Prevalence and characteristics of breakthrough cancer pain in an outpatient clinic in a Catalan teaching hospital: incorporation of the Edmonton Classification System for Cancer pain into the diagnostic algorithm.

BACKGROUND: Breakthrough cancer pain (BTcP) is defined according to its principal characteristics: high intensity, short time interval between onset and peak intensity, short duration, potential recurrence over 24 h and non-responsiveness to standard analgesic regimes. The Edmonton Classification System for Cancer Pain (ECS-CP) is a classification tool that evaluates different dimensions of pain. The aim of this study was to measure prevalence and the main characteristics of BTcP in a sample of advanced cancer patients and to explore the complexity observed when ECS-CP is incorporated into BTcP diagnostics algorithm. METHODS: Descriptive prevalence study (Retrospective chart review). Davies' algorithm was used to identify BTcP and ECS-CP was used to recognize appropriate dimensions of pain. The study was conducted in a sample of advanced cancer patients attending hospital outpatient clinic in Lleida, Spain. 277 patients were included from 01/01/2014 to 31/12/2015. No direct contact was made with participants. The following information was extracted from the palliative care outpatient clinic database: age, gender, civil status, cognitive impairment status, functional performance status and variables related to tumour. Only BTcP cases were included. RESULTS: Prevalence of BTcP was 39.34% (63.9% men). Mean of age was 68.2 years. Main diagnosis was lung cancer (n = 154; 31.6%). Metastases were diagnosed in 83% of the sample. 138 patients (49.8%) were diagnosed with 1 type of BTcP and 139 (50.2%) were diagnosed with more than one type of BTcP. In total, 488 different types of BTcP were recorded (mean 1.75 ± 0, 9), 244 of these types (50%) presented a component of neuropathic pain. Addictive behaviour, measured through CAGE test, was present in 29.2% (N = 81) of the patients and psychological distress was present in 40.8% (n = 113). CONCLUSIONS: Prevalence of BTcP (39.34%) is similar to the one reflected in the existing literature. Study results indicate that the routine use of ECS-CP in a clinical setting allows us to detect more than one type of BTcP as well as additional complexity associated with pain (neuropathic, addictive behavior and psychological distress).

Are the classic signs of infection in concordance with results from percutaneous aspiration to diagnose infection in pressure injuries?

AIM: To explore the concordance between the presence of classic signs of infection and the positive diagnosis identified by the microbiological culture of fluid collected by percutaneous aspiration. BACKGROUND: The classic signs of infection are commonly applied in some contexts to confirm infection in pressure injuries, but its accuracy has been questioned in chronic wounds. Little is known about the concordance of this method with others, such as the deep fluid culture from pressure injuries collected by percutaneous aspiration. DESIGN: Multicentre, cross-sectional observational study. METHODS: Pressure injuries of patients from four health centres were analysed. Three types of data were recorded between February 2011 and March 2012: i) socio-demographic and clinical data, ii) number and type of infection signs and iii) microbiological results of deep fluid culture from injuries. The concordance was calculated with the kappa index to find a possible concordance between both methods. RESULTS: On 40·2% (n = 47) of injuries, two or more classic signs of infection or purulent exudate as unique sign were present, while the total positive results in the microbiological cultures were 50·4% (n = 59). The disparity of positive results, depending on the location and the stage of the pressure injury and the method applied, suggested a poor concordance between methods. The -0·092 kappa index confirmed the non-concordance of the analysed methods. CONCLUSIONS: The tandem strategy is not useful to indicate an infection in pressure injuries. We advocate exploring other signs of infection and the adoption of other more reliable signs together with the classic signs of infection.

Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis.

PURPOSE: We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments. METHODS: Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety. RESULTS: Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate. CONCLUSIONS: CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.

Cross-cultural validation and psychometric testing of the supportive supervisory scale in Spanish.

BACKGROUND: Supervisory effectiveness in long-term care facilities has been identified a key factor in staff satisfaction and quality of care. Determining its utility in Spanish speaking countries will assist with understanding different cultural and health service contexts. OBJECTIVES: To develop and psychometrically test the Supervisory Support Scale in Spanish. The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support, which is a key factor to improving work relationships in long-term care facilities. METHODS: Validation was carried out with 405 participants in 37 long-term care facilities. One-way analysis of variance was the test of significance performed to examine the differences among the facilities and Pearson product-moment correlations were used to assess construct validation of the scale. The mean and standard deviation were calculated for each supervisory score in each facility. Structural equation modelling was used to confirm the dimensions of the scale. RESULTS: The item-to-item correlations were positive, ranging from 0.44 to 0.78, indicating good reliability of the scale. The coefficient alpha for the total scale was 0.96. The 15-item had mean item scores which ranged from 2.89 to 3.96 (SD = 1.01-1.26). Standardised factor loadings ranged within a narrow range: 0.75-0.86 for the 'respecting uniqueness' latent variable and 0.76-0.88 for the 'being reliable' latent variable. Construct validity was demonstrated as measure was positively associated with job satisfaction (r = 0.412, p < 0.0001) and was negatively correlated with HCAs' stress and burden. CONCLUSION: The two-factor solution identified in the original scale that highlighted two key attributes of the supervisor; being reliable and respecting uniqueness, was also demonstrated in the Spanish Supervisory Support Scale as there was a moderate fit of the model. IMPLICATIONS FOR PRACTICE: The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support in nursing facilities which is a key factor to improving staff relationships and care in nursing facilities.

Occupational Precariousness of Nursing Staff in Catalonia's Public and Private Nursing Homes.

Nursing staff who provide care in the nursing homes of Catalonia have more precarious work conditions, including more demanding schedules and work overload, than those in other areas of care. This situation entails two major problems: Detrimental health results for nurses who face psychosocial and physical risks and a negative impact on the care provided to patients, with a decrease in the quality of care. This study aimed to describe the precarious employment situation of nursing staff in nursing homes. We carried out a descriptive study based on the employment precariousness scale (EPRES), which was administered to a sample of 239 nurses and nursing assistants working in public and private nursing homes in Catalonia. The highest level of job insecurity occurred among nursing assistants and in privately managed nursing homes. The precariousness of the working conditions of nursing staff poses a risk both to the workers themselves and to the people they tend to. For this reason, there is a need for greater knowledge on the scale of the problem and the implementation of appropriate legislative measures to alleviate it.

Adaptación transcultural y validación psicométrica en lengua española de la escala Perineal Assessment Tool para la evaluación de la dermatitis por incontinencia / Cross-cultural adaptation and psychometric validation in Spanish language of the Perineal Assessment Tool for Incontinence associated dermatitis assessment

INTRODUCCIÓN: La dermatitis asociada a la incontinencia es un importante problema de salud que puede comprometer la salud de quienes la sufren y representa importantes costes para el Sistema de Salud. La Perineal Assessment Tool es el único instrumento diseñado específicamente para evaluar el riesgo de la dermatitis asociada a la incontinencia. OBJETIVOS: realizar la adaptación transcultural y el análisis de las propiedades psicométricas de la versión española de la Perineal Assessment Tool. MÉTODO: Se utilizó un diseño de estudio observacional dividido en tres fases. En la primera fase se llevó a cabo un proceso de traducción y adaptación transcultural de la escala. En la segunda fase, se realizó una prueba piloto (n = 15) utilizando un diseño transversal para determinar la viabilidad, la fiabilidad intraobservador e interobservador, y la validez de contenido de la versión española de la escala. Finalmente, en la tercera fase se realizó un estudio transversal utilizando una muestra de 171 pacientes para determinar la prevalencia de dermatitis asociada a la incontinencia y analizar la consistencia interna, la validez de criterio y constructo, la sensibilidad, la especificidad, el valor predictivo positivo y negativo, así como los puntos de corte de la escala. RESULTADOS: En la primera fase, la versión española de la escala Perineal Assessment Tool demostró ser viable, administrable en menos de 3 minutos, fácil de comprender y completar. En la segunda fase, el índice de validez del contenido global de la versión española de la escala Perineal Assessment Tool fue de 0,83; la fiabilidad intraobservador, de 0,98, y la fiabilidad interobservador, de 0,99. En la tercera fase, la versión española de la escala Perineal Assessment Tool mostró una consistencia interna de 0,601 y una correlación significativa con los apartados de humedad de las escalas de valoración de riesgo de úlceras por presión Braden y EMINA. La curva de ROC fue de 0,959 y los mejores valores fueron los presentados en una puntuación de 7, mostrando un valor predictivo positivo del 96,7%, un valor predictivo negativo del 0,6%, una sensibilidad del 74,4%, una especificidad del 99,2% y, finalmente, una validez global del 93,6%. CONCLUSIONES: La versión española de la Perineal Assessment Tool ha demostrado ser un instrumento válido y fiable para la evaluación de la dermatitis asociada a la incontinencia en pacientes institucionalizados en el contexto español

INTRODUCTION: Incontinence associated dermatitis is a major health problem that can compromise the health of sufferers and represents significant costs to the Health System. The Perineal Assessment Tool is the only instrument specifically designed to assess the risk of incontinence dermatitis. PURPOSE: It was the cross-cultural adaptation and analysis of the psychometric properties of the Spanish version of the Perineal Assessment Tool scale. METHODS: An observational study design divided into three phases was used. In the first phase, a process of translation and cross-cultural adaptation of the scale was carried out. In the second phase, a pilot test (n=15) was carried out using a cross-sectional design to determine viability, intraobserver and interobserver reliability, and content validity of the Spanish version of the scale. Finally, in the third phase, a crosssectional study was performed using a sample of 171 patients to determine the prevalence of incontinence-associated dermatitis and to analyze the internal consistency, criterion and construct validity, sensitivity, specificity, positive and negative predictive value, as well as the cut-off points of the scale. RESULTS: In the first phase, the Spanish version of the Perineal Assessment Tool proved to be feasible, manageable in less than 3 minutes, easy to understand and complete. In the second phase, the validity index of the overall content of the Spanish version of the Perineal Assessment Tool scale was 0.83, the intra-observer reliability was 0.98 and the inter-observer reliability was 0.99. In the third phase, the Spanish version of the Perineal Assessment Tool scale showed an internal consistency of 0.601 and a significant correlation with the humidity sections of the Braden and EMINA pressure ulcer risk assessment scales. The ROC curve was 0.959 and the best values were presented in a score of 7, showing a positive predictive value of 96.7%, a negative predictive value of %, a sensitivity of 74.4%, a specificity of 99.2% and, finally, an overall validity of 93.6%. CONCLUSIONS: The Spanish version of the Perineal Assessment Tool has proved to be a valid and reliable instrument for the evaluation of incontinence associated dermatitis in institutionalised patients in the Spanish context

Erupción cutánea en una paciente con neoplasia y neutropenia febril / A skin rash in a febrile neutropenic cancer patient

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Prevalencia de la adherencia terapéutica a opioides mayores en una muestra de pacientes oncológicos avanzados. Estudio piloto / Prevalence of the therapeutic adherence to strong opioids analgesics in a sample of advanced cancer patients. A pilot study

OBJETIVO: Determinar la prevalencia de adherencia terapéutica a opioides mayores de la escala analgésica de la Organización Mundial de la Salud (OMS) medida con el test 4-ítem Morisky Medication Adherence Scale (MMAS-4), en una muestra de pacientes oncológicos avanzados. Conocer los factores asociados a adherencia terapéutica en este tipo de paciente. MATERIAL Y MÉTODO: Estudio observacional prospectivo realizado en la Región Sanitaria de Lleida entre septiembre de 2013 y marzo de 2014. Se incluyeron 89 pacientes oncológicos avanzados consecutivamente, atendidos por equipos específicos de fin de vida, ya sea en el domicilio (PADES) o bien en la consulta externa de ámbito hospitalario (UFISS). Se utilizó el test autoadministrado MMAS-4. RESULTADOS: Se incluyeron un total de 89 pacientes de los cuales 48 (54 %) fueron atendidos por PADES y 41 (46 %) por UFISS. Media de edad (70,3 ± 14,1 años). Pacientes varones 64 (72 %). La dosis equivalente de morfina diaria (MEDD) fue de 76,26 ± 74,73 mg. Un total de 47 pacientes (52,8 %) presentaron adherencia al tratamiento. Haber recibido analgésicos por vía transdérmica es un factor que contribuye a la mala adherencia terapéutica (p = 0,006) y fallar la pregunta D del MMAS-4 junto con género femenino contribuye a la mala adherencia terapéutica (p = 0,027). DISCUSIÓN: Se detecta un 52,8 % de adherencia terapéutica a opioides del tercer escalón de la OMS en la muestra estudiada

AIM: To determine the prevalence of the therapeutic adherence to strong opioids analgesics (third step of the analgesic ladder of the World Health Organization [WHO]) in a sample of advanced cancer patients using the Morisky-Green-Levine tool (MMAS-4) and to know the factors associated. METHODS: Observational and prospective study carried out in the Sanitary Region of Lleida between September 2013 and March 2014. A total of 89 advanced cancer patients consecutively attended by end-of-life specific teams both at home (PADES) and at the hospital (UFISS) were included. The self-administered 4-items Morisky-Green-Levine test was used. RESULTS: Mean of age (70, 3 ± 14, 1 years). Man 64 (72 %). Patients attended by the Home care Team 48 patients (54 %). The Morphine Equivalent Daily Dose (MEDD) was 76.26 ± 74.73 mg. The therapeutic adherence was detected in 47 patients (52.8 %). Factors related to the route of administration of the analgesic (transdermal, p = 0,006) and between female genre and to fail to question D of the MMAS-4 (p = 0,027) were detected in the multivariate analysis. DISCUSSION: We detected a prevalence of therapeutic adherence to the analgesics of the third ladder of the WHO of 52,8 % in the sample studied