Hard-to-Heal Wound Healing: Superiority of Hydrogel EHO-85 (Containing Olea europaea Leaf Extract) vs. a Standard Hydrogel. A Randomized Controlled Trial.

Chronic wounds, especially those that are hard-to-heal, constitute a serious public-health problem. Although progress has been made in the development of wound dressings for healing, there is little high-quality evidence of their efficacy, with no evidence of superiority in the use of one hydrogel over another. To evaluate the superiority of a hydrogel (EHO-85), containing Olea europaea leaf extract (OELE), over a standard hydrogel (SH), the promotion and/or improvement of healing of difficult-to-heal wounds was compared in a prospective, parallel-group multicenter, randomized, observer-blinded, controlled trial ("MACAON"). Non-hospitalized patients with pressure, venous or diabetic foot-ulcers difficult-to-heal were recruited and treated with standard care, and EHO-85 (n = 35) or VariHesive (n = 34) as SH. Wound-area reduction (WAR; percentage) and healing rate (HR; mm2/day) were measured. EHO-85 showed a statistically significant superior effect over VariHesive. At the end of the follow-up period, the relative WAR decreased by 51.6% vs. 18.9% (p < 0.001), with a HR mean of 10.5 ± 5.7 vs. 1.0 ± 7.5 mm2/day (p = 0.036). EHO-85 superiority is probably based on its optimal ability to balance the ulcer bed, by modulating pH and oxidative stress. That complements the wetting and barrier functions, characteristics of conventional hydrogels. These results support the use of EHO-85 dressing, for treatment of hard-to-heal ulcers. Trial Registration AEMPS:PS/CR623/17/CE.

EHO-85, Novel Amorphous Antioxidant Hydrogel, Containing Olea europaea Leaf Extract-Rheological Properties, and Superiority over a Standard Hydrogel in Accelerating Early Wound Healing: A Randomized Controlled Trial.

Many advanced wound healing dressings exist, but there is little high-quality evidence to support them. To determine the performance of a novel amorphous hydrogel (EHO-85) in relation to its application, we compared its rheological properties with those of other standard hydrogels (SH), and we assessed the induction of acceleration of the early stages of wound healing as a secondary objective of a prospective, multicenter, randomized, observer-blinded, controlled trial. The patients were recruited if they had pressure, venous, or diabetic foot ulcers and were treated with EHO-85 (n = 103) or VariHesive® (SH) (n = 92), and their response was assessed by intention-to-treat as wound area reduction (WAR (%)) and healing rate (HR mm2/day) in the second and fourth weeks of treatment. Results: EHO-85 had the highest shear thinning and G'/G″ ratio, the lowest viscous modulus, G″, and relatively low cohesive energy; EHO-85 had a significantly superior effect over SH in WAR and HR, accelerating wound healing in the second and fourth weeks of application (p: 0.002). This superiority is likely based on its optimal moisturizing capacity and excellent pH-lowering and antioxidant properties. In addition, the distinct shear thinning of EHO-85 facilitates spreading by gentle hand pressure, making it easier to apply to wounds. These rheological properties contribute to its improved performance.

Superiority of a Novel Multifunctional Amorphous Hydrogel Containing Olea europaea Leaf Extract (EHO-85) for the Treatment of Skin Ulcers: A Randomized, Active-Controlled Clinical Trial.

This 8-week, multicenter, randomized, active-controlled, observer-blinded clinical trial was designed to demonstrate the accelerating effect on wound healing of the novel Olea europaea leaf extract hydrogel (EHO-85) by comparing it to a widely used amorphous hydrogel. Results showed that EHO-85 significantly accelerated wound healing, regardless of ulcer etiology (pressure, venous leg or diabetic foot) and prognosis, doubling the median wound area reduction compared with a reference amorphous hydrogel (79.4% vs. 39.7%; difference: −39.7%, 95% CI: −71.1 to −21.3%; p < 0.001). The intention-to-treat analysis was conducted on 195 patients from 23 Spanish health centers/nursing homes. This novel treatment balances the ulcer microenvironment by modulating reactive oxygen species and pH. These actions complement the moistening and barrier functions inherent to amorphous hydrogels, whilst also conferring EHO-85 its documented granulation formation and pain relief properties. Furthermore, efficacy was achieved safely and in a cost-efficient manner due to its multi-dose format, which reduced the amount of product needed by 85.8% over 8 weeks compared to single-use hydrogel. The present randomized controlled trial is a relevant milestone in evidence-based practice for being the first to demonstrate (i) the effectiveness of an amorphous hydrogel in accelerating wound healing and (ii) the superiority of a specific hydrogel over another.

Characteristics of the Spanish Older People in the Use of Accidents and Emergency Unit Services (2014-2017).

The aim of this study was to determine which factors are related to Accidents and Emergency Unit (AEU) use by the elderly Spanish population. Observational analysis of the 2014 European Survey of Health in Spain (ESHS-2014; N = 6,520) and the 2017 Spanish Health Survey (SHS-2017; N = 7,024) was employed. About one third (4,095, 30.2%) of the sample used the AEU, and they were primarily women (32.6%). Comorbidity (p = .01), presence of physical limitation in the prior 6 months to the survey, and a history of several diseases (p < .001)-as in diabetes (p < .001), osteoarthritis (p < .001), and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease (p < .001)-were associated with AEU visits in both surveys. Female sex and several cardiovascular diseases were only significant in the ESHS-2014. In the SHS-2017, depressive status was an independent risk factor. This epidemiological data allow a better understanding of the use of AEU, suggesting indications for the care process.

Evolution in the use of health services by older people in Spain (2009-2017).

As people age, they tend to increase their use of health services. For this, the aims of this study were to analyse the frequency and variability in the use of different health services by people over 65 years, their evolution from 2009 to 2017 and the factors associated it. We carried out a cross-sectional study with 25,465 people over 65 years who participated in the National Health Survey in Spain in 2011/2012 and 2017 and the European Health Survey in Spain in 2009 and 2014. A descriptive analysis was performed using the attendance records of family/general physicians, nurse consultations, or both over the last 12 months as well as these data over the following years of study. Our findings show that approximately 93.2% of the participants had consulted with a family/general physician over the last year, and women were almost twice as likely to do so compared with men (61.2% vs. 38.8%). The use of health services gradually increased from 2009 to 2017, being the visits to nursing that more increased their frequency. Being a woman and a widower as well as having no higher education, a low social class, a serious or long-term illness, obesity and bed restraint were associated with a greater use of health services. Findings suggested that the increased health services due to ageing and comorbidities associated with it present new challenges. It is necessary to determine realistic plans that can meet future healthcare demands and not lead to a collapse of the health system. For this it is very important the primary prevention of chronic diseases, functional limitations, obesity and disability.

Gender, socioeconomic, medical, and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey.

Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.

Health Professionals Who Suffer Intimate Partner Violence: A Descriptive, Multicenter, and Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to know who are the people who assist women, who work as a health professional in the Spanish Public Health System, when they suffer intimate partner violence (IPV). METHODS: A descriptive, cross-sectional, multicenter study was conducted. The participants were female health professionals (N = 794) working within the Spanish Public Health System. The instrument used was Delgado, Aguar, Castellano, and Luna del Castillo's (2006) scale to measure ill-treatment of women. RESULTS: Two hundred seventy women suffered IPV (34%). Of the female health professionals who suffered IPV, 25.9% had spoken with someone about the violence, most commonly talking to trusted people (24.3%), a psychologist (24.3%), health professionals (20%), and others (20%). Married female health professionals living with their current or last partner/husband, residing in an urban area, and with their own salary were least likely to speak about their problem. CONCLUSION: Female health professionals who suffer IPV usually speak about this problem with trusted people instead of consulting a health professional, which may leave the problem in the private sphere. This can be because of victims not wanting to report the violence for fear of their intimate partner or wanting it to remain private. This may deprive the victims of the help they need. For this reason, the health services should establish screening for IPV not only for their patients but also for their workers.

Prevalence and factors associated with influenza vaccination of persons over 65 years old in Spain (2009-2014).

BACKGROUND: Influenza is a major public health problem. Achieving 65% coverage in people over 65 years old is a health policy priority in Spain. OBJECTIVE: To determine the coverage of influenza vaccination in Spain in 2014 for people over 65 years and to analyze the factors associated with coverage and its progression between 2009 and 2014. METHODS: A descriptive cross-sectional study was conducted that included 18,442 non-institutionalized individuals over 65 years who had participated in the National Health Survey in Spain in 2011 and in the European Health Survey in Spain in 2009 and 2014. Socio-demographic variables, health variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with anti-influenza vaccination. RESULTS: Influenza vaccination coverage has declined from 2009 (74.5%) to 2014 (57.4%). There are significant differences in the vaccination coverage among the different Spanish autonomous communities in the different years studied. Influenza vaccination was associated with males, low social class, and low level of education. There is greater participation in other preventive measures, such as assessing blood pressure, blood glucose, and cholesterol, than in influenza vaccination. CONCLUSIONS: Fewer people over 65 years old than recommended by the WHO participated in the influenza vaccination campaign in Spain in 2014. This coverage declined progressively from 2009 to 2014.

Programmed home visits by nursing professionals to older adults: prevention or treatment? / Visita agendada do profissional de enfermagem a idosos em seu domicílio: prevenção ou tratamento? / La visita programada del profesional en enfermería a las personas mayores en su domicilio ¿Prevención o Tratamiento?

conocer la repercusión de la visita domiciliaria de los profesionales en enfermería a personas de 65 años o más, pluripatológicas, en morbimortalidad.

compreender o impacto da visita domiciliar dos profissionais de enfermagem a pessoas com 65 anos ou mais, com diversas doenças, em morbimortalidade.

conocer la repercusión de la visita domiciliaria de los profesionales en enfermería a personas de 65 años o más, pluripatológicas, en morbimortalidad.

Valoración de la satisfacción de usuarios de consulta de Enfermería en Centros de Salud a partir de indicadores de calidad técnicos y de comunicación / Evaluation of user satisfaction of nursing consultation in health centers based on quality and technical communication indicators

Objetivos: Medir la satisfacción relacionada con aspectos técnicos y comunicativos de los usuarios de consulta de Enfermería en Atención Primaria. Métodos: Estudio descriptivo realizado con pacientes usuarios del Servicio de Enfermería de los Centros de Salud (CCSS) de Córdoba y provincia. Los pacientes fueron entrevistados utilizando dos tipos de preguntas, cerradas y abiertas que recogían sus opiniones y satisfacción en dominios comunicacionales como la relación enfermera-paciente, la información recibida o el tiempo empleado; así como los procedimientos utilizados. Análisis descriptivo e inferencial (Test de Ji-cuadrado; p<0,05). Las preguntas abiertas se agruparon en categorías en un proceso de análisis cualitativo que implicó a dos investigadoras independientes. Resultados: Participaron 335 pacientes. Se obtuvo un 76,5% de satisfacción en las respuestas cerradas respecto a los procedimientos utilizados en la sala de curas, sin embargo el 26,1% de los pacientes planteo alguna sugerencia o propuesta de cambio en las respuestas abiertas. Al 89,1% de satisfacción en información recibida en respuestas cerradas, el 16,1% hizo sugerencias de cambio en las respuestas abiertas. En cuanto a la relación enfermera paciente, los resultados fueron: un 94,2% mostraba satisfacción frente a un 7,5% que planteó sugerencias en preguntas abiertas; en referencia al tiempo empleado la satisfacción oscilo del 88,5% al 16,8%. Conclusiones: La mayoría de los pacientes que consultaron con Enfermería en los Centros de Salud mostraron satisfacción con la atención recibida, si bien les gustaría participar más en la toma de decisiones(AU)

Objectives: To measure the satisfaction related to communication and technical aspects of the users of nursing consultation in Primary Care. Material and methods: Descriptive study conducted with patients using the nursing service Health Centers. After consultation with the staff, the patients were interviewed using two types of open and closed questions that assessed their views and satisfaction with some communication domains. Frequency distributions and exploring the differences between the two measures were explored using descriptive and inferential analysis (chi-square test, P <0.05). Open-ended questions were grouped into categories in a process of qualitative analysis involving two researchers independently. Results: 335 patients participated, 76.5% was obtained of the closed-ended satisfaction regarding the procedures used in the treatment room, and however, 26.1% of patients won’t have any suggestions or proposed changes in the open responses. To 89.1% of satisfaction with information received in closed responses, 16.1% made suggestions for change in the open answers. As the nurse patient, the results were 94.2% showed satisfaction, compared to 7.5% which raised suggestions on open questions, and time used the ratio was 88.5% vs. 16.8%. Discussion and Conclusions: Most patients who consult with nurses in health centers showed satisfaction with care received, however they would like to participate more in decision making(AU)

Factores relacionados con el manejo inefectivo del régimen terapéutico en pacientes crónicos de consulta de enfermería / Factors related to Ineffective Handle of Therapeutic Regimen (IHTR) in chronic patients of nursing consultation

Objetivo: Analizar-identificar las causas que producen Manejo Inefectivo del Régimen Terapéutico en pacientes crónicos de consulta de enfermería. Metodología: Estudio descriptivo, cuantitativo y cualitativo. Análisis descriptivo, cuantitativo, cualitativo e inferencial (prueba de la Ji-cuadrado y test ANOVA). En el análisis cualitativo se etiquetaron los resultados en cuatro categorías: Conocimientos y habilidades del usuario. Motivación y dificultades para cuidarse. Apoyo familiar y social. Relación con el equipo sanitario. Resultados: Participaron 25 pacientes en el estudio cuantitativo y 6 en el cualitativo. Presentan una media de 4 patologías, siendo las más prevalentes Diabetes (80%), Obesidad (76%), HTA (68%), EPOC (12%), Cardiopatías y otros procesos (20%). En el análisis de las entrevistas, los mayores problemas fueron: incumplimiento de dieta y ejercicio físico. Al apoyo familiar le conceden un valor importante y ponderan positivamente la relación con el equipo sanitario. Conclusión: el personal sanitario debe asumir la existencia de pacientes no cumplidores, y establecer las medidas necesarias para detectarlos (AU)

Objective: Analyze-identify the underlying causes of IHTR in chronic patients attending nursing consultation. Methods: Descriptive study, quantitatively and qualitatively. Descriptive analysis, quantitatively, qualitatively and analytic statistical as the Chi-square proof and the ANOVA test. In the qualitatively analysis the results were tag in four categories: User Knowledge and Ability. Motivation and difficulties for self-healing. Family and social support. Sanitary Staff relation. Results: 25 patients took part in the quantitatively study, and 6 in the qualitatively one. They show an average of 4 chronic pathologies, being the most prevalent: Diabetes (80%), Obesity (76%), AHT (68%), COPD (12%), Heart Diseases and other processes (20%). In the analysis of the interviews, the biggest problems were the failure of diet and physical exercise. They give a high value to the family support; and they are pleased with the sanitary staff relations. Conclusions: The Sanitary Staff must assume the existence of non-compliant patients, and they must establish the steps to detect it (AU)

Preferencias, satisfacción y grado de participación de los pacientes en la toma de decisiones en las consultas de enfermería de los centros de salud / Preferences, satisfaction level of patient participation in making decisions in health centre nursing clinics

Objetivos. Valorar las preferencias, la satisfacción y el grado de participación de los pacientes en el proceso de toma de decisiones con las enfermeras de los centros de salud. Método. Se diseñó un estudio observacional descriptivo con un enfoque metodológico mixto cualicuantitativo, realizado con pacientes que utilizaron los servicios de enfermería de nueve centros de salud de Andalucía. Tras ser atendidos, los pacientes fueron entrevistados, recogiéndose sus opiniones y satisfacción con el proceso de implicación en la toma de decisiones. Se llevó a cabo un análisis estadístico descriptivo, y para comprobar la existencia de diferencias entre las respuestas a las preguntas cerradas y las abiertas agrupadas del cuestionario, se utilizo el test de la χ2 (p<0,05). Análisis cualitativo: las preguntas abiertas fueron agrupadas en categorías en un proceso que involucró a tres investigadores independientemente. Resultados. Participaron 237 pacientes. Un 59% (138) prefiere un rol colaborativo con la enfermera a la hora de tomar decisiones. Un 96,2% (228) de los usuarios encuestados declararon estar satisfechos o muy satisfechos con el proceso de toma de decisiones en la consulta de enfermería; sin embargo, el 17,4% (41) hizo sugerencias para mejorarlo. Para los pacientes las principales áreas de mejora estaban relacionadas con habilidades comunicativas para ayudar a decidir, consensuar o realizar consejos. Conclusiones. Los profesionales de enfermería deberían tener en cuenta que más de la mitad de sus pacientes desean participar en las decisiones a adoptar en la consulta con su enfermera y que en la práctica esta participación puede ser mejorada incorporando habilidades comunicativas específicas. Las encuestas que incorporan preguntas abiertas permiten detectar de una manera mas precisa los problemas de la atención prestada (AU)

Aims. To assess patient preferences their satisfaction level and their participation in decision making with nurses. Methods. Cross-sectional and mixed quantitative-qualitative study carried out in people attending the nursing services of 9 Health Centres in Andalusia. Patients were interviewed immediately after receiving nursing treatment using two different questionnaires for assessing their opinions, satisfaction and perception of involvement in the decisional process. A descriptive analysis using the χ2 test (P<.05) was performed to assess the differences among close-ended and open-ended questions. Qualitative analysis: Open-ended questions were grouped into categories by a process involving three researchers independently. Results. A total of 235 patients took part, of whom 59% (138) preferred a collaborative role with the nurse when making decisions. In the closed questions, 96.2% (228) of the surveyed patients declared to be satisfied or very satisfied with the decision making process; nevertheless 17.4% (41) made specific suggestions for improving this process. For them the main improvement areas were related to: general communication skills or a more specific one such as: strategies for helping them make decisions, reaching common ground or giving advice. Conclusions. Nurses should be aware that most patients wish to be involved in decision making and in clinical practice this participation can be improved by obtaining specific communicational skills. Surveys that include open-ended questions are more useful to assess the quality of care (AU)

[Preferences, satisfaction level of patient participation in making decisions in health centre nursing clinics]. / Preferencias, satisfacción y grado de participación de los pacientes en la toma de decisiones en las consultas de enfermería de los centros de salud.

AIMS: To assess patient preferences their satisfaction level and their participation in decision making with nurses. METHODS: Cross-sectional and mixed quantitative-qualitative study carried out in people attending the nursing services of 9 Health Centres in Andalusia. Patients were interviewed immediately after receiving nursing treatment using two different questionnaires for assessing their opinions, satisfaction and perception of involvement in the decisional process. A descriptive analysis using the χ(2) test (P<.05) was performed to assess the differences among close-ended and open-ended questions. Qualitative analysis: Open-ended questions were grouped into categories by a process involving three researchers independently. RESULTS: A total of 235 patients took part, of whom 59% (138) preferred a collaborative role with the nurse when making decisions. In the closed questions, 96.2% (228) of the surveyed patients declared to be satisfied or very satisfied with the decision making process; nevertheless 17.4% (41) made specific suggestions for improving this process. For them the main improvement areas were related to: general communication skills or a more specific one such as: strategies for helping them make decisions, reaching common ground or giving advice. CONCLUSIONS: Nurses should be aware that most patients wish to be involved in decision making and in clinical practice this participation can be improved by obtaining specific communicational skills. Surveys that include open-ended questions are more useful to assess the quality of care.