Efectividad de una intervención educativa enfermera en pacientes crónicos complejos / Effectiveness of a nursing training intervention in complex chronic patients

OBJETIVO: Evaluar el efecto de una intervención formativa realizada por enfermeras en pacientes crónicos complejos durante el ingreso hospitalario en un servicio de Medicina Interna. MÉTODO: Ensayo clínico pragmático de una intervención educativa de enfermeras frente a la actuación habitual. Para el grupo de intervención se diseñó un plan de educación en cuidados, personalizado para cada paciente, en función de las necesidades detectadas en una primera entrevista. La intervención se extendió durante el tiempo del ingreso y se dispuso de un teléfono de contacto al alta para la resolución de dudas. RESULTADOS: De entre los 498 pacientes seleccionados inicialmente fueron excluidos 131 por no cumplir los criterios para ser considerados pacientes crónicos complejos o por no detectarse deficiencias en su formación o sus cuidados. Un paciente (0,20%) no aceptó participar y no hubo abandonos. De los 366 participantes, 190 se integraron en el grupo de intervención y 176 en el control. En los primeros 8 días tras el alta, reingresaron 2 (1,05%) pacientes del grupo de intervención y 8 (4,54%) del grupo control (p = 0,05). En los primeros 30 días tras el alta reingresaron 26 (13,70%) y 33 (18,75%), respectivamente (p = 0,10). CONCLUSIONES: Este estudio muestra como una intervención educativa por enfermeras en pacientes crónicos complejos, realizada durante el ingreso hospitalario en unidades de Medicina Interna, puede reducir los reingresos a corto plazo

OBJECTIVE: To evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number. METHOD: Pragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts. RESULTS: Among the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p=.05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p=.10) were readmitted. CONCLUSIONS: This study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions

Effectiveness of a nursing training intervention in complex chronic patients. / Efectividad de una intervención educativa enfermera en pacientes crónicos complejos.

OBJECTIVE: To evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number. METHOD: Pragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts. RESULTS: Among the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p=.05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p=.10) were readmitted. CONCLUSIONS: This study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions.

Cybervictimization among secondary students: social networking time, personality traits and parental education.

BACKGROUND: Cyberbullying among children and adolescents is a major public health concern. However, research has not yet definitively identified the risk factors associated with cybervictimization. The purpose of this study was to determine the association of cybervictimization with use of social networks, personality traits and parental education in secondary students. METHODS: The study population consisted of 765 secondary students (56.5% girls) from Majorca (Spain) who were aged 15.99 years (grade 4). The data were from the 16 secondary school centers that participated in the ITACA Project, a multi-center, cluster randomized controlled trial. Cybervictimization was measured by the Garaigordobil Cybervictimization Scale, and the Big Five Questionnaire for Children was used to assess personality traits. RESULTS: Results showed that 39.9% of the students were cybervictims. Univariate analysis indicated that more girls than boys were cybervictimized (43.1% vs 35.7%). Cybervictims spent more time in social networking sites than non-victims (6 h 30 min vs. 5 h 16 min) and had greater emotional instability (0.16 vs. -0.23) and extraversion (0.11 vs. -0.09) and were less conscientious (- 0.001 vs. 0.20). Multivariable analysis indicated that social networking time was not significantly associated with cybervictimization after controlling for personality traits, but the same personality traits remained significantly associated. CONCLUSIONS: Our findings indicate that cyberbullying is a frequent and relevant problem in adolescents. Big Five personality traits are related with cybervictimization. Possible ways to design interventions include promoting social leisure activities, encourage responsible attitudes and provide stress coping tools.

Alcohol and Tobacco Consumption, Personality, and Cybervictimization among Adolescents.

Cyberbullying has emerged as a public health problem. Personality may play an important role in substance use and cybervictimization. The aim of this study was to examine whether tobacco and alcohol consumption and personality traits are associated with cybervictimization in Spanish adolescents. A cross-sectional study was conducted with 765 secondary students (aged 14-16) from 16 secondary schools in Spain. Participants completed a questionnaire assessing sociodemographic characteristics; tobacco and alcohol consumption; cybervictimization (Garaigordobil Scale); and personality traits (Big Five Questionnaire). A logistic regression model controlling for sex, age, parental education and personality traits was used to determine the independent associations and interactions between tobacco and alcohol consumption and cybervictimization. The results indicate that a total of 305 adolescents (39.9%) reported that they were cyberbullied in the past year. Girls were more likely to be cyberbullied than boys. Cybervictims had a significantly greater monthly alcohol consumption (OR = 1.51; 95% CI = 1.05-2.15), higher scores for extraversion (OR = 1.31; 95% CI = 1.06-1.63) and emotional instability (OR = 1.53; 95% CI = 1.27-1.83); as well as lower scores for conscientiousness (OR = 0.78; 95% CI = 0.63-0.95). These results suggest that personality traits and alcohol consumption are independently associated with cybervictimization. Our study suggests the existence of underlying common personality factors for cybervictimization and alcohol and tobacco use.

Screening for generalized anxiety disorder in Spanish primary care centers with the GAD-7.

The aim of the study was to determine the criterion validity of a computerized version of the General Anxiety Disorder-7 (GAD-7) questionnaire to detect general anxiety disorder in Spanish primary care centers. A total of 178 patients completed the GAD-7 and were administered the Composite International Diagnostic Interview (CIDI) for DSM-IV Axis I Disorders, which was used as a reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. A cut-off of 10 yielded a sensitivity of .87, a specificity of .78, a positive predictive value of .93, a negative predictive value of .64, a positive likelihood ratio of 3.96 a negative likelihood ratio of .17 and Younden's Index of .65. The GAD-7 performed very well with a cut-off value of 10, the most frequently used cut-off point. Thus, a computerized version of the GAD-7 is an excellent screening tool for detecting general anxiety disorder in Spanish primary care settings.

Sensibilidad química múltiple: evaluación clínica de la gravedad y perfil psicopatológico / Multiple chemical sensitivity: Clinical evaluation of the severity and psychopathological profile

Introducción y objetivo: La sensibilidad química múltiple (.SQM) es un trastorno multisistémico de etiología controvertida que afecta a algunos sujetos al exponerse a productos químicos a concentraciones no perjudiciales. El objetivo de este trabajo es describir las características epidemiológicas, clínicas y psicológicas de una muestra de pacientes con SQM, para un posterior tratamiento grupal específico. Pacientes y método: Estudio descriptivo de los pacientes diagnosticados de SQM en una unidad de toxicología, mediante la administración del cuestionario Quick Environmental Exposure and Sensitivity Inventory, junto con la entrevista estructurada SCID-II, la escala de ansiedad HAS y el test de personalidad tipo A, PCTA. Resultados: Se incluyeron 73 pacientes, con una edad media de 52,6 años (rango 33-77; DE 9,29), siendo 66 mujeres (90,4%). El 53% estaban clasificados como grado i-ii y ii. Sesenta y un pacientes (83%) presentaron algún tipo de comorbilidad, fundamentalmente dolor crónico, fibromialgia y fatiga crónica, con niveles de ansiedad mayores (puntuación media 19,2), predominio de rasgos de personalidad fóbico-evitativo y patrón de conducta tipo A (31,1%). Conclusiones: La SQM afecta principalmente a mujeres de mediana edad, con comorbilidades (dolor crónico, fibromialgia y fatiga crónica), elevada ansiedad y conductas de evitación. Este análisis previo debería ayudar a ofrecer un abordaje psicoterapéutico específico a estos pacientes (AU)

Introduction and objective: Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. Patiens and method: Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. Results: Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. Conclusions: MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients (AU)

[Multiple chemical sensitivity: Clinical evaluation of the severity and psychopathological profile]. / Sensibilidad química múltiple: evaluación clínica de la gravedad y perfil psicopatológico.

INTRODUCTION AND OBJECTIVE: Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. PATIENS AND METHOD: Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. RESULTS: Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. CONCLUSIONS: MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients.

Los niños ante la pérdida de uno de los progenitores: revisión de pautas de comunicación eficaces

Objetivo: La muerte es un tema tabú en la sociedad actual, y por ello es común que los padres tengan dudas acerca de cómo abordar este tema con los menores. Los objetivos de este trabajo son: 1) describir el concepto evolutivo de muerte y la forma de afrontamiento de niños y adolescentes ante una pérdida y 2) hacer una revisión bibliográfica de las principales recomendaciones y pautas para abordar el proceso de comunicación y preparación de los niños ante esta situación. Método: Se ha hecho una búsqueda bibliográfica sistemática en bases de datos primarias y secundarias (TripDatbase, PsycInfo, PubMed, Cochrane Library, Psicodoc) combinando diferentes términos clave. Resultados: La mayor parte del material revisado procede del ámbito anglosajón. En nuestro país la mayoría tiene un formato divulgativo, y no consta a los autores de este trabajo la publicación de investigaciones regladas. Sin embargo sí es posible extraer de todo el material revisado una serie de pautas generales que facilitan la comunicación con los menores en esas situaciones. Conclusiones: La comunicación adecuada y en base a unas pautas establecidas contribuye a facilitar el proceso de elaboración del duelo en los niños y adolescentes

Aims: Death is a taboo in our society, and it is common that parents have questions about how to cope with children this issue. The aims of this paper are: 1) to describe the developmental concept of death and the ways of coping in children and adolescents in case of loss 2) to make a literature review of the main recommendations and guidelines to address the communication process and preparation children in this situation. Method: A systematic literature search has been made in primary and secondary databases (TripDatbase, PsycInfo, PubMed, Cochrane Library, Psicodoc), by combining different keywords. Results: Most of the reviewed material comes from England and USA. In our country the majority has an informative format, and we have no evidence of published regulated research. However it is possible to remove from all the material reviewed a number of general guidelines to facilitate communication with children in case of loss of a loved one. Conclusions: The correct and based on established guidelines communication makes easier the process of grief in children and adolescents

Estrategias de afrontamiento de una muestra de pacientes con trastorno límite de personalidad en terapia dialéctico conductual / No disponible

Introducción: el uso adecuado de estrategias de afrontamiento está relacionado con una mayor sensación de bienestar. Esta relación podría ser muy importante para el tratamiento de pacientes con trastorno límite de la personalidad. Las personas diagnosticadas con TLP tienen dificultades para el manejo del estrés. Este estudio trata de averiguar si existen diferencias entre las estrategias de afrontamiento que emplea la población no-clínica y los pacientes con TLP. El cuestionario COPE lo evalúa. Metodología: Se analizan las puntuaciones del cuestionario COPE en 58 pacientes con diagnóstico de trastorno límite de personalidad en terapia dialéctico-conductual. Resultados: en los pacientes con TLP evaluados existe un predominio de estrategias de afrontamiento basadas en el afrontamiento emocional y evitación cognitiva. Conclusiones: los pacientes con TLP emplean estrategias de afrontamiento más desadaptativas que la población no-clínica. Un entrenamiento en habilidades de afrontamiento podría suponer una mejoría en el bienestar de estos pacientes. En la terapia dialéctico-conductual de Linehan se promueven el aprendizaje y desarrollo de habilidades de afrontamiento. Son necesarios estudios que evalúen la eficacia del entrenamiento en habilidades de afrontamiento al estrés en pacientes con TLP

Introduction: The proper use of coping strategies is related to a greater sense of wellbeing. This relationship could be very important for the treatment of patients with borderline personality disorder. Individuals diagnosed with BPD have significant difficulty managing stress. The current study seeks to ascertain whether there are indeed differences between the coping strategies employed by the non-clinical population and patients with BPD. The COPE is a questionnaire that assesses. Methodology: We analyzed COPE questionnaire scores in 58 patients diagnosed with borderline personality disorder treated with dialectical behavioral therapy. Results: BPD patients assessed there is a predominance of coping strategies based on emotional and cognitive avoidance coping. Conclusions: Patients with BPD use more maladaptive coping strategies than non-clinical population. A coping skills training could lead to an improvement in the welfare of these patients. In dialectical behavioral therapy learning are promoved and skills development adaptive stress coping. Studies are needed to evaluate the effectiveness of training in stress coping skills in patients with BPD

Incidencia de infecciones nosocomiales en el Hospital Dr. Enrique Garcés (Quito) / Incidence of nosocomiales infections in Hospital Dr. Enrique Garcés (Exempt)

Presenta un estudio prospectivo de incidencia de infecciones Nosocomiales en el Hospital "Dr. Enrique Garcés", durante el período de may. a sep. 1996, en loservicios de Ginecología, Obstetricia, Neonatología, Pediatría, Medicina Interna e Infectología y Unidad de Cuidados Intensivos. Fueron incluidos en el estudio, todos los pacientes admitidos en el hospital durante este período y con una estadía hospitalaria de más de 48 horas. La incidencia acumulada de Infecciones Nosocomiales (IAIN) fue de 16.3 por ciento y la ines vs paciente fue de 1.1. La localización más frecuente de Infección Nosocomial (IN) por servicio fue: Pulmonar (61.5 por ciento) en UCI; Septicemia (92.9 por ciento) en Neonatología; Vías urinarias (47.6 por ciento) en Medicina Interna e Infectología; Endometritis (15.3 por ciento) en Gineco.Obstetricia. El 84 por ciento de pacientes con IN recibieron antimicrobianos previos al desarrollo del proceso infeccioso intrahospitalario. El porcentaje de confirmación microbiológica fue de 70.6 por ciento. Entre los gérmenes aislados hubo predominio de enterobacterias (72.0 por ciento). Las IN prolongaron la estadía hospitalaria en una media de 15 días más con respecto al promedio de estadía normal en el hospital.