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Background Less invasive monitoring, such as radial arterial pulse contour analysis (ProAQT® sensor), represents an alternative when hemodynamic monitoring is necessary to guide postoperative management and invasive monitoring is not technically feasible. The aim of the study is to evaluate the accuracy of the ProAQT® sensor cardiac output measurements in comparison with Pulmonary Artery Catheter (PAC) during the postoperative course of patients who underwent cardiac surgery with cardiopulmonary bypass. Case presentation Prospective observational study in a Surgical Intensive Care Unit of a tertiary university hospital. Ten patients with a mean age of 73.5 years were included. The main comorbidities were hypertension, diabetes, dyslipidemia and the preoperative left ejection fraction was 43.8 ± 14.5%. Regarding the type of surgery, six patients underwent valve surgery, two underwent coronary artery bypass grafting and two underwent aortic surgery. The cardiac index measured simultaneously by the ProAQT® sensor was compared with the PAC. The parameters were evaluated at predefined time points during the early postoperative courses (6 h, 12 h, 24 h, 48 h and 72 h). The degree of agreement with the cardiac index between the PAC and the ProAQT® sensor along the time points was measured using the concordance correlation coefficient, Bland–Altman analysis, and four-quadrant plot. Sixty-three pairs of measurements were analyzed. We showed that measurements of cardiac index were slightly higher with PAC (β ̂ = − 0.146, p-value = 0.094). The concordance correlation coefficient for the additive model of cardiac index was 0.64 (95% Confidence Interval: 0.36, 0.82), indicating a high concordance between both sensors. Bland-Altmann analysis showed a mean bias of 0.45 L·min−1·m−2, limits of agreement from − 1.65 to 2.3 L·min−1·m−2, and percentage of error was 82.5%. Four-quadrant plot of changes in cardiac index showed a good concordance rate (75%), which increases after applying the exclusion zone (87%). Conclusions In patients undergoing cardiac surgery, the ProAQT® sensor may be useful to monitor cardiac index during the postoperative period, especially when more invasive monitoring is not possible.

Background The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. Method The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. Results Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. Conclusion RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.

Background Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods We designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group. Results We recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period. Conclusions The most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management. Trial registration Clinical Trials: NCT03630744.

Introducció: El càncer colorrectal (CCR) és la indicació més comú per a realitzar una ostomia. Els pacients ostomitzats necessiten un tractament individual, expert abans i després de l‟intervenció quirúrgica. L‟educació i assessorament que aquests reben en la fase preoperatòria contribuirà a reduir el retard de l'alta hospitalària. En aquest treball, ens centrem en les persones que se‟ls ha de practicar una ileostomia, ja que la seva adaptació sol ser més complexa, a conseqüència de la continuïtat i composició dels efluents que s‟eliminen per l‟estoma i les complicacions que es poden produir, en relació amb la nutrició i una mala utilització dels dispositius terapèutics. Objectiu: Conèixer l‟efectivitat d‟un programa d‟educació sanitària dirigit a pacients portadors d‟ileostomia per tal de millorar la capacitat d‟autocuidatge, alimentació i reduir les complicacions en el postoperatori. Metodologia: El projecte d'educació per a pacients ileostomitzats, es basa en un estudi de caràcter quasi-experimental pre-test/post-test sense presència de grup control, que és centra en observar i valorar la situació abans de la participació a la intervenció educativa i un cop l‟intervenció ha finalitzat. La intervenció es durà a terme amb la col·laboració de l‟HUAV i HUSM. S‟han elegit aquests hospitals, ja que, actualment són els hospitals de referència que formen part del programa BPSO®, i treballen conjuntament basant-se amb els resultats de la millor evidència científica disponible recollida en GBP que tenen implantades. L‟obtenció de les dades es realitzarà a través de mètodes quantitatius i qüestionaris autoadministrats. Limitacions de l’estudi: que no es reuneixi mostra suficient per fer les sessions de forma grupal i pèrdua de participants. Conclusió: Amb la intervenció plantejada, s‟emfatitza la importància de l‟educació sanitària com a eina fonamental perquè les persones ostomitzades adquireixin coneixements i els apliquin al seu dia a dia i així puguin evitar complicacions i s‟adaptin ràpidament a una nova vida. Background: Colorectal cancer (CRC) is the most common indication for an ostomy. Osmotized patients need an individual, expert treatment before and after surgery. The education and counselling they receive during the pre- operative phase will help to reduce hospital discharge delay. In this project, we focus on people who have to practice an ileostomy, since their adaptation is usually more complex, as a result of the continuity and composition of the effluents that are eliminated by the stoma and the complications that can occur, in relation to nutrition and poor use of therapeutic devices. Aims: Understand the effectiveness of a health education program aimed at patients with ileostomy to improve the ability to self-cure, feeding and reduce postoperative complications. Methods: The education project for ileostomized patients is based on a quasi- experimental pre-test/post-test without the presence of a control group, which focuses on observing and evaluating the situation before participating in the educational intervention and once the intervention has finished. The intervention will be carried out with the collaboration of HUAV and HUSM. These hospitals have been selected, since they are currently the reference hospitals that are part of the BPSO program, and work together on the basis of the best scientific evidence available in GBP that they have implemented. The obtaining of the data will be carried out through quantitative methods and self- administered questionnaires. Limitations of the study: Do not gather enough sample to make the sessions in group form and loss of participants. Conclusions: With the intervention raised, the importance of health education is emphasized as a fundamental tool for ostomised patients to acquire knowledge and apply them to their day-to-day so that they can avoid complications and adapt quickly to a new life.

Objectives: The understanding and adherence to postoperative care instructions are factors that influence the recuperation process after any surgical procedure. The aim of this study was to determine the percentage of patients who strictly follow the postoperative instructions after the extraction of an impacted lower third molar in relation to sociocultural level, preoperative anxiety scores and how postoperative information is provided to the patient. Study Design: Patients were randomly assigned to one of three different test groups according to how the postoperative instructions were presented: verbal, written and a group that received additional information. Before surgery, patients were required to complete the Corah Dental Anxiety Scale and personal information (age, gender and educational level) was also collected. P 0.05). Quitting smoking or drinking of alcoholic/carbonated beverages were the main influential factors for the lack of adherence to postoperative care instructions during the week after surgery. Conclusions: Presentation of postoperative instructions, preoperative anxiety scores and sociocultural level do not appear to be key factors that promote the adherence to postoperative instructions.

Màster en Lideratge i Gestió d'Infermeria, Universitat de Barcelona. Escola Universitària d'Infermeria, curs: 2016-2017, Director: Maribel Peró, Objetivo: El propósito de este estudio es realizar una escala para determinar la complejidad del manejo de los cuidados por parte del personal de enfermería del paciente quirúrgico en el post operatorio inmediato de una URPA (Unidad de Recuperación Post Anestésica). Ámbito del estudio: El trabajo de investigación se realizará en el ámbito del área quirúrgica, concretamente en los quirófanos centrales de la Fundació Privada Hospital Asil de Granollers, hospital comarcal de la provincia de Barcelona. Se efectuará durante el turno de tarde (15.05 a 22h) ya que es la zona horaria con más presión asistencial y más variabilidad de complejidades se prevé recoger. Se iniciará en septiembre de 2017 y finalizará en febrero de 2019. Metodología: El diseño de investigación será cuantitativo, observacional, descriptivo y transversal o de prevalencia. Los pacientes se escogerán de forma consecutiva, es decir en orden de llegada a la URPA. Implicaciones para la práctica. En la práctica implicará una mejora en el conocimiento de la complejidad del paciente y como realizar su adecuada atención. Posteriormente se podrán estudiar las cargas de trabajo de enfermería en relación a los cuidados requeridos por cada tipo de paciente con la finalidad de aportar los recursos humanos necesarios en cada momento.

Objetivo: Conocer la calidad del descanso nocturno tras una intervención para minimizar la presencia de luz y el ruido nocturnos en las áreas de observación de urgencias (AOU) de un hospital urbano. Metodo: Se realiza un ensayo clínico cuasiexperimental con un grupo preintervención (Grupo PRE) y otro posterior (Grupo POS) a la intervención, mediante cuestionario ad hoc sobre repercusión de luz y ruido en la calidad del descanso nocturno en el AOU del Hospital Clínic de Barcelona. La intervención consistió en cambios estructurales para reducir luz y el ruido ambientales, así como la instauración de un procedimiento normalizado de trabajo para modificar los planes de cuidados nocturnos. Resultados: Se incluyeron en el Grupo PRE 50 enfermos y 371 en el Grupo POS. El grupo PRE declaró haber tenido un buen descanso en un 72% de los casos frente al 91% del grupo POS (p < 0,001). Factores como el dolor, las intervenciones enfermeras o el sueño diurno no repercutieron en la calidad del sueño. Conclusiones: La luz y el ruido ambientales influyen en el descanso nocturno en AOU más que otras variables conocidas. Intervenciones sobre la luz y el ruido pueden mejorar objetivamente el descanso nocturno de los pacientes.

n-3 Fatty acids have clinical benefits. The primary aim of the present study was the assessment of infection in patients who underwent major high-risk elective gastrointestinal surgery receiving postoperatively fish oil (FO)-supplemented parenteral nutrition (PN), compared with those receiving a standard olive oil (OO) emulsion. The secondary aims were the assessment of anti-inflammatory response and evaluation of tolerance and safety of these emulsions. A prospective, randomised, double-blind study was performed in patients requiring at least 5 d of PN. An isoenergetic and isoproteic formula was administered: group A received OO alone, while group B received OO that was partially replaced with FO (16·6 %, w/w). End points were outcome measures (mortality, sepsis, infection, hospitalisation days and PN duration), inflammatory response (C-reactive protein (CRP), prealbumin and leucocytes) and safety (TAG and glucose metabolism, and liver and kidney function). Statistical analysis was done using Student's t test and Fisher's exact test (P v. 78·6 %, P = 0·007). CRP, prealbumin and leucocytes were not significantly different between the groups. There were no differences in safety parameters. We conclude that high-risk surgical patients receiving FO-supplemented PN for 5 d present a lower incidence of infection. Emulsions were safe and well tolerated.

Treball Final de Grau en Infermeria. Codi: IN1138. Curs: 2014/2015 La artroplastia total de rodilla o el reemplazo total de la articulación de la rodilla por una prótesis supone la intervención más efectiva en el tratamiento de enfermedades degenerativas como la artrosis de rodilla de evolución grave, ya que en esencia, reduce el dolor en la zona y mejora la capacidad funcional y la calidad de vida de los pacientes teniendo en cuenta que permite el desarrollo de movimientos efectivos de las extremidades inferiores. 1 Con la elaboración de este plan de cuidados mi objetivo principal es la creación de intervenciones y actividades claras y organizadas que posibiliten la prevención de complicaciones potenciales que puedan aparecer una vez haya finalizado el proceso quirúrgico, tras una intervención de ATR. Las intervenciones planteadas se aplican dentro de la fase postoperatoria donde el umbral de acción de enfermeria para prevención de complicaciones se hace más extensible y posee mayor validez. Como estrategia metodológica, centro mi plan de cuidados basándome en la identificación de patrones funcionales alterados de salud de Marjory Gordon presentes en los pacientes, durante el postoperatorio, y una vez identificados dichos patrones, aplico la taxonomia NANDA-NOC-NIC como herramienta de intervención para la elaboración de intervenciones y actividades que serán aplicadas diariamente, en respuesta a los patrones funcionales alterados desde el momento en el cual los pacientes abandonan el bloque quirúrgico. Como conclusión principal, la aplicación de este plan de cuidados supondria una mejora en la atención al paciente y en la organización del trabajo de todo el equipo involucrado en el manejo de la salud de los pacientes intervenidos por ATR.