Eficacia de un programa de autocontrol en el tratamiento con anticoagulantes orales antivitamina K. Estudio de factibilidad / Effectiveness of a self-management programme in the treatment of antivitamin K oral anticoagulants. A feasibility study

INTRODUCCIÓN Y OBJETIVO: Evaluar la eficacia de un programa de autocontrol en pacientes con tratamiento anticoagulante oral (TAO) en el mantenimiento del nivel ratio internacional normalizada (INR) en rango terapéutico vs. el método tradicional realizado antes de la intervención, así como las complicaciones, la calidad de vida y el tiempo invertido en los controles. PACIENTES Y MÉTODOS: Estudio piloto de factibilidad con medidas pre-post. Se incluyó a 15 pacientes mayores de 18 años que acudían al control desde hacía más de 6meses. En la fase pre, el paciente realizaba los controles y el seguimiento desde la consulta hospitalaria. Tras realizar una intervención educativa individual al paciente para capacitarlo en la punción, el uso del coagulómetro, el manejo de las tablas de dosificación y el posterior seguimiento desde la consulta virtual, se comparó el porcentaje de controles de INR en rango, las complicaciones, la calidad de vida, y el tiempo invertido para realizar los controles pre (tradicional) y postintervención (autocontrol). RESULTADOS: El porcentaje de controles de INR en rango terapéutico en la fase post fue significativamente mayor que en la pre (65,6% vs. 37,8% p < 0,001). Las complicaciones leves, como las complicaciones graves, disminuyeron en la fase post (20% vs. 0% y 6,7% vs. 0%). Mejoraron significativamente las 5dimensiones del cuestionario de calidad de vida y disminuyó el tiempo invertido. CONCLUSIONES: En nuestra experiencia el autocontrol del TAO sugiere una mejora significativa en el control de pacientes, una disminución de las complicaciones, una mejora en la calidad de vida y un ahorro de tiempo

BACKGROUND AND OBJECTIVES: To compare the efficacy of a self-monitoring programme vs. the conventional method used before the intervention in maintaining the international normalised ratio (INR) in the therapeutic range in patients receiving oral anticoagulants, as well as complications, quality of life and the time invested in the tests. PATIENTS AND METHODS: Pre-pospilot and feasibility study. The study included 15 patients over the age of 18 years who had been attending the monitoring programme for more than 6months. In the pre phase, patients performed the tests and follow-up in the outpatient clinic. After conducting an individual training session with each patient to teach them how to perform venipuncture, use the coagulometer, manage dosing tables and subsequent follow-up from the virtual clinic, we compared the percentage of in-range INR tests, complications, quality of life, and the time invested in performing the tests pre-(conventional) and post-intervention (intervention for self-monitoring). RESULTS: The percentage of INR tests in the therapeutic range was significantly higher in the post-phase than in the pre-phase (65.6% vs. 37.8%, p<.001). Likewise, the incidence of both minor and serious complications decreased in the post-phase (20% vs. 0%, and 6.7% vs. 0%, respectively). Finally, all 5dimensions of the quality of life questionnaire improved significantly, while the time invested decreased. CONCLUSIONS: In our experience, OAT self-monitoring is associated with a significant improvement in patient management, a reduction in the rate of complications, improved quality of life and timesaving

Effectiveness of a self-management programme in the treatment of antivitamin K oral anticoagulants. A feasibility study. / Eficacia de un programa de autocontrol en el tratamiento con anticoagulantes orales antivitamina K. Estudio de factibilidad.

BACKGROUND AND OBJECTIVES: To compare the efficacy of a self-monitoring programme vs. the conventional method used before the intervention in maintaining the international normalised ratio (INR) in the therapeutic range in patients receiving oral anticoagulants, as well as complications, quality of life and the time invested in the tests. PATIENTS AND METHODS: Pre-pospilot and feasibility study. The study included 15 patients over the age of 18 years who had been attending the monitoring programme for more than 6months. In the pre phase, patients performed the tests and follow-up in the outpatient clinic. After conducting an individual training session with each patient to teach them how to perform venipuncture, use the coagulometer, manage dosing tables and subsequent follow-up from the virtual clinic, we compared the percentage of in-range INR tests, complications, quality of life, and the time invested in performing the tests pre- (conventional) and post-intervention (intervention for self-monitoring). RESULTS: The percentage of INR tests in the therapeutic range was significantly higher in the post-phase than in the pre-phase (65.6% vs. 37.8%, p<.001). Likewise, the incidence of both minor and serious complications decreased in the post-phase (20% vs. 0%, and 6.7% vs. 0%, respectively). Finally, all 5dimensions of the quality of life questionnaire improved significantly, while the time invested decreased. CONCLUSIONS: In our experience, OAT self-monitoring is associated with a significant improvement in patient management, a reduction in the rate of complications, improved quality of life and timesaving.

[Efficacy of interventions aimed at the main carers of dependent individuals aged more than 65 years old. A systematic review]. / Eficacia de las intervenciones dirigidas a cuidadores principales de personas dependientes mayores de 65 años. Una revisión sistemática.

BACKGROUND: In our environment, care of the dependent elderly is usually provided by family members, thereby ensuring autonomy and avoiding institutionalization of the dependent adult. Thirty-three percent of Spanish caregivers have acknowledged the importance of acquiring the knowledge and skills necessary for daily care. Consequently, several interventions have been developed by health professionals from distinct disciplines. OBJECTIVE: The purpose of this study was to systematically review and evaluate the efficacy of published interventions for the caregivers of dependent elderly individuals. MATERIAL AND METHODS: We conducted a systematic review of the literature on interventions in the caregivers of the dependent elderly (older than 65 years old) published between 1996 and 2006. The inclusion criteria included controlled clinical trials with outcome measures related to effectiveness in reducing caregiver burden, anxiety and depression. Our search yielded 15 reports. RESULTS: The interventions produced statistically significant reductions in burden (40%), anxiety (50%) and depression (90%). Interventions requiring active participation by caregivers and those based on cognitive-behavioral therapy were more effective than those focused on knowledge acquisition. CONCLUSION: Due to the heterogeneity of caregiving interventions, evaluation of both the clinical and statistical significance of these interventions is essential. Reducing the chronic stress experienced by caregivers is difficult to achieve. Consequently, future experimental designs should take into account the needs reported by caregivers as well as promote active participation.

Eficacia de las intervenciones dirigidas a cuidadores principales de personas dependientes mayores de 65 años. Una revisión sistemática / Efficacy of interventions aimed at the main carers of dependent individuals aged more than 65 years old. A systematic review

Introducción: el cuidado de un anciano dependiente en nuestroentorno social es asumido por los miembros de su familia o cuidadoresprincipales (CP); ellos son los responsables de mantenerla autonomía del anciano y de su permanencia en el entorno familiar.El 33% de los CP españoles manifiestan la importancia deadquirir conocimientos y habilidades para el cuidado, por lo queprofesionales de la salud de distintas disciplinas han diseñadodiferentes programas de intervención.Objetivo: el propósito de este estudio fue realizar una revisiónsistemática sobre la eficacia de las intervenciones dirigidas a CPde ancianos dependientes.Material y métodos: se realizó una revisión sistemática de la literaturacientífica publicada sobre intervenciones dirigidas a CPde personas mayores de 65 años dependientes, realizadas de1996 a 2006. Los criterios de inclusión fueron: artículos primarioscon selección aleatoria grupo experimental/grupo control y queanalizaran la eficacia de la intervención sobre la sobrecarga, laansiedad o la depresión. La muestra final la compusieron 15 estudiosque cumplían los criterios de inclusión.Resultados: las intervenciones mostraron resultados estadísticamentesignificativos sobre la sobrecarga (40%), la ansiedad(50%) y la depresión (90%).Las intervenciones con participación activa de los CP y basadasen terapia cognitivo conductual fueron más eficaces que aquellascuyo contenido se centró exclusivamente en la adquisiciónde conocimientos.Conclusiones: la heterogeneidad de las intervenciones hacenimprescindible, en esta área de estudio, valorar la relevancia clínicade los resultados además de la significación estadística. Dadoque los efectos del cuidado son estresores crónicos difícilmentemodificables, en futuros estudios se debería planteardiseños experimentales, sin olvidar las necesidades expresadaspor los propios CP y promoviendo su participación activa(AU)

Background: in our environment, care of the dependent elderlyis usually provided by family members, thereby ensuring autonomyand avoiding institutionalization of the dependent adult.Thirty-three percent of Spanish caregivers have acknowledgedthe importance of acquiring the knowledge and skills necessaryfor daily care. Consequently, several interventions have been developedby health professionals from distinct disciplines.Objective: the purpose of this study was to systematically reviewand evaluate the efficacy of published interventions for the caregiversof dependent elderly individuals.Material and methods: we conducted a systematic review of theliterature on interventions in the caregivers of the dependent elderly(older than 65 years old) published between 1996 and 2006.The inclusion criteria included controlled clinical trials with outcomemeasures related to effectiveness in reducing caregiverburden, anxiety and depression. Our search yielded 15 reports.Results: the interventions produced statistically significant reductionsin burden (40%), anxiety (50%) and depression (90%).Interventions requiring active participation by caregivers andthose based on cognitive-behavioral therapy were more effectivethan those focused on knowledge acquisition. Conclusion: due to the heterogeneity of caregiving interventions,evaluation of both the clinical and statistical significance of theseinterventions is essential. Reducing the chronic stress experiencedby caregivers is difficult to achieve. Consequently, future experimentaldesigns should take into account the needs reportedby caregivers as well as promote active participation(AU)

[Informal caretakers in Spain, their profile and care provided]. / Los cuidadores informales en España. Perfil y cuidados prestados.

The authors carried out a systematic search in main data bases and a methodological content review by paired authors about selected publications. The authors reviewed and analyzed 332 articles about informal caretakers and they chose 182 which complied with their selection criteria. The profile for informal caretakers of persons aged over 65 in Spain is identified as well as the type of care he/she provides. It is worth highlighting the introduction of a new factor in caretaking for the elderly during recent years at a national Spanish level, and since the 1990s on an international level: paid non-professional immigrant caretakers. This phenomenon makes the different traits which ethnic minority caretakers have reflect on the dynamics and the results of this study.

La Enfermería y el cuidado comunitario / Nursing and community care

Las nuevas políticas sanitarias de cuidado comunitario requiere nun enfoque innovador para potenciar la promoción de la salud. Esteartículo parte de la visión propuesta por la Organización Mundialde la Salud de “Salud para Todos”. Desde la conceptualización del empoderamiento, se propone la participación de la comunidada lo largo del proceso de promoción de la salud mediante la identificaciónde problemas e intervenciones válidas para cada grupo poblacional, siempre centrándose en sus necesidades

New healthcare policies on community care require an innovative approachto enhance health promotion. This article takes the view of the WHO proposal on “Health for Every One”. From the conceptualisation of empowerment, the participation of thecommunity throughout the process of health promotion is proposedby identifying the problems and valid interventions for each populationgroup that are logically based on the needs of each group

Estrategias para la investigación en enfermería oncológica en el siglo XXI / Strategies in oncology nursing research for the twenty-first century

Las enfermeras oncológicas tienen que afrontar los retos del cuidado oncológico dentro de una expectativa de calidad asistencial. La investigación de enfermería oncológica es necesaria para dar respuesta a problemas actuales o potenciales de los pacientes con cáncer. Además, el cuidado profesional de las enfermeras requiere la integración de la investigación como actividad fundamental, bien participando en proyectos de investigación o bien utilizando los resultados de la evidencia empírica en la práctica asistencial. Este trabajo presenta la estrategia para potenciar la investigación de enfermería centrándose en cuatro aspectos: Obtención de más financiación, aumento de la productividad científica, mejora de la diseminación de los resultados y potenciación del consumo de los resultados publicados por las enfermeras asistenciales (AU)

Oncology nurses have to COPE with the demands of the cancer within a reference framework of quality care. Oncology nursing research is needed to respond to actual or potential cancer patient problems. Besides, professional nursing care requires research as a fundamental activity. All nurses have to participate in research as generators of knowledge by participating in nursing research or as consumers of research results in focusing in four targeted aspects: Greater funding directed towards nursing research, increased production of clinical research, improved dissemination, enhanced consumption of research publications by clinicians (AU)