El mayor de los agradecimientos de esta tesis se lo debo a mi madre. Gracias mamá por absolutamente todo, si hoy esta tesis es una realidad es porque tú estás siempre a mi lado para que cumpla mis sueños y metas, verdaderamente no es suficiente todo el tiempo del mundo para agradecerte todo lo que haces por mí. Infinitas gracias por apoyarme en cada paso que doy, por conocerme a la perfección, por ser mi consejera incansable, mi referente en la vida, a quien admiro profundamente. Gracias por tu sonrisa, por la bondad que hay en tus ojos, por tus palabras de ánimo y de tantísimo amor, por enseñarme a poner en cada cosa lo mejor de mí como tú siempre haces, porque de ti he aprendido todo lo bueno que tengo. Gracias por confiar en mí, por ser el pilar de la familia, por cuidarme incansablemente en días de tanto esfuerzo y sacrificio, por tener ese corazón tan inmenso. Ni todas las palabras más bonitas del mundo son suficientes para expresarte mi agradecimiento, porque tú eres el motor de mi vida y de cada logro en ella, tanto en esta andadura como en todos los caminos que decido recorrer. Gracias una vez más mamá por ser tan sumamente increíble y maravillosa, te quiero más que a nadie en el mundo.A mi padre, por quererme siempre pase lo que pase, por transmitirme tu amor a la música que tanto me ha aportado a lo largo de este camino, por hacer todo lo posible e imposible por ayudarme, por tu cariño y confianza en mí. Te quiero, gracias a ti también por tu apoyo papá.A mi hermano, al que tantísimo admiro, esa gran mente e inmenso corazón. Gracias por los sabios consejos que sólo los genios como tú pueden transmitir, porque me has llevado a la meta cada día, te quiero infinito más uno hermano, gracias por enseñarme a luchar, por enseñarme que lo único que llega lejos es el esfuerzo y el buen hacer, por ser mi compañero de batallas desde que llegué al mundo.A mis sobrinos David y Raúl, los motores de mi corazón. Vuestra sonrisa e inocencia mantienen despiertos cada uno de mis sentidos, promueven cada uno de mis logros, os adoro. No existe mejor momento en mi vida que ir a buscaros a la salida del cole, no existe mayor recompensa que uno de vuestros abrazos y besos, no hay obra más bella que uno de vuestros dibujos, no hay título mejor que el de ser vuestra tata, os quiero con todas mis fuerzas.A mi cuñada Toñi, porque no podría dejar de agradecerte ni un segundo ser junto a mi hermano la creadora de dos de mis maravillas, por amar a mi hermano, por nuestra complicidad y amistad.Las referencias bibliográficas empleadas atienden al formato del IEEE -Institute of Electrical and Electronics Engineers.Asimismo, es importante destacar que con anterioridad a este Capítulo el lector dispone de un índice de figuras, tablas, sitios web visitados y acrónimos utilizados en la redacción de la tesis, a los que se aludirá durante el texto de la misma.Cada capítulo o apartado del mismo dispone además de una serie de conclusiones parciales por estudio previas a las conclusiones generales de la tesis doctoral.
and Areti Angeliki Veroniki (PhD). Thanks for all your time answering my questions during the interviews and for responding my emails. Without you, this dissertation would not exist.Second, I want to thanks my three PhD advisors for their intellectual and emotional support. Their different backgrounds have enriched my learning process, and contributed to the completion of this dissertation in varied ways. Choices and imperfections in this dissertation are my own. Thanks also to Ian Graham (PhD) and Sylvie Grosjean (PhD) for being my host mentors with the ERASMUS MUNDUS NOVADOMUS CHEMEDPHO scholarship (2016-2017), which funded me in order to conduct most of my empirical research in Canada. Thanks to Amparo Cortés Lucas (PhD), who was the coordinator of the NOVADOMUS CHEMEDPHO for all her support during my application, and my stay in Canada. Thanks to Ángela Villena Aleixos, for her patience and hard work in drawing with AUTOCAD all the versions of some images included in this dissertation and some other images, which I have finally decided to leave out.Thanks to all assessors and jury members who have accepted pleasingly to assess this dissertation, as either principals or substitutes. I am sure that they will do a very good job providing me with thoughtful feedback. Thanks to all administrative staff (Mila, Beatriz, Rosa) of the Departamento A causal model to explain data reuse in science: a study in health disciplines v de Comunicación Audiovisual, Documentación e Historia del Arte (UPV) for all their administrative support of all bureaucratic issues for the submission and defense of my dissertation.I am also grateful to very generous people, who I have met during my PhD and have contributed in varied aspects along the dissertation journey. I was very fortunate to find all of them on my way. They are my colleagues at INGENIO, especially -in no especial order-Isabel Piqueras,
Introduction: Delirium is considered one of the great geriatric syndromes because of the economic and social impact it has on the health system.The presence of this syndrome in the elderly has been shown to be more prevalent in those cases that have been operated on by orthopaedic surgeries.Objective: Firstly, the aim is to analyse the clinical and socioenvironmental predictive factors in the development of ACS or delirium during hospitalisation for hip fracture. On the other hand, it is proposed to address a nursing care plan or good practice action in nursing to prevent, palliate or reduce ACS in patients hospitalized for hip fracture. Methodology: Two types of methodology have been used to develop this work. On the one hand, a prospective cohort study carried out with a sample of 287 orthogeriatric patients (87.2 ± 3.2 years) recruited in the Trauma Unit of the Hospital Complex of León. Predisposing, precipitating and risk factors in the development of acute confusional syndrome were analysed according to sociodemographic, baseline, surgical, pharmacological variables, comorbidities and complications. The statistical data were analyzed by means of a Chi -test of association between categorical variables, Mann-Whitney U test for the contrast of means between groups, multivariate logistic regression test and segmentationanalysis by means of the CHAID method. On the other hand, a bibliometric review of the scientific literature on the approach to nursing performance in the phases of diagnosis and treatment of ACS in elderly patients hospitalized for CF diagnosis was carried out. Results:The results of the predictive factors show that the presence of anaemia (30.5 % vs 47.4 %; OR=0.48) is a significant (P<.05) and effective (although with a slight effect: 2 %) predictor of delirium. Furthermore, ASA in categories 3 or 4 (36.3 %; OR=1.95), cognitive impairment, UTI (63.4 % vs 27.6 %; OR=4.54), visual disturbances (44.8 % vs 29.7 %; OR=1.92) and RAO (58.1 % vs 29.7 %; OR=3.28), in this order, are predictive variables of delirium in hospitalized older patients with hip fracture. Based on the multidimensional nature of the variables that precipitate ACS, we propose to combine the pharmacological therapeutic approach with non-pharmacological action. In this sense, the results of the bibliometric study highlight the relevance of nonpharmacological factors to be implemented in nursing care plans or good practice for the treatment of ACS. Conclusion:The environmental predictive factors that impact on the development of delirium can be controlled from the very moment of the patient's hospitalisation. Therefore, on the basis of a good nursing practice action plan, it is possible to minimise the disruption caused by this syndrome to the patients, their families and health care providers themselves.
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