Post-Transplant Complications in Patients Undergoing Autologous Hematopoietic Cell Transplantation (HCT)-A Comparative Analysis of Home Care versus Hospitalized Patients.

Background and Objectives: The increase in indications for hematopoietic cell transplants (HCTs) has led to the development of new care options after said transplant, such as home care after transplantation, which improves the patients' quality of life. The main purpose of this research is to analyze the differences in the appearance of post-transplant complications between patients having underwent autologous HCT with at-home post-transplant modalities and those under in-hospital post-transplant care. Materials and Methods: An observational, analytical, longitudinal, and retrospective study of cases and controls. All transplanted people in the domiciliary model since 2020 are included as cases (20 subjects). For each case, two controls (40 subjects) are proposed among patients who received an autologous transplant in a hospital in the last five years with a similar demographic and pathological base profile in each case. Results: No significant differences were found between cases and controls, except for the Karnofsky value, which was higher in people receiving home treatment (91.7% vs. 87.74%; p = 0.05). The average number of days of the process post-transplantation was more significant at home (processing days 22.4 ± 2.6; post-transplantation days of 16.4 ± 2.08 versus 21.21 ± 4.18, with a mean of 15.51 ± 3.96 days post-transplant (days of the process p = 0.022; days post-transplant p = 0.002)). There is a more significant presence of neutropenic fever, mucositis, and positive blood cultures in the post-transplant patients who remain in the hospital. In contrast, the patients receiving home care post-transplantation undergo significantly more weight loss. Regarding the odds ratio of the appearance of adverse events, in the hospital setting, it is up to 8.5 times more likely to encounter neutropenic fever, 4.63 times more likely for mucositis, and 6.65 times more likely for the presence of pathogens in blood cultures. Conclusions: The home care modality in the post-transplant phase does not show an inferiority in conditions in the management and safety of the patient concerning the appearance of adverse events. However, more significant weight loss is detected in patients at home, and an increased risk of episodes of neutropenic fever, mucositis, and positive blood cultures for patients in hospital settings.

Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction.

BACKGROUND: Factors such as the manufacturing materials, shape or even the mechanical and thermal response of sitting Pressure Redistribution Support Surfaces (PRSS) can be potential contributors to pressure ulcers. However, few studies have compared a number of characteristics of the most frequently used devices. OBJECTIVE: To compare three potential contributors to pressure ulcers in five commercial PRSS: pressure redistribution, temperature and perceived comfort. METHOD: Study with a cross-over randomized design in healthy volunteer participants. Data was collected in a temperature and relative humidity controlled environment. To assess thermal response, the temperature (Flir-E60) of the region of interest was captured before and after use of each PRSS for further analysis. The region of interest was the gluteal zone. To assess the pressure redistribution a pressure mat (XSensor®) was used between the 5 cushion and each study participant using a standardized method. Finally, a subjective perception questionnaire recorded comfort, adaptability and thermal sensation parameters. Data analysis levels of significance were set at 0.05. RESULTS: A total of 22 participants completed the assessments. There were no statistically significant differences in baseline temperatures between PRSS (>0.05). Pressure redistribution analysis showed significant differences between all PRSS in all variables evaluated except in the maximum and peak pressure index al sacrum. The subjective assessment suggested no major user-perceived differences between PRSS. CONCLUSION: Seat cushions made of open cell polyurethane foam blocks of variable hardness and the horseshoe cushion (also open cell polyurethane foam) seem to provide a more effective pressure relief characteristic than those injected with polyurethane foam and gel in most of the studied pressure variables. However, the cushions provide similar thermal response and perceived comfort.

Prevalence of pressure ulcers in the paediatric population and in primary health care: An epidemiological study conducted in Spain.

AIM: The primary goal of this study was to estimate the prevalence of pressure ulcers in the paediatric population cared for in primary health care. MATERIALS: The data of this epidemiological study were extracted from the records of the 24 departments that attended to an approximate population of 1 million inhabitants between 0 and 18 years old from 2012 to 2015. The study included children requiring assistance to reduce pressure ulcer incidence. The paediatric population was categorised into neonates and infants (0-2 years), young child (3-6 years), child (7-12 years) and adolescents (13-18 years). The primary outcome was information on the prevalence of pressure ulcers. Secondary outcomes were classification of ulcers in terms of location and category. Other outcomes included the total number of consultations owing to pressure ulcers. RESULTS: The sample included 65,359 children who attended 813 centres of primary health care. The prevalence of pressure ulcers was 1.72%. A higher prevalence was observed in children younger than 3 years (2.89%), with children at age 1 year showing the most prevalence (4.77%). The highest number of diagnosed ulcers was located in the lower back and heels, regardless of the age range. CONCLUSION: Overall, the prevalence of pressure ulcers in the paediatric population attended to in primary health care is low when compared to that of hospitalised and acutely ill children. The figures advise that special attention should be paid to the care of the population younger than 3 years, because this population shows the highest prevalence.

Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale.

AIM: To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability. BACKGROUND: Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants. METHOD: The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed. For the second stage, the inter-rater/intra-rater agreement and construct validity were evaluated using a cross-sectional design. Finally, in the third stage, a cohort study to analyse pressure ulcers' incidence, diagnostic tests and the cut-off points of the scale was performed. RESULTS: In the first phase, the content validity index was 0.93. In the second phase (336 neonates), the intra-rater reliability was 0.93 and the inter-rater reliability was 0.97. The construct validity has shown a two-dimensional model that fits better, representing "pressure duration and intensity" and "skin immaturity." In the third phase (268 neonates) the best values were those presented by the score 17: receiver operating characteristic curve was 0.84, showing a sensitivity of 91.18%, specificity of 76.50%, positive predictive value of 36.05% and negative predictive value of 98.35%. CONCLUSION: The scale has shown evidence of validity and reliability to measure the neonatal risk of pressure ulcers in the Spanish context. IMPLICATIONS FOR NURSING MANAGEMENT: Pressure ulcers are an adverse event recognised in paediatric units and specifically in neonatal units. The intent of the Spanish Neonatal Skin Risk Assessment Scale is to identify hospitalised neonates requiring prevention measures and their specific risk factors, to provide useful diagnostic information to improve the neonatal skin care into Spanish speaking countries. The Neonatal Skin Risk Assessment Scale could ensure the efficient and effective allocation of limited preventive resources, support clinical and management decisions, allow risk-adjusted cases in epidemiological studies, facilitate the development of risk assessment protocols and serve as evidence in litigation cases. All these features could facilitate developing best practice in nursing management and improve the quality and safety of neonatal care.

Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%-17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%-5.45%]), while it was 28.18% (CI95% = [20.02%-37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e-NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66-0.97]), the use of non-invasive mechanical ventilation (RR 12.24; CI95% = [4.02-37.32]), and the length of stay (RR 1.08; CI95% = [1.02-1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09-0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non-invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.

Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Complications Associated with Peripherally Inserted Central Catheters (PICC) in People Undergoing Autologous Hematopoietic Stem Cell Transplantation (HSCT) in Home Hospitalization.

INTRODUCTION: The SARS-CoV-2 pandemic generated the need to keep immunosuppressed patients away from hospital institutions for as long as possible. This in turn stimulated the implementation of a home hospitalization model for autologous hematopoietic stem-cell transplantation (HSCT). PURPOSE: To analyze whether there are significant differences in post-transplantation complications related to catheters observed in patients treated in the home-transplant care modality compared to patients treated in the hospital. METHODOLOGY: Observational, analytical, longitudinal, and retrospective study of cases and controls. A convenience sample was chosen, in which the cases comprised 20 patients included in the home HSCT care model. For each patient, it was considered suitable to propose two controls among those who received autologous transplantation in the last five years with a baseline demographic and pathological profile similar to the case for whom they were control. RESULTS: The home patients achieved an average of 22.4 ± 2.6 days of evolution with an average of 16.4 ± 2.08 days post-transplant, compared to the hospital process with an average of 21.21 ± 4.18 days of evolution and 15.51 ± 3.96 days post-transplant (evolution days p = 0.022; post-transplant days p = 0.002). A higher percentage of use of parenteral nutrition (p = 0.036) and transfusions (p = 0.003) was observed during the post-transplant phase in the hospital. The rest of the therapeutic measures did not show significant differences. When analyzing the frequency of adverse effects in the post-transplant phase, a significant increase in neutropenic fever (OR = 8.55) and positive blood cultures (OR = 6.65) was observed in hospital patients. Any other significant differences in other variables related to PICC were found (presence and days of neutropenic fever, catheter infection, complications, pathogens, admission to the ICU, or death). Concerning local complications (pain, DVT, Medical adhesive-related Skin Injury, and erythema), there was more erythema in the hospital (p = 0.056). CONCLUSIONS: The results obtained indicate that regarding the appearance of complications associated with PICCs in home hospitalization HSCT patients, there are no significant differences compared to hospitalization, so that home care can be a safe context for people with these lines.

Cross-cultural adaptation to Spanish and content validity of three nutritional risk scales.

INTRODUCTION: There are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country. OBJECTIVES: Cross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content. MATERIAL AND METHODS: Cross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales. RESULTS: Starting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item "weight and height". CONCLUSION: This study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item "weight and height" to consider its use in a Spanish child population adequate.

[Special surfaces for managing pressure in pediatrics (II). Choice, assigned algorithm (Tarise) and management models]. / Superficie especial del manejo de la presión (SEMP) pediátrica (y II). Elección, algoritmo de asignación (Tarise) y modelos de gestión.

Bed sores among children are an adverse effect provoked by the application of new technology adapted to pediatrics. Special surfaces for managing pressure in pediatrics are a preventive measure effective to avoid the development of these lesions. So that children benefit from this preventive measure, it must be adapted to their specific circumstances. In order for this to occur, it is fundamental to know: the specific characteristics which differentiate children from adults, and the type of special surfaces for managing pressure in pediatrics which are available on the market and to evaluate their appropriateness and effectiveness. The Group of Nurses to Improve Quality in Pediatrics at the University Clinical Hospital in Valencia has developed some tools which make it possible to manage and assign different sizes and types of special surfaces for managing pressure in pediatrics by means of a scientific method (Tarise). These are based on anthropometric measurements (Pediatric Space table) for each age range, the risk to develop a bed sore or skin ulcer due to pressure, the presence of a bed sore, the pathological seriousness and the type of special surfaces for managing pressure in pediatrics.

[Special therapeutic surfaces for handling pressure in pediatrics (I). Characteristics and competency]. / Superficie especial del manejo de la presión (SEMP) pediátrica. (I). Características e idoneidad.

Bed sores among pediatric patients constitutes an all too common adverse effect provoked by the application of new technologies adapted to a pediatrics context. Special Therapeutic Surfaces for Handling Pressure has proven to be an effective measure among adults. But the use of Special Therapeutic Surfaces for Handling Pressure for adults on children constitutes a grave error which can even be prejudicial for a pediatric patient. This is deemed an error due to the differences in anthropometrical measures between children and adults plus the specific design of Special Therapeutic Surfaces for Handling Pressure for adults. So that pediatric patients are benefited by this preventive measure, this measure must be adapted to pediatrics own specific circumstances. Along this line, the use of static Special Therapeutic Surfaces for Handling Pressure on patients at risk has proven to have a better cost-benefit ratio, a greater degree of comfort, and a greater degree of security than dynamic ones. To apply the most adequate Special Therapeutic Surfaces for Handling Pressure, we need to their specific characteristics as well as those of a pediatric patient. The best complement to Special Therapeutic Surfaces for Handling Pressure Special Therapeutic Surfaces for Handling Pressure are local devices which provide relief to pressure, preferably those which comply with the national norms for health products.

A prospective, longitudinal study to assess use of continuous and reactive low-pressure mattresses to reduce pressure ulcer incidence in a pediatric intensive care unit.

Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009-2011) study was conducted among PICU patients. The two pediatric mattresses - one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg - were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need). Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 -17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.