Enfermeria Clinica最新文献

Objective

To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity.

Design

Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. Location: 27 PC teams from Catalonia. Participants: > 50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. Intervention: 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training.

Measurements

Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated.

Results

The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was −357.95€ (95% CI: −2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: −15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference −0.01, 95% CI −0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY.

Conclusions

Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.

Objective

Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program.

Methods

Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed.

Results

A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45).

Discussion

The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Objective

The objective of this paper is to explore the influence of web 2.0 as a complementary support network to traditional networks for the promotion of breastfeeding (BF).

Method

Qualitative and exploratory study carried out from September 8 to December 31, 2022, at the Las Vegas Health Centre (Corvera), Health Service of the Principality of Asturias (SESPA). The participants were 5 professional experts in BF and 7 breastfeeding mothers, who made up two focus groups, selected by convenience sampling. The analysis consisted of transcription of data, in-depth reading, analysis by grouping concepts and classification of the information into categories.

Results

After the final analysis, seven categories were identified, organised according to the proximity of the topic and the proposed objective, based on the most significant discourses of the study: Difficulties during BF, Importance of receiving help: First support networks, Other support networks, A health system with deficiencies, Pandemic and BF 2.0, Health 2.0 and apps in BF: new form of support and Characteristics of an “ideal” app on BF.

Conclusions

Web 2.0 has revolutionised the way mothers access information and support on BF, creating an online support network connecting mothers and professionals around the world, providing up-to-date information and enabling a source of emotional support through the creation of peer groups. This positive influence of web 2.0 has had a significant impact on promoting BF and empowering mothers to make informed decisions about their breastfeeding process.

Objective

To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity.

Method

Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis.

Results

A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001).

Conclusion

The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Objective

To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals.

Methods

We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016 to 2018 for publications in English, French, Portuguese and Spanish.

The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration.

The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category.

Results

A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR + = 0.87). Multifactorial (RR + = 0.89) and education-based (RR = +0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively.

Conclusions

Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

Objective

Many older adults in Indonesia decide to live in nursing homes. Living in a nursing home has been associated with the incidence of cognitive decline in older adult that leads to decreasing ability to perform daily activity. This study aimed to determine the association between demographic and clinical characteristics with cognitive functions in older adults living in nursing homes in Indonesia.

Methods

This study used a cross-sectional design and involved 60 older adults in a nursing home. Cognitive function was evaluated using the Montreal Cognitive Assessment instrument. Demographic and clinical characteristics such as age, education level, length of stay in the nursing home, as well as serum levels of brain-derived neurotrophic factor and dopamine were studied. Spearman-Rank test was used for data analysis.

Results

Cognitive function of attention had a positive correlation with age (r = 0.314, p = 0.015), length of stay in the nursing home (r = 0.268, p = 0.038), and negative correlation with dopamine serum levels (r = -0.425, p = 0.001). The cognitive function of naming has a positive correlation with age (r = 0.263, p = 0.042).

Conclusions

Age, length of stay, and dopamine levels associated with cognitive function in older adult living in nursing homes. The older adult should be assessed in term of factors associated with cognitive function to make the cognitive improvement programs in nursing homes.

Purpose

The study aimed to determine body image and levels after surgery in cornea transplant patients.

Materials and methods

The population of this cross-sectional study was composed of 383 patients presented to the Eye Bank unit of a University Hospital after corneal transplantation. Sample size of 193 patients was calculated with 0.5 power, a margin of error of 5%, representing 95% of the universe. The data were collected through face-to-face interviews with the patients by the researcher and the study was completed with 178 patients in September - November 2022. The data were collected using a Patient Information Form, the Body Image Scale, and the General Self-Efficacy Scale. Parametric tests, Pearson Correlation, Student's T-test, and One-Way Analysis of Variance tests were performed were used in the data analysis.

Results

It was determined that the mean Body Image Scale score of the transplant patients participating in the study was 159.41 ± 36.99 and the mean Self-Efficacy Scale score was 30.37±8.31. When the comparison of the mean scores was examined, the difference between the mean scores of gender, marital status, occupation, and body image scale was statistically significant (P < .05), while the difference between the self-efficacy mean scores was not statistically significant (P > .05). There was a positive, moderately strong significant relationship between body image and the self-efficacy of the patients (P < .01) (r = .57)

Conclusion

It was found that the patient's body image and self-efficacy levels were high, and self-efficacy increased as the body image increased.