Economic Analysis of Cochlear Implants in Adults With Bilateral Severe-to-Profound Hearing Loss. A Systematic Review of the Literature.

OBJECTIVE: To determine the cost-effectiveness or cost-utility of cochlear implants (CI) in adults with severe to profound bilateral hearing loss. DATABASES REVIEWED: PubMed (Medline), The Cochrane Library, Embase via Elsevier, EBSCOhost CINAHL, and Scopus. METHODS: The study included adult participants with severe to profound bilateral neurosensory hearing loss. The analysis encompassed quality of life improvements, costs, cost-effectiveness, cost-utility, cost-benefit, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Systematic reviews, meta-analyses, case series, and prospective or retrospective cohort studies published in English between 2010 and 2023 were retrieved. Exclusion criteria included incomplete studies, abstracts, clinical cases, editorials, letters, studies involving pediatric populations, single-side deafness, methodology research, noneconomic aspects of CI, mixed child and adult data, and studies published before 2010. The risk of bias was assessed following the criteria outlined in Appendix I of the economic evaluation's quality assessment as per the NICE Guideline Development Method. RESULTS: Ten articles met the criteria and were included in the qualitative synthesis. One study conducted a prospective cost-utility analyses, one carried out a cost-benefit analyses, one was a randomized controlled clinical trial focusing on cost-utility, and another was a clinical trial addressing cost-effectiveness. Six studies employed Markov models, and one study utilized uniquely the Monte Carlo method. None quantified the economic impact of improved hearing on cognitive function. CONCLUSIONS: The heterogeneity of sources impacted data quality. Unilateral and sequential bilateral CI appeared to be cost-effective when compared with bilateral hearing aids or nontechnological support. When properly indicated, simultaneous bilateral CIs are cost-effective compared to no interventions and to unilateral cochlear implantation through differential discounting or variations from the base cases, especially with a life expectancy of 5-10 years or longer.

[Effect of the guideline implementation "Risk assessment and prevention of pressure ulcers" of the Registered Nurses'Association of Ontario (RNAO).] / Alcance de la implantación de la guía "Valoración del riesgo y prevención de úlceras por presión" de la Registered Nurses' Association of Ontario (RNAO).

OBJECTIVE: The Best Practice Spotlight Organizations Program is being developed in Spain to reduce the variability of clinical practice by implementing clinical practice guidelines from the Registered Nurses' Association of Ontario. This study described the results of the implementation of the guide "Risk assessment and prevention of pressure ulcers". METHODS: We carried out a retrospective observational study (2015-2018) at the Hospital Universitario Virgen de las Nieves on 4,464 patients from 22 hospitalization units, analyzing type of unit, risk assessment, preventive measures, origin and category of ulcers. Descriptive analysis and contingency tables were performed with the Chi-square statistic p<0.05. RESULTS: The patients at risk were 62.2% in medical units, 53.4% in surgical units and 90% in intensive care. The application of preventive measures was 67.9%, 60.2% and 92.1% (respectively) for each unit. In medical units, 13.1% of pressure ulcers were identified, of which 68.1% were present at the time of admission. While in surgical units and intensive care they developed during hospitalization (60.8% and 88.9% respectively) (p<0.001). The presence of ulcers seemed to show a decreasing trend in the years analyzed (19.6% to 11.2%). CONCLUSIONS: There are favorable environments for implantation (medical units and intensive care) that reflect a higher level of risk assessment, use of pressure management surfaces and a decrease in prevalence. The recommendations have not been implemented homogeneously, with differences depending on the type of unit.

OBJETIVO: El Programa Centros Compro-metidos con la Excelencia en Cuidados®, se desarrolla en España, para reducir la variabilidad de la práctica clínica, implantando guías de práctica clínica de la Registered Nurses' Association of Ontario. Este estudio describió los resultados de la implantación de la guía "Valoración del riesgo y prevención de las úlceras por presión". METODOS: Se realizó un estudio observacional retrospectivo (2015-2018) en el Hospital Universitario Virgen de las Nieves sobre 4.464 pacientes de 22 unidades de hospitalización, analizando el tipo de unidad, la valoración del riesgo, las medidas preventivas, la procedencia y la categoría de las úlceras. Se realizó análisis descriptivo y tablas de contingencia con el estadístico Chi-cuadrado p<0,05. RESULTADOS: Los pacientes de riesgo fueron el 62,2% en unidades médicas, 53,4% en las quirúrgicas y el 90% en cuidados intensivos. La aplicación de medidas preventivas fue del 67,9%, 60,2% y 92,1% (respectivamente) para cada unidad. En unidades médicas se identificaron un 13,1% de úlceras por presión, de las cuales el 68,1% estaban presentes en el momento del ingreso. Mientras que en unidades quirúrgicas y en cuidados intensivos se desarrollaron durante la hospitalización (60,8% y 88,9% respectivamente) (p<0,001). La presencia de úlceras pareció mostrar una tendencia a la disminución en los años analizados (19,6% a 11,2%). CONCLUSIONES: Existen entornos favorecedores para la implantación (unidades médicas y cuidados intensivos) que reflejan mayor nivel de valoración del riesgo, de utilización de superficies de gestión de la presión y disminución de la prevalencia. No se ha conseguido implantar las recomendaciones de forma homogénea existiendo diferencias en función del tipo de unidad.

Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological Study. / Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico.

AIM: To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD: Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS: A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD=1.8) lower than the surgical ones 13.5 (SD=2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD=1.4) and district hospitals 13.03 (SD=1.46) (p=.001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p=.005), prevalence of nosocomial infections (p=.036), postoperative sepsis (p=.022), zero bacteraemia verification (p=.045) and mortality from heart failure (p=.004). CONCLUSIONS: The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.

Nursing care to address community health of the indigenous population in the Peruvian Amazon. / Cuidados enfermeros para el abordaje de la salud comunitaria en población indígena de la Amazonia peruana.

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community¼ is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors.

Access to healthcare among Chinese immigrants living in Seville, Spain.

OBJECTIVE: To investigate the use of healthcare services and factors associated with accessing them among Chinese immigrants living in Southern Spain. METHOD: A mixed methodology was used. A cross-sectional survey was first administered to Chinese immigrants (n=133), and they were asked about their visits to the doctor, use of emergency services, and hospitalization. A phenomenological approach was then used with key informants (n=7). In the interviews, additional information, such as barriers and facilitators to improving accessibility, was explored. RESULTS: In the previous year, 51% had visited a doctor and 34% had visited an Emergency Department. The main reasons for hospitalization were pregnancy (37.5%) and surgery (25%). At least 20% of the sample reported having never visited a doctor. Language difficulties and time constraints were identified as important barriers to accessibility. Sex differences were found among the reasons for lack of time, which, in men, were related to work (odds ratio [OR]=7.7) and, in women, were related to childcare (OR=12). The majority of Chinese immigrants preferred to use Traditional Chinese Medicine as their first treatment rather than visiting a doctor. CONCLUSIONS: A lower use of health services was found among Chinese immigrants in Spain compared to the native population. When using health services, they choose acute care settings. Communication and waiting times are highlighted as major barriers. Adapting these demands to the healthcare system may help immigrants to trust their healthcare providers, thus increasing their use of health services and improving their treatment.

Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study.

Indigenous communities usually experience higher levels of mortality and poorer access to healthcare services compared to non-indigenous communities. This study aims to understand the most prevalent health problems and their treatment in the Asháninka indigenous communities of the Peruvian Amazon. We conducted an ethnographic study in order to explore the perceived health problems, the use of traditional medicine and the resources offered by the official Peruvian healthcare system. Field notes and semi-structured interviews were used. A total of 16 indigenous and four non-indigenous people were interviewed, and interpretative analysis was used to identify themes. The Asháninka community is an overlooked population, which, due to distance restrictions, misconceptions and ethnical disparities, is far away from an appropriate healthcare system and is subjected to acute medical conditions such as infections and gastrointestinal problems. This group tends to seek traditional medicine, mostly herbal medications and traditional healers. The use of a health professional is seen as a last resort. Although the official Peruvian health system incorporates community participation strategies to improve the healthcare of indigenous people, the shortage of material, human resources and cultural sensitivity makes this difficult. Healthcare strategies should be devised and implemented in order to minimize health inequality in this population.

Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients.

AIMS AND OBJECTIVES: The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification. BACKGROUND: Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments. DESIGN: A cross-sectional validation study in two acute care hospitals in Spain. METHODS: This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument. RESULTS: Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbach's alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance. CONCLUSIONS: Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency. RELEVANCE TO CLINICAL PRACTICE: Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases.