Case report: Self-administration of alpha-1 antitrypsin therapy: a report of two cases.

Intravenous augmentation therapy with human alpha-1 proteinase inhibitor for the management of respiratory disease is recommended for people with alpha-1 antitrypsin deficiency (AATD) who are nonsmokers or former smokers. Augmentation therapy usually requires weekly administration at the hospital or clinic and poses an additional burden for patients due to interference with daily life, including work and social activities. Self-administration is a useful alternative to overcome this limitation, but there is a lack of published information on clinical outcomes. We report two cases of individuals with AATD at different stages of the disease who were successfully managed with self-administered augmentation therapy, with increased satisfaction because of the independence gained, lack of interference with clinical stability, and no relevant safety issues.

Evaluación de la motivación para la cesación tabáquica en pacientes hospitalizados / Assessing motivation to smoking cessation in hospitalized patients

Objetivo: Evaluación del nivel de motivación para la cesación tabáquica en los pacientes que ingresan en un hospital de agudos, identificación de los factores que predicen el inicio del cambio y establecimiento de un grupo de riesgo susceptible de intervención. Método: Estudio transversal descriptivo. Evaluación retrospectiva de las historias clínicas de 248 pacientes fumadores mayores de 18 años ingresados en unidades médicas y quirúrgicas de un hospital comarcal, entre mayo de 2014 y abril de 2015. Se valoraron datos sociodemográficos, variables relacionadas con la necesidad de respirar, consumo de cigarros/día, motivación para la cesación tabáquica, interés manifestado y antecedentes de patología respiratoria e ingresos previos. Resultados: El resultado del test de Richmond indicó que el 54% de los pacientes (n=134) tenía una baja motivación para dejar de fumar frente al 11,7% (n=29) que manifestaron una alta motivación. El grupo de pacientes que quería recibir ayuda (n=77) estaba constituido fundamentalmente por hombres (p=0,009), ingresados a cargo de especialidades médicas (p=0,026) principalmente cardiología (51,%) y consumidores de 11-29 cigarrillos/día (p=0,015). La presencia de disnea al ingreso, antecedentes de patología respiratoria e ingreso en el año previo por motivos respiratorios no constituyeron variables predictivas para obtener una respuesta motivadora hacia la cesación tabáquica. Conclusión: Se evidencia un grupo de pacientes afectados respiratoriamente con baja motivación para dejar de fumar que no quieren recibir ayuda y que deben ser considerados grupo diana para planificar estrategias motivadoras para el inicio del cambio (AU)

Aim: To assess motivation to quit smoking in patients admitted to an acute care hospital, determine predictors of readiness to change, and identify a risk group that requires targeted motivational interviewing. Methods: A cross-sectional descriptive study. A retrospective study was performed on the medical records of 248 patients aged >18 years with smoking habits admitted to the medical and surgery units of a district hospital between May 2014 and April 2015. The data collected included sociodemographic data, data on respiratory function, number of cigarettes smoked per day, motivation to quit smoking, patient-reported readiness to quit, history of respiratory diseases and previous admissions. Results: The Richmond test revealed that 54% of patients (n=134) were poorly motivated to quit smoking vs. 11.74% (n=29) who reported to be highly motivated. The group of patients who reported to be willing to receive support (n=77) was prevailingly composed of men (p=.009) admitted to a medical care unit (p=.026) -mainly the Unit of Cardiology (51%)- who smoked 11/29 cigarettes/day (p=.015). Dyspnoea at admission, a history of respiratory disease and previous admissions for respiratory problems were not predictors of readiness to quit. Conclusions: This study identifies a risk group of patients with respiratory disease, low motivation to quit smoking and poor readiness to receive smoke cessation support, that should be the target of motivational approaches to behavior change (AU)

Assessing motivation to smoking cessation in hospitalized patients. / Evaluación de la motivación para la cesación tabáquica en pacientes hospitalizados.

AIM: To assess motivation to quit smoking in patients admitted to an acute care hospital, determine predictors of readiness to change, and identify a risk group that requires targeted motivational interviewing. METHODS: A cross-sectional descriptive study. A retrospective study was performed on the medical records of 248 patients aged >18 years with smoking habits admitted to the medical and surgery units of a district hospital between May 2014 and April 2015. The data collected included sociodemographic data, data on respiratory function, number of cigarettes smoked per day, motivation to quit smoking, patient-reported readiness to quit, history of respiratory diseases and previous admissions. RESULTS: The Richmond test revealed that 54% of patients (n=134) were poorly motivated to quit smoking vs. 11.74% (n=29) who reported to be highly motivated. The group of patients who reported to be willing to receive support (n=77) was prevailingly composed of men (p=.009) admitted to a medical care unit (p=.026) -mainly the Unit of Cardiology (51%)- who smoked 11/29 cigarettes/day (p=.015). Dyspnoea at admission, a history of respiratory disease and previous admissions for respiratory problems were not predictors of readiness to quit. CONCLUSIONS: This study identifies a risk group of patients with respiratory disease, low motivation to quit smoking and poor readiness to receive smoke cessation support, that should be the target of motivational approaches to behavior change.

Gestión enfermera del dolor en pacientes hospitalizados con patologías médicas no oncológicas / Pain management nursing in hospitalized patients with non-oncological diseases

OBJETIVO: Evaluar la gestión del dolor en los pacientes hospitalizados con patologías médicas no oncológicas y analizar los factores que influyen en su valoración. MÉTODO: Estudio transversal descriptivo. Se evaluaron de forma retrospectiva los episodios de dolor reflejados en las historias clínicas de 105 pacientes mayores de 18 años ingresados en unidades médicas de un hospital comarcal entre septiembre y diciembre de 2014. Se examinó la documentación y gestión de los episodios de dolor a través de 22 variables definidas en base a los criterios de calidad del proceso de manejo del dolor. RESULTADOS: Se llevaron a cabo un total de 184 mediciones. En el 70,1% de los casos (n = 129) se evaluó y reflejó el valor de la escala visual analógica EVA, y en el 44,3% de los episodios (n = 54) se reevaluó el dolor. En el grupo de pacientes menores de 70 años el dolor se reevaluó de forma significativa superior a los mayores de 70 años; 53,1 vs.26,8% (p = 0,01), y en las mujeres fue considerado un dolor puntual sin relación con el motivo de ingreso (50 vs.25,7% p = 0,027). En el 21,1% de los casos (n = 26) la enfermera incluyó el diagnóstico de dolor como problema de colaboración en el plan de cuidados. CONCLUSIÓN: Se desprenden áreas de mejora en la gestión del dolor, fundamentalmente en lo referente al registro de sus características y reevaluación. La edad y el sexo de los pacientes influyen significativamente en su abordaje

AIM: To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. METHODS: A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged > 18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. RESULTS: A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n = 129); pain was reassessed in 44.3% (n = 54) of PATIENTS: Pain reassessment was significantly more frequent in patients aged < 70 years, as compared to older patients (53.1 vs.26.8%, respectively; p = 0.01). Pain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs.25.7% p = 0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the PATIENTS: CONCLUSIONS: Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain

[Pain management nursing in hospitalized patients with non-oncological diseases]. / Gestión enfermera del dolor en pacientes hospitalizados con patologías médicas no oncológicas.

AIM: To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. METHODS: A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged>18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. RESULTS: A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n=129); pain was reassessed in 44.3% (n=54) of patients. Pain reassessment was significantly more frequent in patients aged<70 years, as compared to older patients (53.1 vs. 26.8%, respectively; p=0.01). Pain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs. 25.7% p=0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the patients. CONCLUSIONS: Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain.