Differentiating Pressure Ulcer Risk Levels through Interpretable Classification Models Based on Readily Measurable Indicators.

Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve the data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity, and skin moisture. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. Thus, the primary aim of this approach is to provide nursing professionals with valuable insights for assessing the potential risk levels of pressure ulcers, which could support their decision-making and allow, for example, the application of suitable preventive measures tailored to each patient's requirements. The interpretability of the models proposed and their performance, evaluated through stratified cross-validation, make them a helpful tool for nursing care in estimating the pressure ulcer risk level.

[Spanish translation and cross-cultural adaptation of the Pressure Ulcer Quality of Life Questionnaire (PU-QOL).] / Traducción y adaptación transcultural al español del cuestionario de calidad de vida y úlceras por presión PU-QOL.

OBJECTIVE: Pressure ulcers (PU) are the most prevalent of the dependency-related injuries, affecting the quality of life of the patients who suffer them. However, there are no instruments adapted to the Spanish context to evaluate this quality of life. The use of specific tools in Spanish to evaluate the quality of life perceived by patients with PUs is considered an indispensable element for healthcare decisions. The aim of this paper was to translate and culturally adapt the Pressure Ulcer Quality of Life Questionnaire (PU-QOL) into Spanish for the measurement of health-related quality of life in patients with pressure ulcers. METHODS: A translation, back-translation, and pre-test method was used on the target population to obtain an adapted version of the original PU-QOL instrument. The area was Primary Care. The participants were fifteen Primary Care patients. Main steps: 1) Direct translation; 2) Synthesis and concordance of versions by an expert committee; 3) Back translation; 4) Consistency of the back translation with the author from the original questionnaire; and 5) Analysis of comprehensibility through cognitive interviews with a sample of patients. RESULTS: An instrument to measure perceived quality of life in patients with PU was obtained, composed of ten scales and eighty-three items. The scales and items of the original questionnaire were maintained. Conceptual and semantic analysis produced adjustments in wording, clarification and reformulations adapted to the Spanish context. CONCLUSIONS: We present this first phase of translation and cross-cultural adaptation of the PU-QOL questionnaire in Spanish, which could be a useful tool for decision-making on health care in patients with PUs.

OBJETIVO: Las úlceras por presión (UPP) son las lesiones más frecuentes de las relacionadas con la dependencia y tienen un gran impacto en la calidad de vida de quienes las sufren. Disponer de herramientas en español específicas para evaluar la calidad de vida percibida por los pacientes con UPP se considera un elemento indispensable para la toma de decisiones sobre los cuidados de salud. El objetivo de este estudio fue traducir al español y adaptar culturalmente el cuestionario Pressure Ulcer Quality of Life Questionnaire (PU-QOL) para la medición de la calidad de vida relacionada con la salud en pacientes con úlceras por presión. METODOS: Se utilizó un método de traducción, retrotraducción y pretest a la población diana para obtener una versión adaptada del instrumento original PU-QOL. El emplazamiento fue la Atención Primaria. Los participantes fueron quince pacientes de Atención Primaria. Mediciones principales: 1) Traducción directa; 2) Síntesis y conciliación de las versiones por un comité de expertos; 3) Traducción inversa; 4) Conciliación de la traducción inversa con la autora del cuestionario original; y 5) Análisis de la comprensibilidad mediante entrevistas cognitivas a una muestra de pacientes. RESULTADOS: Se obtuvo un instrumento de medición de calidad de vida percibida en pacientes con UPP, compuesto por diez escalas y ochenta y tres ítems. Se mantuvieron las escalas e ítems del cuestionario original. El análisis conceptual y semántico produjo ajustes de redacción, clarificación y reformulaciones adaptadas al contexto español. CONCLUSIONES: La disponibilidad de un cuestionario en español de medición de calidad de vida percibida, como es el PU-QOL, del que presentamos esta primera fase de traducción y adaptación transcultural, podrá ser un elemento útil para la toma de decisiones sobre los cuidados en salud en pacientes con UPP.

Decision-Tree-Based Approach for Pressure Ulcer Risk Assessment in Immobilized Patients.

Applications where data mining tools are used in the fields of medicine and nursing are becoming more and more frequent. Among them, decision trees have been applied to different health data, such as those associated with pressure ulcers. Pressure ulcers represent a health problem with a significant impact on the morbidity and mortality of immobilized patients and on the quality of life of affected people and their families. Nurses provide comprehensive care to immobilized patients. This fact results in an increased workload that can be a risk factor for the development of serious health problems. Healthcare work with evidence-based practice with an objective criterion for a nursing professional is an essential addition for the application of preventive measures. In this work, two ways for conducting a pressure ulcer risk assessment based on a decision tree approach are provided. The first way is based on the activity and mobility characteristics of the Braden scale, whilst the second way is based on the activity, mobility and skin moisture characteristics. The results provided in this study endow nursing professionals with a foundation in relation to the use of their experience and objective criteria for quick decision making regarding the risk of a patient to develop a pressure ulcer.

Pressure Ulcers Risk Assessment According to Nursing Criteria.

Pressure ulcers (PU) represent a health problem with a significant impact on the morbidity and mortality of immobilized patients, and on the quality of life of affected people and their families. Risk assessment of pressure ulcers incidence must be carried out in a structured and comprehensive manner. The Braden Scale is the result of an analysis of risk factors that includes subscales that define exactly what should be interpreted in each one. The healthcare work with evidence-based practice with an objective criterion by the nursing professional is an essential addition for the application of preventive measures. Explanatory models based on the different subscales of Braden Scale purvey an estimation to level changes in the risk of suffering PU. A binary-response logistic regression model, supported by a study with an analytical, observational, longitudinal, and prospective design in the Granada-Metropolitan Primary Healthcare District (DSGM) in Andalusia (Southern Spain), with a sample of 16,215 immobilized status patients, using a Braden Scale log, is performed. A model that includes the mobility and activity scales achieves a correct classification rate of 86% (sensitivity (S) = 87.57%, specificity (SP) = 81.69%, positive predictive value (PPV) = 91.78%, and negative preventive value (NPV) = 73.78%), while if we add the skin moisture subscale to this model, the correct classification rate is 96% (S = 90.74%, SP = 88.83%, PPV = 95.00%, and NPV = 80.42%). The six subscales provide a model with a 99.5% correct classification rate (S = 99.93%, SP = 98.50%, PPV = 99.36%, and NPV = 99.83%). This analysis provides useful information to help predict this risk in this group of patients through objective nursing criteria.

Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study.

BACKGROUND: Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients' own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. OBJECTIVE: This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers-associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. METHODS: The DSGM runs SIRUPP, which is linked to patients' electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. RESULTS: The project commenced in June 2017 and is expected to conclude in April 2020. CONCLUSIONS: This study addresses two main health outcomes-the time needed for wound healing and the mortality associated with pressure ulcers-both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13701.

[Waiting rooms for cancer patients: instruments for their analysis and improvement]. / Las salas de espera para pacientes con cáncer: instrumentos para su análisis y mejora.

OBJECTIVE: To conduct a quality analysis of the waiting rooms in the departments of oncology and oncological radiotherapy in Andalusian Health Service hospitals. MATERIAL AND METHODS: In order to carry out the project, both quantitative (structured observation) and qualitative methods (focus groups) were combined. In the first place, parameters for the analysis were identified. Secondly, a structured observation of all the waiting rooms was conducted for subsequent evaluation. Finally, in order to obtain an impression, focus groups were formed from patients who had been in waiting rooms in the Departments of Oncology and Radiotherapy. RESULTS: It was observed that physical features relating to ease of accessibility, refreshment and patient comfort (i.e. furnishings, toilets), environmental conditions (noise, ventilation), as well as the organisational and functional aspects of the services relating to information (reception, health and non-health information), privacy (the calling system, confidentiality) and the time patients had to wait in these rooms, reveal areas for significant improvement. The results also underline the correlation between the waiting room deficiencies identified by direct observation and the opinions expressed by the patients in the focus groups. CONCLUSIONS: The physical and structural issues, as well as the functional and healthcare findings addressed in the project, when globally analysed, reveal that waiting rooms are in need of improvement if the experience of the patients using them is to be of therapeutic benefit.

Implementation of a comprehensive cancer plan. A health planning experience.

Here we describe the working method used to implement an Integrated Cancer Health Plan in Andalusia (Spain) and to set out some of the lines of work for improving quality of care and health network planning. Four main initial considerations were made: (1) work must be centred on patients and respect for their autonomy; (2) cancer requires action at every healthcare level; (3) integration of expert professionals is to be encouraged; and (4) relevant information and data should be systematically used for planning. Two operative approaches were also established: structured participation and evidence-based healthcare. This methodology was used in various planning programmes, largely in relation to healthcare resources. In this article, as examples, we describe the development of two types of programmes: one for radiotherapy equipment and another for the management of lymphoedema in breast cancer patients. Analysis of results obtained against cancer is always controversial. It is necessary to review the healthcare structure used in terms of effectiveness and excellence. Comprehensive or integrated health plans are a useful model for a wide-ranging and multi-level approach to cancer. The structured and real participation of experts and an evidence- based healthcare strategy proved very useful in this public health planning experience.

Oncology care planning. Elements for care quality and management improving.

BACKGROUND: The improvement of care quality depends on the education and skills of the professional team as well as on an adequate work method, which uses the right instruments of clinical management such as medical history, registers or protocols. OBJECTIVES: Defining standardized criteria related to the oncology care quality and applying them to a group of hospitals within the framework of continuous improvement establishing comparisons among them. MATERIAL AND METHODS: Information taken from 14 Andalusian public hospitals, in 2003 and first semester of 2004. A total of 35 variables were collected from official sources, validated studies and surveys as a starting point, grouped in four main issues (medical history, protocols, central commission and tumour sub-commissions), delays (diagnostic, treatment and early diagnostic), variability (cytostatics and radiotherapy), research (clinical trials and financed projects) and work loads. OUTCOMES: In 3 out of 14 centers medical histories are unique for each patient. In average, 3 of the 6 most frequent tumor locations have joint protocols. The delays for the diagnostic test vary from 1 to 23 days and from 11 to 29 days for treatments. The consumption increase of 12 cytostatics was of 71.8% (average of 602,413 euro per hospital). The average rate of patients undergoing irradiation was of 34 %. 109 clinical trials were approved (a centre performes 26) and 20 projects were financed (Health Department, Consejería de Salud). The attendance pressure was of 140 patients per specialist in MO and RO (maximum of 241 and 214 respectively and minimum of 85 and 69). COMMENTS: The information gathered in this study shows a diverse nature, and meets items not always taken into consideration, in a global way, but with a clearly complementary nature. No doubt, they offer a scenery that deepens into the complexity of which today means the improvement of the quality of the non-monographic hospital centres that attend patients suffering from cancer. It finally offers instruments for the improvement of the clinical management which we understand it is of certain usefulness.