Enfermeria Clinica最新文献

Objective

To assess the association between age, parity, nationality, educational level, employment and partner support with depression and anxiety during pregnancy. To determine the impact of the evolution of the COVID-19 pandemic on the anxiety and depression levels of the participants.

Method

Cross-sectional descriptive correlational study carried out in the Osakidetza/Basque Health Service, Primary Care, Bizkaia (Spain). A total of 295 pregnant women between 8 and 41 weeks participated. The association between age, parity, nationality, educational level, employment, partner support and COVID-19 incidence rates during the study period and depression (measured with the Edinburgh Postnatal Depression Scale) and anxiety (measured with the State-Anxiety Inventory/STAI-S subscale) scores during pregnancy was measured. A logistic regression model was constructed and odds ratios and their 95% confidence intervals were estimated.

Results

The mean score was 18.75 points for anxiety (SD 8.69) and 6.45 points for depression (SD 4.32). Women expecting their second or later child had higher scores for depression (OR 2.51 [95%IC: 1.26-5.01]) and anxiety (OR 1.98 [95%IC: 1.01-3.89]). Having completed university studies was associated with lower scores in depression (OR 0.28 [95%IC: 0.11-0.77]) and in anxiety (OR 0,2 [95%IC: 0.08-0.54]). A good relationship with the partner was associated with lower levels of anxiety (OR 0.45 [95%IC: 0.24-0.81]). The mean anxiety and depression scores are related to the incidence of COVID-19 cases; the anxiety score was significantly higher in periods of higher incidence.

Conclusions

Greater emotional care for pregnant women with low educational level, multiparous and with weak support from their partner, would reduce anxiety and depression in pregnancy. Health emergency situations affect mental health during gestation.

Objective

To evaluate the effectiveness of a group intervention based on Mindfulness in patients with anxiety and depression treated in a community mental health center. Secondarily, to evaluate quality of life and adherence to the intervention.

Methods

Quasi-experimental study with evaluations pre-post intervention in people over 18 years of age treated at the Les Corts Adult Mental Health Center (AMHC), Barcelona, between March 2015 and December 2019.

Inclusion criteria: 1) anxiety symptoms (Hamilton Anxiety Rating Scale > 10 points); 2) sign informed consent. Variables collected: 1) anxiety; 2) depression (Beck Depression Inventory); 3) quality of life (EuroQoL [EQ-5D]) and 4) adherence to the intervention. The intervention (9 weekly sessions; 75 minutes) was carried out by two nurses. Each group consisted of 10-15 patients.

Results

128 patients were included, of which 103 were women with a mean age of 52.23 years (SD 12.78). Comparisons pre and post measures, its showed improvements in relation to anxiety, depressive symptoms and general quality of life (p < 0.001) and in its dimensions of anxiety-depression (EQ-5D) (p = 0.003). The mean number of sessions attended was 6.17 (SD 2.31), and they were statistically significant and positively correlated with an improvement in anxiety (p < 0.001) and depressive symptoms (p = 0.021). There were no differences between age groups.

Conclusion

The intervention group based on Mindfulness improves anxiety and depressive symptoms, as well as the quality of life. This improvement in the symptomatology is associated with a greater adherence to the intervention.

Objective

To explore the experiences of primary healthcare (PHC) midwives with the implementation of telemedicine in pregnancy and puerperium care during the COVID-19 pandemic.

Method

Exploratory qualitative study based on an inductive content analysis of 15 semi-structured interviews with intentionally selected PHC midwives in four Spanish Autonomous Regions, during 2021-2022.

Results

Five categories were identified: (1) changes in the modality of care in pregnancy and puerperium: prioritization of pregnant women, unprotected puerperium, an increase of home visits and decline of parental education groups; (2) implementation of telemedicine in a changing scenario: the positive and negative side of telemedicine; (3) reaction of women to telemedicine; (4) strategies implemented by midwives for a humanized care, and (5) learning for the future.

Conclusions

The use of telemedicine by primary healthcare midwives enabled the care of pregnant and postpartum women during the pandemic in Spain. The positive aspects of the implementation of this type of care raise possibilities for change towards a hybrid format of healthcare.

Objective

To determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors.

Method

Follow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL:(pressure ulcers (PU), moisture-associated skin damage (MASD) and friction injuries (FI)), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: Chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression.

Results

Forty nine patients were included and 170 PP were performed. Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95% CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 (61.8-71.3) vs 64 (43-71) years old in the non-lesion group (NLG), P=.04. Eighty percent of the LG had PVD vs 20% of the NLG, p = 0.03. The median total hours on PP of the LG was 96.9 (56.1-149.4) vs 38.2 (18.8-57) of the NIG, P<.001. Multivariate analysis selected total PP hours (OR: 1.03; 95% CI: 1.01-1.05) and PVD (OR: 8.9; 95% CI: 1.3-58.9) as predisposing factors for developing DRSL.

Conclusions

There is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity. The accumulated hours in probe position and peripheral vascular disease favor their development.

At the beginning of breastfeeding, difficulties such as rusty-pipe syndrome may appear. Very little known, it presents with colostrum that is brown in color, rusty or bloody in appearance bilaterally. Despite having a spontaneous resolution and being painless, it requires education and training in its approach by health personnel.

This syndrome generates stress and maternal concern. The clinical case of a postpartum woman who wishes to breastfeed is presented, and the situation experienced during the first postpartum week and the care plan that is designed and applied in the midwife's primary care consultation to achieve the initial objective and maintenance of breastfeeding are reported.

Resolution is spontaneous during the first days, it is recommended to assess the newborn's tolerance to colostrum and not suspend breastfeeding in general for this reason. More research is required to publicize this syndrome and improve the advice and counseling of breastfeeding professionals.

Objective

Evaluating the changes of the perineal muscles in primigravid women with obesity (BMI ≥ 30) and to compare the progress with primigravid women in normal BMI range.

Methods

A prospective longitudinal cohort study was carried out. The pregnant women were studied at three moments: at 12 weeks’ gestation, at 34 weeks’ gestation and at 12 weeks after delivery. During the ckeck-up, perinometric measurements were taken to determine basal tone (BT), maximum contractile force (FMax) and applied forced (AF). In addition, the Oxford test (MOS) was used. General statistical mixed models were used for the statistical study.

Results

Fifty nulliparous pregnant women (25 with BMI ≥ 30 and 25 with BMI < 25) were recruited at the beginning of the study and 39 completed the entire study. Basal tone (BT) was 4.62 ± 0.24 Nw at the beginning of pregnancy and decreased to 4.18 ± 0.26 Nw after delivery. Contractile capacity was 5.56 ± 0.79 Nw at week 12 and increased to 6.34 ± 1.24 Nw after delivery. When comparing the FCMax at week 12 in obese vs. normal weight pregnant women, values of 5.51 ± 87 Nw vs. 5.61 ± 0.71 Nw were observed (P=.941). Postpartum values were 6.72 ± 1.17 Nw vs. 5.95 ± 1.21 Nw (P=.024), higher in the obese population.

Conclusions

There is an increase in contractile strength (Fmax) at 12 weeks postpartum in order to counteract the significant decrease in basal tone (BT). The body has compensatory mechanisms that allow recovery after 3 months postpartum, with greater muscle strength in obese patients.

Objective

The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students.

Method

Over three years, the study was conducted in the Faculty of Nursing of Murcia with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: 1) Quasi-experimental study in a single group (n = 12) before and after attending the palliative care course with clinical simulation with actors to assess the communication skills (CICAA scale). 2) Qualitative study with phenomenological perspective after clinical simulation (174 reflective students’ narratives). 3) Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students).

Results

Students who interacted with actors in clinical simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the clinical simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship.

Conclusions

Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

Objectives

To summarize the current evidence and develop recommendations on the most effective management of partial-thickness graft donor sites in adults to improve re-epithelialization, pain, and infection.

Methodology

Umbrella review. A systematic search of Pubmed, CUIDEN, Cochrane Library, CINHAL Plus, SCOPUS, and LILACS databases was conducted between October and December 2021, including systematic reviews published in the last 10 years that inquired about the effectiveness of any partial-thickness graft donor site healing strategy. Reviews with very low critical appraisal according to AMSTAR 2 were excluded. Included reviews were scored using the SIGN scale to determine their level of evidence and grade of recommendation.

Results

Five systematic reviews with meta-analysis were included. A statistically significant improvement in re-epithelialization and pain was observed in platelet-rich plasma and human amniotic membrane in relation to the control group. In addition, wound infection also decreased in platelet-rich plasma. A decrease in re-epithelialization time was also observed in recombinant human growth hormone.

Conclusions

The use of platelet-rich plasma is recommended to improve re-epithelialization, pain, and infection in partial-thickness graft donor sites in adults. The application of human amniotic membrane is recommended to accelerate re-epithelialization and reduce pain, and recombinant human growth hormone is recommended to accelerate the time to completely heal these wounds.

Aim

To study the health status of a group of patients with liver transplantation by alcohol-related disease vs another etiology before and after the transplantation.

Method

Longitudinal cohort study of liver transplant patients from November 2019 to July 2022. Adult patients attended in the unit of transplantation of a hospital for a first liver transplant, both elective and urgent, were included. Patients who already had a transplanted organ and those who required liver re-transplantation in the first month after the first transplant were excluded. Sociodemographic and clinical variables, MELDNa, liver frailty index, emotional-behavioral effects of transplantation, level of anxiety and depression were collected. Pearson's chi-square, Student's t, Mann-Whitney U, and Wilcoxon sign tests were used for statistical analysis.

Results

The sample was n = 67 liver transplant patients with a mean age of 56.37 years, 67.2% being men and 39% due to alcohol-related liver disease. 9% of all included patients were urgent transplants. Alcohol consumption was associated with older age, a high rate of liver frailty, and a non-active work situation. Alcoholic etiology correlated with increased concern during the first six months after liver transplantation.

Conclusion

There are differences in the health status between liver transplant patients for alcohol-related liver disease vs other etiology. Nurses must consider the etiology of liver disease to guide care and interventions throughout the transplant process.