Usefulness and Safety Evaluation of Chemotherapy Administration Device for Nurses: Experimental Study.

OBJECTIVE: Antineoplastic drugs are considered high risk, and computerized systems favor safe administration. The objective of the study was to test the usefulness and safety of a new mobile device compared to the standard device for administering these antineoplastic treatments. DATA SOURCES: This multicenter, quasi-experimental pre-post study assessed an intervention in two cancer centers in June and July 2020. Nineteen nurses participated by completing 57 questionnaires. The outcome variables were usefulness, ease of use, efficiency, safety, attitudes, and satisfaction with the new mobile device; they were measured by means of the USE questionnaire (Usefulness, Satisfaction, and Ease of use) and the Technology Attitude Survey (TAS). Professionals rated the new device higher than the standard device and showed a favorable attitude toward technology. CONCLUSION: The tested device was useful, effective, safe, and specific to the antineoplastic treatment administration process, garnering greater satisfaction among professionals than the standard. IMPLICATIONS FOR NURSING PRACTICE: As new technologies can improve care for patients with cancer, it is essential to develop strategies to improve the experience of professionals for optimal implementation.

La planificación compartida de la atención en personas con enfermedad oncológica en un instituto monográfico de cáncer: estudio descriptivo retrospectivo / Advance care planning in people with cancer disease in a monographic cancer institute: retrospective cross-sectional study

Introducción: La planificación compartida de la atención (PCA) promueve que las personas expresen deseos, preferencias o preocupaciones con el objetivo de facilitar un proceso de atención consensuado y compartido entre paciente, familia y equipo. Esto es especialmente relevante en el contexto oncológico. Materiales y métodos: Se desarrolló un estudio descriptivo para analizar las prácticas de PCA de los profesionales a partir de los registros en las historias clínicas de los últimos 3 meses de vida de una muestra de pacientes fallecidos en un hospital monográfico de cáncer. Se definieron variables sociodemográficas, diagnóstico, nivel de intensidad terapéutica, estado cognitivo y variables de PCA: preferencias, preocupaciones, lugar de atención y defunción preferentes, elección del representante y documento de voluntades anticipadas (DVA). Resultados: Se incluyeron 54 pacientes, el 61,1 % hombres; mediana de edad: 64,5 años. Patología oncológica principal: respiratoria (22,2 %). Las variables relacionadas con la PCA fueron: preferencias 74,1 % (n = 40); preocupaciones 75,9 % (n = 41); representante 7,4 % (n = 4); lugar de atención 27,8 % (n = 15); lugar de defunción: 16,7 % (n = 9). Ninguno disponía de DVA. Son los equipos de cuidados paliativos quienes registran principalmente las preferencias y preocupaciones, asociados a un nivel de intensidad terapéutica 3A. El registro de preocupaciones se asoció con la capacidad de expresión del paciente (p < 0,001). Discusión: El registro de dimensiones de PCA es escaso y se recoge principalmente en cuidados paliativos. Escasean variables como la figura representante o los DVA. La integración precoz de la PCA en la práctica clínica facilitaría la toma de decisiones con pacientes oncológicos y contribuiría a adecuar el proceso asistencial a los deseos y preferencias de los mismos. (AU)

Introduction: Advance care planning (ACP) encourages people to express wishes, preferences and concerns in order to facilitate a shared care process involving patients, their families and professionals. This is especially relevant in the cancer context. Materials and methods: A cross-sectional study was carried out to analyze the ACP process practices of professionals through the clinical records of a sample of patients in their last 3 months of life who died during one month in a monographic cancer hospital. Sociodemographic variables, diagnosis, level of therapeutic intensity, cognitive status, and ACP variables were defined: preferences, concerns, preference for place of care and place of death, choice of representative, and advance directive document (ADC) existence. Results: N = 54; 61.1 % men; median age: 64.5 years. Main cancer disease: respiratory (22.2 %). ACP-related variables included preferences (74.1 %, n = 40); concerns (75.9 %, n = 41); proxy (7.4 %, n = 4); place of care (27.8 %, n = 15); place of death (16.7 %, n = 9). None had an ADC. Preferences and concerns are mainly recorded by palliative care teams, and the level of therapeutic intensity in the preferences/concerns record was 3A. Concerns were associated with level of patient self-expression (p < 0.001). Conclusions: ACP dimensions are scarcely recorded. Recording occurs mainly in the end-of-life context. Variables such as presence of a representative and ADCs are rarely registered. Early integration of ACP in clinical practice would facilitate shared decision-making with cancer patients, and would help define the care process according to their wishes and preferences. (AU)

Factors associated with delayed postsurgical voiding interval in ambulatory spinal anesthesia patients: a prospective cohort study in 3 types of surgery.

BACKGROUND: Spinal anesthesia has been considered inappropriate for ambulatory surgery patients because of concern about voiding dysfunction. The purpose of this study was to analyze the relationship between voiding interval and type of surgery under spinal anesthesia with lidocaine and to identify other nonanesthetic risk factors for delayed voiding. PATIENTS AND METHODS: A prospective study of 406 patients undergoing to ambulatory surgery under spinal anesthesia with lidocaine was performed. Voiding interval was defined as the time in minutes from the injection of local anesthetic to the patient's first spontaneous voiding. Univariate and multivariate linear regression models were constructed to identify risk factors associated with length of voiding interval. RESULTS: A total of 187 patients underwent herniorrhaphy; 187 patients underwent lower limb surgery; and 32 patients went benign anorectal surgery. The mean +/- sd voiding interval was 230 +/- 50.5 minutes. Factors associated with length of voiding interval in the univariate analysis were sex, body mass index (BMI), type and duration of surgery, lidocaine dose, and volume of fluid administered. Factors that remained significant in the multivariate model were sex, BMI, lidocaine dose and type of surgery: spontaneous voiding came later after inguinal herniorrhaphy surgery than after lower-limb surgery (regression coefficient 20 minutes; 95% confidence interval 11.5-29.8). Multivariate models performed for each type of surgery separately identified sex and lidocaine dose as factors related to length of voiding interval in all types of surgery. CONCLUSIONS: A longer voiding interval was associated with inguinal herniorrhaphy, spinal lidocaine dose, and male sex.