Predictive Model and Mortality Risk Score during Admission for Ischaemic Stroke with Conservative Treatment.

BACKGROUND: Stroke is the second cause of mortality worldwide and the first in women. The aim of this study is to develop a predictive model to estimate the risk of mortality in the admission of patients who have not received reperfusion treatment. METHODS: A retrospective cohort study was conducted of a clinical-administrative database, reflecting all cases of non-reperfused ischaemic stroke admitted to Spanish hospitals during the period 2008-2012. A predictive model based on logistic regression was developed on a training cohort and later validated by the "hold-out" method. Complementary machine learning techniques were also explored. RESULTS: The resulting model had the following nine variables, all readily obtainable during initial care. Age (OR 1.069), female sex (OR 1.202), readmission (OR 2.008), hypertension (OR 0.726), diabetes (OR 1.105), atrial fibrillation (OR 1.537), dyslipidaemia (0.638), heart failure (OR 1.518) and neurological symptoms suggestive of posterior fossa involvement (OR 2.639). The predictability was moderate (AUC 0.742, 95% CI: 0.737-0.747), with good visual calibration; Pearson's chi-square test revealed non-significant calibration. An easily consulted risk score was prepared. CONCLUSIONS: It is possible to create a predictive model of mortality for patients with ischaemic stroke from which important advances can be made towards optimising the quality and efficiency of care. The model results are available within a few minutes of admission and would provide a valuable complementary resource for the neurologist.

Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study.

The use of telemedicine has greatly increased, largely derived from the COVID-19 pandemic, which has created the need for a guide aimed towards the adequate management of a modality of health care: the video consultation. A Delphi study composed of three rounds was conducted with 16 experts in holding video consultations and managing non-technical skills from different specialties and nationalities to conceive a consensus on the criteria needed for properly managing video consultations by healthcare professionals. The consensus criteria were defined by three dimensions (preparation of video consultation, video consultation process, and post-video consultation) and their corresponding items. Excellent consensus data was obtained; therefore, use is recommended by any healthcare professional who is going to utilize a video consultation, in order to manage it effectively.

Increase in Video Consultations During the COVID-19 Pandemic: Healthcare Professionals' Perceptions about Their Implementation and Adequate Management.

In response to the COVID-19 pandemic, health care modalities such as video consultations have been rapidly developed to provide safe health care and to minimize the risk of spread. The purpose of our study is to explore Spanish healthcare professionals' perceptions about the implementation of video consultations. Based on the testimonies of 53 professionals, different categories emerged related to the four identified themes: benefits of video consultations (for professionals, patients, and the health system, and compared to phone calls), negative aspects (inherent to new technologies and the risk of a perceived distancing from the professional), difficulties associated with the implementation of video consultations (technological difficulties, lack of technical skills and refusal to use video consultation among professionals and patients), and the need for training (technological, nontechnical, and social-emotional skills, and adaptation of technical skills). Additionally, the interviewees indicated that this new modality of health care may be extended to a broader variety of patients and clinical settings. Therefore, since video consultations are becoming more widespread, it would be advisable for health policies and systems to support this modality of health care, promoting their implementation and guaranteeing their operability, equal access and quality.

Mindfulness therapies on health professionals.

Health professionals are exposed to situations of emotional vulnerability by being in continuous contact with patients and their suffering, which can cause conditions such as compassion fatigue. To address this issue, therapies such as mindfulness are being used to reduce stress and promote self-compassion. The objective of this research was to carry out a systematic review and meta-analysis to analyse the types of mindfulness interventions that are being used for healthcare professionals and their effectiveness in reducing stress and improving self-compassion and mindfulness. Following the PRISMA guideline, a systematic review of original studies was carried out in the following databases: Medline, Scopus, Cinhal, PsycINFO, Lilacs, and Science Direct, without a limited time frame. Controlled experimental mindfulness interventions on health professionals were selected, in which the following outcome variables were measured: stress, self-compassion, and mindfulness. A meta-analysis was performed with a random effects model. In cases of very high heterogeneity, the data were analysed by subgroup. Mindfulness-Based Stress Reduction Therapy (MBSR) was the most often used in the studies. There is diversity in the implementation of MBSR, and a common finding is a reduction of stress and increased mindfulness in health professionals. However, studies that analyse self-compassion are scarce. The effect of these therapies varies depending on how long the individual has been practising meditation. In conclusion, more studies are needed to describe the clinical usefulness of these programmes, to jointly analyse these three variables (stress, self-compassion, and mindfulness), and to measure compassion fatigue as an outcome variable.

Competencia de las enfermeras de cuidados críticos para integrar y aplicar la práctica basada en la evidencia / The competence of Critical Care nurses to incorporate and apply Evidence-Based Practice

OBJETIVO: evaluar la competencia de los y las enfermeras de cuidados intensivos y urgencias para integrar y aplicar la práctica basada en evidencias (PBE).MÉTODO: estudio descriptivo transversal realizado sobre el total de enfermeras (N=110) de las Unidades de Cuidados Intensivos y Urgencias del Hospital Torre cárdenas (Almería). Para la recogida de los datos se utilizó un instrumento validado, el cuestionario de práctica basada en la evidencia (CPBE-19). Se midieronademás variables sociodemográficas. Para el tratamiento delos datos se calcularon índices de estadística descriptiva y pruebas de contraste de hipótesis (t de Student, ANOVA, Kruskal-Wallis, r de Pearson).RESULTADOS: la tasa de respuesta fue del 100%. Las actitudes de los participantes hacia la PBE mostraron la puntuación media más alta (5,42), seguido de los conocimientos/habilidades (3,61) yla práctica (3,40). Se encontraron diferencias estadísticamente significativas entre las enfermeras que trabajaban en la unidad de cuidados intensivos y la dimensión práctica (3,80 vs 2,98, p = 0,002); entre quienes que poseían otro título universitario y la dimensión conocimiento (4,45 vs 3,52 , p= 0,014); y entre las formadas en evidencia y cada una de las dimensiones: actitud (6,00vs 5,32, p= 0,025), práctica (4,41 vs 3,22, p= 0,001) y conocimiento/habilidades (4,55 vs 3,45, p= 0,001). Se encontraron correlaciones significativas entre las tres dimensiones del EBPQ-19.CONCLUSIONES: las enfermeras mostraron actitudes positivas hacia la PBE y su uso para apoyar la toma de decisiones clínicas, sin embargo hay una falta de correlación entre la actitud positiva y las puntuaciones medias más bajas de las dimensiones conocimientos/habilidades y práctica

OBJECTIVE: to understand the incidence of phlebitis in the Fundación Hospital de Jove, in Gijón, before and after implementing improvement actions (withdrawal of peripheral vein catheters (PVCs) not used during24 hours, and review and update of nursing records).MATERIAL AND METHOD: intervention before-and-after study. Two longitudinal cuts were conducted in October-December, 2011 (period 1,baseline), and March-May, 2012 (period 2, after two improvement actions).A total of 3,876 vein catheters were reviewed, the incidence of phlebitis associated with PVC was determined, and the associated variables were analyzed (age, gender, unit of admission, catheter gauge, site of insertion, type of infusion, unit of insertion, Maddox Index, and drugs administered).RESULTS: the incidence of phlebitis by peripheral vein catheters was8.7% in the first cut, and 7.6% in the second cut; the most frequently used size was 20 G, with 64.9% and 75.2%. The anatomical site with higher incidence of phlebitis was the forearm. Those PVCs inserted in the Emergency Unit showed a higher incidence of phlebitis. The completion of nursing records was improved, from 53.56% to 64.41%.CONCLUSIONS: an improvement has been achieved regarding the incidence of phlebitis and record completion. However, it is necessary to continue working with nurses in order to improve these data, encouraging the training of these professionals on those aspects