CHRONOFALLS: A multicentre nurse-led intervention in the chronoprevention of in-hospital falls in adults.

BACKGROUND: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. METHODS: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. RESULTS: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. CONCLUSIONS: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies. TRIAL REGISTRATION: The project was registered on the Clinical Trials Registry NCT04367298 (29/04/2020).

Psychological factors associated with sleep disorders in patients with axial spondyloarthritis or psoriatic arthritis: A multicenter cross-sectional observational study.

BACKGROUND: Studies in axial spondyloarthritis (AxSp) have shown that intensity of pain, anxiety, depression and inflammatory activity are associated with poor sleep quality. AIM: To describe mood and sleep disorders and positive psychological factors in patients with AxSp and psoriatic arthritis (PsA) and to evaluate the psychological factors that are potentially involved in sleep disorders. DESIGN: Multicenter cross-sectional observational study based on a series of patients with AxSp and PsA. PARTICIPANTS: Participants were selected consecutively from patients aged ≥18 years with AxSp or PsA followed at the rheumatology department of 4 Spanish hospitals. INCLUSION CRITERIA: age ≥18 years, AxSp (ASAS criteria) or PsA (CASPAR criteria), ability to understand the study and prepared to complete the questionnaires. METHODS: Main outcomes: Oviedo Sleep Quality questionnaire result. SECONDARY OUTCOMES: psychological status evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire, health-related quality of life evaluated using SF-36, perception of pain evaluated using the short questionnaire for assessment of pain (BDU) and fatigue evaluated using the Fatigue Scale (FACIT) questionnaire. We performed a descriptive multivariate linear regression analysis to study factors that were independently associated with sleep disorders. The STROBE guidelines were adopted. RESULTS: We included 301 patients (152 [50.5%] with AxSp and 149 [49.5%] with PsA). The multivariate linear regression analysis for the whole sample showed that insomnia was inversely associated with emotional recovery and biologic disease-modifying antirheumatic drugs and directly associated with depression in both groups. The analysis by disease (AxSp and PsA) showed that insomnia was independently associated with depression and emotional recovery. CONCLUSIONS: Insomnia may be associated with other mood disorders, quality of life and inflammatory activity in the patients studied here. RELEVANCE TO CLINICAL PRACTICE: A nurse intervention can be carried out to prevent sleep disorders knowing the consequences and triggers of the problem.

Chronoprevention in hospital falls of older people: protocol for a mixed-method study.

BACKGROUND: Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. METHODS: A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. DISCUSSION: With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials.gov ID: NCT04367298.

[Appearance of hematomas after blood extractions related with needle gauge related]. / Calibre de la aguja hematomas y dolor tras extracciones de sangre.

We want to know the method that less damage produced in the patient when making a venous blood extraction. The objective of this study is to compare the system of extraction that provokes less hematomas and reduces pain in the patients. We studied 175 patients; the variables studied were age, duration of the technique, occurrence of haematoma, pain perceived according to numerical scale of the pain. The study shows that does not exist relation between the appearance of haematomas and the catheter with which the venous puncture is realized, at least, not between catheters of 21 and 20 gauge. It was noted that the patients feel less pain when needles of calibre 21 gauge (butterflies) were used. The extraction time is lightly bigger with this system, but if we want to offer some quality care, we must perform the extraction of blood with the butterfly device (needles of 21 G).

Calibre de la aguja. Hematomas y dolor tras extracciones de sangre / Appearance of hematomas after blood extractions related with needle gauge related

Se quiere conocer el método que menos daño producirá realizar una extracción de sangre venosa al paciente. Para ello se compara el sistema de extracción que provoca menos hematomas y disminuye el dolor en los enfermos. Fueron estudiados 175 individuos y se recogieron, entre otras, las variables edad, duración de la técnica, aparición de hematoma, dolor percibido según escala numérica. El resultado desvela que no existe relación entre la aparición de hematomas y el catéter con el que se realiza la punción venosa, al menos, no entre catéteres de calibres 21 G y 20 G. A pesar de esto sí se observó que el paciente siente menos dolor cuando se le punciona con aguja de calibre 21 G (palomilla). El tiempo de extracción es ligeramente superior con este sistema, pero si queremos ofrecer unos cuidados de calidad debemos realizar las extracciones sanguíneas con el sistema de palomilla (agujas de 21 G)(AU)

We want to know the method that less damage produced in the patient when making a venous blood extraction. The objective of this study is to compare the system of extraction that provokes less hematomas and reduces pain in the patients. We studied 175 patients; the variables studied were age, duration of the technique, occurrence of haematoma, pain perceived according to numerical scale of the pain. The study shows that does not exist relation between the appearance of haematomas and the catheter with which the venous puncture is realized, at least, not between catheters of 21 and 20 gauge. It was noted that the patients feel less pain when needles of calibre 21 gauge (butterflies) were used. The extraction time is lightly bigger with this system, but if we want to offer some quality care, we must perform the extraction of blood with the butterfly device (needles of 21 G)(AU)