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El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

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La trombosis de la vena porta (TVP) en pacientes con o sin cirrosis hepática (CH) se define como una obstrucción de la vena porta debido a la formación de un trombo que puede extenderse a las venas mesentéricas superiores y esplénica. Esta es una complicación común de la enfermedad hepática avanzada. Se creía que la TVP se producía predominantemente debido al potencial protrombótico del paciente con CH, ya que se observaba una mayor incidencia de TVP en CH con una puntuación MELD y Child-Pugh más altas, con una prevalencia informada del 10 % al 25%.

Portal vein thrombosis (PVT) in patients with or without hepatic cirrhosis (CH) is defined as an obstruction of the portal vein due to the formation of a thrombus that may extend to the superior mesenteric and splenic veins. This is a common complication of advanced liver disease. It was believed that PVT predominantly occurred due to the prothrombotic potential of the patient with CH, as a higher incidence of PVT was observed in CH with higher MELD and Child-Pugh scores, with a reported prevalence of 10% to 25%.

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AIMS: Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients. MATERIALS AND METHODS: In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR. RESULTS: There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 µg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR < 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) µg/L, P < 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (r = 0.196, P < 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12-6.15), P < 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543-0.778), P < 0.01)]. CONCLUSIONS: Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.

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INTRODUCTION: The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain. MATERIAL AND METHODS: Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged. RESULTS: A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC. CONCLUSION: Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.

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INTRODUCTION: Since the intensive care units are one of the most sensitive hospital settings and critically ill patients undergo various stressful factors that put their lives in danger, a more advanced level of nursing practice is imperative to accommodate these issues and provide optimal care of patients. OBJECTIVES: To review the literature describing the roles and activities performed by advanced practice nurses in intensive care units. REVIEW METHODS: We conducted a scoping review to search published articles using Scopus, PubMed, CINAHL (EBSCOhost), Science Direct, MEDLINE (EBSCOhost) and Cochrane Library during a 10-year period from 2013 to 2023. RESULTS: We identified 729 records, from which eleven articles were included in the review. We included six reviews and five original articles or research papers. With regard to the target area of our review, we used the information provided by these studies and categorized the contents related to the roles of advanced practice nurses in intensive care units into five sections, including direct practice, education and counseling, research, collaboration, and leadership. CONCLUSION: Advanced practice nurses are essential members of critical care team by playing various roles in practice, education, research, collaboration, and leadership, and therefore, they can increase patients' access to critical care and improve healthcare outcomes. The advancement of technology and complexity of care in intensive care units have led to the role expansion of these nurses which results in task-shifting between doctors and nurses. Therefore, it is considered essential for nursing and medical professionals to reach an agreement to establish standardized roles for advanced practice nurses.

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Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood-brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48-72h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and kidney replacement therapy (KRT) with hemodialysis (HD) in patients in chronic KRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.

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Objective To better understand drivers of disease progression in non-alcoholic steatohepatitis (NASH), we assessed clinical and sociodemographic markers of fibrosis progression in adults with NASH.Patients and methodsPhysician-reported patient demographics and clinical characteristics were utilised from the real-world Global Assessment of the Impact of NASH (GAIN) study. Factors associated with likelihood of fibrosis progression since NASH diagnosis were identified using a logistic regression model.ResultsOverall, 2349 patients in Europe from the GAIN study were included; mean age was 54.6 years and 41% were women. Significant covariates included age, years since diagnosis, employment status, fibrosis stage at diagnosis, type 2 diabetes mellitus, hypertension, liver transplant and liver biopsy at diagnosis. Risk of progression was 1.16 (95% confidence interval 1.12–1.20; p<0.001) times higher for each additional year since NASH diagnosis and 5.43 (2.68–11.37; p<0.001) times higher when physicians proposed a liver transplant at diagnosis. Compared with full-time employed patients, risk of progression was 1.77 (1.19–2.60; p=0.004) times higher for unemployed patients and 3.16 (1.30–7.63; p=0.010) times higher for those unable to work due to NASH.ConclusionsDisease duration, NASH severity and presence of other metabolic comorbidities could help to assess risk of progression in patients with NASH. (AU)

Objetivo Para comprender mejor los factores que impulsan la progresión de la enfermedad en la esteatohepatitis no alcohólica (NASH), evaluamos los marcadores clínicos y sociodemográficos de la progresión de la fibrosis en adultos con NASH.Pacientes y métodosSe utilizaron las características demográficas y clínicas de los pacientes informadas por los médicos del estudio de Evaluación Global del Impacto de NASH (GAIN) del mundo real. Los factores asociados con la probabilidad de progresión de la fibrosis desde el diagnóstico de EHNA se identificaron mediante un modelo de regresión logística.ResultadosEn total, se incluyeron 2.349 pacientes en Europa del estudio GAIN; la edad media fue 54,6 años y el 41% eran mujeres. Las covariables significativas incluyeron edad, años desde el diagnóstico, situación laboral, estadio de fibrosis en el momento del diagnóstico, diabetes mellitus tipo 2, hipertensión, trasplante de hígado y biopsia de hígado en el momento del diagnóstico. El riesgo de progresión fue 1,16 (intervalo de confianza del 95% 1,12-1,20; p < 0,001) veces mayor por cada año adicional desde el diagnóstico de EHNA y 5,43 (2,68-11,37; p < 0,001) veces mayor cuando los médicos propusieron un trasplante de hígado. en el momento del diagnóstico. En comparación con los pacientes empleados a tiempo completo, el riesgo de progresión fue 1,77 (1,19-2,60; p = 0,004) veces mayor para los pacientes desempleados y 3,16 (1,30-7,63; p = 0,010) veces mayor para aquellos que no podían trabajar debido a a NASH.ConclusionesLa duración de la enfermedad, la gravedad de NASH y la presencia de otras comorbilidades metabólicas podrían ayudar a evaluar el riesgo de progresión en pacientes con NASH. (AU)

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In this article we approach the concept of paradoxical lucidity (LP) (an unexpected, spontaneous, significant and relevant episode of communication or connection) in persons with advanced dementia. The existence of LP could change the paradigm of dementia as a degenerative, chronic, progressive and irreversible disease (where neuronal death plays the leading role), towards a model where functional deficits of neuronal networks acquire importance, which raises new potentially reversible therapeutic and rehabilitative possibilities. We analyze the ethical consequences that these episodes may have with respect to the implicated persons (patients, caregivers and professionals in charge of their care) and try to answer the following question: Do persons with advanced dementia continue to maintain their personal identity despite suffering cognitive impairment so severe?. The LP indicates that this is possible. In this work we make a transversal outline of the different concepts and theories of personal identity in these patients, from different areas of knowledge (philosophy, psychology, neuroscience).

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The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a "Resident Nurse Intern" (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care.

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The number of advanced practice roles in healthcare is increasing in response to several factors such as changes in medical education, economic pressures, workforce shortages and the increasing complexity of health needs of the population. The Advanced Critical Care Practitioner Curriculum, developed by the Faculty of Intensive Care Medicine in the UK (United Kingdom), enables the development and delivery of a structured education programme which can contribute to addressing these challenges. This article outlines how one university designed and implemented this programme, the first of its kind in Northern Ireland.

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INTRODUCTION: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

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INTRODUCTION: Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD: A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS: Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION: Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.

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Objetivo: Descrever como os enfermeiros atuantes na Atenção Primária identificam sua autonomia profissional no desenvolvimento das práticas de Enfermagem. Métodos: Trata-se de uma pesquisa exploratória, descritiva, de abordagem qualitativa. Participaram de entrevistas online 28 enfermeiros que atuam na Atenção Primária de um município do Sul do Brasil, entre o período de outubro de 2020 até fevereiro de 2021. Para tratamento dos dados, foi utilizada a análise de conteúdo temática. Resultados: Emergiram duas categorias: 1) Resolutividade das práticas da Enfermagem; 2) Respaldo nas regulamentações profissionais e evidências científicas. A Enfermagem dispõe de maior autonomia frente à atenção à saúde da mulher, Infecções Sexualmente Transmissíveis e no cuidado à pessoa com feridas, pois no momento da consulta do enfermeiro, despontam habilidades e competências para a tomada de decisão na prática clínica. Em relação à regulamentação para exercício profissional, os profissionais enfatizaram a importância dos protocolos para respaldar as ações. Conclusão: O protagonismo do enfermeiro e sucesso nas experiências indicam um caminho promissor para a discussão e implementação da Enfermagem de Prática Avançada no Brasil. (AU)

Objective: To describe how nurses working in Primary Care identify their professional autonomy in the development of Nursing practices. Methods: This is an exploratory, descriptive research with a qualitative approach. Twenty-eight nurses who work in Primary Care in a municipality in southern Brazil participated in online interviews, between October 2020 and February 2021. For data processing, thematic content analysis was used. Results: Two categories emerged: 1) Resolving nursing practices; 2) Support in professional regulations and scientific evidence. Nursing has greater autonomy in the care of women's health, Sexually Transmitted Infections and in the care of the person with wounds, because at the time of the nurse's consultation, skills and competences for decision-making in clinical practice emerge. Regarding regulation for professional practice, professionals emphasized the importance of protocols to support actions. Conclusion: The role of nurses and success in the experiences indicate a promising path for the discussion and implementation of Advanced Practice Nursing in Brazil. (AU)

Objetivo: Describir cómo los enfermeros que actúan en la Atención Primaria identifican su autonomía profesional en el desarrollo de las prácticas de Enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, con abordaje cualitativo. Veintiocho enfermeros que actúan en la Atención Primaria de un municipio del sur de Brasil participaron de entrevistas en línea, entre octubre de 2020 y febrero de 2021. Para el procesamiento de datos, se utilizó el análisis de contenido temático. Resultados: Emergieron dos categorías: 1) Prácticas resolutivas de enfermería; 2) Apoyo en normativa profesional y evidencia científica. La enfermería tiene mayor autonomía en el cuidado de la salud de la mujer, Infecciones de Transmisión Sexual y en el cuidado de la persona con heridas, porque en el momento de la consulta del enfermero emergen habilidades y competencias para la toma de decisiones en la práctica clínica. En cuanto a la regulación para la práctica profesional, los profesionales destacaron la importancia de los protocolos para apoyar las acciones. Conclusión: El papel de los enfermeros y el éxito de las experiencias indican un camino promisorio para la discusión e implementación de la Enfermería de Práctica Avanzada en Brasil. (AU)

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Objetivo: Mapear e analisar os potenciais desafios e estratégias na implementação da Enfermagem de Práticas Avançadas, no modelo de atendimento pré-hospitalar móvel brasileiro, a partir da experiência de outros países. Métodos: Revisão narrativa, a partir da análise da literatura sobre o tema, realizada em duas etapas: Revisão de documentos de entidades internacionais e busca de artigos nas bases nas bases Pubmed, LILACS, Scielo e no Google Scholar. Ao final, foi realizada a análise de cada desafio elencado e suas respectivas estratégias, quando aplicados ao modelo pré-hospitalar móvel brasileiro. Resultados: Os principais desafios analisados foram: compreensão do papel dos enfermeiros de práticas avançadas; a definição do escopo de práticas e das políticas de formação e qualificação; a regulamentação da atuação; a redução da resistência médica; os custos de implementação e a definição de mecanismos de remuneração. As estratégias de enfrentamento incluem: a sensibilização do público, definição do conjunto de prerrogativas e dos mecanismos de credenciamento e formação, associados a constituição de currículos potentes. Conclusão: Foram mapeados e analisados desafios e estratégias, que permitiram antecipar o cenário de aplicação da proposta da Enfermagem de Práticas Avançadas no modelo pré-hospitalar brasileiro, viabilizando proposição de ações fundamentais para a implementação e o sucesso da estratégia no país. (AU)

Objective: To map and analyze the potential challenges and strategies in the implementation of Advanced Practice Nursing in the Brazilian mobile pre-hospital care model, based on the experience of other countries. Methods: Narrative review, based on the literature on the subject, carried out in two stages: Review of documents from international organizations and search for articles in the databases Pubmed, LILACS, Scielo and Google Scholar. At the end, the analysis of each challenge listed and their respective strategies was carried out, when applied to the Brazilian mobile prehospital model. Results: The main challenges analyzed were: understanding the role of advanced practice nurses; definition of the scope of training and qualification practices and policies; the regulation of performance; the reduction of medical resistance; implementation costs and definition of remuneration mechanisms. Coping strategies include: raising public awareness, defining the set of prerogatives and mechanisms for accreditation and training, associated with building powerful curricula. Conclusion: Challenges and strategies were mapped and analyzed, which made it possible to anticipate the scenario of application of the Advanced Practice Nursing proposal in the brazilian prehospital model, enabling the proposition of fundamental actions for the implementation and success of the strategy in the country. (AU)

Objetivos: Objetivos: Mapear y analizar los potenciales desafíos y estrategias en la implementación de la Enfermería de Práctica Avanzada en el modelo de atención prehospitalaria móvil brasileña, a partir de la experiencia de otros países. Métodos: Revisión narrativa, basada en la literatura sobre el tema, realizada en dos etapas: Revisión de documentos de organismos internacionales y búsqueda de artículos en las bases de datos Pubmed, LILACS, Scielo y Google Scholar. Al final, se realizó el análisis de cada desafío listado y sus respectivas estrategias, cuando se aplicó al modelo prehospitalario móvil brasileño. Resultados: Los principales desafíos analizados fueron: comprender el papel de las enfermeras de práctica avanzada; definición del alcance de las prácticas y políticas de formación y cualificación; la regulación del desempeño; la reducción de la resistencia médica; costos de implementación y definición de mecanismos de retribución. Las estrategias de afrontamiento incluyen: sensibilizar al público, definir el conjunto de prerrogativas y mecanismos de acreditación y formación, asociados con la construcción de planes de estudio potentes. Conclusión: Se mapearon y analizaron desafíos y estrategias que permitieron anticipar el escenario de aplicación de la propuesta de Enfermería de Práctica Avanzada en el modelo prehospitalario brasileño, posibilitando la proposición de acciones fundamentales para la implementación y éxito de la estrategia en el país. (AU)

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Overview and aim: Pregnancy at an advanced maternal age has become a reality. The acceptance rate of an unwanted pregnancy in this age group is lower, resulting in a higher proportion of pregnancy interruptions. This study aims to characterize abortion by request (AR) in advanced maternal age. Methods: Descriptive study of AR requested by women aged 40 years old or older, over a period of six years, in an Obstetrics service of a Portuguese tertiary hospital. Descriptive data analysis was performed using SPSS® version 26. Results: 194 women were included in the study (n=194), with a median age of 42 years, most of them Portuguese (94.3%) and with no history of performing AR (75.2%). The contraceptive methods used prior to AR were used oral contraception (47.0%) and barrier contraception (39.1%). Medical abortion was performed in the entire sample, with a success rate of 96.9%. After AR, intrauterine contraception (44.3%), oral contraception (22.7%) and the vaginal ring (7.2%) were the preferred contraceptive methods. Discussion/Conclusions: Changes in women's health and contraceptive needs motivate new approaches and contraceptive strategies. After AR, a significant percentage of woman chose long-term and non-user-dependent methods. Particularly in women aged 40 or over, these methods, in addition to their highly effective and safe contraceptive role, may bring additional non-contraceptive benefits, namely the therapeutic effect in abnormal uterine bleeding.(AU)

Introducción y objetivoEl embarazo a una edad materna avanzada se ha convertido en una realidad. La tasa de aceptación de un embarazo no deseado en esta edad es menor, lo que se traduce en una mayor proporción de interrupciones del embarazo. Este estudio tiene como objetivo caracterizar la interrupción voluntaria del embarazo (IVE) en edad materna avanzada.MétodosEstudio descriptivo de las IVE solicitadas por mujeres de 40 años o más, durante un período de 6 años, en un servicio de obstetricia de un hospital terciario portugués. El análisis descriptivo de los datos se realizó con SPSS® versión 26.ResultadosSe incluyeron en el estudio 194 mujeres (n=194), con una mediana de edad de 42 años, la mayoría portuguesas (94,3%) y sin antecedentes de realización de IVE (75,2%). Los métodos anticonceptivos utilizados antes de la IVE fueron la anticoncepción oral (47,0%) y la anticoncepción de barrera (39,1%). El aborto médico se realizó en toda la muestra, con una tasa de éxito del 96,9%. Después de la IVE, la anticoncepción intrauterina (44,3%), la anticoncepción oral (22,7%) y el anillo vaginal (7,2%) fueron los métodos anticonceptivos preferidos.Discusión/conclusionesLos cambios en la salud de las mujeres y las necesidades anticonceptivas motivan nuevos enfoques y estrategias anticonceptivas. Después de la IVE, un porcentaje significativo de mujeres eligió métodos a largo plazo y no dependientes de la usuaria. Particularmente en mujeres de 40 años o más, estos métodos, además de su función anticonceptiva altamente efectiva y segura, pueden traer beneficios adicionales no anticonceptivos, por ejemplo, el efecto terapéutico en el sangrado uterino anormal.(AU)

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BACKGROUND: As individuals age, the prevalence of osteoarthritis tends to increase gradually. α-Klotho is a hormone renowned for its anti-aging properties. However, the precise role of serum α-Klotho in osteoarthritis is still not fully comprehended. METHODS: We conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. Serum α-Klotho levels were measured using an enzyme-linked immunosorbent assay (ELISA). Osteoarthritis was assessed through self-reported questionnaires. Through univariate and multivariate logistic regression analyses, smooth curve fitting, threshold effect analysis, and subgroup analyses, we delved into the potential association between them. RESULTS: The study encompassed a cohort of 10,265 participants. In fully adjusted models of multivariate logistic regression analysis, we identified a negative correlation between serum ln α-Klotho and OA (OR = 0.77, 95% CI: 0.65-0.91, p = 0.003). When stratifying serum α-Klotho levels into tertiles, individuals in the highest tertile exhibited a 26% reduced risk of OA compared to those in the lowest tertile (OR = 0.84, 95% CI: 0.73-0.97, p = 0.014). Subsequent analyses indicated a linearly negative association. In subgroup analyses, we explored the relationship between serum ln α-Klotho and osteoarthritis across diverse populations, revealing the persistence of this association in the majority of subgroups. CONCLUSION: Serum α-Klotho levels exhibit a significant negative linear correlation with the prevalence of osteoarthritis in middle-aged and elderly populations in the United States.

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Las funciones de la Enfermera de Práctica Avanzada se están definiendo poco a poco en muchos países, aunque con diferencias notables en sus funciones. Para facilitar su compresión, el Consejo Internacional de Enfermería la define como: “Una enfermera registrada que ha adquirido la base de conocimientos de experto, las capacidades de adopción de decisiones complejas y las competencias clínicas necesarias para el ejercicio profesional ampliado, cuyas características vienen dadas por el contexto o el país en el que la enfermera está acreditada para ejercer. Como nivel de entrada se recomienda un título de nivel medio universitario”. La Enfermera de Práctica Avanzada es, por tanto, una enfermera experta capaz de aplicar el aprendizaje científico en un marco humanístico, servir de referencia para los pacientes y otros profesionales, y asumir nuevas responsabilidades. Las diversas funciones que se han realizado y se siguen realizando en la profesión enfermera, así como la creciente demanda de calidad asistencial en nuestra sociedad y los avances tecnológicos que se producen, hace sensibilizar al profesional de enfermería sobre las necesidades específicas de formación. Progresivamente, esta figura se ha ido extendiendo a países como Reino Unido, Irlanda, Australia, Bélgica, Holanda y otros países europeos. En España, el recorrido es pequeño, aunque se han ido desarrollando algunos roles de práctica avanzada en Andalucía, Cataluña o País Vasco. Varias Comunidades Autónomas, han ido afinando el perfil de esta figura, pero, la falta de apoyo institucional y reconocimiento legal lleva a una confusión sobre su papel, desarrollo competencial y marco legal. (AU)

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Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

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Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

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Mapear as ações do Enfermeiro de Prática Avançada nos campos de ensino clínico e estágio curricular supervisionado de um curso de graduação em enfermagem. Métodos: estudo transversal, descritivo, incluindo 21 enfermeiros. A coleta de dados deu-se por questionário sócio-profissiográfico, alinhado às competências do Conselho Internacional de Enfermeiros no tocante à Prática Avançada de Enfermagem. Resultados: Os enfermeiros demonstraram médio conhecimento em Prática Avançada de Enfermagem, e ações de prática avançada mapeadas como prescrição de agentes terapêuticos para lesões, procedimento de catéter central de inserção periférica, solicitação de exames de imagem e swab peri-anal, pareceres em lesão, manejo e consulta de enfermagem no pré-parto, assistência no parto. Competências no domínio do cuidado e no domínio da gestão/educação foram evidenciadas. Conclusão: evidenciou-se potenciais de ação de Prática Avançada na Instituição de Ensino.(AU)

To map the actions of Advanced Practice Nurses in the clinical teaching and supervised curricular internship fields of an undergraduate nursing course. Methods: A cross-sectional, descriptive study including 21 nurses. Data was collected using a socio-professional questionnaire, aligned with the International Council of Nurses' competencies regarding Advanced Nursing Practice. Results: The nurses demonstrated medium knowledge of Advanced Nursing Practice, and mapped advanced practice actions such as prescribing therapeutic agents for injuries, peripherally inserted central catheter procedures, requesting imaging tests and peri-anal swabs, injury opinions, management and nursing consultation in the prepartum period, and assistance in childbirth. Skills in the care domain and the management/education domain were highlighted. Conclusion: There was potential for action in Advanced Practice at the Teaching Institution.(AU)

Mapear las acciones de las Enfermeras de Práctica Avanzada en los campos de la enseñanza clínica y de las prácticas curriculares supervisadas de un curso de enfermería de pregrado. Métodos: Se trató de un estudio transversal, descriptivo, en el que participaron 21 enfermeras. Los datos fueron recogidos a través de un cuestionario socio-profesional, alineado con las competencias del Consejo Internacional de Enfermería en relación a la Práctica Avanzada de Enfermería. Resultados: Las enfermeras demostraron conocimiento medio de la Práctica Avanzada de Enfermería, y mapearon acciones de práctica avanzada como prescripción de agentes terapéuticos para lesiones, procedimientos de catéter central de inserción periférica, solicitud de pruebas de imagen e hisopos perianales, emisión de dictámenes sobre lesiones, manejo y consulta de enfermería en el período preparto, asistencia al parto. Se destacaron las competencias en el ámbito de los cuidados y en el de la gestión/educación. Conclusión: Hubo potencial de actuación en la Práctica Avanzada en la Institución de Enseñanza.(AU)

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