Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review.

Introduction: Silver-releasing dressings are used in the treatment of infected wounds. Despite their widespread use, neither the amount of silver released nor the potential in vivo toxicity is known. The aim of this study was to evaluate the cytotoxic effects and the amount of silver released from commercially available dressings with infected wounds. Methods: The review was conducted according to the PRISMA statement. The Web of Science, PubMed, Embase, Scopus, and CINAHL databases were searched for studies from 2002 through December 2022. The criteria were as follows: population (human patients with infected wounds); intervention (commercial dressings with clinical silver authorized for use in humans); and outcomes (concentrations of silver ions released into tissues and plasma). Any study based on silver-free dressings, experimental dressings, or dressings not for clinical use in humans should be excluded. According to the type of study, systematic reviews, experimental, quasi-experimental, and observational studies in English, Spanish, or Portuguese were considered. The quality of the selected studies was assessed using the JBI critical appraisal tools. Studies that assessed at least 65% of the included items were included. Data were extracted independently by two reviewers. Results: 740 articles were found and five were finally selected (all of them quasi-experimental). Heterogeneity was found in terms of study design, application of silver dressings, and methods of assessment, which limited the comparability between studies. Conclusion: In vivo comparative studies of clinical dressings for control of infection lack a standardized methodology that allows observation of all the variables of silver performance at local and systemic levels, as well as evaluation of its cytotoxicity. It cannot be concluded whether the assessed concentrations of released silver in commercial dressings for the topical treatment of infected wounds are cytotoxic to skin cells. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351041, PROSPERO [CRD42022351041].

[Design and validation of an instrument about quality of the advance care planning for professionals]. / Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales.

OBJECTIVE: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD: Instrumental questionnaire validation study. SCOPE: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS: Pilot study with 28 professionals. Reliability É·=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

The systematic review: Plurality of approaches and methodologies. / La revisión sistemática: pluralidad de enfoques y metodologías.

A systematic review is considered a "special" type of scientific article that, without being original, summarizes the current state of research on a particular topic, through a rigorous and reproducible systematic process. It emerged in order to offer a deeper insight and to understand a specific phenomenon of reality, based on the results of other research to consolidate existing knowledge and identify unresolved problems. This could facilitate decision-making according to the evidence. However, many synonyms are included under the generic term "review" that, through ignorance or misuse, can be disconcerting. This article explores the different types of published systematic reviews that we can find published, depending on the organization of their approach and the knowledge synthesis methodology used.

Quality of clinical practice guidelines of lower extremity venous ulcers. / Calidad de las guías de práctica clínica sobre úlceras venosas de la extremidad inferior.

The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted. It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II. After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence.

[Implementing evidence and implementation research: two different and prime realities]. / Implementar evidencias e investigar en implementación: dos realidades diferentes y prioritarias.

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity.