Instituto Nacional de Investigacion en Enfermería del Perú

Los patrones de conocimiento en enfermería.

Overview – Patterns of Knowing in Nursing Contributors: Deborah Lindell and Peggy ChinnUpdated October 27, 2022Aesthetic KnowingEthical KnowingEmancipatory and Sociopolitical KnowingEmpiric KnowingPersonal and Spiritual Knowing In 1978, Ba…

La familia Palmieri Huamán otorgaron cuatro becas a igual número de enfermeros para estudiar la Maestría en Ciencias de Enfermería con mención en Gerencia de los Cuidados de Enfermería.

De esta manera, la Escuela de Posgrado de la Universidad Norbert Wiener contribuye a un cambio social positivo y el avance de la profesión de Enfermería.

Los beneficiarios de las becas agradecieron a la familia Palmieri Huamán por la oportunidad que les brindan de seguir creciendo como profesionales, y se comprometieron que al finalizar la maestría van a publicar un artículo científico de alto impacto.

EL DOCTOR PATRICK ALBERT PALMIERI Y LA FAMILIA PALMIERI HUAMÁN OTORGARON CUATRO BECAS A PROFESIONALES DE ENFERMERÍA QUE ESTUDIARÁN EN NUESTRA ESCUELA DE POSGRADO El doctor Patrick Albert Palmieri y la familia Palmieri Huamán otorgaron cuatro becas a igual número de enfermeros para estudiar la Maestría en Ciencias de Enfermería con mención en Gerencia de los Cuidados de Enfermería.

La maestría en enfermería (Universidad Norbert Wiener) de mejor calidad y costo razonable en el Perú.

Charla Informativa: Viernes (18 de noviembre) @ 6:00 p.m.
Formulario de inscripción: https://bit.ly/3FNjvXY

Charla Informativa: Maestría en Ciencia de Enfermería | Viernes 18 de noviembre | Performlead

Este proyecto fue realizado por enfermeras investigadoras en salud comunitaria de la Universidad Norbert Wiener con el propósito de mejorar la salud y el bienestar de nuestros adultos mayores [This project was undertaken by nurse researchers in community health at the Universidad Norbert Wiener with the purpose of improving the health and wellness of our older adults].

Este es un ejemplo de investigación aplicada en enfermería enfocada en intervenciones, algo que rara vez se hace en el Perú [This is an example of applied nursing research focused on interventions, something rarely done in Peru].

La líder del proyecto es la Dra. Orfelina Arpasi y administradora es Dra. Anika Remuzgo [The project leader is Dr. Orfelina Arpasi and administrator is Dr. Anika Remuzgo]. ¡Felicitaciones por este excelente trabajo [Congratulations on the excellent work]!

ESCUELA DE POSGRADO REALIZÓ EN LA PROVINCIA DE CAÑETE CAMPAÑA DE SALUD EN FAVOR DEL ADULTO MAYOR La Escuela de Posgrado de la Universidad Norbert Wiener, en alianza con la Municipalidad Provincial de Cañete y la Micro Red de San Vicente de Cañete, realizó la campaña de salud integral para el adulto mayor, en el que participaron estudiantes y docentes de los programas y carreras de salud de ...

International Nurses Day, the birthday of Florence Nightingale, is the perfect time to donate to support future nurse researchers and leaders! Make your gift at bit.ly/2qjSwMn.

EVIDENCE-BASED PRACTICE - Critical care basics

Fewer Kidney Problems With IV Balanced Crystalloids vs Saline Solutions in Critically Ill Patients

SUMMARY ----- Two new trials have tried to answer a long-standing question: which intravenous (IV) fluid is better, normal saline or balanced crystalloids?

The trials, both conducted at Vanderbilt University in Nashville, Tennessee, show that the use of balanced crystalloids in critically ill and noncritically ill hospitalized patients resulted in a lower incidence of major adverse kidney events. The results were presented this week at the Meeting of the Society of Critical Care Medicine and were published online on February 27 in the New England Journal of Medicine.

Although IV fluid administration is one of the most common medical therapies used in hospitals, little is known about how different types of IV fluids affect outcomes. Use of these fluids is based on physiologic principles, rather than hard evidence from clinical trials. None of the different types of IV fluids has been thoroughly evaluated for safety and efficacy.

In the United States, 0.9% normal saline is the most commonly used IV fluid, but it contains higher concentrations of chloride than human blood. That can cause kidney injury and can negatively affect patient outcomes. Some studies have suggested that use of IV saline may result in higher rates of acute kidney injury, renal dialysis, and death compared to use of balanced crystalloids.

On the other hand, crystalloid solutions, such as lactated Ringer's and Plasma-Lyte A, contain electrolyte concentrations that are closer to what's found in human blood. Yet even these solutions are not truly "balanced" relative to some body fluids, and their use has been associated with metaboloic alkalosis.

To evaluate the effect of these fluids on patient outcomes, Todd W. Rice, MD, an associate professor of medicine at Vanderbilt University, and colleagues conducted two separate open-label studies in two different groups of patients: critically ill patients in the intensive care unit (ICU), and noncritically ill patients admitted to the hospital from the emergency department (ED).

The first study, called the Isotonic Solutions and Major Adverse Renal Events Trial (SMART), was conducted at five ICUs at Vanderbilt University hospital. The researchers enrolled 15,802 critically ill adults and randomly assigned them to receive either normal saline (n = 7860) or balanced crystalloid (lactated Ringer's solution or Plasma-Lyte A, n = 7942).

Results showed that significantly fewer patients in the balanced-crystalloids group (n = 1139; 14.3%), compared to the saline group (n = 1211; 15.4%), met the primary endpoint of major adverse kidney events (a composite of death from any cause, new kidney dialysis, or persistent kidney dysfunction) within 30 days of hospital discharge or enrollment in the study (marginal odds ratio, .91; 95% confidence interval [CI], .84 - .99; conditional odds ratio, .90; 95% CI, .82 -.99; P = 0.04).

The authors caution, though, that the study did not include patients with traumatic brain injury, because of concern that balanced crystalloids may increase intracranial pressure. Therefore, the results may not apply to this group.

The second study, called the Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) trial, included 13,347 adults who were initially seen in the ED (where 88.3% received balanced crystalloids) and who were then hospitalized outside the ICU. Upon admission, these patients were randomly assigned to receive either balanced crystalloids (n = 6708) or normal saline (n = 6639).

Results showed that for both groups, times to hospital discharge (the primary outcome) were similar; the median was 25 days for both groups (adjusted odds ratio with balanced crystalloids, .98; 95% CI, .92 - 1.04; P = .41).

As in the SMART trial, results also showed that fewer patients in the balanced-crystalloids group (315; 4.7%), compared to the saline group (370; 5.6%), met the secondary outcome of major adverse kidney events within 30 days, also a composite of death, new kidney dialysis, or persistent kidney dysfunction (adjusted odds ratio,.82; 95% CI, .70 - .95; P =.01).

Because more than 95% of patients in the balanced-crystalloids group received lactated Ringer's, the study cannot determine which is better, lactated Ringer's or Plasma-Lyte A.

Further analysis for both studies suggested that use of balanced crystalloids rather than normal saline could prevent major adverse kidney events in 1 of every 94 patients admitted to the ICU and in 1 of every 111 noncritically ill patients.

Although these numbers may seem modest, the authors point out that millions of patients nationwide receive these fluids annually. On a national level, any effects associated with the difference could be substantial.

In a linked editorial, John Myburgh, MD, PhD, of the University of New South Wales, the George Institute for Global Health, and St. George Hospital, Sydney, Australia, urges caution when interpreting the results.

Whereas both studies showed that balanced crystalloids were associated with a reduction in the composite outcome of adverse kidney events, he notes that no significant differences between balanced crystalloids and saline were found for short-term mortality or kidney dialysis.

"What clinicians need to consider is whether the results of an open-label trial conducted in a single, major US medical center can be generalized to the ways in which their own patients survive, feel, and function," he writes.

He emphasizes that none of the resuscitation fluids are physiologic and that questions about their safety and efficacy remain despite these results.

"[O]utcomes and health economics are fundamental to informing clinicians about their choice of resuscitation fluids in critically ill patients. The trials presented here inform that thinking but do not provide unequivocal clinical direction," he concludes.

[Veronica Hackethal, Medscape]

REFERENCE ----- (APA style): Semler, M. W., Self, W. H., Wanderer, J. P., Ehrenfeld, J. M., Wang, L., Byrne, D. W., . . . Rice, T. W. (2018). Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine, 378(9), 829-839. https://doi.org/10.1056/NEJMoa1711584

BACKGROUND: Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes.

METHODS: In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first.

RESULTS: Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60).

CONCLUSIONS: Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779).

Balanced Crystalloids versus Saline in Critically Ill Adults | NEJM Original Article from The New England Journal of Medicine — Balanced Crystalloids versus Saline in Critically Ill Adults

PROMISING RESEARCH - Mindfulness meditation and ADHD

Researchers report efficacy of mindfulness meditation in treating adults with ADHD (Attention Deficit Hyperactivity Disorder)

SUMMARY ----- ADHD has an incidence of 4% in the adult population, and is often characterized by the inattention and hyper-activity-impulsivity displayed by patients. Adults with ADHD can also experience executive functioning deficits and emotion dysregulation. While many treatment interventions focus on the hyper-activity aspect of the disorder, treatments that target emotional dysregulation is often more difficult. Current interventions used to manage symptoms include stimulant and nonstimulant medicines, yet these drugs do not target executive functioning or emotional dysregulation. A potential therapy to minimize these symptoms is mindfulness meditation, a practice in which an individual adopts a nonjudgmental attention to one’s current experience.

Practicing mindfulness is a 2-step approach that involves orienting one’s attention purposefully to a moment, and then approaching the moment with curiosity and open-mindedness. This model has been used as an effective therapy for patients with depression and anxiety. This study evaluated the feasibility, treatment acceptability, and preliminary efficacy of a group-based mindfulness meditation as an intervention on core symptoms of ADHD, executive functioning, and emotion dysregulation among adults with ADHD. The authors said it was the first trial of a mindfulness meditation training-only intervention in a sample composed entirely of adults with ADHD.

Twenty-two participants were part of the study, with half in the treatment group and half in the control group. The control group was made up of patients from a waiting list. The weekly group therapy sessions were led by a PhD-level clinical psychologist and lasted 2.5 hours, along with at-home practice. The course was based on the program The Mindfulness Prescription for Adult ADHD, which included a book detailing various mindfulness practices and a CD audio program with exercises.

The researchers found meditation to be a feasible and acceptable treatment for adult ADHD. The program reduced levels of attrition, had high levels of attendance, moderate levels of homework compliance, and high overall treatment acceptability. The mean attendance rate was 7.2 out of 8 sessions, and an overall attendance rate of 89.8% for the treatment group. Homework compliance had a score of 3.9 out of 5. On a treatment satisfaction scale ranging from 1 to 7, with 7 being the highest level of satisfaction, the average was a 5.91.

“These findings add to a growing literature suggesting that mindfulness meditation for ADHD in adulthood is a promising intervention and indicate that a larger, randomized clinical trial is warranted,” the authors concluded. [Summary by Kaitlynn Ely, American Journal of Managed Care]

REFERENCE (APA style) - Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. (2017). A pilot trial of mindfulness meditation training for adhd in adulthood: Impact on core symptoms, executive functioning, and emotion dysregulation. Journal of Attention Disordes, 21(13), 1105-1120. https://doi.org/10.1177/1087054713513328

ABSTRACT ----- BACKGROUND: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group.

AIM: The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample.

METHODS - Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment (n = 11) or waitlist group (n = 9).

RESULTS: Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks.

CONCLUSION: Findings support preliminary treatment efficacy, though require larger trials.

A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation - John T. Mitchell, Elizabeth M. McIntyre, Joseph S. English, Michelle F. Dennis, Jean C. Beckham,... Objective: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulne...

EVIDENCE-BASED PRACTICE - DIABETES MANAGEMENT

The American College of Physicians recommends less intensive glycemic control for people living with type 2 diabetes

SUMMARY: The American College of Physicians (ACP) recommends most people living with type 2 diabetes (T2D) should aim for a target HbA1c between 7% and 8%, rather than

ACP Guidance Statement on HbA | Annals of Internal Medicine | American College of Physicians Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians (*)

Research shows association between diabetes, pregnancy complications

Pregnant women with type 1 and type 2 diabetes were at an increased risk for complications, including emergency Cesarean sections, preterm births and stillbirths, compared with those without diabetes, according to a study in Diabetologia. UK researchers conducted an analysis of almost 814,000 births in Scotland over 15 years and also found that deliveries were an average of 2.6 and 2.0 weeks earlier for type 1 and type 2 diabetes, respectively, compared to women without diabetes.

Type 1, Type 2 Diabetes Associated with Higher Pregnancy Complication Risk Higher rates of stillbirths, the need for emergency Caesarean sections, and infant mortality have all been associated with both type 1 and type 2 diabetes

Conceiving Despite IUD Use Is Tied to Higher Odds for Pregnancy Complications

Millions of women use an IUD as a safe, reliable means of birth control. But a new study finds that in rare cases where conception occurs despite IUD use, the rate of obstetric complications may rise.

Conceiving Despite IUD Use Is Tied to Higher Odds for Pregnancy Complications Millions of women use an IUD as a safe, reliable means of birth control. But a new study finds that in rare cases where conception occurs despite IUD use, the rate of obstetric complications may rise.