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Pedraz-Marcos, Azucena

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Azucena

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Pedraz-Marcos

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ISCIII

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ISCIII::Unidad de Investigación en Cuidados de Salud (Investén-ISCIII)

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Now showing 1 - 9 of 9

Resilience among primary care professionals in a time of pandemic: a qualitative study in the Spanish context
(BMJ Publishing Group, 2023-06-30) Palmar-Santos, Ana María; Pedraz-Marcos, Azucena; Rubio-Casado, Laura Alicia; Pulido-Fuentes, Montserrat; García-Perea, María Eva; Navarta-Sanchez, Maria Victoria; Banco Santander; Ministerio de Ciencia e Innovación (España)
Objectives: This study explores the impact of the COVID-19 pandemic on the Spanish primary care structure and services and the mechanisms implemented by the primary care workforce to restore and reinforce their reference care model. Design: An exploratory, qualitative study with semistructured interviews and a focus group discussion conducted during the fall semester of 2020. Setting: Primary health centres in Madrid (Spain), chosen based on factors such as infection rates during the earliest stages of the pandemic and demographic and socioeconomic aspects. Participants: A total of 19 primary health and social care professionals were purposively selected. Criteria for inclusion were gender (male/female), at least 5 years of experience in their current position, category (health/social/administrative worker), and whether they worked in a rural or urban healthcare setting. Results: Two main themes were identified: (1) reflecting on a model in crisis-particularly the reopening of centres to users and the proactive, participative strategies implemented by primary care professionals to reach their community; and (2) regaining a sense of purpose-how healthcare professionals implemented strategies to sustain their vision of their reference model. The COVID-19 pandemic exposed leadership deficiencies that, together with the initial unavailability of resources and difficulties maintaining face-to-face contact with users, triggered a sense of loss of professional identity. On the other hand, the analysis revealed potential strategies to restore and reinforce the traditional model, such as the adoption of digital technologies and reliance on community networks. Conclusion: This study highlights the importance of a solid reference framework and enhances the strengths and skills of the workforce to reinforce the community-based service provision model.
A mixed methods study using case studies prepared by nursing students as a clinical practice evaluation tool
(Wiley, 2023-09) Palmar-Santos, Ana María; Oter-Quintana, Cristina; Olmos, Ricardo; Pedraz-Marcos, Azucena; Robledo-Martin, Juana; Autonomous University of Madrid (España); Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro Majadahonda
Aim: To identify the presence of variability in the evaluation of case studies prepared by nursing students during their primary care rotations based on the existing evaluation rubric. To explore the difficulties experienced by link lecturers and students in preparing and evaluating case studies. Design: A mixed methods study. Methods: The scores for the rubric items and the final grades for the case studies were collected from a sample of 132 cases. Qualitative information was collected by conducting open-ended interviews with lecturers and a focus group session with students. Results: Statistically significant differences were identified between the lecturers' mean final grades [F(5.136) = 3.984, p = 0.002] and a variety of items in the evaluation rubric (p < 0.05). In addition, effect sizes [η2 (≈0.14)] of considerable magnitude were found. Two themes emerged from the qualitative data: (1). the challenge of preparing the case studies and (2). the variable nature of the evaluations.
Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study
(Wiley, 2023-04) Soilemezi, Dia; Palmar-Santos, Ana; Navarta-Sánchez, M Victoria; Roberts, Helen C; Pedraz-Marcos, Azucena; Haahr, Anita; Sørensen, Dorthe; Bragstad, Line K; Hjelle, Ellen G; Haavaag, Silje Bjørnsen; Portillo, Mari Carmen; Unión Europea. EU Joint Programme-Neurodegenerative Disease Research; The Research Council of Norway; DAM Foundation; Innovation Fund Denmark; Alzheimer's Society; Autonomous University of Madrid (España); Ministerio de Universidades (España)
Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or public contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
Estudio exploratorio prospectivo de los factores asociados a eventos adversos en salud en personas mayores que viven con VIH
(Medwave Estudios Limitada, 2023-03-08) Ramírez, Margarita; Palmar-Santos, Ana; Sánchez-Conde, Matilde; Pedraz-Marcos, Azucena; Brañas, Fátima
[ES] Introducción: Gracias al tratamiento antirretroviral en Occidente, la infección por el virus de la inmunodeficiencia humana (VIH) se ha convertido en una enfermedad crónica. Hoy, el 50% de las personas que viven con VIH son mayores de 50 años y en torno al 20% de los nuevos casos de esta infección se dan en ese mismo grupo etario. Este trabajo tiene por objeto el analizar los factores clínicos y sociodemográficos asociados a eventos adversos en salud (caídas, visitas a urgencias, ingresos hospitalarios y muerte) en una cohorte de personas mayores de 55 años con infección por VIH. Métodos: Estudio exploratorio prospectivo con cuatro años de seguimiento. Se incluyeron personas con infección por VIH seguidas en las consultas de enfermedades infecciosas de dos hospitales de Madrid. Se recogieron datos sociodemográficos y variables clínicas. Se evaluó la situación funcional, mental y social de los participantes. Se revisaron en las historias clínicas de los pacientes número de caídas, visitas a los servicios de urgencias, ingresos hospitalarios y muertes producidas durante el periodo estudiado. Resultados: Se incluyeron 117 pacientes con una edad media de 61,4 (desviación estándar 6,6) años y una mediana de seguimiento de 47 meses (35 a 50). De estos sujetos, el 25% tenía síntomas depresivos y el 10% tenía algún grado de deterioro cognitivo en la visita inicial. Las frecuencias de eventos adversos en salud registradas fueron: caídas del 7,7%, visitas a urgencias del 53%, ingresos hospitalarios del 33,3% y muertes del 2,6%. Los síntomas de depresión se asociaron con caídas y visitas a urgencias en el análisis bivariado. Los factores asociados a ingreso hospitalario fueron haber adquirido la infección por consumo de drogas por vía parenteral, ser frágil y ser menor de 65 años. Se realizó análisis multivariado para el resultado de ingresos hospitalarios con las variables que mostraron p < 0,05 en el análisis bivariado y ninguna de ellas alcanzó significación estadística. Conclusiones: Los síntomas de depresión y el deterioro cognitivo se presentan con una alta frecuencia en estos pacientes, por lo que debería realizarse tamizaje de ambos de forma sistemática en este grupo poblacional. Son necesarios estudios con más pacientes y mayor tiempo de seguimiento que permitan identificar los factores de riesgo asociados a eventos adversos en las personas mayores que viven con VIH. [EN] Objective: This study examines the clinical and sociodemographic factors associated with adverse health outcomes (falls, emergency room visits, hospital admissions and death) in a cohort of patients older than 55 years with HIV infection. Methods: It is an exploratory prospective study with four years follow-up. People with HIV infection followed in the infectious diseases consultation unit of two hospitals in Madrid were included. Sociodemographic data and clinical variables were collected. The functional, mental, and social situations of the participants were assessed. Patient clinical histories were reviewed to gather data on the number of falls, visits to emergency departments and hospital admissions during the period studied. Results: One hundred seventeen patients with a mean age of 61,4 (SD 6,6) years and a median follow-up of 47 months(35 to 50) were included. Of these subjects, 25% had depressive symptoms, and 10% had some degree of cognitive impairment at the baseline visit. The recorded frequencies were: falls 7,7%, visits to the emergency room 53%, hospital admission 33,3% and deaths 2,6%. Depressive symptoms were associated with falls and emergency room visits in the univariate analysis. The factors associated with hospital admission were having acquired the infection through intravenous drug use, frailty and being under 65 years of age. Multivariate analysis was conducted for the hospital admissions outcome, with the variables showing p < 0,07 in the univariate analysis, none of which reached statistical significance. Conclusions: Depression screening and cognitive evaluation should be done systematically in this population group. More studies with more patients and longer follow-up times are necessary.
Closed Endotracheal Suction Systems for COVID-19: Rapid Review
(JMIR Publications, 2023-01-10) Ramírez-Torres, Carmen Amaia; Rivera-Sanz, Félix; Sufrate-Sorzano, Teresa; Pedraz-Marcos, Azucena; Santolalla-Arnedo, Ivan; Center for Biomedical Research of La Rioja (España); University of La Rioja (España)
Background: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. Objective: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. Methods: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." Results: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Conclusions: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.
Perspectives of people with Parkinson's disease and family carers about disease management in community settings: A cross-country qualitative study
(Wiley, 2023-02-02) Navarta-Sánchez, M Victoria; Palmar-Santos, Ana; Pedraz-Marcos, Azucena; Reidy, Claire; Soilemezi, Dia; Haahr, Anita; Sørensen, Dorthe; Smidt, Helle Rønn; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Haavaag, Silje Bjørnsen; Portillo, Mari Carmen; Unión Europea. EU Joint Programme-Neurodegenerative Disease Research; The Research Council of Norway; DAM Foundation; Innovation Fund Denmark; Alzheimer ´s Society (Reino Unido); Autonomous University of Madrid (España); Ministerio de Universidades (España)
Aim: To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease. Background: Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting. Design: A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ. Methods: Individual semi-structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta-ethnographic approach was used to analyse and synthesise cross-national findings. Results: Forty-seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub-themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well-being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management. Conclusions: An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long-term conditions. Patient or public contribution: The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings. Relevance to clinical practice: This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey.
The relationship between sense of coherence and emotional intelligence as individual health assets for mental health promotion in students and healthcare professionals: a scoping review
(Frontiers Media, 2024) Urtubia-Herrera, Valentina; Navarta-Sánchez, María Victoria; Palmar-Santos, Ana María; Pedraz-Marcos, Azucena; García-Gomez, Alberto; Luis, Elkin O; Bermejo-Martins, Elena; Universidad de Navarra (España); Autonomous University of Madrid (España); Ministerio de Universidades (España)
Introduction: Workplace Mental health promotion in healthcare sector, is a global priority due to the stress associated with caregiving environments and the increase of mental health problems among health professionals and students. The role of emotional intelligence (EI) and sense of coherence (SOC) have been identified as critical health protectors. However, the relationship between them as well as the underlying mechanisms of these relationships on health benefits in this population is still unclear. Aim: To synthetize the existing literature on the relationship between emotional intelligence and sense of coherence, as well as their mutual impact on healthcare workers' and student's well-being. Method: A scoping review was conducted following the Joanna Briggs Institute guidelines. A systematic search was conducted in PsyCINFO, CINHAL, SCOPUS and PUBMED databases, using key-terms such as students, health professionals, emotional intelligence, and sense of coherence. Results: A total of 11 articles were included, with a range of years from 2014 to 2022. Evidence was found to support the positive relationship between sense of coherence and emotional intelligence. The use of EI as a training pathway to improve SOC and health promoting behaviors is suggested. The benefits of intervening on these factors contribute to improved health professionals' and students' general well-being and motivation for a better performance, either in their studies or clinical work. Conclusion: The positive relationship between emotional intelligence and a sense of coherence has direct and indirect benefits on students' and healthcare professionals' well-being. Future studies should address longitudinal and experimental analysis to confirm these findings.
Impacto de la arquitectura del hospital en la experiencia de parto: un estudio fenomenológico con madres expertas en su diseño
(Gobierno de Navarra (España), 2024-02-13) Cambra-Rufino, Laura; Müller, Angela E; Parra Casado, Marta; Pedraz-Marcos, Azucena; Unión Europea. Comisión Europea. NextGenerationEU
[ES] Fundamento:: El lugar donde paren las madres condiciona su proceso de parto y nivel de satisfacción. El objetivo de este estudio es identificar las experiencias y percepciones acerca de los elementos de diseño del entorno del parto hasta el alta hospitalaria, que influyen en la experiencia de las madres a largo plazo. Metodología:: Investigación fenomenológica de tipo método biográfico, a través del análisis temático inductivo de veinticinco testimonios de parto en el hospital, escritos por madres arquitectas, ingenieras, paisajistas o diseñadoras de interiores. Resultados:: Los resultados se organizaron en cuatro temas y siete subtemas. El primer tema es la “Impresión a primera vista y largo plazo” que se subdivide en los subtemas “Itinerario despersonalizado en accesos y pasillos” y “Búsqueda instintiva de conexión con la naturaleza”. El segundo tema trata sobre el “Acompañamiento y arropamiento durante el proceso de parto” y se subdivide en “Como en un hotel: espacio para el movimiento y adaptación personalizada” y “Desamparo, frío e incertidumbre: espacios donde estar contra su voluntad”. El tercer tema son los “Daños (en espacios) colaterales”, que engloba “La integración de los aseos en el proceso de parto”, los “Quirófanos inmutables ante el parto por cesárea” y las “Salas de neonatos que no integran a las familias”. El cuarto tema incluye “Propuestas de mejora para nuevos diseños”. Conclusiones:: Esta investigación permite profundizar en aspectos de diseño identificados en literatura reciente y mostrar que son necesarios más estudios que incorporen la experiencia de la mujer en el proceso del parto para promocionar políticas de diseño basadas en evidencias. [EN] Background: The birthplace has a crucial role in shaping the childbirth experience and mothers' satisfaction levels. This study aimed to identify the experiences and perceptions that may have an impact in the long-term on mothers' birthing experience, considering hospital design features in the birthing environment until discharge. Methods: Inductive thematic analysis of twenty-five hospital labor testimonies employing a phenomenological research approach and utilizing a biographical method. Participants were women with a professional background in architecture, landscape architecture, engineering, or interior design. Results: The results are organized into four themes and seven subthemes. The first theme is "First sight and long term impression" which is subdivided into the subthemes "Depersonalized itinerary in entrances and corridors" and "Instinctive search for connection with nature". The second theme deals with "Accompaniment and tucking in during the birthing process", subdivided into "Hotel-like: space for movement and personalized adaptation" and "Helplessness, cold and uncertainty: spaces to be against one's will". The third theme is "Damage in collateral rooms", which includes "The integration of toilets in the birthing process", "Operating rooms unchangeable in the face of cesarean delivery" and "Neonatal units that do not integrate families". Finally, the fourth theme includes "Improvement proposals for new designs". Conclusions: This study contributes to the existing literature by deepening the understanding of the design features identified in hospitals in recent studies. Further research incorporating the experiences of women in the birthing process is needed to facilitate evidence-based design policies.
Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study
(Wiley, 2023-04) Soilemezi, Dia; Palmar-Santos, Ana; Navarta-Sánchez, M Victoria; Roberts, Helen C; Pedraz-Marcos, Azucena; Haahr, Anita; Sørensen, Dorthe; Bragstad, Line K; Hjelle, Ellen G; Haavaag, Silje Bjørnsen; Portillo, Mari Carmen; The Research Council of Norway; DAM Foundation; Innovation Fund Denmark; Alzheimer's Society (Reino Unido); Autonomous University of Madrid (España); Ministerio de Universidades (España); EU Joint Programme – Neurodegenerative Disease Research
Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or public contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.