Socioeconomic Inequalities in Metabolic Syndrome by Age and Gender in a Spanish Working Population.

Lower socio-economic status (SES) is significantly associated with metabolic syndrome (MS) prevalence, possibly affecting women more than men, although evidence in Spain is still limited. The present cross-sectional study analyzed the association between MS and SES by age and gender among 42,146 working adults living in the Balearic Islands (Spain). Prevalence was higher in men (9.4% by ATP-III; 12.3% by IDF) than women (3.8% by ATP-III; 5.7% by IDF) and in the lower social class (7.9% by ATP-III; 10.7% by IDF) than the higher (4.1% by ATP-III; 5.9% by IDF). The SES gradient in MS prevalence was larger in women (PR 95% CI: 3.38, 2.50-4.58 by ATP-III; 3.06, 2.43-3.86 by IDF) than in men (1.23, 1.06-1.41 by ATP-III; 1.15, 1.03-1.30 by IDF) and was already evident from early adulthood, reaching the highest ratio at the late stages of middle adulthood (4.34, 1.11-16.98). Among men, it was significant during the late stages of early adulthood only (1.80, 1.19-2.73). Lower SES influenced MS prevalence in both genders, however, women seemed more affected than men. From a public health perspective, SES could be strongly associated with the burden of MS; in an effort to reduce its prevalence, public health policies should focus on gender differences in socio-economic inequality and consider women with low socio-economic resources as a priority.

Tissue temperature, flux and oxygen of sacral and trochanteric area under pressure of healthy subjects: A quasi-experimental study.

AIM: To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h. METHODS: Quasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements. RESULTS: The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant. CONCLUSION: Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.

Development of a guideline for the treatment of generalized anxiety disorder with the ADAPTE method.

OBJECTIVE: The aim was to develop a clinical guideline for managing generalised anxiety disorder in Primary Health Care and Mental Health, using guideline adaptation methods. DESIGN: A clinical guideline was developed, following the methods of the ADAPTE group, and implemented in a Primary Health Care District and in Mental Health Services in Spain. SETTING: Regional University Hospital of Málaga and District of Primary Health Care Málaga-Guadalhorce (Spain). PARTICIPANTS: The participants were family physicians, psychiatrists and clinical psychologists. The phases of the process included definition of clinical scenarios, literature search and guidelines appraisal, elaboration of recommendations, conducting focus groups with users diagnosed with generalised anxiety disorder, linking the testimonials of users with recommendations, external review and implementation by multifaceted interventions. RESULTS: The final release included 49 Recommendations, of which 47 are from the 2011 NICE guidance for GAD and 2 of the 2011 NICE guideline for common mental disorder. Finally, seven recommendations needed to be adapted to the Spanish health care context, and three recommendations were excluded. CONCLUSIONS: A guideline aimed to improve the quality and effectiveness of the care provided to people with generalised anxiety disorder has been released. The use of adaptation methods has simplified the use of resources and time. This guideline and the process designed for its implementation constitute a suitable collection of resources for the improvement on detection and treatment of GAD in primary health care. Adaptation methods play a key role in the knowledge translation continuum.

Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study).

AIM: To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact® ) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health-related quality of life, level of pain, and time to complete healing. DESIGN: Open randomized controlled trial, with blinded endpoint. METHODS: Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound-related variables (area, exudate, and time to healing), level of pain, adverse effects, and health-related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA-typing technique through polymerase chain reaction to obtain the level of colony-forming units. Measures will be collected at baseline, 4, 8, and 12 weeks. DISCUSSION: Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced. IMPACT: Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.

Pressure levels in the trochanter area according to repositioning at different degrees of inclination in healthy subjects.

OBJECTIVES: Patient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure. METHODS: Analytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface. RESULTS: In total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe. CONCLUSIONS: There are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs.

Pain Catastrophizing and Function In Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

OBJECTIVES: Pain catastrophizing (PC) is the most consistent psychosocial factor predicting of adjustment to chronic pain and may contribute to the development and long-term maintenance of chronic pain. The aim of this review was systematically review and critically appraise the concurrent and longitudinal associations between PC and both pain intensity and disability in individuals with chronic musculoskeletal pain (CMP). MATERIALS AND METHODS: An electronic search of PubMed, Scopus, AMED, CINAHL, PsycINFO, and PubPsych databases, as well as gray literature, was undertaken from inception until September 2018. Cross-sectional and longitudinal studies reporting on the associations between measures of PC, pain intensity, and disability were selected for review. RESULTS: A total of 85 observational studies (92% cross-sectional) were included, with a total sample of 13,628 participants with CMP. Very low-quality evidence (based on the GRADE criteria) indicated that higher levels of PC were often, but not always, significantly associated with and prospectively predicted both chronic pain intensity and disability. Heterogeneity was large after conducting multiple meta-analyses. DISCUSSION: Despite the very low quality of the available evidence, the general consistency of the findings highlights the potential role that PC may play in delaying recovery from CMP. Research that uses higher quality study designs and procedures would allow for more definitive conclusions regarding the impact of PC on pain and function.

Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): a prospective, cohort, multicentre study.

OBJECTIVES: Falls are an important adverse event among institutionalised persons. It is in this clinical setting where falls occur more frequently than in any other, despite the measures commonly taken to prevent them. This study aimed to determine the characteristics of a typical institutionalised elderly patient who suffers a fall and to describe the physical harms resulting from this event. We then examined the association between falls and the preventive measures used. METHODS: This was a prospective cohort study in 37 nursing homes in Spain. The participants were all the nursing home residents institutionalised in these centres from May 2014 to July 2016. Participants were followed up for 9 months. During this period, two observations were made to evaluate the preventive measures taken and to record the occurrence of falls. RESULTS: 896 residents were recruited, of whom 647 completed the study. During this period, 411 falls took place, affecting 213 residents. The injuries caused by the falls were mostly minor or moderate. They took place more frequently among women and provoked 22 fractures (5.35%). The most commonly used fall prevention measure was bed rails (53.53% of cases), followed by physical restraint (16.79%). The latter measure was associated with a higher incidence of injuries not requiring stitches (OR=2.06, 95% CI 1.01 to 4.22, P=0.054) and of injuries that did require stitches (OR=3.51, 95% CI 1.36 to 9.01, P=0.014) as a consequence of falls. Bed rails protected against night-time falls. CONCLUSIONS: Falls are a very common adverse event in nursing homes. The prevention of falls is most commonly addressed by methods to restrain movement. The use of physical restraints is associated with a greater occurrence of injuries caused by a fall.

Use of the ADAPTE Method to Develop a Guideline for the Improvement of Depression Care in Primary Care.

Depression is the most frequent psychiatric disorder in primary health care, and the evidence shows that there is suboptimal management by primary care practitioners, perhaps owing to difficulties in decision making. Because clinical guidelines can improve decision making and management, a clinical guideline to manage depression in primary health care was developed in adherence to the ADAPTE method and was implemented in the Málaga Primary Health Care District in Spain. This column reports on the guideline development process, which produced a set of resources to improve the quality of primary health care-based depression care in Spain.

Diagnostic validity of the STRATIFY and Downton instruments for evaluating the risk of falls by hospitalised acute-care patients: a multicentre longitudinal study.

BACKGROUND: Falls are major adverse events in hospitals. The appropriateness of using risk assessment instruments for falls in hospitals has recently been questioned, although the research performed in this respect presents some methodological shortcomings. The purpose of the present study is to evaluate the accuracy of the Downton and STRATIFY instruments to determine the risk of falls and to predict their incidence in acute care hospitals in the public health system in Andalusia (Spain). METHODS: A longitudinal, multicentre prospective study was made of a cohort of patients recruited between May 2014 and March 2016. The risk of falls was assessed using each of the above instruments during the first 24 h after hospital admittance, with later re-evaluations every 72 h until discharge. Descriptive statistics were obtained, bivariate and multivariate analysis were performed. The diagnostic validity of the process was assessed by calculations of sensitivity, specificity, positive and negative predictive values and ratios of positive and negative likelihood. ROC curve analysis was performed for both instruments. RESULTS: For this study, 1247 patients were recruited, of whom 977 completed all the follow-up assessments. Twenty-three of these patients (2.35%) suffered 24 falls. ROC curve analysis showed that the optimal cut-off point for each assessment instrument was below that described by the authors: AUC STRATIFY = 0.69 (95% CI: 0.57-0.8); AUC Downton = 0.6 (95% CI: 0.48-0.72). With a cut-off point of 1, the sensitivity of STRATIFY was 47.6% and its specificity, 85%. With a cut-off point of 2, Downton presented a sensitivity of 66.7% and a specificity of 55.3%. CONCLUSIONS: The Downton and STRATIFY falls risk assessment instruments presented little utility as means of detecting the risk of falls among a sample of adult patients admitted to acute care hospitals. Fall prevention in hospitals should be based on the study of individual risk factors.

Overweight, obesity and foot posture in children: A cross-sectional study.

AIM: The aim of this study is to examine the relationship between obesity and foot posture in children. METHODS: This cross-sectional study is based on a sample population of 1798 schoolchildren (873 boys and 925 girls) aged between 6 and 12 years. The height and weight of each subject was measured and the body mass index (BMI) was calculated. Foot posture was described by means of the foot posture index (FPI). The differences among various foot postures in relation to BMI, for the total sample, were tested using the Games-Howell test. In addition, cross tabulation for different gender groups and BMI categories was applied and tested using χ2 . RESULTS: The mean BMI was 18.94 (standard deviation (SD) 3.65 kg/m2 ) in the boys and 18.90 (SD 3.64 kg/m2 ) in the girls, and the FPI was 3.97 (SD 2.98) in the boys and 3.68 (SD 2.86) in the girls. The FPI results show that among the boys aged 6 years, the right foot was more pronated than among the girls (FPI 4.8-4.1, P = 0.034), while among the boys aged 7 years, this was true for the left foot (4.4-3.7, P = 0.049). For the other ages, there were no significant differences in the FPI between the sexes. There were no significant differences between the value, or categories, of BMI and the FPI in the different age groups. CONCLUSION: In children aged between 6 and 12 years, body mass does not appear to have an important bearing on static foot posture. Furthermore, the variables gender and age are of scant importance in determining foot posture in children.

Acquiring Competence in Oncology Nursing Skills Through the Use of Film: A Study Protocol.

PURPOSE: To determine the influence of movies as a teaching resource with nursing students to improve their ability to cope with challenging scenarios in oncology nursing, as well as their competence to identify nursing diagnoses in these patients. METHODS: Cluster, randomized controlled trial with nursing students at the University of Málaga (Spain). MEASURES: Accuracy of nursing diagnoses, perceived stressors, death anxiety, empathy, level of decision making, and cognitive closure. CONCLUSIONS: This study will provide information about the efficacy of movies to improve the competence in nursing students for the care of oncology patients, as well as their diagnostic reasoning. IMPLICATIONS FOR NURSING PRACTICE: If significant modifications are obtained, this approach can be an important resource applicable to other contexts of patient care.

Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis.

OBJECTIVE: To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). DESIGN: Cross-sectional analytical study. SETTING: Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. PARTICIPANTS: 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. PRIMARY OUTCOME MEASURE: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. RESULTS: The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). CONCLUSIONS: A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.

[Consensus on competencies for advanced nursing practice in Spain]. / Consenso sobre competencias para la enfermería de práctica avanzada en España.

INTRODUCTION: There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method METHOD: Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS: The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION: This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

RATIONALE, AIMS AND OBJECTIVES: Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. METHODS: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. RESULTS: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. CONCLUSIONS: The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events.

Review of studies on health related quality of life in patients with advanced chronic kidney disease in Spain.

BACKGROUND: Advanced chronic kidney disease (ACKD) has a great impact on health-related quality of life (HRQL). The use of this variable in studies in our field is becoming more frequent, although there has been no comprehensive review of how Spaniards with ACKD are assessed. AIMS: To offer a contrasted vision of the HRQL assessment tools that are most often used on Spanish ACKD population, also analysing how this population perceive their quality of life. METHOD: A review was carried out on literature published on studies undertaken in Spain that had used some kind of instrument, either generic or specific, in order to measure HRQL in patients with different stages of ACKD. Studies in kidney transplant patients were excluded when they were independently reviewed. The research was carried out in CINAHL, CUIDEN, DOCUMED, EMBASE, ERIC (USDE), IME, LILACS, MEDLINE, Nursin@ovid, PubMed, Scielo, Web of Science and TESEO. RESULTS: 53 articles published between 1995 and May 2014 have been included in this review. Renal replacement therapy is the variable that is most often associated with the study of HRQL, with haemodialysis being the most studied. Most of the studies found are cross-sectional and the Short Form-36 Health Survey is the most used instrument. CONCLUSIONS: The majority of the studies show how HRQL is significantly affected in patients who receive renal replacement therapy. These results are independent from the instrument used to measure health-related quality of life and other associated variables throughout the various studies. HRQL has been particularly analysed in patients on haemodialysis, using mainly observational methods and the Short Form-36 Health Survey. There is a need for more studies that address aspects such as HRQL in the pre-dialysis phase, as well as studies with larger samples and longitudinal, analytical and experimental designs.

A multisample model validation of the evidence-based practice questionnaire.

Evidence-based practice may be implemented more successfully if the barriers to its implementation have been previously identified. Many of the available instruments to measure these barriers have been validated in single samples or without confirmatory analyses. The objective of the study was to contrast the goodness of fit of two measurement models (24 items and 19 items) for the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ) in a sample of 1,673 full-time registered nurses in 10 hospitals and 57 primary health care centers in the Spanish Public Health Service. The 19-item model performed better in all four subsamples. A hypothesis of strict invariance, with equal factor loadings, intercepts, and error variance in all contexts in which it was evaluated, was supported. Goodness-of-fit indices provided strong evidence of good fit according to standard cut-off criteria in a multisample confirmatory factor analysis.

Prevalence of premorbid metabolic syndrome in Spanish adult workers using IDF and ATPIII diagnostic criteria: relationship with cardiovascular risk factors.

BACKGROUND: Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. RESEARCH METHODOLOGY/FINDINGS: A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20-65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. CONCLUSIONS: PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.

Effectiveness of an e-learning tool for education on pressure ulcer evaluation.

AIMS AND OBJECTIVES: To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods. BACKGROUND: Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk. DESIGN: A randomised controlled trial was developed including undergraduate nursing students. METHODS: The intervention group used an adaptive self-learning e-learning tool developed by the research team (ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment. RESULTS: The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) (p = 0·01) with the use of ePULab. CONCLUSIONS: The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making.

Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis.

BACKGROUND: Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients. METHODS: Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis. RESULTS: Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient's stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017). CONCLUSIONS: The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the reassessment of these instruments with respect to hospitalized adult patients, and to consider the real compliance by healthcare personnel with procedures related to patient safety, and in particular concerning the prevention of falls.

Perception of evidence-based practice and the professional environment of primary health care nurses in the Spanish context: a cross-sectional study.

BACKGROUND: The study of the factors that encourage evidence-based clinical practice, such as structure, environment and professional skills, has contributed to an improvement in quality of care. Nevertheless, most of this research has been carried out in a hospital context, neglecting the area of primary health care. The main aim of this work was to assess the factors that influence an evidence-based clinical practice among nursing professionals in Primary Health Care. METHODS: A multicentre cross-sectional study was designed, taking the 619 Primary Care staff nurses at the Balearic Islands' Primary Health Care Service, as the study population. The methodology applied consisted on a self-administered survey using the instruments Evidence-Based Practice Questionnaire (EBPQ) and Nursing Work Index (NWI). RESULTS: Three hundred and seventy seven surveys were received (60.9% response rate). Self-assessment of skills and knowledge, obtained 66.6% of the maximum score. The Knowledge/Skills factor obtained the best scores among the staff with shorter professional experience. There was a significant difference in the Attitude factor (p = 0.008) in favour of nurses with management functions, as opposed to clinical nurses.Multivariate analysis showed a significant positive relationship between NWI and level of evidence-based practice (p < 0,0001). CONCLUSIONS: Institutions ought to undertake serious reflection on the lack of skills of senior nurses about Evidence-Based Clinical Practice, even when they have more professional experience. Leadership emerge as a key role in the transferral of knowledge into clinical practice.