[Impacto de la covid-19 en el estrés, la ansiedad y la depresión en personas con Trastorno Obsesivo Compulsivo: una revisión sistemática.] / Impact of covid-19 on stress, anxiety and depression in people with Obsessive-Compulsive Disorder: a systematic review.

OBJECTIVE: The population's mental health has been compromised by a global pandemic, especially in patients with obsessive-compulsive disorder. The objective of this study was to evaluate the levels of stress, anxiety and depression in patients with obsessive-compulsive disorder during COVID-19 pandemic. METHODS: A systematic review was carried out following the PRISMA format in the electronic databases Pubmed, Scopus, Web of Science, Dialnet and Medline between the months of January and May 2023. Method quality was assessed based on the critical evaluation tools for studies of the Joanna Briggs Institute (JBI). RESULTS: A total of twelve studies were included in this review. The mental health of the population has been compromised by the COVID-19 pandemic, with patients with obsessive-compulsive disorder being especially affected. Although there was a wide variability of results, it was observed that the level of stress and anxiety increased during the pandemic. CONCLUSIONS: The mental health of patients with obsessive-compulsive disorder, especially washing machine patients, is compromised in times of pandemic, presenting medium-high levels of stress, anxiety and depression.

OBJETIVO: La salud mental de la población se ha visto comprometida ante una situación de pandemia mundial, especialmente en pacientes con Trastorno Obsesivo Compulsivo (TOC). El objetivo de este estudio fue evaluar los niveles de estrés, ansiedad y depresión en pacientes con TOC durante la pandemia de la COVID-19. METODOS: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Scopus, Web of Science, Dialnet y Medline entre los meses de enero y mayo de 2023. A partir de las herramientas de evaluación crítica para estudios del Joanna Briggs Institute (JBI) se evaluó la calidad metodológica. RESULTADOS: Un total de doce estudios fueron incluidos en esta revisión. La salud mental de la población se vio comprometida ante la pandemia de la COVID-19, siendo especialmente afectados los pacientes con TOC. Aunque existió una amplia variabilidad de resultados, se observó que el nivel de estrés y ansiedad aumentó durante la pandemia. CONCLUSIONES: La salud mental de los pacientes con TOC, especialmente los que tienen TOC de limpieza, se ve comprometida en tiempos de pandemia, presentando niveles medios-altos de estrés, ansiedad y depresión.

Impacto de la COVID-19 en el estrés, la ansiedad y la depresión en personas con Trastorno Obsesivo Compulsivo: una revisión sistemática / mpact of COVID-19 on stress, anxiety and depression in people with Obsessive-Compulsive Disorder: a systematic review

Fundamentos: La salud mental de la población se ha visto comprometida ante una situación de pandemia mundial, especialmente en pacientes con Trastorno Obsesivo Compulsivo (TOC). El objetivo de este estudio fue evaluar los niveles de estrés, ansiedady depresión en pacientes con TOC durante la pandemia de la COVID-19. Métodos: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicasPubmed, Scopus,Web of Science, Dialnet yMedline entre los meses de enero y mayo de 2023. A partir de las herramientas de evaluación crítica paraestudios del Joanna Briggs Institute (JBI) se evaluó la calidad metodológica. Resultados: Un total de doce estudios fueron incluidos en esta revisión. La salud mental de la población se vio comprometidaante la pandemia de la COVID-19, siendo especialmente afectados los pacientes con TOC. Aunque existió una amplia variabilidad deresultados, se observó que el nivel de estrés y ansiedad aumentó durante la pandemia. Conclusiones: La salud mental de los pacientes con TOC, especialmente los que tienen TOC de limpieza, se ve comprometidaen tiempos de pandemia, presentando niveles medios-altos de estrés, ansiedad y depresión.(AU)

Bacground: The population’s mental health has been compromised by a global pandemic, especially in patients with obsessive-compulsive disorder. The objective of this study was to evaluate the levels of stress, anxiety and depression in patients withobsessive-compulsive disorder during COVID-19 pandemic. Methods: A systematic review was carried out following the PRISMA format in the electronic databases Pubmed, Scopus, Web ofScience, Dialnet and Medline between the months of January and May 2023. Method quality was assessed based on the critical evaluationtools for studies of the Joanna Briggs Institute (JBI). Results: A total of twelve studies were included in this review. The mental health of the population has been compromised by theCOVID-19 pandemic, with patients with obsessive-compulsive disorder being especially affected. Although there was a wide variabilityof results, it was observed that the level of stress and anxiety increased during the pandemic. Conclusions: The mental health of patients with obsessive-compulsive disorder, especiallywashing machine patients, is com-promised in times of pandemic, presenting medium-high levels of stress, anxiety and depression.(AU)

Acreditación de laboratorios clínicos: ¿un asunto pendiente? / Accreditation of clinical laboratories: a pending issue?

Los procesos de acreditación en los laboratorios se han convertido en algo cotidiano y conocido en nuestros días. No obstante, el grado de implantación de estos procedimientos de calidad no es tan alto como sería deseable. La complejidad del periodo preanalítico en concreto, requiere de un sistema de garantía de calidad siendo necesarias medidas capaces de acometer estrategias que fomenten la implantación de sistemas de calidad en las Unidades de Laboratorio Clínico. De hecho, la fase preanalítica es un periodo complejo y multidisciplinar sobre el que recae el mayor número de errores reportados en la literatura. Por ello, implementar este tipo de medidas mejoraría el cumplimiento de los procesos asistenciales relacionados, colaborando en una mejora continua de la seguridad clínica, la calidad asistencial y la costoeficiencia del sistema sanitario. (AU)

Impact on functionality of the paliperidone palmitate three-month formulation in patients with a recent diagnosis of schizophrenia: a real-world observational prospective study.

BACKGROUND: Information on the effect of the paliperidone palmitate three-month (PP3M) formulation on functionality in patients in the early stages of psychosis is lacking. The primary aim of this study was to evaluate the impact of PP3M on functionality in patients recently diagnosed with schizophrenia. RESEARCH DESIGN AND METHODS: This was an observational, multicenter, and prospective study in patients with a recent diagnosis of schizophrenia undergoing treatment with PP3M. Evaluations included the Personal and Social Performance (PSP) scale, the Clinical Global Impression-Schizophrenia (CGI-Sch), the Medication Satisfaction Questionnaire and the Involvement Evaluation Questionnaire. RESULTS: A total of 101/110 evaluable patients (91.8%) completed the study and were included in the efficacy analyses. The total PSP score increased from a mean of 68.5 (15.3) at baseline to a mean of 72.1 (15.4) at month 6 and 74.8 (16.7) at month 12 with a before-and-after difference of 3.6 (95% CI, 1.6 to 5.5, p < 0.001) at month 6 and 6.2 (95% CI, 4.2 to 8.3, p < 0.001) at month 12. CGI-Sch severity significantly decreased from a mean score of 2.8 (1.1) at baseline to a score of 2.2 (1.1) at month 12 with a before-and-after difference of -0.6 (95% CI, 0.8 to -0.4, p < 0.001). CONCLUSIONS: Early introduction of PP3M in the course of schizophrenia is associated with a meaningful benefit in social functioning and at least maintains clinical stability.

Plasma rico en plaquetas autólogo tópico para el tratamiento de la úlcera de pie diabético / Autologous platelet rich plasma for the treatment of diabetic foot ulcer

Background: Diabetic foot ulcer is one of the frequent complications of diabetes. 15% to 25% develop ulcers at some point in their lives. The existing evidence on the efficacy of topical autologous platelet-rich plasma (PRP) for the treatment of diabetic foot ulcers was assessed. Method: A search for randomized controlled clinical trials comparing autologous topical PRP vs standard care and placebo was carried out in Pubmed, Cochrane, Lilacs, and Clinical Trials databases. For dichotomous outcomes, relative risk analysis, 95% CI, and the Mantel-Haenszel method were used; for continuous outcomes, the mean difference and inverse variance method were calculated. Results: The result of the search was 153 studies, 28 duplicates were excluded, 59 by title and abstract, and 52 by reading the article. 14 studies were included in the review, 8 for qualitative review and 6 for quantitative. Six studies with a complete ulcer-healing outcome at the end of the intervention were evaluated, out of a total of 415 participants (relative risk 1.24 CI [1.11, 1.40]). The outcome epithelialized area at the end of the intervention, measured in cm², was not reported. A single study measured quality of life and pain. Conclusion: There is evidence of the beneficial effect of topical autologous PRP for the healing of diabetic foot ulcers, however, studies of higher methodological quality, greater production of clinical trials in Latin America, and assessment of the quality of life and pain are needed.

Antecedentes: La úlcera de pie diabético constituye una de las complicaciones frecuentes de la diabetes. Del 15% al 25% de los pacientes presentan úlceras en algún momento de su vida. Se valoró la evidencia existente sobre la eficacia del plasma rico en plaquetas (PRP) autólogo tópico para el tratamiento de úlcera de pie diabético. Método: Se llevó a cabo a partir de datos de Pubmed, Cochrane, Lilacs y Clinical Trials, búsqueda de ensayos clínicos aleatorizados controlados que compararon PRP autólogo tópico frente a cuidados estándar y placebo. Para los resultados dicotómicos se usó el análisis de riesgo relativo, con intervalos de confianza del 95% y el método de Mantel-Haenszel; para los resultados continuos, se calculó la diferencia de medias y método de varianza inversa. Resultados: El resultado de la búsqueda fue 153 estudios, se excluyeron 28 duplicados, 59 por título y abstract y 52 por lectura de artículo. Se incluyeron 14 trabajos en la revisión, 8 para revisión cualitativa y 6 para cuantitativa. Se valoraron 6 estudios con desenlace de curación completa de úlcera al final de la intervención, sobre un total de 415 participantes (riesgo relativo 1.24 [IC 95%: 1.11 a 1.40]). No se informó el desenlace área epitelizada al final de la intervención medida en cm². Un solo estudio midió calidad de vida y dolor. Conclusión: Existe evidencia del efecto beneficioso del PRP autólogo tópico para la curación de úlcera de pie diabético; no obstante, se necesitan estudios de mayor calidad metodológica, mayor producción de ensayos clínicos en Latinoamérica y valoración de calidad de vida y dolor.

Development and criterion validity of the COVID-19 anxiety and fear assessment scale: a cross sectional study.

BACKGROUND: The emergence of the new severe acute respiratory syndrome coronavirus 2, which causes COVID-19 disease, has been a major public health challenge and an increase in the feeling of uncertainty of the population, who is also experiencing an increase in levels of anxiety and fear regarding the COVID-19 disease. OBJECTIVE: The objective of the study was the construct and criterion validation of the Escala de evaluación de la Ansiedad y MIedo a COVID-19 (AMICO, for its acronym in Spanish) to measure both constructs in the general Spanish population. METHODS: Descriptive study of psychometric validation. A field study was carried out to execute univariate and bivariate analyses, in addition to the exploratory and confirmatory factorial analysis of the scale. For the criteria validity study, the State-Trait Anxiety Inventory (STAI) and sensitivity and specificity values were calculated. RESULTS: The study sample was composed of 1036 subjects over 18 years of age, who resided in Spain, where 56.3% were women with a mean age of 48.11 years (SD = 15.13). The study of construct validity reported two factors and 16 items, with a Cronbach's alpha value of 0.92. The scale was concurrently valid with the used gold standard and obtained sensitivity values of 90.48% and specificity values of 76%. CONCLUSIONS: The AMICO scale is valid and reliable for assessing the level of anxiety and fear of COVID-19 in the adult Spanish population and is highly sensitive.

Anxiety and fear related to coronavirus disease 2019 assessment in the Spanish population: A cross-sectional study.

BACKGROUND: The coronavirus disease 2019 pandemic has affected millions of people worldwide, compromising the responsiveness of governments and states and thus generating anxiety and fear at the population level. OBJECTIVE: To assess the level of anxiety and fear of coronavirus disease 2019 in a Spanish adult population group. METHODS: A descriptive cross-sectional study, using the anxiety and fear of COVID-19 assessment scale (AMICO, for its acronym in Spanish). The sample was composed of 1038 subjects. Univariate and bivariate statistical analyses were performed, after analysis of normality in the data distribution. Categorical regression analyses were also executed. FINDINGS: The total sample size was 1036 subjects, 56.3% was made up of females, with a mean age of 48.11 years (SD = 15.13). The mean score obtained on the AMICO scale was 5.54 points (SD = 1.83), with a score range between 1.22 and 10. Bivariate analysis only demonstrated statistically significant differences in the mean score of the scale and the variables: sex, marital status, work area and academic level. The executed categorical regression analysis revealed an R2 value of 0.75 and a significance of p = 0.00. CONCLUSIONS: The results obtained show that the Spanish population presents moderate anxiety levels to coronavirus disease 2019. Women, married, with primary and/or secondary education level, and working in the public transport, services and/or hospitality sectors are more likely to have high levels of fear and anxiety. APPLICATION TO PRACTICE: These results could be used for therapeutic and preventive psychological interventions, and also to plan new research under sex perspective and observing the socio-economic environment.

Plan de cuidados en las necesidades psicoemocionales de los supervivientes de cáncer / Care plan in the psychoemotional needs of cancer survivors

El cáncer es un evidente problema de salud mundial. Es una enfermedad social: padecerla afecta tanto a la mortalidad como a los costes asociados a la morbilidad. La supervivencia de estos pacientes está aumentando, por lo que se está produciendo una transición hacia la cronicidad de la enfermedad. En el presente artículo se describe la situación actual de estos pacientes a nivel nacional e internacional, las características de este colectivo de pacientes, sus necesidades y expectativas, consecuencias derivadas de los tratamientos, afectaciones sociales y psicológicas. Finalmente, se propone un plan de cuidados, con sus criterios de evaluación e intervenciones, para este tipo de pacientes

Cancer is an evident health worlwide problem. It is a social disease: suffering cancer involves both costs related with morbidity and mortality. The increased surveillance of these patients produces a transition to chronic disease, changing their needings, expectations and treatment derived consequences, together with social and psychological affections. Finally, we propose a specific care plan, with outcomes and interventions for this kind of patients

Anticoagulantes directos y Enfermería: un abordaje desde la seguridad clínica / Direct anticoagulants and nursing: an approach from patient's safety

En los últimos años ha aparecido una nueva línea de tratamiento para la prevención del ictus en la fibrilación auricular no valvular, los denominados anticoagulantes directos o nuevos anticoagulantes. El adecuado manejo y seguimiento de estos pacientes resulta imprescindible para minimizar sus efectos secundarios y garantizar la seguridad del paciente. En este artículo, se ofrece una descripción de estos fármacos, analizando sus características, funcionamiento e interacciones junto con las intervenciones enfermeras más habituales, así como una reflexión sobre las implicaciones para la práctica

In recent years, a new line of treatment for the prevention of stroke in non-valvular atrial fibrillation, the so-called direct anticoagulants or new anticoagulants has appeared. The proper management and follow-up of these patients is essential to minimize their side effects and ensure patient safety. In this article, a description of these drugs is given, analyzing their characteristics, functioning and interactions together with the most habitual nursing interventions, as well as a reflection on the implications for the practice

Direct anticoagulants and nursing: an approach from patient's safety. / Anticoagulantes directos y Enfermería: un abordaje desde la seguridad clínica.

In recent years, a new line of treatment for the prevention of stroke in non-valvular atrial fibrillation, the so-called direct anticoagulants or new anticoagulants has appeared. The proper management and follow-up of these patients is essential to minimize their side effects and ensure patient safety. In this article, a description of these drugs is given, analyzing their characteristics, functioning and interactions together with the most habitual nursing interventions, as well as a reflection on the implications for the practice.

Enfermería y seguridad clínica: ¿Cuál es el camino? / Nursing and clinical safety. What is the way?

No disponible

Relevancia de las enfermeras en los errores en la fase preanalítica. Su relación con la seguridad del paciente / Relevance of nurses on the preanalytic phase and patient safety implications

Introducción. La seguridad del paciente constituye en la actualidad uno de los pilares básicos para garantizar la prestación de una atención sanitaria de calidad. Dentro de los tres periodos o fases del proceso laboratorio, es en el primero (el preanalítico) en el que más errores se cometen. Es este el periodo en la que más implicadas están las enfermeras, que deben intervenir en la prevención y detección de estos problemas. Metodología. Se realiza una revisión de la literatura con el objetivo de identificar los errores más frecuentes en esta fase, los factores relacionados, las medidas enfocadas a su detección así como las actuaciones llevadas a cabo para su prevención y control. Se enfatiza en la importancia de las enfermeras en este ámbito, ya que muchos de los errores están relacionados con la toma de muestras. Conclusiones. Como conclusión, cabe destacar la importancia de establecer estándares para una práctica clínica fiable, eficaz y segura, identificar las áreas de mejora y plantear programas formativos que contribuyan a disminuir el riesgo de errores y la variabilidad clínica, con especial mención al papel de las enfermeras en esta etapa (AU)

Introduction. Nowadays, the patient’s safety is considered one of the pillars in a high quality clinical assistance. Inside three steps of laboratory process, it is in the first one, the preanalytical, where most mistakes are made. Nurses are very involved in the development of this period because it is where is included the sampling. Methodology. We reviewed the literature with the aim to identify the most frequent mistakes, the related factors, the measures taken for its detection and prevention. It emphasizes the importance of nurses in this area, as many of the errors are related to sampling. Conclusions. We conclude that it is very important to establish suitable and safe clinical practice standards, identifying improvement areas and planning training programs which contributes to decrease the mistake risk and clinical variability, with special mention to the nurses at this stage (AU)

La consulta de terapia antitrombótica: progresando hacia la Enfermería de Práctica Avanzada / Anticoagulant therapy clinic: Moving towards Advanced Nursing Practice

En la actualidad, en nuestro país, alrededor de un millón de personas reciben anticoagulación oral. El fármaco más empleado es el acenocumarol, que requiere de controles de coagulación para constatar que el paciente se encuentra dentro de su rango terapéutico. Los pacientes suelen empezar este tratamiento en una consulta hospitalaria y, cuando se encuentran estabilizados, son derivados a atención primaria, donde son seguidos por sus enfermeras comunitarias.La práctica habitual es que estas enfermeras asuman los cambios de dosis cuando los pacientes están fuera de rango; no obstante, este aspecto no es realizado por las enfermeras hospitalarias a pesar de disponer de suficiente experiencia y conocimientos para un adecuado manejo de este tipo de pacientes.En la Unidad de Gestión Clínica de Hematología del Hospital Universitario Virgen de la Victoria de Málaga se ha implantado un modelo de Enfermería de Práctica Avanzada que incluye diversos aspectos de la atención y cuidados a los pacientes en terapia antitrombótica, entre los que se encuentra la dosificación de su tratamiento siguiendo un catálogo de rangos terapéuticos y diagnósticos

There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges

[Anticoagulant therapy clinic: moving towards Advanced Nursing Practice]. / La consulta de terapia antitrombótica: progresando hacia la Enfermería de Práctica Avanzada.

There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

Nuevas perspectivas profesionales: la enfermera de práctica avanzada en Urología / No disponible

La Enfermería de Práctica Avanzada es un modelo emergente en España, con gran trayectoria en el contexto anglosajón, y que está empezando a desarrollarse en otros países europeos. Estos nuevos perfiles avanzados toman como base una mayor capacitación de las enfermeras en cuatro vertientes: clínica avanzada, gestión, docencia e investigación, y se materializa en distintas figuras, entre las que cabe destacar la Nurse Practitioner (actualmente denominada Advanced Practitioner) y la Nurse Consultant, caracterizadas por una capacitación específica que les permite desarrollar tareas de mayor nivel de complejidad, basada en la toma de decisiones autónoma y una cartera de servicios propia que va más allá de las actividades tradicionales establecidas en nuestro contexto, y donde la enfermera de práctica avanzada lidérala valoración y el seguimiento de los pacientes e incluso, en el caso de la Nurse Consultant, con participación activa en el diseño de estrategias de salud y como asesora en materia de investigación, gestión y clínica avanzada. En el campo de los cuidados urológicos existen diferentes figuras, conocidas como Advanced Urology Nurse o Urology Nurse Practitioner, cuyo desarrollo ha tenido lugar en EEUU, Canadá e Inglaterra principalmente, con puestos específicos definidos y un sistema de acreditación profesional propio, y que se está planteando como la clave a los modelos más tradicionales en muchos sistemas sanitarios europeos, mejorando la accesibilidad a los servicios a través de una gestión compartida de la demanda asistencial partiendo de un nuevo diseño de los mapas competenciales de los distintos profesionales y, por ende, contribuyendo a la coste-eficiencia de los sistemas sanitarios

The Advanced Practice Nursing is an emerging model in Spain, with great experience in the Anglo-Saxon context, which is being developed in other European countries. These new profiles are based on an advanced further training of nurses in four areas: advanced clinical competencies, clinical management, teaching and research. The Advanced Practice Nursing has two main figures: Nurse Practitioner (also known as Advanced Practitioner) and Nurse Consultant, characterized by a specific training orientate to perform tasks of greater complexity based on autonomous decision making and defined catalogue of services which goes beyond traditional activities set in our context, and where the nurse Advanced Practice leads patient assessment and follow up. The Nurse Consultant also performs health policy design and consultancy functions. Within the urologic care field, different roles have emerged in the U.S., Canada and England known as Advanced Urology Nurse or Urology Nurse Practitioner with defined professional positions and specific professional accreditation systems. These new orientation is being proposed as the key to more traditional models in many European health systems, improving access to healthcare services through a shared management of the clinical demand based on the design of a new competency map for healthcare practitioners and, therefore, contributing to the cost-efficiency of health systems

[RELEVANCE OF NURSES ON THE PREANALYTIC PHASE AND PATIENT SAFETY IMPLICATIONS]. / Relevancia de las enfermeras en los errores en la fase preanalítica. Su relacion con la seguridad del paciente.

INTRODUCTION: Nowadays, the patient's safety is considered one of the pillars in a high quality clinical assistance. Inside three steps of laboratory process, it is in the first one, the preanalytical, where most mistakes are made. Nurses are very involved in the development of this period because it is where is included the sampling. METHODOLOGY: We reviewed the literature with the aim to identify the most frequent mistakes, the related factors, the measures taken for its detection and prevention. It emphasizes the importance of nurses in this area, as many of the errors are related to sampling. CONCLUSIONS: We conclude that it is very important to establish suitable andsafe clinical practice standards, identifying improvement areas and planning training programs which contributes to decrease the mistake risk and clinical variability, with special mention to the nurses at this stage.

A propósito de un caso: doctor ya sabe; esto es un juego / A case report: doctor, you know, this is a game

El caso que vamos a tratar en esta sección, creemos que puede ser muy interesante, pues se trata de un paciente de 32 años que presentando una personalidad previa muy peculiar, ha desarrollado al menos en el tiempo de sus dos ingresos una psicopatología y una alteración de conducta bastante llamativas, esto junto con la biografía del paciente y su forma de relacionarse con todos nosotros hace que el cuadro que presentamos y eso es nuestra principal intención despierte en los lectores la misma curiosidad que despertó en nosotros, profesionales que trabajamos en el Servicio de Psiquiatría del Hospital Provincial de Toledo. Realmente se trata de dos posibles diagnósticos muy distintos en el mismo paciente, el primero que impresiona de trastorno disociativo versus simulación y el segundo encaja más en un cuadro psicótico a filiar(1)(AU)

We will discuss in the present article a very interesting case. This is a patient of 32 years old with a peculiar premorbid personality, who at least during his two previous psychiatric admissions has developed an intriguing psychopatology and behaviordisorder; these aspects, his biography and the way he related with staff members and other patients make us think it can arouse curiosity among readers as well it did among staff members of the Psychiatry Department at Hospital Provincial of Toledo. We thought of 2 possible diagnosis, Dissociative Disorder versus Malingering but we think the second one fits better in a box of Acute Polymorphic Psychotic Disorder without symptoms of Schizophrenia(1)(AU)

Una experiencia de Enfermería de Práctica Avanzada en pacientes con anticoagulación oral / An Advanced Nursing Practice experience in patients receiving oral anticoagulation therapy

En países de nuestro entorno se están desarrollando modelos de Enfermería de Práctica Avanzada (EPA) en diversos ámbitos. Aunque de manera aislada,dentro de nuestras fronteras se están realizando desde hace tiempo diferentes prácticas avanzadas de Enfermería, sin que hasta el momento exista un reconocimiento explícito de ello.En entornos muy específicos, como son las consultas de tratamiento anti -coagulante oral (TAO), siguiendo recomendaciones de la Asociación Española de Hematología y Hemoterapia (AEHH), se están adoptando medidas que tienen elementos característicos de la Enfermería de Práctica Avanzada. En este trabajo se describe la experiencia del cambio organizativo que se está llevando a cabo en la consulta de TAO del Hospital Universitario Virgen de la Victoria mediante un acuerdo de colaboración multidisciplinar que todavía se encuentra en proceso de desarrollo. Todos los pacientes con controles de INR dentro de su rango terapéutico son controlados directamente por las enfermeras de la consulta, lo que actualmente supone el 60% del total de visitas diarias. Los pacientes que acuden por primera vez son atendidos por la enfermera, que realiza la historia clínica y proporciona educación sanitaria. Finalmente, se incluyen algunas reflexiones sobre el desarrollo de la EPA en España (AU)

Models of Advanced Nursing Practice (ANP) are being developed in countries within our setting involving different scopes. Even though in specific sites of our country, these advance nursing practices have been implemented for a long time now, they have not as of yet being explicitly acknowledged.In very specific settings such as Oral Anticoagulation Therapy Units, and following the recommendations issued by the Spanish Association of Hematology and Hemotherapy (AEHH), measures are being adopted which bear the characteristic elements of Advanced Nursing Practices.This work described the organisational change experience that is being carried out at the Oral Anticoagulation Therapy Unit of the Hospital Universitario Virgen de la Victoria via a multidisciplinary collaboration agreement that is still under development. All patients with INR controls within their therapeutic range are followed up directly by the unit´s nurses, which presently account for 60% of the total number of daily visits. Patients seeking consultation for the first time are seen by the nurse who takes their medical history and provides patient education. Lastly, some thoughts on the development of ANP in our country are includedin the paper for consideration (AU)