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Objectives: This study aimed to assess the prevalence and impact of loneliness (De Jong Gierveld scale) and isolation (Lubben scale) on the effects of a hospital-based exercise programme., Design: Secondary analysis of a randomised clinical trial., Setting: Acute Geriatric Unit of a tertiary hospital in Spain., Participants: 103 hospitalised older adults., Intervention: Individualised multicomponent exercise program (20-minute sessions twice a day for 3 consecutive days)., Results: Among the 103 randomised patients included in the analysis (both arms included), 58.3% were male, and their mean age was 87.3 (4.5) years. According to the Lubben scale, 15.8% of patients were at risk of isolation, while 62.7% were in a situation of severe or moderate loneliness according to the De Jong Gierveld scale. In the non-isolated group, training showed a substantial positive impact on Geriatric Depression Scale (B = -1.25, 95% CI = -0.24 to -0.27). In the isolated group, all outcomes improved, but only the Quality of Life showed significant changes (B = 35, 95% CI = 4.96-35.8). The SPPB test (B = 1.62, 95% CI = 0.19-3.04) and Quality of Life, (B = 17.1, 95% CI = 1.84-32.3) showed a significant improvement in the non-loneliness exercise group while no differences were found in the loneliness group., Conclusion: Despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life., (Copyright © 2024. Published by Elsevier Masson SAS.)

Objectives: Despite the demonstrated efficacy of physiotherapy in palliative care programmes, there are scarce data of its real-life impact on patients' and caregivers' wellness and stress. Our aim was to assess effectiveness of a 30-day physiotherapy programme in psychological wellness and health-related quality of life (HRQoL) of patients with advanced chronic diseases or cancer and in their caregivers' stress., Methods: Quasiexperimental before-after study applying personalised kinesitherapy, exercise with curative effects, respiratory physiotherapy, therapeutic massages and ergotherapy. Psychological wellness, HRQoL and caregiver's strain outcomes were measured., Results: 207 patients (60% men, with a mean age of 73.6±12 years) were included; 129 (62.3%) with advanced cancer, and the remaining 78 with advanced chronic diseases. Psychological wellness (Emotional Stress Detection Tool decreased from 12.4±3 to 11±3; p<0.0001), caregiver's strain (Caregiver Strain Index decreased from 8.5±3.2 to 7.9±3.5; p<0.0001) and HRQoL (WHO-BREF physical health domain increased from 8.3±2.6 to 9.4±2.9; p<0.0001) showed a significant improvement after the physiotherapy programme. Global satisfaction with the physiotherapy intervention was also high (Client Satisfaction Questionnaire-8 of 28.3±3.3 points)., Conclusions: A personalised physiotherapy programme incorporated to integral palliative care improved psychological wellness, HRQoL and caregivers' strain of patients with advanced chronic diseases and cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study identifies correlates of the lockdown's psychological distress in frail older community-dwellers (Catalonia, Spain)., Methods: Participants from a community frailty intervention program, with a comprehensive geriatric assessment within the 12-months pre-lockdown and COVID-19 free during the first pandemic wave (March-May 2020), underwent a phone assessment past the lockdown to assess COVID-19-related emotional distress (DME) as well as other sociodemograhic, clinical and psychosocial factors., Results: Of the 94 frail older adults (age = 82,34 ± 6,12 years; 68,1% women; 38,3% living alone), 84,9% were at risk of experiencing moderate-to-high psychological distress, according to the backward stepwise logistic regression model obtained (χ2 = 47,007, p < 0,001, Nagelkerke R 2  = 0,528), based on the following factors: absence of depressive symptoms before lockdown (OR = 0,12, p = 0,014, 95%CI[0,023-0,647]), not carrying out leisure activities during lockdown (OR = 0,257, p = 0,023, 95%CI[0,079-0,832]) and currently experiencing high malaise due to COVID-19 situation (OR = 1,504, p < 0,001, 95%CI[1,241-1,822])., Discussion: These findings suggest that it is necessary to favour a prior overall health status and to empower frail older community-dwellers in the use of a broad repertoire of coping strategies in the face of adversity to foster mental health and keep at bay the potential emotional impact of the situation generated by the COVID pandemic., (© 2022. The Author(s).)

Introduction: The advent of natural orifice endoscopic surgery (NOTES) and new prototypes for performing this surgical procedure led us to design an experimental animal surgical programme., Material and Method: NOTES was performed over a period of one year, in sows, following the European guidelines on the use of experimental animals. Ninety operations were performed with no animals surviving. The following aspects were assessed: 1. Access route complexity (transgastric, transvaginal, transesophageal and transumbilical). 2. Support measures for temporal/spatial orientation. 3. Technical possibilities for visceral orifice closure (clips, T-bars, Obesco clips and endoscopic suture). Resections of fallopian tubes, ovaries, gallbladder, mediastinal lymph nodes, tail of the pancreas and gastrojejunal derivations were performed with one or two endoscopes., Results: This experience enabled us to highlight a series of technical aspects essential for these techniques: 1. Pneumoperitoneum with CO(2) is safer for entry. 2. Orifice size is important to limit contamination. 3. Puncture entry and guided dilation is safer. 4. Good gastric exit location makes it easier to approach viscera to be resected. 5. Intra-abdominal haemorrhage is difficult to control. 6. Leak-free closure cannot be guaranteed with clips, but t-bars and Obesco clips may be effective. 7. Endoscopes that permit triangulation may facilitate the dissection and endoscopic suture., Conclusions: NOTES requires a multidisciplinary team comprising laparoscopic and endoscopic surgeons. Pure NOTES is complex and hybrid forms or transumbilical route could be intermediate steps.

In the words of the author, the 21st Century shall "witness the consolidation of the change from a society which cures to a society which cares for patients". This means that the nursing profession will assume a series of challenges, known as the management challenge, new missions for the nursing professional and the challenge to provide excellence in patient treatment. Probably only with attitudes and reflexive practices, with teamwork and continuous professional development which lasts through one's life, we will provide the correct response.

It is a fact to state that health care has never succeeded in covering such a wide series of sectors of the population in our country. The health care network created both by public as well as private efforts, and occasionally due to the collaboration by both fields, offers a framework of health care services which ensures there is a satisfactory coverage for the general population. It is difficult to provide a rebuttal to this statement; all one needs to do is recall what the status of our health care system was a few years ago. We have not achieved a perfect system. The development of our health care network has been produced by expansion. As we have come to believe that health is an unalienable right, we have to expand health care services to cover everyone. This effort leads to a second phase which brings to bear upon us new problems. One is the quality of health care services and the second is cost.

To put into practice a reform of treatment procedures requires a planned process for change which should have the support of convinced leaders, dynamic working teams, new development procedures and a reflexive practice which guarantees integrated care. All of this is united with the development of an autonomous role, with the acquisition of competence, with a professional compromise and with a capacity to innovate. At the same time, all of these factors should not divert us from our central objective: to generate humane, quality nursing care which allows an individual to utilize his/her energy to reestablish a balance in their health.

Some of the deficiencies which have been detected and need be resolved in order to have a correct determination of the "nursing product" include the lack of a catalog or portfolio of services, the lack of a set standard dealing with the realm of nurses' responsibilities in assistance care, and an insufficiency in the record keeping systems which register the multiple services which nurses carry out. Nurses' diagnoses, clinical trajectories, result-based management form part of the need to make sanitary budgets economically viable. From these perspectives has come the current trend to install standardized operating procedures and to computerize them.

We begin an articles series, by Montserrat Teixidor, these articles will unfold the generic subject of nursing output and health care processes improvement. These first article start with the idea that in a context marked by limited economic resources, the necessity of putting nursing work in objective terms had raised again. Therefore, the authoress introduce us in issues as human resources staff, implementing management new systems and consequences (positives and negatives) that literature refers for nursing, and the essentials of "the invisibility" of caring. All of that would demand the management of imagination.