation were the strategies used for data collection. Data were classified and categorized into logical schemes manually and using the ATLAS-ti program v.5. Results: susto, "wayras", amartelo, pasmo de sol, pasmo de luna and pasmo de sereno are some of the folk illnesses that affect the Bolivian immigrants and that they have to treat in the new migratory context. Conclusions: in the new environment, the group under study preserves culture-bound syndromes that are common in their country of origin. The care strategies used for these health problems are adapted to the resources of the new context and based on interactions with the domestic environment, biomedicine and traditional medicine. It was observed the need for the health professionals to realize that the efficacy of certain therapies occurs within the scope of cultural beliefs and not in that of the scientific evidence.

RESUMO Objetivo: descrever as síndromes vinculadas à cultura mantidas pelos imigrantes bolivianos no novo contexto migratório e analisar os processos de cuidado para esses problemas de saúde. Método: projeto de pesquisa de natureza qualitativa e com abordagem metodológica etnográfica. Amostra: 27 imigrantes bolivianos. As estratégias para a coleta de dados foram as entrevistas em profundidade e a observação participativa. Os dados foram classificados e categorizados em esquemas lógicos manualmente e por meio do programa ATLAS-ti v.5. Resultados: o susto, os "wayras", o amartelo (tristeza), o pasmo de sol, o pasmo de lua e o pasmo de sereno são algumas das síndromes de caráter popular que acometem os imigrantes bolivianos, e que eles tratam no novo contexto migratório. Conclusões: no novo ambiente, as síndromes vinculadas à cultura, comuns em seu país de origem, são mantidas pelo grupo estudado. As formas de cuidado para esses problemas de saúde são adaptadas aos recursos do novo contexto e baseadas em interações com o ambiente doméstico, a biomedicina e a medicina tradicional. Foi constatada a necessidade de que os profissionais de saúde reconheçam que a eficácia de determinadas terapias se dá no âmbito das crenças culturais e não no âmbito da comprovação científica.

RESUMEN Objetivo: describir los síndromes de filiación cultural que mantienen los inmigrantes bolivianos en el nuevo contexto migratorio y analizar los procesos de atención de estos padecimientos. Método: diseño de investigación de carácter cualitativo con enfoque metodológico etnográfico. Muestra: 27 inmigrantes bolivianos. Las estrategias para recoger datos fueron las entrevistas en profundidad y la observación participante. Los datos se categorizaron y ordenaron en esquemas lógicos manualmente y a través del programa ATLAS-ti v.5. Resultados: el susto, los "wayras", el amartelo, el pasmo de sol, el pasmo de luna y el pasmo de sereno son algunos de los síndromes de carácter folk que los inmigrantes bolivianos padecen y tratan en el nuevo contexto migratorio. Conclusiones: en el nuevo entorno, el colectivo estudiado mantiene síndromes de filiación cultural comunes en su país de origen. Las formas de atención de éstos padecimientos se adaptan a los recursos del nuevo contexto y se basan en transacciones con el ámbito doméstico, la biomedicina y la medicina tradicional. Se constata la necesidad de que el profesional sanitario reconozca que la efectividad percibida de ciertas terapias opera dentro del ámbito de las creencias culturales y no en el de la evidencia científica.