Safety culture in maternity hospital: Perception of nurse-midwives.

AIM: To explore nurse-midwives' perceptions of safety culture in maternity hospitals. DESIGN: A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research. METHODS: Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis. FINDINGS: Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication. CONCLUSION: The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential. IMPACT: Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

Improving Access to Care by Admission Process Redesign in a Veterans Affairs Skilled Nursing Facility.

BACKGROUND: Inefficient and inadequate nursing home screening processes can delay care transitions from hospitals to post-acute care facilities and result in inappropriate and delayed transfers. The increased volume of admission requests and need for efficient and effective transfers between care settings converged to make the Community Living Center (CLC; skilled nursing facility in the Department of Veterans Affairs) admission screening process an organizational priority for improvement. A quality improvement (QI) project was conducted to develop a new process for a 112-bed CLC and improve efficiency and access to care. METHODS: The Model for Improvement was used to complete a 13-month continuous QI project. The multidisciplinary QI Workgroup developed aims and measures, analyzed work flow processes, and identified problem areas. Interventions were rapidly tested using Plan-Do-Study-Act cycles. Successful interventions were sustained by developing standard operating procedures and local policy. RESULTS: Several interventions were implemented that focused on standardization, automation, and streamlining. The final result was a new hybrid model that included an Admissions Team consisting of a unit nurse manager, a social worker, and administrative staff. The time from bed request to patient transfer improved from a median of 3.3 days in the baseline period to 2.3 days in the final month of the project. CONCLUSION: A highly structured and team-based QI approach enabled rapid redesign of an admission screening process that improved efficiency and decreased the time from request to admission. This redesign strategy provides instruction for other facilities interested in improving screening processes and access to care.

Prognostic Factors and Treatment Effect Modifiers for Physical Health, Opioid Prescription, and Health Care Utilization in Patients With Musculoskeletal Disorders in Primary Care: Exploratory Secondary Analysis of the STEMS Randomized Trial of Direct Access to Physical Therapist-Led Care.

OBJECTIVE: The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal (MSK) conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist-led pathway in addition to general practitioner (GP)-led care compared to GP-led care alone. METHODS: A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist-led pathway. Data from adults with MSK conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6 months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers. RESULTS: Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6 months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients' age, level of education, duration of symptoms, or MSK presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy. CONCLUSIONS: Patients with MSK conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist-led pathway compared to GP-led care. IMPACT: Patients with MSK conditions receiving primary care in the form of direct-access physical therapist-led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist-led model of care.

Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial.

OBJECTIVE: Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia. METHODS: This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n = 97) or knee osteoarthritis (n = 59) from rural Australia. The intervention involved an eHealth physical activity and an exercise program that included five to eight teleconsultations with a physiotherapist (primary time point three months) or usual care (eg, general practitioner, physiotherapy, and pain medication). The primary outcome was the Patient-Specific Functional Scale (0-30), with a three-point difference between groups being considered the minimum clinically important difference. RESULTS: Participants receiving the eHealth intervention (n = 78) reported significantly greater and clinically worthwhile improvements in function (mean between-group difference 3.6; 95% confidence interval [CI] 1.3-5.9) compared to participants receiving usual care (n = 78). Small but statistically significantly greater improvements in disability (7.2 of 100; 95% CI 2.1-12.3) and quality of life (4.5 of 100; 95% CI 0.0-9.0) also favored the eHealth group. No clinical or statistical differences between groups were found for the secondary outcomes of pain, coping skills, and physical activity levels. CONCLUSION: A physiotherapist-delivered eHealth intervention is effective and provides clinically meaningful improvements in function compared to usual care for people with musculoskeletal pain in rural communities. These findings highlight the potential for eHealth-based programs to improve access to evidence-based exercise interventions for people with musculoskeletal pain in rural communities.

Predictors of Placebo Response to Local (Intra-Articular) Therapy In Osteoarthritis: An Individual Participant Data Meta-Analysis.

OBJECTIVE: We undertook this study to evaluate potential predictors of placebo response with intra-articular (IA) injections for knee/hip osteoarthritis (OA) using individual participant data (IPD) from existing trials. METHODS: Randomized placebo-controlled trials evaluating IA glucocorticoid or hyaluronic acid published to September 2018 were selected. IPD for disease characteristics and outcome measures were acquired. Potential predictors of placebo response included participant characteristics, pain severity, intervention, and trial design. Placebo response was defined as at least a 20% reduction in baseline pain. Logistic regression models and odds ratios were computed as effect measures to evaluate patient and pain mechanisms and then pooled using a random effects model. Generalized mixed-effect models were applied to intervention and trial characteristics. RESULTS: Of 56 eligible trials, 6 shared data, and these were combined with the existing 4 OA Trial Bank studies, yielding 10 studies with IPD of 621 placebo participants for analysis. In the total placebo population, at short-term follow-up, the use of local anesthetic and ultrasound guidance were associated with reduced odds of placebo response. At midterm follow-up, mid- to long-term trial duration was associated with increased odds of placebo response, and worse baseline function scores were associated with reduced odds of a placebo response. CONCLUSION: The administration of local anesthetics or ultrasound guidance may reduce IA placebo response at short-term follow-up. At midterm follow-up, participants with worse baseline function scores may be less likely to respond to IA placebo, and mid- to long-term trial duration may enhance the placebo response. Further studies are required to corroborate these potential predictors of IA placebo response.

Clinical guidelines are silent on the recommendation of physical activity and exercise therapy for low back pain: A systematic review.

OBJECTIVES: To synthesise and evaluate the quality of the recommendations for exercise therapy and physical activity from guidelines for the prevention and/or management of low back pain. DESIGN: Systematic review. METHODS: Included clinical practice guidelines for the management of low back pain published between 2014 and 2022 and searched in 9 databases until September 2022. The quality of evidence was evaluated with the Appraisal of Guidelines, Research and Evaluation tool (AGREE-II instrument). RESULTS: After screening 3448 studies, 18 clinical practice guidelines were included in this review. Only five (27 %) guidelines were judged as having a satisfactory quality of evidence (i.e., rigour of development and applicability), and 13 (72 %) of guidelines are discussed and rated as critical. Regarding physical activity, no guidelines provided recommendations for the primary prevention of low back pain or incorporated adequate physical activity aspects considering type, dosage, frequency, and intensity. For exercises, all (100 %) guidelines recommended at least one type of supervised exercise in the management of low back pain, and 16 (88 %) provided an overall recommendation for people to stay active. CONCLUSIONS: Guidelines offer minimal or, sometimes, no detail regarding physical activity or specific exercise regimens for the management and prevention of low back pain. When some guidance is provided, the recommendations typically lack specificity concerning the type, intensity, duration, and frequency of exercise and, in many cases, they represent a combination of scarce available evidence and stakeholder perspectives.

A systematic review of the unit costs of allied health and community services used by older people in Australia.

BACKGROUND: An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. METHOD: A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. RESULTS: The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. CONCLUSIONS: Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

Implications of the COVID-19 Pandemic on the Family Structural Dimensions: A Correlational Study.

The COVID-19 pandemic caused changes in the families' social support network, employment status, and family income, which are the focus of attention of family health nurses. This study aims to describe the pandemic's repercussions in the areas of attention of the structural dimension of families according to the Dynamic Model of Family Assessment and Intervention, as perceived by Portuguese families, and to relate the changes in their employment status according to the variables of the structural dimension. A quantitative, descriptive, and correlational study was conducted using snowball sampling. A questionnaire of sociodemographic characterization and assessment of the family structural dimension according to the model's operational matrix was applied to 235 family members. Changes were found in their employment status; family income; intensity and frequency of contact with family, friends, and coworkers; frequency of contact with educational/health/religious institutions and community groups; cultural activities; and housing comfort conditions such as the use of heating/air conditioning, gas, and water consumption. Changes in employment status were related to family income, interaction with friends, frequency of cultural activities, and use of air conditioning and heating. Knowing the implications of the pandemic on the family's structural dimension results in a nursing intervention more focused on family needs.

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis.

INTRODUCTION: Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. OBJECTIVE: This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. DESIGN: This was an observational survey involving a consumer review panel and an HCP review panel. PARTICIPANTS: 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n = 9), pharmacists (n = 7), an orthopaedic surgeon (n = 1), a rheumatologist (n = 1), nurse practitioner (n = 1) and a general practitioner (n = 1), all with at least three years of clinical experience and who reported working closely with this target patient population within the last 12 months. METHODS: Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. RESULTS: Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses). CONCLUSIONS: This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.

Opioids are medications that are often used to treat severe or chronic pain. However, they can have serious adverse effects and are not usually recommended for long-term use. This study aimed to create educational materials for patients with chronic low back pain or hip or knee osteoarthritis who are taking opioids and to evaluate the materials' perceived usability, acceptability, and credibility from the perspective of both healthcare professionals (HCPs) and patients. The materials included a brochure and a personal plan and were developed by a team of researchers and clinicians. Both materials were evaluated by HCPs and patients in separate review panels. The brochure and personal plan were found to be usable, acceptable, and credible by both groups. The materials were created to support patients in reducing their opioid use and were refined based on feedback from both HCPs and patients. The materials may be useful in supporting the complex process of tapering off opioids, which can be hindered by various barriers related to both patients and HCPs.

A mixed-methods feasibility study of a comorbidity-adapted exercise program for low back pain in older adults (COMEBACK): a protocol.

BACKGROUND: The prevalence of low back pain increases with age and has a profound impact on physical and psychosocial health. With increasing age comes increasing comorbidity, and this also has pronounced health consequences. Whilst exercise is beneficial for a range of health conditions, trials of exercise for low back pain management often exclude older adults. It is currently unknown whether an exercise program for older adults with low back pain, tailored for the presence of comorbidities, is acceptable for participants and primary healthcare providers (PHCPs). Therefore, this mixed-methods study will assess the feasibility of an 8-week comorbidity-adapted exercise program for older people with low back pain and comorbid conditions. METHODS: The 3-phased feasibility study will be performed in a primary healthcare setting. PHCPs will be trained to deliver a comorbidity-adapted exercise program for older people with low back pain and comorbidities. Healthcare-seeking adults > 65 will be screened for eligibility over telephone, with a recruitment target of 24 participants. Eligible participants will attend an initial appointment (diagnostic phase). During this initial appointment, a research assistant will collect patient demographics, self-reported outcome measurement data, and perform a physical and functional examination to determine contraindications and restrictions to an exercise program. During the development phase, PHCPs will adapt the exercise program to the individual and provide patient education. During the intervention phase, there will be two supervised exercise sessions per week, over 8 weeks (total of 16 exercise sessions). Each exercise session will be approximately 60 min in duration. A qualitative evaluation after the last exercise program session will explore the feasibility of the exercise program for participants and PHCPs. Progression criteria will determine the suitability for a fully powered randomised controlled trial. DISCUSSION: This mixed-methods feasibility study will assess an exercise program for older adults with low back pain and comorbidities. Once assessed for feasibility, the exercise program may be tested for effectiveness in a larger, fully powered randomised controlled trial. This information will add to the sparse evidence base on appropriate options for managing back pain in older adults. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry registration number: ACTRN12621000379819p (06/04/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000379819p ). TRIAL SPONSOR: Macquarie University, Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.

Food Myths or Food Facts? Study about Perceptions and Knowledge in a Portuguese Sample.

Food myths are nutritional concepts poorly justified or even contradict existing scientific evidence that individuals take as the truth. Knowledge in nutrition is an important tool in tackling misinformation and in the promotion of adequate food choices. This study aimed to investigate the beliefs and perceptions of a sample of the Portuguese population regarding a series of food myths and facts, evaluating, consequently, the level of knowledge and the main sources of information. The research was conducted on a sample of 503 participants, using a questionnaire disclosed online, by email, and social networks, between May and June of 2021. Thirty statements, some true and others false, were analyzed to assess people's perceptions. Based on the respondents' answers, a score was calculated for each statement, allowing to differentiate the correct (positive score) from incorrect (negative score) perceptions. The results showed that most statements obtained positive scores, corresponding to correct perceptions. Moreover, the level of knowledge was measured, being very high for 21.7% of the participants and high for 42.1%. The main sources where the participants acquire nutritional information are scientific journals (43.3%), website of the Portuguese General Health Office (DGS) (31.4%), and technical books (31.0%), which is concordant with the level of trust in these sources. Hence, it was concluded that, despite the levels of nutritional knowledge, there are still several food myths that need to be debunked, through the proper channels, in order to promote healthy, balanced, and adequate eating behaviors.

Benefits of STRENOLD Program on Health-Related Quality of Life in Adults Aged 60 Years or Older. In Common Sport Study.

BACKGROUND: The proportion of older adults is increasing worldwide and, with it, the physical inactivity common to this age group. Therefore, the promotion of active aging is a strategic factor in health policies for older people. The aim of this study was to identify the benefits and viability of the strength training program (STRENOLD) in health-related quality of life in adults over 60. METHODS: A controlled experimental study was carried out with a sample of 181 people over 60 years old from different European countries belonging to the European project IN COMMON SPORTS. A pair work strength program was administered (STRENOLD) over a period of 24 months, consisting of two single sessions per week. Their health status was evaluated (EQ-5D-5L) before and after the interventions. RESULTS: The adherence rate was over 89% and the tolerability rate over 100% in all participating countries. Significant improvements in the participants' health were demonstrated in the areas of mobility, usual activities, pain/discomfort, and anxiety/depression. CONCLUSIONS: The regular practice of physical exercise, through the partnered STRENOLD strength program, has benefits on mobility, usual activities, pain/discomfort, and anxiety/depression, in short, health benefits for older adults.

How much change in symptoms do spinal surgeons expect following lumbar decompression and microdiscectomy?

The study aimed to determine how much change in neurogenic claudication spinal surgeons expect in patients following lumbar decompression for lumbar spine stenosis (LSS), and radicular leg pain following microdiscectomy. Secondary aims were to identify surgeons' preferences regarding surgical techniques for lumbar decompression, and their rating of the quality of current evidence for lumbar decompression. All Australian spine surgeons were invited, of whom 71 completed the survey (31% response rate). Only registered spinal surgeons were included. The online survey, administered using REDCap, included 4 sections: demographics and background; expected change in symptoms on a +/- 100% scale (-100% worst, 0% no change and 100% best possible); surgical preference; and rating of current evidence for lumbar decompression compared with other treatments. There were 71 complete responses, 76% were neurosurgeons (N = 54), predominantly male (96%; N = 68). On average, surgeons expected an 86% (median: 87%, inter-quartile range (IQR): 80%, 91%) improvement in neurogenic claudication following lumbar decompression for LSS and 89% (median: 91%, IQR: 85%, 95%) improvement in radicular pain following microdiscectomy. A multiple linear regression found no surgeon characteristics were associated with expected change following surgery. The preferred surgical technique for LSS was full laminectomy (58%; N = 41). Thirty-five percent of surgeons accurately rated the evidence supporting the superiority of lumbar decompression compared with non-surgical care for LSS as low quality. Spine surgeons expect large symptom improvements following lumbar decompression and microdiscectomy. Understanding of the current evidence was higher for lumbar decompression with fusion, than for decompression alone for LSS.

TEXT4myBACK - The Development Process of a Self-Management Intervention Delivered Via Text Message for Low Back Pain.

OBJECTIVE: To develop a bank of text messages for a lifestyle-based self-management intervention for people with low back pain (LBP). DESIGN: Iterative development process. SETTING: Community and primary care. PARTICIPANTS: Fifteen researchers, clinicians, and consumer representatives participated in the concept and initial content development phase. Twelve experts (researchers and clinicians) and 12 consumers participated in the experts and consumers review phase. Full study sample of participants was N=39. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We first conducted two 2-hour workshops to identify important domains for people with LBP, sources of content, appropriate volume, and timing of the messages. The messages were then drafted by a team of writers. Second, we invited expert researchers and clinicians to review and score the messages using a 5-item psychometric scale according to (1) the appropriateness of the content and (2) the likelihood of clinical effectiveness and to provide written feedback. Messages scoring ≤8 out of 10 points would be modified accordingly. Consumers were invited to review the messages and score them using a 5-item psychometric scale according to the utility of the content, the understanding of the content, and language acceptability and to provide feedback. Messages scoring ≤12 out of 15 points would be improved. RESULTS: Exercise, education, mood, sleep, use of care, and medication domains were identified and 82 domain-specific evidence-based messages were written. Messages received a mean score of 8.3 out of 10 points by experts. Twenty-nine messages were modified accordingly. The mean score of the messages based on consumers feedback was of 12.5 out of 15 points. Thirty-six messages were improved. CONCLUSIONS: We developed a bank of text messages for an evidence-based self-management intervention using a theory-based, iterative, codesign process with researchers, consumers, and clinicians. This article provides scientific support for future development of text message interventions within the pain field.

Perceptions Towards Healthy Diet of the Portuguese According to Area of Work or Studies.

INTRODUCTION: A healthy diet is crucial for the maintenance of health. Therefore, the aim of this work is to evaluate the perceptions towards a healthy diet among the participants with work or studies in areas related to diet and nutrition and those who did not. METHODS: Anonymous questionnaire data was collected in a cross-sectional study on a non-probabilistic sample of 902 participants living in Portugal. RESULTS: The results showed that the participants' perceptions were, in general, compliant with a healthy diet. However, significant differences were found between gender (p=0.004), between the different civil state groups (p=0.016), between the participants who were responsible for buying their own food and those who were not and also regarding the living environment. The variable area of work or studies also showed significant differences (p=0.001), so that people who had work or studies related to agriculture obtained a higher score. Regarding this variable, the mean values of nutrition and agriculture areas were not statistically different between them, but were statistically different from the mean values of psychology and health areas. The participants who had work or studies in areas showing diet and nutrition-related issues achieved a higher mean score (0.72±0.35) when compared to the participants who did not (0.58±0.30). CONCLUSION: However, despite the results, it is important to continue developing campaigns that better communicate nutritional aspects, so that people can increase their knowledge on this subject.

Predictors of placebo response to local (intra-articular) therapy in osteoarthritis: an individual patient data meta-analysis protocol.

INTRODUCTION: Osteoarthritis (OA) is a highly prevalent and disabling condition with limited safe and effective treatment options. Intra-articular therapies are increasingly being used, however whether the effect of these agents is due to active treatment or placebo remains unclear. As the placebo response can be attributed to multiple factors, assessment of the placebo response using individual patient data (IPD) meta-analysis will give insight into the different modifiers of response to placebo. The aim of this IPD meta-analysis is to investigate the predictors of placebo response in intra-articular injection trials in OA. IPD meta-analysis is considered to be superior to conventional meta-analysis, as it combines multiple trial data, facilitates the standardisation of analyses across different studies and allows measuring derivation of the desired information. METHOD AND ANALYSIS: A systematic literature search will be conducted for randomised clinical trials comparing corticosteroid and viscosupplementation/hyaluronic acid intra-articular injections with placebo for knee and hip OA. Pubmed (Medline), EMBASE, Web of Science, Cochrane Central and SCOPUS will be searched from inception to September 2018. Corresponding authors of the original trials will be contacted to obtain IPD. Risk of bias will be assessed using the Cochrane Collaboration's tool. The primary outcome will be change in pain from baseline. Secondary outcomes will be change in function and patient's global assessment. Potential predictors of placebo response assessed will include patient's characteristics, pain mechanism characteristics, radiographic severity, pain severity, intervention characteristics and trial design characteristics. A multilevel logistic regression analyses will be applied. Results will be reported using the Preferred Reporting Items for Systematic review and Meta-Analysis -IPD guidelines. ETHICS AND DISSEMINATION: This study does not include identifiable data and ethical approval was obtained by the original investigators. Results of the IPD meta-analysis will be disseminated for publication in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42018095188.

Correction: Management of vertebral compression fracture in general practice: BEACH program.

[This corrects the article DOI: 10.1371/journal.pone.0176351.].

Patient safety culture in nurses' clinical practice / Cultura de segurança do doente na prática clínica dos enfermeiros / Cultura de seguridad del paciente en la práctica clínica de enfermería

Abstract Objective: to assess the psychometric characteristics of the Hospital Survey on Patient Safety Culture, to characterize the patient safety culture, and to assess the influence of the sociodemographic and professional variables on the safety culture dimensions. Method: a methodological, observational, analytical and cross-sectional study conducted with 360 nurses in which the Hospital Survey on Patient Safety Culture questionnaire was used. The data were submitted to descriptive and inferential analysis, as well as to feasibility and validity studies. Results: the nurses' mean age is 42 years old, their mean time of professional experience is 19 years, and they are mostly female. Good internal consistency was obtained (Cronbach's alpha: 0.83), as well as acceptable model fit quality indices. Teamwork within units, Supervisor expectations and Feedback and communication about errors were the dimensions that obtained scores above 60%. Non-punitive response to error, Frequency of events reported, Support for patient safety and Staffing presented scores below 40%. These dimensions are influenced by age, schooling level and professional experience. Conclusion: the psychometric properties of the questionnaire certify its good quality. Teamwork can be considered as an enhancing factor for the safety culture. Assessing the safety culture allowed identifying problematic dimensions, thus enabling planning of future interventions.

Resumo Objetivo: avaliar as caraterísticas psicométricas do Hospital Survey on Patient Safety Culture, caracterizar a cultura de segurança do doente e avaliar a influência das variáveis sociodemográficas e profissionais nas dimensões da cultura de segurança. Método: estudo metodológico, observacional, analítico, transversal, realizado com 360 enfermeiros, utilizando o questionário Hospital Survey on Patient Safety Culture. Os dados foram submetidos à análise descritiva, inferencial e estudos de fiabilidade e validade. Resultados: os enfermeiros possuem em média 42 anos de idade, 19 anos de experiência profissional e são maioritariamente do sexo feminino. Obteve-se boa consistência interna (alfa de Cronbach - 0,83) e índices aceitáveis de qualidade de ajustamento do modelo. O trabalho em equipa dentro das unidades, expetativas do supervisor, feedback e comunicação sobre o erro, foram dimensões que apresentaram scores acima dos 60%. A resposta ao erro não punitiva, frequência da notificação, apoio à segurança pela gestão, dotação de profissionais, apresentaram scores abaixo dos 40%. Estas dimensões são influenciadas pela idade, escolaridade e experiência profissional. Conclusão: as propriedades psicométricas do questionário certificam a sua qualidade. O trabalho em equipa pode ser considerado um fator potenciador da cultura de segurança. Avaliar a cultura de segurança permitiu identificar dimensões problemáticas, possibilitando o planeamento de intervenções futuras.

Resumen Objetivo: evaluar las características psicométricas de la Hospital Survey on Patient Safety Culture, caracterizar la cultura de seguridad del paciente y evaluar la influencia de variables sociodemográficas y profesionales en las dimensiones de la cultura de seguridad. Método: estudio metodológico, observacional, analítico, transversal, realizado con 360 enfermeros, utilizando el cuestionario Hospital Survey on Patient Safety Culture. Los datos fueron sometidos a análisis descriptivo e inferencial y estudios de confiabilidad y validez. Resultados: los enfermeros tienen en promedio 42 años de edad, 19 años de experiencia profesional y la mayoría es de sexo femenino. Se obtuvo buena consistencia interna (alfa de Cronbach - 0,83) e índices aceptables de bondad de ajuste del modelo. El trabajo en equipo dentro de las unidades, las expectativas del supervisor, el feedback y la comunicación del error fueron las dimensiones que presentaron puntajes superiores al 60%. La respuesta al error no punitiva, la frecuencia de notificación, el apoyo a la seguridad por parte de los gestores, la dotación de personal, presentaron puntajes por debajo del 40%. Estas dimensiones son influenciadas por la edad, la educación y la experiencia profesional. Conclusión: las propiedades psicométricas del cuestionario certifican su calidad. El trabajo en equipo puede considerarse un factor que potencia la cultura de seguridad. La evaluación de la cultura de seguridad permitió identificar las dimensiones que tenían problemas y poder planificar futuras intervenciones.

Construction and validity of the Interprofessional Communication in Health Scale / Construcción y validación de la Escala de Comunicación Interprofesional en Salud / Construção e validação da Escala de Comunicação Interprofissional em Saúde

ABSTRACT Objectives: to construct and validate the Interprofessional Communication Scale in Health. Methods: a psychometric study was carried out on a sample of 360 nurses from a hospital and university center in central Portugal. Reliability was assessed through internal consistency and construct validity through exploratory and confirmatory factor analysis. Results: the Interprofessional Communication in Health Scale, consisting of 27 items, is organized into 3 factors: "Teamwork", "Conflict management" and "Leadership", with a total variance of 51.1%. Good internal consistency was obtained, with a Cronbach's alpha of 0.842, and adequate Goodness of Fit Index model. Conclusions: the Interprofessional Communication in Health Scale presents a factorial structure with adequate validity and reliability results, and may constitute a useful self-report instrument in assessing interprofessional communication in health.

RESUMEN Objetivos: construir y validar la Escala de Comunicación Interprofesional en Salud. Métodos: el estudio psicométrico se realizó sobre una muestra de 360 enfermeras de un centro hospitalario y universitario del centro de Portugal. La confiabilidad se evaluó a través de la consistencia interna y la validez de constructo mediante análisis factorial exploratorio y confirmatorio. Resultados: la Escala de Comunicación Interprofesional en Salud, compuesta por 27 ítems, se organiza en 3 factores: "Trabajo en equipo", "Gestión de conflictos" y "Liderazgo", con una varianza total del 51,1%. Se obtuvo una buena consistencia interna, con un alfa de Cronbach de 0,842, y adecuados índices de bondad de ajuste del modelo. Conclusiones: la Escala de Comunicación Interprofesional en Salud presenta una estructura factorial con resultados adecuados de validez y confiabilidad, pudiendo constituir un instrumento de autoinforme útil en la evaluación de la comunicación interprofesional en salud.

RESUMO Objetivos: construir e validar a Escala de Comunicação Interprofissional em Saúde. Métodos: o estudo psicométrico foi realizado em uma amostra com 360 enfermeiros de um centro hospitalar e universitário da região centro de Portugal. A confiabilidade foi avaliada através da consistência interna e a validade do construto pela análise fatorial exploratória e confirmatória. Resultados: a Escala de Comunicação Interprofissional em Saúde, constituída por 27 itens, está organizada em 3 fatores: "Trabalho em equipe", "Gestão de conflitos" e "Liderança", com uma variância total de 51,1%. Obtiveram-se boa consistência interna, com alfa de Cronbach de 0,842, e índices adequados de qualidade de ajustamento do modelo. Conclusões: a Escala de Comunicação Interprofissional em Saúde apresenta uma estrutura fatorial com resultados adequados de validade e de confiabilidade, podendo constituir-se um instrumento de autorresposta útil na avaliação da comunicação interprofissional em saúde.

Safety culture in obstetric nurses' clinical practice / La cultura de seguridad en la práctica clínica de enfermeros especializados en obstetricia / Cultura de segurança na prática clínica dos enfermeiros obstetras

ABSTRACT Objective: to identify the safety culture dimensions that influence obstetric nurses' clinical practice. Method: an observational, analytical and cross-sectional study, carried out from September 2018 to May 2019 at two maternity hospitals integrated in a hospital center in the Central region of Portugal. A total of 70 obstetric nurses answered the Hospital Survey on Patient Safety Culture. The data were submitted to descriptive and inferential analysis. The dimensions were considered strong when they presented scores ≥ 75.0% of positive answers, and deemed as problematic with scores ≤ 50.0%. Results: the "Teamwork within units" dimension was the one that obtained scores above 75.0%. The "Supervisor expectations", "Feedback and communication about errors", "Communication openness", "Organizational learning" and "Hospital handoffs and transitions" dimensions obtained scores between 50.0% and 65.0%. The "Non-punitive response to error", "Frequency of events reported", "Management support for patient safety" and "Staffing" dimensions had scores below 40.0%. Conclusion: the results of this study show that "Teamwork within units" is a strong safety culture dimension in maternity hospitals. However, the prevalence of a punitive culture, underreporting of adverse events, insufficient number of obstetrical nurses and little commitment of the hospital management are considered as problematic dimensions that influence obstetric nurses' practice. This assessment of the safety culture contributes to planning interventions that reduce the incidence of errors and improve the safety of obstetric care.

RESUMEN Objetivo: identificar las dimensiones de la cultura de seguridad que influencian la práctica clínica de enfermeros especializados en Obstetricia. Método: estudio observacional, analítico y transversal, realizado en dos maternidades integradas en un centro hospitalario de la región Central de Portugal entre septiembre de 2018 y mayo de 2019. Un total de 70 enfermeros especializados en Obstetricia respondió la Hospital Survey on Patient Safety Culture. Los datos se sometieron a análisis descriptivo e inferencial. Las dimensiones fueron consideradas sólidas cuando presentaron puntuaciones ≥ 75,0% de respuestas positivas, y problemáticas cuando obtuvieron valores ≤ 50,0%. Resultados: la dimensión "Trabajo en equipo dentro de las unidades" fue la que obtuvo puntuaciones superiores al 75,0%. Las dimensiones "Expectativas del supervisor", "Feedback y comunicación sobre los errores", "Apertura en la comunicación", "Aprendizaje organizacional" y "Transferencias y transiciones hospitalarias" obtuvieron puntuaciones entre 50,0% y 65,0%. Las dimensiones "Respuesta no punitiva a los errores", "Frecuencia d eventos notificados", "Apoyo de la gerencia a la seguridad del paciente" y "Dotación de profesionales" presentaron porcentajes inferiores al 40,0%. Conclusión: los resultados de este estudio demuestran que el "Trabajo en equipo dentro de las unidades" es una dimensión sólida de la cultura de seguridad en las maternidades. Sin embargo, la prevalencia de una cultura punitiva, de la subnotificación de eventos adversos, una dotación insuficiente de enfermeros especializados en Obstetricia u el bajo nivel de compromiso de la gerencia hospitalaria se consideran dimensiones problemáticas que influencian la práctica de los enfermeros especializados en Obstetricia. Esta evaluación de la cultura de seguridad ayuda a planificar intervenciones que reducen la incidencia de errores y mejoran la seguridad de la asistencia obstétrica.

RESUMO Objetivo: identificar as dimensões da cultura de segurança que influenciam a prática clínica dos enfermeiros obstetras. Método: estudo observacional, analítico, transversal, realizado em duas maternidades integradas em um centro hospitalar da região Centro de Portugal, no período de setembro de 2018 a maio de 2019. Um total de 70 enfermeiros obstetras respondeu ao Hospital Survey on Patient Safety Culture. Os dados foram submetidos à análise descritiva e inferencial. As dimensões foram consideradas fortes quando apresentaram scores ≥75,0% de respostas positivas, e consideradas problemáticas, quando apresentaram scores ≤ a 50,0%. Resultados: a dimensão "trabalho em equipe dentro das unidades" foi a dimensão que obteve scores acima de 75,0%. As dimensões "expectativas do supervisor", "feedback e comunicação sobre o erro", "abertura na comunicação", "aprendizagem organizacional" e "transferências e transições hospitalares" obtiveram pontuações entre 50,0% e 65,0%. As dimensões "resposta ao erro não punitiva", "frequência da notificação de eventos", "apoio à segurança do paciente pela gestão" e "quantidade de profissionais" apresentaram scores abaixo de 40,0%. Conclusão: os resultados deste estudo mostram que o trabalho em equipe dentro das unidades é uma dimensão forte da cultura de segurança nas maternidades. Contudo, a prevalência de uma cultura punitiva, de subnotificação de eventos adversos, uma quantidade insuficiente de enfermeiros obstetras e pouco comprometimento da gestão hospitalar são consideradas como dimensões problemáticas que influenciam a prática dos enfermeiros obstetras. Essa avaliação da cultura de segurança contribui para o planejamento de intervenções que reduzem a incidência de erros e melhoram a segurança da assistência obstétrica.