The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). AIM: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. METHODS AND PROCEDURES: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. RESULTS: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. CONCLUSION: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. OUTCOMES AND RESULTS: Knowledge and understanding of these events should allow for better management of similar situations in the future.

This study contributes to a growing body of research that examines the experiences of IDD individuals and their families during the early months of the COVID-19 pandemic. A qualitative phenomenological interpretative approach was used following the recommendations of qualitative research practices in health care. Our findings reveal that relatives of persons with IDD who lived in residential care homes felt that the residents were not adequately cared for by the staff, who applied measures for containment and contagion prevention that were disproportionate, resulting in their needs not being considered; these recommended measures had been developed for elderly care homes. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. The present findings show that residential care homes for persons with IDD require specific action protocols in crisis situations that are adapted to the needs and characteristics of each centre,thus adopting a model of care based on human rights.

Análisis de las complicaciones del acceso vascular en hemodiálisis. Una revisión sistemática / Analysis of complications of vascular access in hemodialysis: A systematic review

Introducción:El acceso vascular sigue siendo uno de los retos más importantes en todas las unidades de diálisis, por todas las complicaciones derivadas de su uso y el gran impacto en la mor-bimortalidad del enfermo renal. Los tres tipos de acceso vascu-lar más utilizados son la fístula arteriovenosa nativa, el injerto o fístula arteriovenosa protésica y el catéter venoso central. Objetivo: Analizar y evaluar la situación actual y la incidencia de las complicaciones relacionadas con los diferentes accesos vasculares en hemodiálisis. Metodología: Se realizó una revisión sistemática en las bases de datos PubMed, CINAHL, SCOPUS y SciELO. Se incluyeron todos los artículos originales de menos de 5 años de antigüe-dad en los que uno de sus objetivos fuera analizar la preva-lencia o incidencia de las complicaciones de cualquier acceso vascular en hemodiálisis en población adulta. Resultados: El número de artículos para el análisis fueron 15. De ellos, 14 fueron estudios observacionales y uno, un ensa-yo clínico multicéntrico. Se analizaron datos demográficos de los pacientes, la prevalencia de complicaciones entre todos los accesos vasculares y la incidencia de complicaciones se-gún fístula nativa/protésica/catéter venoso central.Conclusiones: La fístula arteriovenosa nativa es el acceso vas-cular de elección ya que tiene tasas de complicaciones muy bajas. De entre ellas, la trombosis, es la complicación con más incidencia. El uso de catéter venoso central todavía es muy habitual, pese a ser el acceso vascular que presenta mayores tasas de complicaciones como las infecciones y la bacteriemia, produciéndose en un 10%-17% de los pacientes portadores.(AU)

Introduction: Vascular access remains one of the most important challenges in all dialysis units due to the complications associated with its use and its significant impact on the morbidity and mortality of renal patients. The three most used types of vascular access are native arteriovenous fistula, graft or prosthetic arteriovenous fistula, and central venous catheter. Objective: To analyze and evaluate the current situation and incidence of complications related to different vascular accesses in hemodialysis. Methodology : A systematic review was conducted using the PubMed, CINAHL, SCOPUS, and SciELO databases. All original articles published within the last 5 years that aimed to analyze the prevalence or incidence of complications related to any vascular access in hemodialysis in the adult population were included. Results: A total of 15 articles were included for analysis. Among them, 14 were observational studies, and one was a multicenter clinical trial. Demographic data of the patients, the prevalence of complications across all vascular accesses, and the incidence of complications for native fistula/prosthetic fistula/central venous catheter were analyzed. Conclusions: Native arteriovenous fistula is the preferred vascular access due to its very low complication rates. Among the complications, thrombosis has the highest incidence. The use of central venous catheters is still common, despite having higher rates of complications such as infections and bacteremia, occurring in 10%-17% of the patients.(AU)

Intervenciones enfermeras para disminuir la sobrecarga de cuidadores informales. Revisión sistemática de ensayos clínicos / Nursing interventions to reduce the overload on informal caregivers. Systematic review of clinical trials

Introducción: Los cuidadores informales suelen ser miembros de la familia de un paciente, que conducen a la dependencia del paciente del cuidador. Esto puede resultar en perturbaciones en la calidad de vida de los cuidadores. Para abordar los efectos negativos de la atención informal, existen varios tipos de intervenciones eficaces para reducir las visitas médicas tanto de los cuidadores informales como de los pacientes a su cargo. Objetivo: Examinar la eficacia de las intervenciones de enfermería existentes diseñadas para reducir la sobrecarga del cuidador informal de personas con enfermedad crónica. Metodología: Diseño: Revisión sistemática. Fuentes de datos: Bases de datos como Pubmed (MEDLINE), Embase, The Cochrane Library y CINAHL fueron buscadas usando palabras clave sobre intervenciones de enfermería en cuidadores familiares. Los artículos publicados entre 2014-2019 fueron recuperados y sometidos a análisis de datos y síntesis de conocimientos Método de revisión: Dos revisores seleccionados de forma independiente. La evaluación de la calidad se basó en la lista de verificación de evaluación de declaraciones prisma. La síntesis es narrativa. Resultados: Noventa y cinco estudios fueron examinados en su totalidad, y setenta y siete fueron descartados por no proporcionar resultados adecuados. El recuento final de artículos incluidos en esta revisión fue de dieciocho que fueron todos ensayos clínicos aleatorizados. Conclusiones: El análisis de los diferentes estudios muestra eficacia en la reducción de síntomas como estrés, ansiedad, depresión o incluso necesidades insatisfechas. Las intervenciones más eficaces para reducir la carga del cuidador fueron las visitas domiciliarias y las intervenciones psicoeducacionales, tanto individuales como grupales. (AU)

Background: Informal caregivers are usually family members, which lead to dependence of the patient on the caregiver. This may result in disturbances to the caregivers' quality of life. Address the negative effects of informal caregiving, several types of interventions have been reported to be effective in reducing medical visits by both informal caregivers and the patients in their care Aim: Examine the effectiveness of existing nursing interventions designed to reduce the overload of the informal caregiver of people with chronic illness. Methodology: Design: Systematic review Data Sources: Databases including Pubmed (MEDLINE), Embase, The Cochrane Library and CINAHL were searched using keywords about nursing interventions in family caregivers. Articles published between 2014-2019 were retrieved and underwent data analysis and knowledge synthesis. Review method: Two reviewers independently selected studies. Quality appraisal was based on PRISMA statements appraisal checklist. Synthesis was narrative. Results: Ninety-five studies were examined in their entirety, with seventy-seven being discarded as not providing results or not related to reducing overload. The final count of articles included in this review was eighteen which were all randomised clinical trials. Seven were categorized as technology-based interventions; two as self-help manuals; one as a physical activity-based intervention; and eight as group or individual psychoeducational therapy. Conclusions: Analysis of the different studies shows effectiveness in reducing symptoms such as stress, anxiety, depression or even unmet needs. The interventions that were found to be most effective in reducing caregiver overload were home care visits and psychoeducational interventions, both individual and group. (AU)

Programa de formación basado en técnicas de comunicación básica y asistida para las enfermeras de extrahospitalaria / A training communication program designed for emergency nurses working at ambulance

La comunicación es la clave para comprender la vulnerabilidad emocional de los pacientes en estado crítico. Un cambio repentino en la salud, experimentado por estas personas debido a un accidente o enfermedad, puede causar un efecto psicoemocional como la ansiedad o el estrés postraumático. Objetivo principal: Evaluar un programa de formación en técnicas de comunicación básica y asistida (CONECTEM) para enfermeras pre-hospitalarias y conocer la utilidad y la satisfacción percibida del programa de formación. Métodos: El estudio presenta un diseño observacional-descriptivo cuasi experimental. La muestra fue de 12 enfermeras pre-hospitalarias seleccionadas según los criterios de inclusión. Se realizó un test post formación para evaluar los conocimientos adquiridos de las enfermeras. Resultados: El 100% de las enfermeras que realizaron el entrenamiento en CONECTEM fueron aptas para implementar la intervención comunicativa en la ambulancia. El 60% de las enfermeras consideró que la formación fue muy útil para mejorar la calidad de la atención en los pacientes críticos trasladados en ambulancia. La satisfacción percibida por las enfermeras de la formación CONECTEM, fue muy buena en un 42,4% y buenas, en un 58,3%. Conclusiones: Los resultados respaldan la importancia de la formación en técnicas de comunicación asistida y alternativa (CAA) para mejorar las curas integrales al paciente crítico y ponen de manifiesto la necesidad de formación en comunicación de las enfermeras de pre-hospitalaria. (AU)

Communication is the key to understanding the emotional vulnerability of patients in critical condition. A sudden change in health experienced by these individuals due to an accident or illness can lead to serious psycho-emotional outcomes. Main objective: To conduct and evaluate an augmentative alternative communication training program (CONCETEM) for pre-hospital nurses and determine its utility and the satisfaction of the nurses. Methods: The study has an observational-descriptive design. The sample was 12 pre-hospital nurses selected by inclusion criteria. Post-training evaluation was conducted by the research team to learn whether nurses could perform the communicative intervention. Results: 100% of the nurses who underwent CONECTEM training were prepared to implement communicative intervention in the ambulance. 60% of the nurses considered that the training was very useful for improving the quality of care for critically ill patients transferred by ambulance. The nurses' satisfaction with the communication training was ‘very good' for 42.4% and ‘good' for 58.3%. Conclusions: The results support the importance of Augmentative Alternative Communication training to improve outcomes in critically ill patients and reveal that nurses feel that more training is needed. (AU)

Nursing Intervention to Improve Positive Mental Health and Self-Care Skills in People with Chronic Physical Health Conditions.

The exponential increase in the number of people suffering chronic illness has become a problem for which healthcare services need a response. The inclusion of self-care and positive mental health as part of a strategy to promote health offers an opportunity for a reorganization oriented towards community spaces and group interventions. This study undertook the assessment of an intervention designed to optimize the agency of and capacity for self-care and positive mental health by utilizing activities drawn from the Nursing Intervention Classification (NIC), specifically from Field 3 (Behavioral), and organized as a program called PIPsE. A quasi-experimental design was prepared with an intervention group (n = 22) and a control group (n = 22), in a primary care center in the Barcelona metropolitan area. The instruments used were two ad hoc questionnaires to collect sociodemographic and satisfaction information and two scales: the Appraisal of Self-care Agency Scale (ASA) and the Positive Mental Health Questionnaire (PMHQ). The results obtained showed a significant increase in self-care capacity and both overall positive mental health and mental health by factors in the intervention group.

Effectiveness of the Online "Dialogue Circles" Nursing Intervention to Increase Positive Mental Health and Reduce the Burden of Caregivers of Patients with Complex Chronic Conditions. Randomized Clinical Trial.

The personal demands involved in caring for a chronically ill person can lead to emotional and physical exhaustion in caregivers. The aim of this study was to evaluate the effectiveness of an online nursing intervention called "dialogue circles" designed to reduce caregiver overload and enhance positive mental health (PMH) in family caregivers. We used a pre-post design. The sample consisted of 86 family caregivers of patients with complex chronic conditions, randomly assigned to the intervention group (n = 43) or the control group (n = 43). All participants completed the Zarit scale and the Positive Mental Health Questionnaire 15 days before starting the intervention and 30 days after its completion. Comparison of the post-test changes revealed statistically significant differences between the two groups in PMH and overload, with the intervention group showing greater positive changes in all dimensions of PMH after the intervention and lower scores on overload. In conclusion, the results suggest that incorporating dialogue circles as an online nursing intervention in the caregivers of patients with complex chronic conditions can enhance PMH and decrease caregiver overload, especially in settings where face-to-face encounters are not possible.

A Communicative Intervention to Improve the Psychoemotional State of Critical Care Patients Transported by Ambulance.

BACKGROUND: Communication is key to understanding the emotional state of critical care patients. OBJECTIVE: To analyze the effectiveness of the communicative intervention known as CONECTEM, which incorporates basic communication skills and augmentative alternative communication, in improving pain, anxiety, and posttraumatic stress disorder symptoms in critical care patients transported by ambulance. METHODS: This study had a quasi-experimental design with intervention and control groups. It was carried out at 4 emergency medical centers in northern Spain. One of the centers served as the intervention unit, with the other 3 serving as control units. The nurses at the intervention center underwent training in CONECTEM. Pretest and posttest measurements were obtained using a visual analog scale to measure pain, the short-version State-Trait Anxiety Inventory to measure anxiety, and the Impact of Event Scale to measure posttraumatic stress disorder symptoms. RESULTS: In the comparative pretest-posttest analysis of the groups, significant differences were found in favor of the intervention group (Pillai multivariate, F2,110 = 57.973, P < .001). The intervention was associated with improvements in pain (mean visual analog scale score, 3.3 pretest vs 1.1 posttest; P < .001) and posttraumatic stress disorder symptoms (mean Impact of Event Scale score, 17.8 pretest vs 11.2 posttest; P < .001). Moreover, the percentage of patients whose anxiety improved was higher in the intervention group than in the control group (62% vs 4%, P < .001). CONCLUSION: The communicative intervention CONECTEM was effective in improving psychoemotional state among critical care patients during medical transport.

Validation of a Questionnaire to Analyze the Expectations of First-Year Nursing Students.

AIM: The aim of this study was to design and validate a questionnaire to analyze students' expectations, along with their level of interest and overall satisfaction with their nursing studies. BACKGROUND: The expectations of students on entering university are closely related to the level of interest that they have in their area of study and their general satisfaction with it. This is certainly a conditioning factor in their learning. In this regard, there are few quantitative instruments that measure the expectations of first-year nursing students. METHOD: A mixed questionnaire was constructed using items validated in previous studies, along with new items formulated following a review of the literature. The questionnaire was validated with a sample of 339 first-year degree program nursing students. RESULTS: The scales of expectations and degree of interest showed strong internal consistency (Cronbach's α > .7). CONCLUSION: The questionnaire to evaluate the expectations and interest of students demonstrated satisfactory psychometric properties.

Positive Mental Health and Self-Care in Patients with Chronic Physical Health Problems: Implications for Evidence-based Practice.

BACKGROUND: The capacity for self-care and positive mental health (PMH) has an influence on well-being and on one's approach to chronic illness. PURPOSE: The aim was to determine the level of PMH and self-care agency as well as the relations among sociodemographic variables, PMH, and the level of self-care among patients with chronic physical health problems. We also examined correlations between PMH and self-care agency. METHODS: A descriptive, cross-sectional correlational study was conducted with a sample of 209 patients at a primary care center. The instruments used were the Positive Mental Health Questionnaire and the Appraisal of Self-Care Agency scale. The STROBE statement was used. RESULTS: Significant differences were found in the PMH factors in relation to sociodemographic variables and health conditions. Suffering one or more chronic diseases was associated negatively, and significantly, with the capacity for self-care. The four most prevalent chronic health problems in the sample were hypertension, hypercholesterolemia, obesity, and diabetes mellitus. LINKING EVIDENCE TO ACTION: In people with chronic physical health problems, there is a positive relationship between PMH and self-care capacity. An increase in the possibility of caring for oneself saw an increase in PMH; conversely, an increase in PMH brought with it an increased capacity for self-care as well. Therefore, if actions are taken to increase PMH, the capacity for self-care will also increase.

COVID-19 en el enfermo renal. Revisión breve / COVID-19 in renal patient. Brief Review

En diciembre de 2019 se identificó en China una nueva subespecie de coronavirus al que denominaron SARS-CoV-2, responsable de la enfermedad posterior a la que la OMS llamó COVID-19. La enfermedad se ha propagado rápidamente provocando una pandemia mundial. Todavía se desconoce mucho del SARS-CoV-2, pero las primeras investigaciones respaldan la hipótesis de que la gravedad de la COVID-19 viene condicionada por la respuesta hiperinflamatoria que se produce en nuestro organismo al contacto con el SARS-CoV-2. La gravedad del cuadro se relaciona con la insuficiencia respiratoria que provoca, no obstante, existen estudios que no limitan la afectación pulmonar. Investigaciones apuntan a que el mecanismo de acceso del SARS-CoV-2 al organismo está muy relacionado con la enzima ACE2. Enzima que entre otros tejidos, se puede encontrar en el epitelio de las células tubulares renales. Esta es la causa por la que existen datos de pacientes con COVID-19 que tienen una gran afectación en la función renal y pueden cursar con IRA (factor de mal pronóstico). Por este motivo, unido a que las comorbilidades asociadas con una mayor mortalidad durante la infección COVID-19 son comunes en los pacientes con enfermedad renal crónica, creemos necesario conocer los resultados que aportan los diferentes estudios realizados sobre esa materia

In December 2019, a new subspecies of coronavirus was identified in China, which was named SARS-CoV-2, responsible for the disease that WHO called COVID-19. The disease has spread rapidly causing a global pandemic. Much is still unknown about SARS-CoV-2, but the first findings support the hypothesis that the severity of COVID-19 is conditioned by the hyperinflammatory response, which occurs in our body after contacting SARS-CoV-2. The severity of the symptoms is conditioned by the respiratory failure caused, however there are studies that are not limited to lung involvement. Evidence suggests that the access mechanism of the SARS-CoV-2 virus is closely related to the ACE2 enzyme. An enzyme that, among other tissues, can be found in the epithelium of renal tubular cells. For this reason, there are data on patients with COVID-19 who are severely affected in kidney function and may have acute kidney failure (a poor prognostic factor). For this reason, together with the fact that the comorbidities associated with a higher mortality during COVID-19 infection are common in patients with chronic kidney disease, it is necessary to know the available evidence on this matter

Study of the effect of anti-rhGAA antibodies at low and intermediate titers in late onset Pompe patients treated with ERT.

Late onset Pompe disease (LOPD) is a genetic disorder characterized by slowly progressive skeletal and respiratory muscle weakness. Symptomatic patients are treated with enzyme replacement therapy (ERT) with alglucosidase alpha (rhGAA). Although most of ERT treated patients develop antibodies against rhGAA, their influence on clinical progression is not completely known. We studied the impact of anti-rhGAA antibodies on clinical progression of 25 ERT treated patients. We evaluated patients at visit 0 and, after 1 year, at visit 1. We performed several muscle function tests, conventional spirometry and quantitative muscle MRI (qMRI) using 3-point Dixon analysis of thigh muscles at both visits. We also obtained serum samples at both visits and anti-rhGAA antibodies were quantified using ELISA. Antibody titers higher than 1:200 were identified in 18 patients (72%) of our cohort. Seven patients (28%) did not develop antibodies (0 to <1:200), 17 patients (68%) developed low to intermediate titers (1:200 to <1:31,200) and 1 patient (4%) developed high titers (>1:31,200). We analyzed the effect of low and intermediate antibody titers in clinical and radiological progression. There were no differences between the results of muscle function tests, spirometry or fat fraction analyzed using qMRI between patients with and without antibodies groups at baseline. Moreover, antibody titers did not influence muscle function test, spirometry results or qMRI results at year 1 visit. Most of the LOPD patients developed antibodies against ERT that persisted over time at low or intermediate levels. However, antibodies at these low and intermediate titers might not influence clinical response to the drug.

Casos clínicos sobre trasplante renal / Case reports about renal transplantation

No disponible

Accesos vasculares: reto constante en las unidades de hemodiálisis / Vascular accesses: constant challenge in hemodialysis units

No disponible

Alteraciones de la nutrición en la enfermedad renal / Nutrition disorder in renal disease

No disponible

El síndrome metabólico en el paciente renal / Metabolic syndrome in renal patients

No disponible

El ejercicio físico y el paciente renal crónico / No disponible

No disponible

Características del sueño de los pacientes en una unidad de cuidados intensivos / Sleep characteristic of patients in intensive care unit

El sueño, en cuanto acto de dormir, es un estado de reposo uniforme de un organismo, en contraposición con el estado de vigilia, que es cuando el ser humano está despierto. El sueño se caracteriza por los bajos niveles de actividad fisiológica (presión sanguínea, respiración, frecuencia cardiaca) y por una respuesta menor ante estímulos externos.El descanso nocturno de los pacientes ingresados en Cuidados Intensivos es un aspecto de gran importancia dentro del proceso de salud/enfermedad, ya que tiene una repercusión directa en su adecuada recuperación.Las Unidades de Cuidados Intensivos han sido consideradas generadoras de estrés debido a su propia arquitectura y su avanzada tecnología, relacionándose de este modo con la aparición de síntomas cognitivos por parte de los pacientes que conjuntamente con otros factores han desembocado en el llamado "síndrome UCI". El objetivo de la presente revisión es describir los factores que influyen sobre el sueño de los pacientes de cuidados intensivos(AU)

The dream, as a measure of sleep, is a uniform resting state of an organism, as opposed to the waking state, when man is awake. Sleep is characterized by low levels of physiological activity (blood pressure, respiration, heart rate) and a lower response to external stimuli. Night rest of patients admitted to intensive care is an issue of great importance in the process of health/disease, as it has a direct impact of their adequate recovery Intensive Care Units have been considered generating stress due to this architecture and advanced technology, thus interacting with the appearance of cognitive symptoms by patients in conjunction with other factors have resulted in the ¨ICU Syndrome¨. The aim of this review is to describe the factors that the influence the dreams of intensive care patients(AU)

La propedeuticacclinica y el aprendizaje de la clinica cerebro vascuaar / The clincal proppedeutic and learning of the clinic vascular brain

Se exponen los criterios de los autores sobre cómo desde la asignatura Propedéutica Clínica se puede contribuir al aprendizaje de las Enfermedades Cerebro Vasculares y cómo a la vez estas entidades facilitan el aprendizaje de los elementos esenciales de esta asignatura. Se plantea la necesidad del ajuste del contenido del campo neurológico de la Propedéutica en cuanto a síndromes clínicos y algunas precisiones en la didáctica de las habilidades clínicas. Al mismo tiempo, se destaca la importancia del contacto del estudiante con este tipo de enfermos en el campo de la formación de valores.

The authors criteria are suggested about how from de Clinical Propedeutic is posible contribute to the learning of Cerebrovascular disease and at the same time these nosologic entities facilitate the learning of the essential elements of this asignature. Is considerated the necesitiy of adjust the neurological contents of the asignature´s programs and some precisions in the didactic of clinical skills. The authors also highligh the importance of the students contacts with this kind of patients in relation with the formations of ethical and moral values.

Las bases biológicas en las ciencias de la salud / The biological bases in sciences of the health

Enfoca a la biología y sus principales elementos componentes