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Efficacy and safety of dexamethasone compared to placebo in patients with severe influenza infection. (FLUDEX study): a study protocol for a randomised controlled trial in Spain

Por: Ramos-RIncon · J.-M. · Cebollada · J. · Giner · L. · Paz Ventero · M. · Moreno-Perez · O. · Otero-Rodriguez · S. · Sanchez-Paya · J. · Rodriguez · J. C. · Merino · E.
Introduction

The combination with corticosteroids as immunomodulators has been the subject of debate in different infectious syndromes. The main objective of this study is to evaluate the efficacy (the percentage of patients hospitalised with influenza with a status of 3 or higher according to the Hospital Recovery Scale (HRS) on day 7 after the start of treatment) and safety of dexamethasone.

Methods and analysis

Investigator-initiated multicentre, blinded, randomised placebo-controlled trial with two parallel treatment arms. The study population will consist of adult patients (over 18 years of age) hospitalised with severe influenza. One arm will receive one capsule of 6 mg of dexamethasone for 7 days, and the other arm will receive one capsule of placebo for 7 days of antibiotic treatment for 7 days or longer. Both groups will receive oseltamivir (75 mg/12 hours orally) for 5 days, extendable to 10 days depending on the investigator decision. Randomisation will occur in equal proportion (1:1). Patients with bronchial hyper-responsiveness that requires systemic corticosteroids for more than 24 hours, preinclusion treatment with corticosteroids for more than 24 hours at a dose equal to or higher than 1 mg/kg methylprednisolone (0.2 mg/kg dexamethasone or 1.25 mg/kg prednisone), inability to administer oral oseltamivir, patients with severe comorbidity with a life expectancy of

Ethics and dissemination

The study is approved by the Institutional Review Board of Alicante Health Department—Dr. Balmis General University Hospital (LOC-100061146). The results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal

Trial registration number

NCT06528444.

Efficacy of virtual reality in reducing pain, anxiety and fear in hospitalised children: a systematic review and meta-analysis protocol

Introduction

Paediatric hospitalisation, encompassing the period from admission to discharge, often involves feelings of pain, fear and anxiety, primarily due to clinical diagnoses and, more significantly, discomfort and stress-inducing procedures. Numerous methodologies and interventions have been investigated and implemented to alleviate these phenomena during paediatric hospitalisation. Virtual reality (VR), for example, has demonstrated efficacy in pain relief for hospitalised children in recent studies. This systematic review, therefore, aims to identify and evaluate the effectiveness of VR in alleviating pain, fear and anxiety in hospitalised children undergoing painful procedures.

Method and analysis

This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. A systematic search will be conducted in March and April 2025 across the following databases, with no restrictions on language or publication year: PubMed, Embase, Scopus, Web of Science, Cumulated Index in Nursing and Allied Health Literature, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomised and quasi-randomised clinical trials involving children (aged 2–10 years) and adolescents (aged 10–18 years) who received VR interventions during painful procedures. Data will be managed and analysed using Review Manager software (RevMan 5.2.3). In cases of significant heterogeneity (I² > 50%), a random-effects model will be employed to combine studies and calculate the OR with a 95% CI. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias 2.0 tool, and the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework.

Ethics and dissemination

This study will solely review published data; thus, ethical approval is not required. This systematic review is expected to provide subsidies, evidence and insights into the use of VR. It is also anticipated that the results will directly impact the improvement of care for these patients and the qualification of professional care.

PROSPERO registration number

CRD42024568297.

Effectiveness of an Online Training Program on Brief Tobacco Intervention (BTI) for Nurses: A Quasi‐Experimental Study. The E‐Learning BTI Project

ABSTRACT

Introduction

Smoking is the leading cause of preventable deaths. The training of professionals on brief tobacco interventions (BTIs) increases the effectiveness of these interventions.

Objective

To assess the effectiveness of an online training program on BTI based on the 5As and 5Rs model in acquiring anti-tobacco brief advice competencies among nurses.

Method

Quasi-experimental study with a pre-test and post-test design, with a control group and without random assignment. In the experimental group (EG), online training was provided in three sections: BTI theoretical content and methodology, clinical scenario videos, and feedback. Each scenario assessed the 5As and 5Rs as a validated instrument (BTI-Prof(C)). The control group (CG) only assessed the three videos of clinical scenarios. In both groups, competence was measured at the following points in time: T0 (before the training), T1 (at the end of the training), and T2 (after 90 days). The efficacy of the intervention was measured through a two-way ANOVA, and the variation rate was calculated from T0 to T1 and from T0 to T2.

Results

236 nurses participated (157 EG; 79 CG). The mean age was 42.9 years, and 76.7% were women. There was a significant group*time interaction in the three cases, indicating that the online BTI training increases the competence of these professionals in clinical scenario 1 (F = 10.210; p ≤ 0.001; η 2 = 0.081), clinical scenario 2 (F = 6.235; p = 0.002; η 2 = 0.051), and clinical scenario 3 (F = 11.271; p ≤ 0.001; η 2 = 0.090).

Conclusion

A brief, asynchronous, and online intervention using standardized video-based cases is effective in improving nurses' BTI competence. This type of training can be a useful option for the National Health System as part of a global and continuous strategy for nurses to perform BTI.

Clinical Relevance

An asynchronous online training program provides nurses with standardized, evidence-based tools to implement brief tobacco interventions in routine care, offering a scalable and practical solution to strengthen preventive strategies in health systems.

¿El dolor producido por la punción directa influye en los resultados de la gasometría arterial?

Introducción. La punción arterial para el análisis gasométrico provoca dolor de intensidad variable. Este dolor podría alterar la dinámica ventilatoria y, por tanto, los parámetros respiratorios de la muestra sanguínea. Objetivos. Determinar la posible relación entre el dolor inducido por la punción arterial y los parámetros obtenidos del análisis gasométrico de estas muestras de sangre. Como objetivos secundarios, obtener la prevalencia del dolor provocado en la muestra estudiada y la posible asociación con el número de intentos. Metodología. Estudio transversal que incluyó 100 muestras arteriales de 61 pacientes durante el primer semestre de 2024. La intensidad del dolor, reportada mediante la escala NRS-11, fue la variable principal de estudio. Se analizó la asociación de esta variable con variables gasométricas (por ejemplo, pH, pO2, pCO2 y lactato) y con otras variables sociodemográficas y relacionadas con punción arterial. Resultados. La edad fue de 69,43 ± 13,07 y el 68% eran hombres. Respecto a la variable principal de resultado, la puntuación media del dolor fue de 4,03 ± 2,61. La intensidad del dolor no mostró asociación con ninguna variable gasométrica. Sin embargo, el número de intentos de obtener con éxito una muestra arterial mostró significación. Tras ajustar por otras variables, cada intento adicional aumentaba el dolor en 1,14 puntos. Discusión. No se encontró asociación entre el dolor de la punción arterial y los parámetros del análisis gasométrico, por lo que los resultados pueden interpretarse de forma robusta en situaciones en las que no es posible un manejo adecuado del dolor.

ABSTRACT

Introduction. Arterial puncture for gasometrical analysis causes pain of varying intensity. This pain could alter the ventilatory dynamics and therefore the respiratory parameters of the blood sample. Objectives. To determine the possible relationship between the pain induced by arterial puncture and the parameters obtained from the gasometrical analysis of these blood samples. As secondary objectives, to obtain the prevalence of pain caused in the sample studied and the possible association with the number of attempts. Methodology. Cross-sectional study involving 100 arterial samples from 61 patients during the first half of 2024. Pain intensity reported by the NRS-11 was the main study variable. The association of this variable with gasometrical variables (for example: pH, pO2, pCO2, lactate) and with other variables of different nature (sociodemographic and related to the arterial puncture itself) was analyzed. Results. The age was 69,43 ± 13,07 and 68% were men. Regarding the main outcome variable, the mean pain score was 4.03 ± 2.61. Pain intensity showed no association with any of the gasometric variables. However, the number of attempts to successfully obtain an arterial sample showed significance. After adjustment for other variables, each additional attempt increased pain by 1.14 points. Discussion. No association was found between arterial puncture pain and gasometric analysis parameters, so the results can be robustly interpreted in situations where adequate pain management is not possible.

Cuidados y Tuberculosis a través del cuadro “Ciencia y Caridad” de Pablo Picasso (1897)

Resumen: Introducción: La tuberculosis es una enfermedad infectocontagiosa con una alta tasa de prevalencia, reconocida como una alerta para la salud global y, al mismo tiempo, como una dolencia persistente a lo largo de la historia humana. La trayectoria histórica y cultural de la tuberculosis está marcada por representaciones visuales y escritas a lo largo de los años. Objetivos: Analizar las representaciones del cuidado de la tuberculosis en la pintura Ciencia y Caridad de Pablo Picasso. Métodos: Se trata de un estudio histórico desde la perspectiva de la microhistoria, utilizando un análisis pre-iconográfico e iconográfico. La fuente histórica fue la pintura Ciencia y Caridad de Pablo Picasso, de 1897. Resultados: Estas representaciones sugieren el papel de la monja y el cuidado de enfermería, simbolizando la caridad, además de la acumulación de tareas, diferencias laborales de género y cuidado holístico con la familia. El médico, representado de forma destacada en primer plano, simboliza la ciencia de la época. La paciente, afectada por la tuberculosis, se encuentra en el centro de la imagen, con rostro pálido, ojos hundidos y cuerpo delgado. Además, en el entorno se identifica un oratorio, que puede significar una relación con la espiritualidad, especialmente con el catolicismo, lo cual se asocia con la figura de la monja. También se observaron características de un ambiente húmedo, como ventanas cerradas con manchas. Conclusión: En este contexto, el cuidado de enfermería para pacientes con tuberculosis se representa como una práctica colectiva que involucra a la familia, abordando tanto las necesidades del paciente como las de su entorno. Las representaciones del cuidado durante el período del Realismo, basadas en la obra analizada, destacan un modelo de atención centrado en satisfacer las necesidades del paciente, enfatizando el ambiente, la espiritualidad y la evolución de la enfermería como una práctica orientada al bienestar integral. 

Systematic review on the measurement properties of patient-reported outcome measures (PROMs) for measuring well-being in young children

Por: Morato-Espino · P. G. · Ramos · J. M. R. · Gomez · I. N.
Objective

This systematic review aims to summarise and assess the measurement properties of existing instruments for measuring child well-being.

Design

A systematic review of measurement properties following the COnsensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and the Joanna Briggs Institute methodology was performed.

Data sources

A search was performed in PubMed, Medline Complete, CINAHL Plus, Psychology & Behavioral Sciences (via EBSCOHost) and GoogleScholar (last search August 2024).

Eligibility criteria

This review focused on studies that evaluated the measurement properties of instruments to measure the well-being of children ages 2–7 years, published between 2000 and 2023. We excluded studies that used the child well-being instrument as an outcome measure or to validate another instrument.

Risk of bias and data synthesis

The methodological quality of eligible studies was evaluated using the COSMIN Risk of Bias checklist, the measurement properties of the instruments per study were assessed using the updated criteria for good measurement properties and an overall rating for the measurement property of each instrument is determined and compared against the criteria for good measurement properties. The quality of evidence was evaluated using the modified Grading of Recommendations Assessment, Development and Evaluation approach, and measurement recommendations were formulated. Results were presented using a narrative synthesis and tables.

Results

Three measures from three studies were included, and they presented moderate to high quality evidence for structural validity, internal consistency and construct validity. However, limited evidence was available for content validity.

Conclusion

Few instruments to measure the well-being of children aged 2–7 years are available, and only three measurement properties were fully evaluated in these studies. This review was conducted even if there was incomplete or unavailable information regarding their content validity. Further research is recommended before these measures may be recommended for use.

Prospero registration number

CRD42023428953.

Novel non-synonymous and synonymous gene variants of <i>SRD5A2</i> in patients with 46,XY-DSD and DSD-free subjects

by Luis Ramos

SRD5A2 gene variants are associated with deficiency of steroid 5α-reductase type 2, which is an autosomal recessive disorder of sex development (DSD) present in 46,XY males with ambiguous genitalia. To determine the causality of the disorder, this study involved genetic screening of SRD5A2 in six unrelated patients with this condition. Polymerase chain reaction (PCR) assays excluded large duplications, insertions, or deletions, while bidirectional Sanger sequencing identified 15 single-nucleotide variants (SNVs), six patients with 46,XY-DSD carrying pathogenic non-synonymous SNVs (nsSNVs), and three subjects who were DSD-free with novel synonymous SNVs (sSNVs). Genomic outcomes showed that 9 non-synonymous coding SNVs are linked to patients with SRD5A2-associated steroid 5α-reductase type 2 deficiency (c.169G > C: p.E57Q; c.145G > A: p.A49T/c.686T > C: p.F229S; c.100G > A: p.G34R/c.344G > A: p.G115D; c.591G > T: p.E197D; c.92C > T: p.S31F/c.481A > C: p.I161L (a novel missense variant; Km,app =  1.19 ±  0.1 μM, Vmax,app =  688 ±  145.8 pmol/mg P/min); c.686T > C: p.F229S). This analysis also highlighted 2 non-disease-causing sSNVs in three DSD-free subjects (c.243G > T: p.T81 = ; c.594C > T: p.I198=). These silent mutations or sSNVs in the SRD5A2 gene have no functional consequences and might not be involved in steroid 5α-reductase 2 deficiency. The identification of these sSNVs in both healthy controls and patients might suggest natural genetic variability with a very low allele frequency in the Mexican population. Furthermore, these findings indicated that nsSNVs in the SRD5A2 gene altered normal development of external male genitalia, supporting their pathogenicity.

Monitoring the Sustainability of a Breastfeeding Guideline During the COVID‐19 Pandemic: A Mixed‐Methods Study

ABSTRACT

Aim

To analyse the impact of the COVID-19 pandemic on the sustainability of a breastfeeding (BF) clinical practice guideline (CPG) for women without COVID-19, throughout the 5 waves of the pandemic.

Desing

A mixed-methods design was utilised.

Methods

For the quantitative approach, an interrupted time series design was utilised, as well as the analysis of CPG sustainability reports as a qualitative approach. The study setting was in a health area in the Spanish health system from April 2019, until October 2021. The sample was composed of 2239 mother–infant dyads.

Results

The exclusive-BF rate at hospital discharge obtained values between 90% and 94.8%, without statistically significant changes. A significant increase in the risk of not starting BF in the first feeding was observed (adjusted odds ratio = 9.36; 95% CI: 1.04–84.13), between the pre-pandemic period and the first wave. Skin-to-skin contact (SSC) decreased in the first wave to 82.20%, and the oscillations observed throughout the pandemic were not statistically significant. In general, the qualitative indicators were maintained. A decrease was observed in the spaces used for postpartum care due to the re-assigning to the intensive care unit. Also, the acquisition of materials and equipment decreased.

Conclusions

The measures implemented for the sustainability of the BF CPG during the 5 waves of the pandemic were positive. The programmes of implementation of BF guidelines were shown to resist the COVID-19 pandemic.

Impact

Our findings contribute to the understanding and evolution of the main indicators of the sustainability of a BF CPG on COVID-19 context, providing details on the magnitude of the effect and the process of change.

Reporting Method

The Preferred Reporting Items for observational studies (STROBE) checklist was followed.

Patient or Public Contribution

No Patient or Public Contribution.

The choice of treatment and the motivations behind it impact clinical outcomes among patients with adequate control of their rheumatic disease: A real-life study

by Irazú Contreras-Yáñez, Guillermo A. Guaracha-Basáñez, Diana Padilla-Ortiz, Laura L. Franco-Mejía, Laura V. Vargas-Sánchez, Julia G. Jiménez-Decle, Virginia Pascual-Ramos

Introduction

Many factors influence how doctors make treatment decisions. The study compares the outcomes of patients with rheumatic diseases and adequate control (AC) whose treating rheumatologists prescribed their first choice of treatment (FCHO) versus the second choice (SCHO) and the motivations behind them. It also investigates the motivations associated with FCHO.

Patients and methods

The study was conducted at an outpatient clinic from February 2023 to February 2024. Patients with an RMD diagnosis were identified using systematic sampling (P-1). After their consultation, their rheumatologists detailed their treatment choice (FCHO vs. SCHO), the motivations behind it, and the outcomes. In a subsample of patients from P-1 and AC (SubP-1), treating rheumatologists repeated the assessment of outcomes at the next scheduled consultation. Descriptive statistics and multivariate regression analysis were used.

Results

There were 703 patients enrolled (P-1), 543 (77.2%) had AC, and 292 (Subp-1) underwent a follow-up evaluation. In P-1 and subP-1, FCHO was prescribed to 644 (91.5%) and 269 (92.1%) patients.Motivations related to evidence-based medicine and personal experience were more frequently referred to in FCHO. Concerns related to current or future drug shortages and a history of adverse events/intolerance were more frequent in SCHO.In SubP-1, a higher proportion of patients remained in AC and experienced remission/ improved disease activity with FCHO. Patients who received FCHO experienced a greater risk for favorable outcomes.The following motivations were associated with FCHO: “It aligns with guidelines”; “solid scientific evidence supporting the treatment effectiveness”; “I am concerned that the shortage of the drug may hinder the continuation of the treatment” and “history of adverse events or intolerance”.

Conclusions

Patients with AC of their underlying RMD, whose rheumatologists prescribed their FCHO, had better outcomes than those who were prescribed SCHO. Evidence-based motivations, rheumatologists´ concern of medication shortage, and patient-related motivations were associated with FCHO.

Muerte contemporánea: ¿huellas valiosas y duraderas o negación de la muerte?

Ensayo reflexivo cuya propuesta aborda el informe contemporáneo titulado “Black Mirror” de la vida real: Brasil funda Startup para recrear personas muertas, escrito para la revista Forbes Brasil y publicado el 20 de septiembre de 2020. Lo que nos interesa problematizar en este ensayo se refiere al gobierno del otro, a la disciplina y a los posibles cambios biopolíticos resultantes de esta enternización de uno mismo. A partir de los Estudios Culturales, utilizando específicamente conceptos de Foucault y Byung-Chul Han, analizamos cómo se presentan los discursos sobre la muerte en este informe, entendiendo el gobierno de los cuerpos y las formas de vida, en una perspectiva en la que una identidad humana sería mapeada, procesada y monetizada en una inteligencia artificial. Ampliando el significado foucaultiano, estaríamos pasando de la sociedad disciplinar y biopolítica a la sociedad de ingresos y de la “psicopolítica”, del panóptico al panóptico virtual o digital. Es seductor mantenerse vivo y producir emociones positivas en las personas que amamos, incluso después de nuestra muerte. Para los profesionales de la salud, estas reflexiones son válidas en la conducción de cuidado, las prácticas asistenciales y en la comprensión de la finitud.

El significado de soledad en el adulto mayor que pertenece a un grupo de apoyo

Objetivo: Comprender el significado de la soledad que tiene el adulto mayor que participa en grupos de apoyo. Metodología: estudio cualitativo fenomenológico hermenéutico, la selección de participantes fue por muestreo intencionado, 25 adulto mayores logrando la saturación teórica, se aplicó entrevista a profundidad para la recolección de datos, que partió de una pregunta central, el análisis se realizó según planteamientos de Cohen y Steeves. Resultados: Emergieron tres temas. La soledad es algo que enferma y entristece. El amparo de las creencias religiosas como refugio ante la soledad. La compañía mejora el no sentirse solo. Conclusión: Es un compromiso para enfermería seguir nutriendo la discusión sobre lo que la soledad puede significar para este grupo poblacional, pero más allá de simplemente tratar de entender que significa para ellos, poder brindar herramientas de análisis que permitan diseñar estrategias dirigidas al desarrollo de acciones que propendan por mitigar y superar la soledad.

The role of orthobiologics in chronic wound healing

Abstract

Chronic wounds, characterized by prolonged healing processes, pose a significant medical challenge with multifaceted aetiologies, including local and systemic factors. Here, it explores the complex pathogenesis of chronic wounds, emphasizing the disruption in the normal phases of wound healing, particularly the inflammatory phase, leading to an imbalance in extracellular matrix (ECM) dynamics and persistent inflammation. Senescent cell populations further contribute to impaired wound healing in chronic lesions. Traditional medical management focuses on addressing underlying causes, but many chronic wounds resist to conventional treatments, necessitating innovative approaches. Recent attention has turned to autologous orthobiologics, such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and mesenchymal stem cells (MSCs), as potential regenerative interventions. These biologically derived materials, including bone marrow aspirate/concentrate (BMA/BMAC) and adipose tissue-derived stem cells (ADSCs), exhibit promising cytokine content and regenerative potential. MSCs, in particular, have emerged as key players in wound healing, influencing inflammation and promoting tissue regeneration. This paper reviews relevant scientific literature regarding basic science and brings real-world evidence regarding the use of orthobiologics in the treatment of chronic wounds, irrespective of aetiology. The discussion highlights the regenerative properties of PRP, PRF, BMA, BMAC and SVF, showcasing their potential to enhance wound healing. Despite advancements, further research is essential to elucidate the specific roles of each orthobiologic and determine optimal applications for different wound types. The conclusion underscores the evolving landscape in chronic wound management, with a call for more comprehensive studies to refine treatment strategies and maximize the benefits of regenerative medicine.

La corrupción de la beneficencia en los debates parlamentarios del Trienio Liberal en España (1820-1823)

Una de las principales novedades del debate parlamentario de la ley de beneficencia en el Trienio Liberal radicó en las delaciones de irregularidades en la gestión de este tipo de establecimientos. La meta principal de este estudio es analizar dichas denuncias sobre la base de una triple diferenciación: las que apuntan a las irregularidades debidas a una mala gestión de los recursos económicos, las que se refieren a la administración concejil y las que tienen que ver con la dejadez de quienes cuidaban a los menesterosos en tales casas. Los debates parlamentarios del Trienio liberal en la Ley de Beneficencia se constituyen como fuente principal del estudio. Metodológicamente se aborda el análisis de las intervenciones de los diputados que participaron en la elaboración de dicha normativa. Lo extraño en esta época no eran estas irregularidades, asumidas como algo natural, sino el hecho de que fueran denunciadas por los parlamentarios, pues ello evidencia un cambio sustancial en cuanto a la voluntad de controlar la gestión económica de estos establecimientos, así como la responsabilidad de los cuidadores.

Pérdida significativa como factor del alcoholismo

La relación de la pérdida significativa de un ser querido y el alcoholismo ha minimizado las implicaciones sobre mecanismos de afrontamientos para generar conductas saludables. Este artículo se basa en entrevistas semiestructuradas a profundidad en hombres de entre 30 y 70 años, con más de 10 años en Alcohólicos Anónimos del Estado de Tamaulipas, México. El objetivo fue reflexionar sobre los significados de la pérdida significativa de un ser querido y el alcoholismo. En la búsqueda del significado, se explica que un factor que lleva al alcoholismo no es una sola pérdida significativa de personas queridas, sino un cúmulo también de pérdidas materiales y no materiales, se reflejaron recursos limitados para afrontar las pérdidas, la relación entre la pérdida significativa con el alcoholismo fue mediado por dos principales aspectos, las creencias sobre los efectos que produce el consumo de alcohol como formas de escapar de la realidad y las influencia de la familia al inicio del consumo de alcohol. Por otra parte, la presencia de lo espiritual, la conciencia y las emociones que experimentan durante su proceso de duelo y alcoholismo, los llevó a identificar el problema de la adicción, que permitió influir en el proceso de rehabilitación.

Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study

Abstract

Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann–Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.

Longitudinal study of changes observed in quality of life, psychological state cognition and pulmonary and functional capacity after COVID‐19 infection: A six‐ to seven‐month prospective cohort

Abstract

Aims

To investigate the health-related quality of life (HRQoL), symptoms, psychological and cognitive state and pulmonary and physical function of nonhospitalised COVID-19 patients at long-term, and to identify factors to predict a poor HRQoL in this follow-up.

Background

Studies have focused on persistent symptoms of hospitalised COVID-19 patients in the medium term. Thus, long-term studies of nonhospitalised patients are urgently required.

Design

A longitudinal cohort study.

Methods

In 102 nonhospitalised COVID-19 patients, we collected symptoms at 3 months (baseline) and at 6–7 months (follow-up) from diagnosis (dyspnoea, fatigue/muscle weakness and chest/joint pain), HRQoL, psychological state, cognitive function, pulmonary and physical function. This study adhered to the STROBE statement.

Results

HRQoL was impaired in almost 60% of the sample and remained impaired 6–7 months. At 3 months, more than 60% had impaired physical function (fatigue/muscle weakness and reduced leg and inspiratory muscle strength). About 40%–56% of the sample showed an altered psychological state (post-traumatic stress disorder (PTSD), anxiety/depression), cognitive function impairment and dyspnoea. At 6–7-months, only a slight improvement in dyspnoea and physical and cognitive function was observed, with a very high proportion of the sample (29%–55%) remained impaired. Impaired HRQoL at 6–7 months was predicted with 82.4% accuracy (86.7% sensitivity and 83.3% specificity) by the presence at 3 months of muscle fatigue/muscle weakness (OR = 5.7 (1.8–18.1)), PTSD (OR = 6.0 (1.7–20.7)) and impaired HRQoL (OR = 11.7 (3.7–36.8)).

Conclusion

A high proportion of nonhospitalised patients with COVID-19 experience an impaired HRQoL, cognitive and psychological function at long-term. HRQoL, PTSD and dyspnoea at 3 months can identify the majority of patients with COVID-19 who will have impaired quality of life at long-term.

Relevance to clinical practice

Treatments aimed at improving psychological state and reducing the fatigue/muscle weakness of post-COVID-19 patients could be necessary to prevent the patients’ HRQoL from being impaired at 6–7 months after their reported recovery.

Development, Validation, and Usability of the Chatbot ESTOMABOT to Promote Self-care of People With Intestinal Ostomy

imageThis study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent (P

Sistemas de inteligencia y asignación de profesionales en la futura Agencia Estatal de Salud Pública

Sr. Director: El Reglamento Sanitario Internacional (2005) exponía que las amenazas para la salud pública internacional en el siglo XXI se centraban en 7 campos: enfermedades epidemiógenas, enfermedades transmitidas por los alimentos, brotes accidentales, brotes intencionados, accidentes por sustancias químicas tóxicas, accidentes radio nucleares y desastres ambientales [Fragmento de texto].

Aprendiendo a vivir con limitaciones

Objetivo principal: Exponer las vivencias de una persona al adaptarse al vivir con nuevas limitaciones. Metodología: Se escoge una metodología cualitativa llevándose a cabo mediante una entrevista en profundidad y su posterior transcripción a un relato biográfico. Resultados: Los resultados del estudio, muestran cómo Luna tuvo que enfrentarse a un cambio de vida, que no le resultó fácil. No supo cómo actuar con las limitaciones que se fue encontrando día a día, sin apoyos por parte del personal sanitario, y las dificultades que tuvo al solicitar un grado de minusvalía. Conclusión: Esta investigación pone en manifiesto que como personal sanitario deberíamos valorar el contexto de nuestros pacientes e intentar apoyarles en sus dudas, darles tiempo a manifestarlas para intentar ayudarles, es decir, mantener un buen feedback con ellos para obtener una buena relación terapéutica.

Políticas públicas de atención integral a la salud de personas que conviven con el Virus de Inmunodeficiencia Humana

Objetivo: caracterizar las producciones científicas sobre atención integral de salud, promovidas a través de políticas públicas para perso-nas que conviven con el Virus de Inmunodeficiencia Humana. Metodología: Revisión integrativa de literatura, a través de la búsqueda en las bases de datos PUBMED, LILACS y la biblioteca virtual SCIELO, utilizando los descriptores “Políticas Públicas de salud”, “Síndrome de inmunodeficiencia adquirida”, “Atención integral de salud” y el operador booleano “Y”, resultando en una muestra, después de leídos, de 12 artículos. Los resultados de este estudio nos permitieron identificar y clasificar el estado de las políticas públicas para la atención de esta población, en tres categorías: A: políticas y / o directrices insuficientes; B: Necesidad de mejoras e inversiones en políticas existentes; C: éxito de los programas, siendo imprescindible una articulación internacional de gobiernos y organismos no gubernamentales para la elaboración de políticas más ajustadas a las realidades y objetivando la atención integral de salud de esta población.

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