Design and validation of a predictive model for determining the risk of developing fibromyalgia.

OBJECTIVES: Fibromyalgia is a prevalent disease of unknown aetiology and is difficult to diagnose. Despite the availability of the American College of Rheumatology criteria for diagnosis, it continues to be a challenge in the field of primary health care in terms of identifying individuals with susceptibility to developing the disease. The aim of this study is to design and validate a predictive model of fibromyalgia in subjects with a history of chronic pain. METHODS: This multicentre observational retrospective cohort study was performed on patients aged >18 years, who visited four primary health centres between 2017 and 2020, with a diagnosis of fibromyalgia or arthritis. The Bootstrapping resampling method was used for the validation of the model. RESULTS: A total of 198 subjects with fibromyalgia (93 with osteoarthritis, 20 with other types of arthritis, 4 with rheumatoid arthritis) and 120 without fibromyalgia (116 with osteoarthritis, 23 with other types of arthritis, 7 with rheumatoid arthritis) participated in the study. The predictive factors of the final model were self-reported age at onset of symptoms, first-line family history of neurological diseases, exposure to levels of stress, history of post-traumatic acute emotional stress, and personal history of chronic widespread pain prior to diagnosis, comorbidity, and pharmacological prescription during the year of diagnostic confirmation. The predictive capacity adjusted by Bootstrapping was 0.972 (95% CI: 0.955-0.986). CONCLUSIONS: The proposed model showed an excellent predictive capacity. The risk calculator designed from the predictive model allows health professionals to have a useful tool to identify subjects at risk of developing fibromyalgia.

Paediatric nursing clinical competences in primary healthcare: A systematic review.

AIMS: To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide. DESIGN: A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement. DATA SOURCES: The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search. REVIEW METHODS: Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies. RESULTS: Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks. CONCLUSION: Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care. IMPACT: Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries.

AIMS AND OBJECTIVES: The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. BACKGROUND: Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. DESIGN: A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. METHODS: The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. CONCLUSIONS: The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. RELEVANCE TO CLINICAL PRACTICE: Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.

A motivational interview program for cardiac rehabilitation after acute myocardial infarction: study protocol of a randomized controlled trial in primary healthcare.

BACKGROUND: Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences and goals, which is the core of the motivational interview. The objective of this study was to evaluate the efficacy of a cardiac rehabilitation program with a motivational interview in patients discharged from hospital after acute myocardial infarction. METHODS/DESIGN: A randomized, non-pharmacological clinical trial in six primary healthcare centers in Barcelona (Spain) will assess whether a tailored cardiac rehabilitation program consisting of four motivational interviews and visits with family physicians, primary healthcare nurses and a cardiologist, coordinated with the reference hospital, results in better cardiac rehabilitation than standard care. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction will be randomized to a cardiac rehabilitation group with a motivational interview program or to standard primary healthcare. The main outcome will be physical function measured by the six-minute walk test, and the secondary outcome will be the effectiveness of secondary prevention: a composite outcome comprising control of blood pressure, cholesterol, diabetes mellitus, smoking and body weight. Results will be evaluated at 1,3 and 6 months. DISCUSSION: This is the first clinical trial to study the impact of a new primary healthcare cardiac rehabilitation program with motivational interviews for patients discharged from hospital after myocardial infarction. Changes in lifestyles and habits after myocardial infarction are a core element of secondary prevention and require patient-centered care strategies such as motivational interviews. Therefore, this study could clarify the impact of this approach on health indicators, such as functional capacity. TRIAL REGISTRATION: ClinicalTriasl.gov NCT05285969 registered on March 18, 2022.

[Descriptive study of the type of patient cared for in a link-nursing program]. / Estudio descriptivo de la tipología de pacientes atendidos en un programa de enfermeras de enlace.

OBJECTIVE: Determine the type of patients in a program of link nursing of the urban area. METHODS: Descriptive observational study conducted at the Hospital Clinic de Barcelona (HCB). The study population were patients hospitalized in the Institute of Orthopedics, Internal Medicine, Cardiology, Vascular Surgery and Post Coronary Care. The data was obtained through the registration of patients enrolled in the program between November 2006 and April 2008. We analyzed sociodemographic variables (gender, age, reason for admission, the institution where hospitalized, hospital stay, primary care (PAC) reference destination of the patient on discharge from hospital) and physical variables (Barthel dependency score and recommendations of the link nurse to reference PAC). RESULTS: Information was analysed from 2025 (99.26%) out of 2040 eligible patients. Fifteen were excluded because they did not have complete information for data analysis. The average age for men was 73.55 years and 66.53 years for women (P<0.01). There was sever dependence in 92 (9.10%) males and 61 (6.02%) women (P<0.01). The average number of hospital stays for men was 9.7 and 9.65 for women (P<0.01). Continuity of care at home was not required in 571 (56.48%) males and 605 (59.66%). CONCLUSIONS: The majority of the population was elderly with an index of slight dependence, demonstrating that this population need continuous monitoring of their progress after discharge, although the Barthel index was not severe or total.