Enfermería y Fisioterapia

Percutaneous Electrolysis for Patellar Tendinopathy: A Systematic Review and Meta-Analysis

2026-11-05T05:05:18Z

Percutaneous Electrolysis for Patellar Tendinopathy: A Systematic Review and Meta-Analysis Góngora Rodríguez, Jorge Manuel; Rosety Rodríguez, Miguel Ángel; Fernández Santos, Jorge del Rosario; Ayala Martínez, Carmen María; Góngora Rodríguez, Jorge Manuel Patellar tendinopathy is a chronic musculoskeletal condition characterized by localized pain and functional impairment. This systematic review and exploratory meta-analysis aimed to synthesize current evidence on the effectiveness of percutaneous electrolysis (PE), combined with eccentric exercise, for improving functional performance in individuals with patellar tendinopathy. Following PRISMA guidelines and registration in PROSPERO (CRD420251233971), comprehensive searches were performed in Cochrane Library, PEDro, PubMed, ScienceDirect, Scopus, and Web of Science databases. Only two randomized controlled trials, published between 2016 and 2021, met the eligibility criteria and were included in the quantitative synthesis. Functional capacity recorded using the Victorian Institute of Sport Assessment-Patella (VISA-P) scale was the primary outcome. Both included studies presented some concerns regarding risk of bias. The pooled random-effects meta-analysis (REML estimation with Hartung–Knapp–Sidik–Jonkman adjustment) revealed no statistically significant difference favoring PE over control interventions (Hedges’ g = –0.10; 95% CI: –2.69 to 2.50; p = 0.72). Statistical heterogeneity was nominally low (I2 = 0%), although this metric is uninformative with only two studies. Between-group differences in both studies were below the minimal clinically important difference for the VISA-P scale. The certainty of evidence according to the GRADE framework was rated as very low. Given the extremely limited evidence base, these findings should be considered strictly exploratory. The very low certainty of evidence precludes definitive conclusions regarding the comparative effectiveness of PE. Larger, adequately powered randomized trials with standardized protocols and long-term follow-up are needed.

Scrolling Less, Learning More: Nudging Strategies to Reclaim Students’ Attention from Social Media Distractions in the Age of TikTok: A Scoping Review

2026-10-30T05:09:57Z

Scrolling Less, Learning More: Nudging Strategies to Reclaim Students’ Attention from Social Media Distractions in the Age of TikTok: A Scoping Review Paramio Leiva, Alberto; Zayas García, Antonio Background: The pervasive use of short-form video platforms such as TikTok has introduced unprecedented challenges to student attention, cognitive self-regulation, and academic performance. Recent interest has grown around “nudging” strategies, or non-coercive behavioral interventions, to help students regain control over their digital habits in educational settings. This review aims to (1) synthesize recent empirical evidence on the attentional and academic impact of problematic social media use (particularly TikTok) among students, (2) identify and classify nudging strategies that mitigate these effects, and (3) evaluate their relative effectiveness and practical application in educational contexts. Methods: A scoping review was conducted on studies published between 2020 and 2024. Search terms included combinations of “social media”, “attention”, “nudge”, and “academic performance” across databases such as Scopus and Web of Science. Of 142 records identified, 15 studies met eligibility criteria, including 7 empirical interventions using nudging techniques. Data extraction focused on intervention type, theoretical rationale, outcomes, and focus gain. Results: Across interventions, temporal/commitment nudges improved attendance and on-task engagement, with grade gains for goal-setting in one classroom experiment. Environmental nudges that reduce cue salience (e.g., notification filtering, grayscale) and choice-based bundles of micro-strategies reduced screen time/problematic use and improved sleep in a randomized trial; grayscale also reduced daily phone use in experimental tests, though some users disliked its aesthetics. Cognitive/reflective supports were qualitatively associated with better management of checking urges. Observational and longitudinal studies clarified mechanisms and correlates, informing what nudges should target. Multi-component, autonomy-preserving designs showed the most consistent benefits. Conclusions: Nudging strategies offer a promising path to reclaim student attention in the digital age. Educators and technologists should prioritize adaptive, customizable, and ethically designed interventions to promote intentional engagement and digital well-being. Future studies should explore long-term efficacy, personalization through Artificial Intelligence, and cultural variability in nudge receptivity.

Desarrollo y validación de un sistema de soporte a la decisión clínica basado en IA estrecha para el manejo de heridas crónicas

2026-09-26T04:01:02Z

Desarrollo y validación de un sistema de soporte a la decisión clínica basado en IA estrecha para el manejo de heridas crónicas Carrión Jiménez, Gorka Introducción: Las heridas crónicas constituyen un problema de salud pública infrarrepresentado, asociado a elevada morbilidad, consumo de recursos y variabilidad en la práctica clínica enfermera. En el caso de las lesiones cutáneas relacionadas con la dependencia, la complejidad etiológica y la dificultad diagnóstica incrementan el riesgo de intervenciones inadecuadas, retrasos en la cicatrización y peores resultados en salud. En este contexto, los sistemas de soporte a la decisión clínica basados en inteligencia artificial estrecha se plantean como una herramienta para estructurar la valoración y favorecer decisiones coherentes con la evidencia disponible. Objetivo: Diseñar y planificar el desarrollo y la validación de un sistema digital de soporte a la decisión clínica basado en IA estrecha para el manejo de heridas crónicas, con especial énfasis en las lesiones cutáneas relacionadas con la dependencia, en el marco de un proyecto de tesis doctoral en enfermería. Material y método: Se propone un proyecto de investigación multimétodo, articulado en cuatro fases secuenciales e interrelacionadas: síntesis de la evidencia y consenso de expertos (Fase I), desarrollo tecnológico del sistema (Fase II), validación de la concordancia diagnóstica y fiabilidad (Fase III) y evaluación de la efectividad clínica mediante un ensayo clínico aleatorizado por conglomerados (Fase IV). El diseño integra una revisión sistemática siguiendo PRISMA, una técnica Delphi modificada, ingeniería de prompts clínicos, definición de métricas de rendimiento diagnóstico y análisis de resultados clínicos, uso del sistema, carga de trabajo y costes directos. Conclusiones: El proyecto plantea un itinerario metodológico para el diseño, desarrollo y validación de un sistema de soporte a la decisión clínica centrado en el juicio enfermero y sustentado en IA estrecha, con énfasis en la explicabilidad, la supervisión humana y la gobernanza ética y regulatoria. Se espera que el sistema mejore la precisión diagnóstica, la coherencia de las intervenciones y la eficiencia en el manejo de las heridas crónicas.

Associations of Phase Angle, GLIM-Defined Malnutrition, and Rectus Femoris Ultrasound with 30-Day Mortality in Critically Ill Adults: A Prospective Cohort Study

2026-09-26T04:01:41Z

Associations of Phase Angle, GLIM-Defined Malnutrition, and Rectus Femoris Ultrasound with 30-Day Mortality in Critically Ill Adults: A Prospective Cohort Study García García, Alejandro; Úbeda Iglesias, Alejandro; Pozo Romero, Helena; Trujillo Garrido, Nuria; Muñoz Alférez, María José; Sánchez Sánchez, Eduardo Background and aims: Early phenotyping in the ICU is challenging because severity scores do not capture malnutrition, cellular integrity, or muscle reserve. We assessed whether phase angle (PhA), GLIM-defined malnutrition, and rectus femoris ultrasound were associated with 30-day mortality and whether continuous PhA added prognostic information beyond illness severity. Methods: We analyzed a prospective single-center cohort of adults admitted to a 12-bed ICU. Within 24–48 h, patients underwent bioelectrical impedance analysis, rectus femoris ultrasound, GLIM, mNUTRIC, CONUT, APACHE II, and SOFA assessment. Primary multivariable analyses treated PhA and rectus femoris cross-sectional area (CSA) as continuous variables; ROC-derived cut-offs were considered exploratory. Potential non-linearity was examined with restricted cubic splines, and the continuous PhA model underwent bootstrap internal validation. Results: Among 125 patients (63.2% men; median age 68 [60–76] years), 30-day mortality was 24.0% (30/125). GLIM-defined malnutrition was present in 78.4%, including 12.0% with severe malnutrition. Non-survivors had lower PhA (4.3 [3.6–4.8] vs. 4.8 [4.2–5.5]°; p = 0.008) and smaller rectus femoris CSA (2.6 [1.9–3.4] vs. 3.6 [2.5–5.0] cm2; p = 0.007). In the adjusted continuous PhA model, APACHE II (OR 1.23 per point, 95% CI 1.13–1.34; p < 0.001) and severe GLIM-defined malnutrition (OR 5.95, 95% CI 1.45–24.32; p = 0.013) remained independently associated with mortality, whereas lower PhA did not (OR 1.11 per 1° lower, 95% CI 0.74–1.69; p = 0.611). Adding continuous PhA to the reference model changed AUC from 0.868 to 0.867 and did not improve fit (likelihood ratio p = 0.607). Continuous CSA was also not independently associated with mortality (OR 1.17 per 1 cm2 lower, 95% CI 0.81–1.69; p = 0.412). Conclusions: APACHE II and protocol-defined severe GLIM malnutrition, but not continuous admission PhA or rectus femoris CSA, retained independent associations with 30-day mortality; the GLIM association should be interpreted in light of the protocol-specific morphofunctional operationalization of the muscle criterion. Lower PhA and CSA characterized non-survivors in unadjusted analyses; cohort-derived thresholds should be considered hypothesis-generating and require external validation.