Pursuing precision in medicine and nutrition: the rise of electrochemical biosensing at the molecular level.

In the era that we seek personalization in material things, it is becoming increasingly clear that the individualized management of medicine and nutrition plays a key role in life expectancy and quality of life, allowing participation to some extent in our welfare and the use of societal resources in a rationale and equitable way. The implementation of precision medicine and nutrition are highly complex challenges which depend on the development of new technologies able to meet important requirements in terms of cost, simplicity, and versatility, and to determine both individually and simultaneously, almost in real time and with the required sensitivity and reliability, molecular markers of different omics levels in biofluids extracted, secreted (either naturally or stimulated), or circulating in the body. Relying on representative and pioneering examples, this review article critically discusses recent advances driving the position of electrochemical bioplatforms as one of the winning horses for the implementation of suitable tools for advanced diagnostics, therapy, and precision nutrition. In addition to a critical overview of the state of the art, including groundbreaking applications and challenges ahead, the article concludes with a personal vision of the imminent roadmap.

Proteomics analysis of prefrontal cortex of Alzheimer's disease patients revealed dysregulated proteins in the disease and novel proteins associated with amyloid-ß pathology.

BACKGROUND: Alzheimer's disease (AD) is a progressive, chronic, and neurodegenerative disease, and the most common cause of dementia worldwide. Currently, the mechanisms underlying the disease are far from being elucidated. Thus, the study of proteins involved in its pathogenesis would allow getting further insights into the disease and identifying new markers for AD diagnosis. METHODS: We aimed here to analyze protein dysregulation in AD brain by quantitative proteomics to identify novel proteins associated with the disease. 10-plex TMT (tandem mass tags)-based quantitative proteomics experiments were performed using frozen tissue samples from the left prefrontal cortex of AD patients and healthy individuals and vascular dementia (VD) and frontotemporal dementia (FTD) patients as controls (CT). LC-MS/MS analyses were performed using a Q Exactive mass spectrometer. RESULTS: In total, 3281 proteins were identified and quantified using MaxQuant. Among them, after statistical analysis with Perseus (p value < 0.05), 16 and 155 proteins were defined as upregulated and downregulated, respectively, in AD compared to CT (Healthy, FTD and VD) with an expression ratio ≥ 1.5 (upregulated) or ≤ 0.67 (downregulated). After bioinformatics analysis, ten dysregulated proteins were selected as more prone to be associated with AD, and their dysregulation in the disease was verified by qPCR, WB, immunohistochemistry (IHC), immunofluorescence (IF), pull-down, and/or ELISA, using tissue and plasma samples of AD patients, patients with other dementias, and healthy individuals. CONCLUSIONS: We identified and validated novel AD-associated proteins in brain tissue that should be of further interest for the study of the disease. Remarkably, PMP2 and SCRN3 were found to bind to amyloid-ß (Aß) fibers in vitro, and PMP2 to associate with Aß plaques by IF, whereas HECTD1 and SLC12A5 were identified as new potential blood-based biomarkers of the disease.

Diagnostic accuracy study of the VALENF instrument in hospitalization units for adults: a study protocol.

Recently, the VALENF instrument, Nursing Assessment by its acronym in Spanish, was developed as a meta-tool composed of only seven items with a more parsimonious approach for nursing assessment in adult hospitalization units. This meta-tool integrates the assessment of functional capacity, the risk of pressure injuries and the risk of falls. The general objective of this project is to validate the VALENF instrument by studying its diagnostic accuracy against the instruments commonly used in nursing to assess functional capacity, the risk of pressure injuries and the risk of falls. An observational, longitudinal, prospective study is presented, with recruitment and random selection based on admissions to six adult hospitalization units of the Hospital Universitario de La Plana. The study population will be made up of patients hospitalized in these units. The inclusion criteria will be patients over 18 years of age with a nursing assessment within the first 24 h of admission and an expected length of stay greater than 48 h and who sign the informed consent form. The exclusion criteria will be transfers from other units or centers. A sample of 521 participants is estimated as necessary. The evaluation test will be the VALENF instrument, and the reference tests will be the Barthel, Braden and Downton indices. Sociodemographic variables related to the care process and results such as functional loss, falls or pressure injuries will be collected. The evolution of functional capacity, the risk of falls and the risk of pressure injuries will be analyzed. The sensitivity, specificity and positive predictive values of the VALENF instrument will be calculated and compared to those of the usual instruments. A survival analysis will be performed for pressure injuries, falls and patients with functional loss. The VALENF instrument is expected to have at least the same diagnostic validity as the original instruments.Trial registration The study will be retrospectively registered (ISRCTN 17699562, 25/07/2023).

Prevalence of falls in noninstitutionalized people aged 65-80 and associations with sex and functional tests: A multicenter observational study.

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65-80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk-specific fall prevention programs to prevent disabilities in older people.

The advocacy role of nurses in cardiopulmonary resuscitation.

BACKGROUND: The decision whether to initiate cardiopulmonary resuscitation may sometimes be ethically complex. While studies have addressed some of these issues, along with the role of nurses in cardiopulmonary resuscitation, most have not considered the importance of nurses acting as advocates for their patients with respect to cardiopulmonary resuscitation. RESEARCH OBJECTIVE: To explore what the nurse's advocacy role is in cardiopulmonary resuscitation from the perspective of patients, relatives, and health professionals in the Basque Country (Spain). RESEARCH DESIGN: An exploratory critical qualitative study was conducted from October 2015 to March 2016. Thematic analysis was used to analyse the data. PARTICIPANTS: Four discussion groups were held: one with patients and relatives (n = 8), two with nurses (n = 7 and n = 6, respectively), and one with physicians (n = 5). ETHICAL CONSIDERATIONS: Approval was obtained from the Basque Country Clinical Research Ethics Committee. FINDINGS: Three significant themes were identified: (a) accompanying patients during end of life in a context of medical dominance, (b) maintaining the pact of silence, and (c) yielding to legal uncertainty and concerns. DISCUSSION: The values and beliefs of the actors involved, as well as pre-established social and institutional rules reduced nurses' advocacy to that of intermediaries between the physician and the family within the hospital environment. On the contrary, in primary health care, nurses participated more actively within the interdisciplinary team. CONCLUSION: This study provides key information for the improvement and empowerment for ethical nursing practice in a cardiac arrest, and provides the perspective of patients and relatives, nurses and physicians.

The SUMAMOS EXCELENCIA Project.

AIM: The gap between research and clinical practice leads to inconsistent decision-making and clinical audits are an effective way of improving the implementation of best practice. Our aim is to assess the effectiveness of a model that implements evidence-based recommendations for patient outcomes and healthcare quality. DESIGN: National quasi-experimental, multicentre, before and after study. METHODS: This study focuses on patients attending primary care and hospital care units and associated socio-healthcare services. It uses the Joanna Brigg's Institute Getting Research into Practice model, which improves processes by referring to prior baseline clinical audits. The variables are process and outcome criteria for pain, urinary incontinence, and fall prevention, with data collection at baseline and key points over 12 months drawn from clinical histories and records. Project funding was received from the Spanish Strategic Health Action in November 2014. DISCUSSION: The project results will provide knowledge on the effectiveness of the Getting Research into Practice model, to apply evidence-based recommendations for the detection and management of pain, urinary incontinence, and fall prevention. It will also establish whether using research results, based on clinical audits and situation analysis, is effective for implementing evidence-based recommendations and improving patients' health. IMPACT: This nationwide Spanish project aims to detect and prevent high-prevalence healthcare problems, namely pain in patients at any age and falls and urinary incontinence in people aged 65 and over. Tailoring clinical practice to evidence-based recommendations will reduce unjustified clinical variations in providing healthcare services. Clinical Trial ID: NCT03725774.

The nurse work environment in Spanish nurses following an economic recession: From 2009 to 2014.

AIM: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System. BACKGROUND: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout. METHOD: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care. RESULTS: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics. CONCLUSIONS: Professional factors may influence these changes more than labour conditions and remuneration aspects. IMPLICATIONS FOR NURSING MANAGEMENT: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses.

[Presence of relatives during cardiopulmonary resuscitation: Perspectives of health professionals, patients and family in the Basque Country]. / Presencia de familiares durante la reanimación cardiopulmonar: perspectivas de pacientes, familiares y profesionales de la salud en el País Vasco.

OBJECTIVE: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. DESIGN: A qualitative exploratory study and thematic analysis were developed. SITE: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. PARTICIPANTS: The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. METHOD: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. RESULTS: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. CONCLUSIONS: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives.

Efficacy of the Otago Exercise Programme to reduce falls in community-dwelling adults aged 65-80 years old when delivered as group or individual training.

AIM: This study will compare how falls can be reduced in non-institutionalized older Spanish adults aged 65-80 years by providing group or individual exercise sessions using the Otago Exercise Programme. BACKGROUND: The Otago Exercise Programme is a progressive home-based exercise programme, where trained health professionals help people engage in strength, balance and endurance exercises. Its format is based on the evidence from four clinical trials. The benefits of the Otago Exercise Programme are the same for people who have and have not suffered falls and it can also be used for visually impaired people. DESIGN: A multicentre, simply blinded, randomized, non-inferiority clinical trial, with two arms-group training and individual training-that started in January 2017 and will continue until December 2019. METHODS: Each study group has 364 subjects, who will take part in four individual or group sessions delivered mainly by nurses over an 8-week period, with a reinforcement session 6 months later. Data will be collected at baseline and after 6 and 12 months. The fall percentage will be the most relevant clinical variable and we will also consider safety, viability, compliance, economic analysis and therapeutic value. Approval and funding was granted in December 2016 for this 3-year study by the Spanish Health Research Fund (PI16CIII/00031). DISCUSSION: Older people from 65-80 years old tend to be more isolated and tackling worries about falls can improve social activities and independence. It has been shown that group training provides better adherence to exercise than individual training and this study will test that hypothesis for the Otago Exercise Programme.

[Predicting Care and Repercussions for Caregivers of Surgical Patients at Home]. / Predicción de cuidados y repercusiones en los cuidadores en el domicilio de pacientes quirúrgicos.

Objectives: To analyze the correlation between the state of health, knowledge, and social support of surgical patients' caregivers at home, with the intensity of nursing care and its consequences. Methods: A longitudinal observational study with follow-up at admission, discharge and 10 days following discharge at home, held in the surgical hospitalization unit at the Vic University Hospital, (Barcelona). A non-randomized and consecutive sample of 317 informal caregivers of surgical patients with abdominal surgery was included in the study. The characteristics of caregivers were studied using the Nursing Outcomes Classification indicators. The intensity of nursing care, consequences and impact on patient quality of life was evaluated through the validated ICUB97-R questionnaire. Results: Most of the caregivers were women, with an average age of 52,9 ± 13,7years, with no previous experience as caregivers. The greatest intensity of care and impact was observed on caregivers who attended dependent and/or cancer diagnosed patients at home, dedicating the largest time to provide care (p < 0,005). Predictor variables for the occurrence of consequences during convalescence at home were emotional health satisfaction, routine activity disruption, fear, sleep pattern and being a dependent patient. Conclusions: Emotional health satisfaction, routine activity disruption, fear, sleep pattern and being a dependent patient before surgery are strong predictive variables for the occurrence of consequences on caregivers during convalescence at home. There is a significant negative correlation between punctuations in the ICUB97-R questionnaire and the Nursing Outcomes Classification indicators.

Sleepiness in Spanish nursing staff--influence of chronotype and care unit in circadian rhythm impairment: research protocol.

AIMS: To determine how prevalent circadian rhythm impairments are in nurses working in medical, surgical and intensive care units in five Spanish hospitals and how the quality of night-time sleeping and sleepiness affect the nurses' morning and evening chronotypes. BACKGROUND: Shift work is a recognized work pattern for nurses in all countries. Given the important role that nurses play in hospital care, it is vital to establish what repercussions this has on the nurses' working schedules and how any disturbance in circadian rhythm affects patient safety. DESIGN: A multicentre, observational, descriptive and cross-sectional study in seven hospitals in the Spanish National Health System. METHOD: A stratified sample of 1,300 nurses is being collected in three types of units: medical, surgical and intensive care. The 3-year study started in January 2012 and will continue until December 2014, with no exclusion criteria. The Kronowise(®) will be used to monitor the nurses' circadian rhythms, by recording their activity, position and wrist temperature. We will also use three questionnaires to evaluate sleep quality, daytime drowsiness and chronotype: (a) Pittsburg Sleep Quality Index; (b) Epworth Daytime Sleepiness Scale; and (c) Morning and Evening Questionnaire. Data will be collected from each hospital and statistical analysis will be carried out using the SPSS 19.0. DISCUSSION: The study findings will show the current state of the nurses' circadian rhythms and how shift work can affect them and their job performance. Funding for this 3-year study was granted in December 2011 by the Spanish Health Research Fund (PI 11/00646, Health Ministry). This project is also funded by the Instituto de Salud Carlos III (RETICEF, RD12/0043/0011, RD12/0043/0006).

Psychometric properties of the Spanish version of the Health of Nation Outcome Scales for schizophrenia patients.

Accessible Summary What is known on the subject? Functioning is one of the most affected areas in schizophrenia. Social, occupational and personal domains are affected, and these deficits are responsible for a major part of the disability associated with the disorder. There are several instruments to measure functioning, but the HoNOS provides a wide assessment of impairment in 12 areas of functioning. What does the paper add to existing knowledge? The Spanish version of the HoNOS shows good properties in terms of reliability and validity for use in schizophrenia patients. Although some authors divide the scale according to proposed underlying dimensions, in schizophrenia this division may not be appropriate. What are the implications for practice? A reliable and easy-to-use measure of impairment in different areas of functioning is useful for optimizing the treatment and rehabilitation of patients with schizophrenia. ABSTRACT: INTRODUCTION: The HoNOS scale was designed for the assessment of psychosocial impairment in various domains. While it is widely used in psychiatric settings, it has not been validated in Spanish for use in patients with schizophrenia. AIM: To examine the psychometric properties of the Spanish version of the HoNOS scale in a sample of schizophrenia patients. METHOD: A total of 194 individuals aged 18 to 65 with schizophrenia spectrum diagnoses were evaluated using the HoNOS. Illness severity and level of functioning were also assessed. RESULTS: The HoNOS showed moderate internal consistency, good inter-observer reliability and good test-retest reliability. Factor analysis revealed an internal structure consisting of four factors, with item distribution differing from the theoretical dimensions proposed for the original scale. DISCUSSION: The Spanish version of the HoNOS scale is a reliable and valid instrument for assessing psychosocial impairment in individuals diagnosed with schizophrenia spectrum disorders. However, further research is needed to determine its internal structure more accurately. IMPLICATIONS FOR PRACTICE: The HoNOS scale provides researchers and clinicians with a valid measure of impairment in twelve different domains, which can facilitate and guide the treatment of schizophrenia patients.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

Delirium risk screening and assessment among older patients in general wards and the emergency department: a best practice implementation project.

OBJECTIVES: The aim of this project was to improve compliance with evidence-based criteria regarding risk of delirium and the assessment of delirium among older patients in the general hospitalization wards and the emergency department. INTRODUCTION: More than 50% of older hospitalized patients experience delirium. Some studies have highlighted the need to implement an orientation protocol in the emergency department and to continue this in the general wards, with the aim of decreasing the delirium rate among older patients admitted to hospital. METHODS: The project followed the JBI evidence implementation framework. We conducted a baseline audit, a half-way audit, and final audit of 50 patients at risk of delirium admitted to the emergency department and the general wards, respectively. The audits measured compliance with eight criteria informed by the available evidence. RESULTS: In the final audit, three of the eight criteria achieved more than 50% compliance in the general wards: pressure injury screening (96%); monitoring changes (74%); and performing interventions (76%). In the emergency department, worse results were reported because of the service conditions. The exception was the criterion on the training of nurses on the topic, with 98%. The integration of a tool to screen for delirium in older patients in the hospital's electronic clinical history records increased the percentage of compliance with audit criteria regarding the use of the scale and delirium detection (rising from 0% to 32% in the final audit in the general wards). CONCLUSION: Through the implementation of this project, validated and evidence-based evaluation will ensure that nurses are supported through appropriate measures to reduce patient confusion and aggression resulting from delirium.

Living at the Wrong Time: Effects of Unmatching Official Time in Portugal and Western Spain.

Human circadian rhythmicity is subjected to the internal circadian clock, the sun and social clocks (official time, social/work schedules). The discrepancy among these clocks, as occurs when official time does not match its geographical time zone, may produce circadian disruption. Western Spain (GMT+1/+2) and Portugal (GMT0/+1) share similar longitudes (sun time) but have different official times. This provides a unique opportunity to evaluate the effects of official time on circadian rhythmicity and sleep in elderly and retired populations (with no remunerated duties presumed, although other social commitments may be present) at both locations. Although both populations slept enough for their age (7-8 h), circadian robustness (e.g., interdaily stability, relative amplitude) was greater in Portugal, especially during weekdays, while greater desynchronization (both body temperature vs. motor activity and body temperature vs. light exposure) tended to occur in the Spaniards. Once corrected by GMT0, meals took place later in Spain than in Portugal, especially as the day progresses, and a possible interplay between bed/meal timings and internal desynchronization was found. Our results point to the possible deleterious effect on circadian system robustness when official time is misaligned with its geographical time zone.

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology.

BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

[Scoping review about the recommendations for home isolation in the COVID-19 pandemic]. / Scoping review sobre las recomendaciones para el aislamiento domiciliario en la pandemia de COVID-19.

AIM: The COVID-19 pandemic has affected countries on all continents where containment and isolation measures have been systematically applied. This review aims to synthesize the available evidence on the management of home isolation due to COVID-19 infection. METHOD: A scoping review has been carried out using the Trip Database, PUBMED, CINAHL, COCHRANE and Scopus controlled language without any limits. From all the documents located, information was extracted on the date of publication, country of publication, type of study, assessment of the level of evidence and degree of recommendation, and results of interest to answer the research question. Critical reading of the selected documents has been carried out, but without using it as an exclusion criterion but rather informative. RESULTS: 163 records were located and 14 were selected. The recommendations have been grouped into 10 topics around all the daily management of home care. CONCLUSIONS: The scarcity of robust evidence on isolation from COVID-19 infection is objective. Most of the documents are reviews carried out after the consensus of experts at the international level.

Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study.

OBJECTIVES: The aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish. DESIGN: Cross-sectional observational study. SETTING: Two health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia. PARTICIPANTS: A total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties including content validity, construct validity and reliability of the scale have been tested. RESULTS: The overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55. CONCLUSIONS: The Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.

SUMAMOS EXCELENCIA® Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS).

The use of certain strategies for the implementation of a specific recommendation yields better results in clinical practice. The aim of this study was to assess the effectiveness of an evidence-based model using clinical audits (GRIP model), for the implementation of recommendations in pain and urinary incontinence management as well as fall prevention, in the Spanish National Health System during the period 2015-2018. A quasi-experimental study has been conducted. The subjects were patients treated in hospitals, primary care units and nursing home centers. There were measures related to pain, fall prevention and urinary incontinence. Measurements were taken at baseline and at months 3, 6, 9, and 12. The sample consisted of 22,114 patients. The frequency of pain assessment increased from 59.9% in the first cycle to a mean of 71.6% in the last cycle, assessments of risk of falling increased from 56.8% to 87.8% in the last cycle; and finally, the frequency of assessments of urinary incontinence increased from a 43.4% in the first cycles to a mean of 62.2% in the last cycles. The implementation of specific evidence-based recommendations on pain, fall prevention, and urinary incontinence using a model based on clinical audits improved the frequency of assessments and their documentation.

Witnessed resuscitation of adult and paediatric hospital patients: An umbrella review of the evidence.

OBJECTIVE: To examine the research evidence about whether families were allowed to witness cardiopulmonary resuscitation on hospitalised adult and paediatric patients; and the views of patients, families and health professionals, about witnessed cardiopulmonary resuscitation. DESIGN: An umbrella review methodology of systematic reviews with sufficient methodological quality. REVIEW METHODS: Papers published in Spanish and English between, 1 January 2009 and 31 December 2018 were considered. The following databases were searched: PubMed, CINAHL, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, PsycInfo, Embase, the Central Supplier Database and the Joanna Briggs Institute, Evidence-based Practice Database. Two independent reviewers assessed the papers for methodological quality employing instruments from the Joanna Briggs Institute. Critical appraisal, extraction and synthesis were carried out, employing the established methods for umbrella reviews and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO number CRD42019145610). RESULTS: The search identified 12 systematic reviews with moderate-to-high quality, which covered 110 original papers. Habitually, health professionals expressed controversial views and showed some reluctance to let families be present during cardiopulmonary resuscitation. In contrast, family members felt strongly that they should be present and patients agreed. Key factors that facilitated witnessed cardiopulmonary were a formal institutional policy, educating health professionals, and designating a health professional to support the family. Educational and cultural backgrounds influenced healthcare professionals' experiences and their attitudes towards witnessed cardiopulmonary resuscitation. In general, Anglo-Saxon countries showed greater support for this practice. These included the United States, which was the country that dominated the literature on this subject. CONCLUSIONS: The best available evidence supports allowing the family to be present during cardiopulmonary resuscitation. It is necessary to include this practice in educational curricula and to train emergency personnel in its implementation. Culturally sensitive policies need to be designed, and the public to be aware of their right to be present.