Analysis of headache management in Andalusia.

INTRODUCTION AND OBJECTIVE: Headache is a frequent reason for consultation between primary care physicians, emergency services physicians, and neurology specialists; however, it is not always well managed. The Andalusian Society of Neurology's Headache Study Group (SANCE) aimed to analyse headache management at different levels of care. MATERIAL AND METHODS: We conducted a descriptive cross-sectional study with data gathered through a retrospective survey in July 2019. Participants completed a series of structured questionnaires on different social and work-related variables from 4 different groups of healthcare professionals (primary care [PC], emergency departments, neurology departments, headache units). RESULTS: A total of 204 healthcare professionals completed the survey: 35 emergency department physicians, 113 PC physicians, 37 general neurologists, and 19 neurologists specialising in headache. Eighty-five percent of PC physicians reported prescribing preventive drugs, which were maintained for at least 6 months (59%), with flunarizine and amitriptyline being the most commonly used. Most patients attended at neurology consultations (65%) are referred by PC physicians, with changes in the headache pattern being the main reason for referral (74%). Healthcare professionals across all levels of care showed great interest in headache and in receiving training in headache management (97% of PC physicians, 100% of emergency services physicians, 100% of general neurologists). CONCLUSIONS: Migraine sparks great interest among healthcare professionals from different levels of care. Our results also reveal a lack of resources for headache management, which is reflected in the long waiting times. Other means of bilateral communication between different levels of care should be explored (eg, e-mail).

Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study.

Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND: Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS: Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS: In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.

Experiences of nursing students participating in end-of-life education programs: A systematic review and qualitative metasynthesis.

OBJECTIVE: The aim of this review was to explore the experiences of nursing students participating in end-of-life education programs. DESIGN: A systematic review. DATA SOURCES: Exhaustive literature searches were performed using seven electronic databases: Medline, Scopus, Web of Science, CINAHL Plus, Dialnet Plus, Eric and Cuiden Plus. REVIEW METHODS: In total, 6572 studies published from 2008 until 2018 were examined. The Critical Appraisal Skills Program was used to assess the quality of the studies included in the review. The findings were synthesized using meta-aggregation. RESULTS: Seventeen studies were included in this systematic review, representing a sample of 606 nursing students. Simulation methods were most common among the educational programs analyzed. The analysis of qualitative data allowed us to identify 260 illustrations which were grouped into 14 categories and three themes: feelings and emotions during the performance of the pedagogical activity, end-of-life education among nursing students and competencies acquired on death and end-of-life. The most highlighted communication skills were learning to listen and building confidence to speak with the patient, family and the general public. CONCLUSIONS: End-of-life programs generally helped students acquire communication skills, learn concepts and improve the administration of this type of care. In addition, they perceived the experience as an opportunity to learn more about oneself, gain trust and support critical thinking. Nonetheless, the evidence available in this field is limited due to the small number of studies, plus the limited data reported. Thus, further studies on this subject are necessary.

Effectiveness of a primary care nurse delivered educational intervention for patients with type 2 diabetes mellitus in promoting metabolic control and compliance with long-term therapeutic targets: Randomised controlled trial.

BACKGROUND: Systematic reviews and meta-analyses have shown very different values for the effectiveness of education in type 2 diabetes mellitus. However, the achievement of therapeutic targets after educational programs has been poorly evaluated. OBJECTIVE: Evaluate the effectiveness of a structured and individualised education program for type 2 diabetes, provided by a primary care nurse, which featured educational reinforcements and family support to achieve metabolic control, and long-term therapeutic targets. METHODS: Randomised controlled clinical trial with two arms: Intervention and control group. The intervention consisted of six face-to-face sessions of 30 min and follow-ups after 12 and 24 months for 236 participants with type 2 diabetes mellitus in a primary care setting in Andalusia (Spain). The primary outcome variables were the values and achievement of the type 2 diabetes mellitus control targets established by the American Diabetes Association: Glycated haemoglobin, fasting blood glucose, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, systolic and diastolic blood pressure. The secondary outcome variable was body mass index. RESULTS: From an overall total of 236 participants, 54.2% were male and the average age was 65.1 ±â€¯9.5. After 12 months, the glycated haemoglobin level and systolic blood pressure decreased in the intervention group. After 24 months, the following variables significantly improved among the intervention group participants: basal glycemia, glycated haemoglobin, total cholesterol low-density lipoprotein cholesterol, and diastolic blood pressure. The glycated haemoglobin target (<7%) was better achieved in the intervention group than in the control group (35.2% vs 24.7%, p < 0.003). The rest of the targets were not met. CONCLUSION: Continual diabetes education with reinforcement sessions provided by a nurse achieved reductions in glycated haemoglobin, basal glycaemia, total cholesterol, low-density lipoprotein-cholesterol and systolic blood pressure in both the medium and long term. It also increased the proportion of participants who achieved the therapeutic target of glycated haemoglobin.

Telemedicine: contributions, difficulties and key factors for implementation in the prison setting.

Information and communication technologies are transforming the way we understand health, via a hyper-connected world in which patients, professionals and society take on new challenges and roles. This change is creating an ecosystem called connected health, in which telemedicine acquires special importance when distance (not only geographical), is a critical factor. It can respond to financial, social or safety needs or questions of dignity, as is the case with prisoners when they are transferred handcuffed and under custody to hospitals. Bringing health services closer to patients who cannot autonomously travel contributes towards humanising healthcare. Tele-consultations, long-distance encounters between patients and health professionals, reduce the direct and social costs inherent to habitual clinical practice and are very highly valued by patients in prison. Despite its potential benefits in the prison setting, the implementation of telemedicine in Spain continues to be scarce and irregular, which, amongst other things, is due to a lack of awareness of this healthcare practice, the severe shortage of resources currently endemic to the prison health service system and the lack of interoperability solutions for clinical information between the healthcare administration and the prison health services, which unfortunately continue to depend on an organisation outside the healthcare ambit (the Ministry of Home Affairs), despite the legal provisions requiring them to be fully integrated into regional health services. The SARA (Administration Applications and Networks Systems) Network and the Reúnete© Service offer solid, secure, free technology is available to all prisons, to set in motion telemedicine programs at a nationwide level.

Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. / Investigando el autocuidado en una muestra de pacientes con insuficiencia cardiaca descompensada: un estudio transversal.

BACKGROUND: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. PATIENTS AND METHODS: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83±8 were recruited to participate in this study. RESULTS: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1±1; b) "forget to take one of your medicines", 2±2; c) "ask for low-salt items when eating out or visiting others", 2±1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2±1; b) reduce fluid intake, 1±1; c) take an extra diuretic, 1±1. Over 50% of our sample felt confident or very confident at following professional advice (3±1), keeping themselves free of symptoms (3±1), recognizing changes in their condition (3±1) and evaluating the significance of such changes (3±1). CONCLUSIONS: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.

Telemedicina: aportaciones, dificultades y claves para su implantación en el medio penitenciario / Telemedicine: contributions, difficulties and key factors for implementation in the prison setting

Las tecnologías de la información y comunicación están transformando la forma de entender la salud, a través de un mundo hiperconectado en el que pacientes, profesionales y sociedad adquieren nuevos retos y protagonismos. Esta transformación crea un ecosistema, que se denomina salud conectada, dentro del cual la telemedicina adquiere especial relevancia cuando la distancia, no solo geográfica, es un factor crítico. Puede responder a razones económicas, sociales, de seguridad, o de dignidad, como les ocurre a las personas ingresadas en prisión cuando son trasladadas custodiadas y esposadas a los hospitales. Acercar los servicios de salud al paciente que no puede desplazarse en condiciones de autonomía contribuye a humanizar la asistencia sanitaria. Las teleconsultas, encuentros a distancia entre pacientes y profesionales de la salud, reducen los costes directos y sociales respecto a la práctica clínica habitual y son muy bien valoradas por los pacientes que se encuentran en prisión. Pese a los potenciales beneficios de la telemedicina en el medio penitenciario, su implantación en España sigue siendo muy escasa e irregular, debido, entre otros factores, a la falta de difusión de esta práctica asistencial, a la grave insuficiencia de medios que atraviesan los servicios de salud penitenciarios y a la falta de soluciones de interoperabilidad de la información clínica entre la administración sanitaria y los servicios de salud penitenciarios, que desgraciadamente siguen dependiendo de una organización no sanitaria, el Ministerio del Interior, pese a las disposiciones legales que obligan a su plena integración en los servicios autonómicos de salud. La Red SARA (Sistemas de Aplicaciones y Redes para las Administraciones) y el Servicio Reúnete© ofrecen tecnología sólida, segura, gratuita y a disposición de todos los centros penitenciarios, para poner en marcha programas de telemedicina a nivel nacional

Information and communication technologies are transforming the way we understand health, via a hyper-connected world in which patients, professionals and society take on new challenges and roles. This change is creating an ecosystem called connected health, in which telemedicine acquires special importance when distance (not only geographical), is a critical factor. It can respond to financial, social or safety needs or questions of dignity, as is the case with prisoners when they are transferred handcuffed and under custody to hospitals. Bringing health services closer to patients who cannot autonomously travel contributes towards humanising healthcare. Tele-consultations, long-distance encounters between patients and health professionals, reduce the direct and social costs inherent to habitual clinical practice and are very highly valued by patients in prison. Despite its potential benefits in the prison setting, the implementation of telemedicine in Spain continues to be scarce and irregular, which, amongst other things, is due to a lack of awareness of this healthcare practice, the severe shortage of resources currently endemic to the prison health service system and the lack of interoperability solutions for clinical information between the healthcare administration and the prison health services, which unfortunately continue to depend on an organisation outside the healthcare ambit (the Ministry of Home Affairs), despite the legal provisions requiring them to be fully integrated into regional health services. The SARA (Administration Applications and Networks Systems) Network and the Reúnete© Service offer solid, secure, free technology is available to all prisons, to set in motion telemedicine programs at a nationwide level

OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study.

BACKGROUND AND PURPOSE: OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome. METHODS: We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months. RESULTS: A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045). CONCLUSIONS: This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.

¿Es posible la eliminación del virus de la hepatitis C en el entorno penitenciario? / Is HCV elimination possible in prison?

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Barriers in implementing research among registered nurses working in the care of the elderly: a multicenter study in Spain.

OBJECTIVE: This study identified barriers to the utilization of research results perceived by nurses who work in nursing homes in Spain. METHODS: An observational, cross-sectional, descriptive, and multicentre study was conducted in 126 nursing homes in different Spanish cities. The BARRIERS to Research Utilization Scale (BARRIERS scale) was used to identify barriers. RESULTS: A total of 756 nurses responded (92.48%). BARRIERS scale variables with the highest scores included Characteristics of the organization (mean=24.89, SD=4.37), followed by Professional features (mean=21.87, SD=4.85). The specific barriers that were rated the highest included "not enough time on the job to implement new ideas" (mean=3.89, SD=0.98), followed by "unknown nursing research" (mean=2.75; SD=1.22) and "Doctors do not cooperate in the implementation" (mean=3.01, SD=1.85). CONCLUSIONS: Geriatric nurses perceive time as the main barrier to implementing the results of research in practice. The number and nature of the barriers are consistent with studies from other countries. Knowledge of the barriers is crucial for institutions and educators to instigate measures that improve the implementation of nursing research, especially in an area like elderly care. To our knowledge, this is the first study conducted among geriatric nurses in Spain.

Changing negative stereotypes regarding aging in undergraduate nursing students.

OBJECTIVE: The aim of this study was to explore the modification of stereotypes and myths regarding aging among third-year nursing students before and after undergoing an Aging Nursing course. METHOD: A within-subject repeated-measures descriptive study was conducted. The Negative Stereotypes Questionnaire about Aging (CENVE) was used. RESULTS: The overall prevalence of negative stereotypes was 62.0% pre-intervention (P1) and 12.3% post-intervention (P2) measured; these values were 63.5% (P1) and 9.2% (P2) for the health factor, 43.1% (P1) and 4.9% (P2) for the motivation and social factors and 58.3% (P1) and 3.8% (P2) for the character-personality factor. Paired Student's t tests confirmed that the differences were statistically significant. CONCLUSIONS: There was a high prevalence of negative stereotypes toward aging among the nursing students, even though they had conducted clinical practice and were in their third year. The course was demonstrated to be effective in modifying these stereotypes. The proper training of future professionals markedly contributes the dispensation of proper care and the eradication of ageism, which remains prevalent in the healthcare system.

Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia.

We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and non-professional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia.

[Rapid headache guidelines. Neurology consensus between Neurology (SAN) and Primary Care (SEMERGEN Andalucía). Referral criteria]. / Guía rápida de cefaleas. Consenso entre Neurología (SAN) y Atención Primaria (SEMERGEN Andalucía). Criterios de derivación.

Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm. A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral.

Presentación de la Organización Nacional de Trasplantes / Introduction of the National Transplant Organization (ONT)

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Coordinación de las actividades de donación y trasplantes: alarmas de donación / Coordination of donation and transplantation activities. Donation alarm

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