A Randomized Clinical Trial on the Use of Antiseptic Solutions for the Pin-Site Care of External Fixators: Chlorhexidine-Alcohol Versus Povidone-Iodine.

Pin-site infections remain a common clinical complication in patients with external fixators. Pin-site care is commonly performed with either chlorhexidine-alcohol solution or povidone-iodine solution. This study aimed to investigate the superiority of chlorhexidine-alcohol solution versus povidone-iodine solution for external fixator pin-site care in pin-site infection. This prospective randomized clinical trial using an open, parallel-group design was conducted in a single Spanish hospital. Eligible consenting patients from November 2018 to May 2019 who underwent placement of an external fixator were included. Patients were randomly assigned to receive pin-site care using either a 2% chlorhexidine-alcohol solution or a 10% povidone-iodine solution. The primary endpoint was the development of a pin-site infection. In total, 568 pins were analyzed (128 patients, with a mean of 4.3 pins per patient). No significant differences were found between groups. However, statistically significant differences were found regarding time and infection variables. The longer the person had the fixator, the higher the risk of infection, t(x) = 5.49, p = .002. Both chlorhexidine-alcohol and povidone-iodine solutions are equally effective antiseptic agents for the prevention of infections in external fixators.

Variables to Predict Mortality in Hip Fractures in Patients Over 65 Years of Age: A Study on the Role of Anticoagulation as a Risk Factor.

The objective of this research was to study the possible relationship between the consumption of dicoumarinic agents (understanding the consumption of acenocoumarol as regulated and monitored anticoagulation) and the mortality rate in people older than 65 years undergoing a hip fracture (HF) intervention. It was a retrospective, observational and descriptive study. Nine hundred fifty-seven patients were included who underwent an intervention for HF between the years 2012 and 2014 in a third-level hospital. Patients took acenocoumarol (16.1%), which compared with nonanticoagulated patients took longer in receiving intervention, they remained hospitalized for more days, and they presented greater mortality within the first year after the intervention. Likewise, those who presented greater risk according to the classification system used by the American Society of Anesthesiologists (ASA) to estimate the risk of anesthesia for the different states of the patients who were anticoagulated also suffered greater mortality. The next factors increased the mortality in the first year: advanced age, delayed surgery, male sex, need for transfusion, high international normalized ratio, consumption of acenocoumarol, and a high ASA risk. We concluded the consumption of acenocoumarol increased the risk of mortality within the first year after surgery in 1.3 of possible cases. Other risk factors that also independently increased the risk of mortality included advanced age, male sex, delayed surgery, the need for transfusions, and surgical risk (for high levels in the ASA classification).

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia.

BACKGROUND: Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. OBJECTIVE: To validate the Spanish translation of the ICECAP-O's capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. METHOD: Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). RESULTS: The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). CONCLUSIONS: This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.

Prevalencia de úlceras por presión en pacientes sometidos a artrodesis de columna / Prevalence of pressure ulcers in patients undergoing an arthrodesis spine

Objetivos: Identificar la incidencia de úlceras por presión (UPP) en el quirófano en pacientes sometidos a artrodesis de columna realizadas en el intervalo de 2 años. Material y métodos: Diseño descriptivo, trasversal retrospectivo. Revisión de historias clínicas. Resultados: Se valoraron 269 pacientes, 52% mujeres, de una media de edad de 58,7 años. Las posiciones más frecuentes fueron decúbito supino y decúbito prono (34% ambas). La prevalencia de UPP fue del 14%, con un 51,4% de grado II, y la localización más frecuente fue tórax y frente. La mayor frecuencia de aparición fue a partir de las 4 horas de intervención, pero no hallamos relaciones significativas entre la aparición de úlceras por presión y otras variables. Conclusiones: Es necesario llevar a cabo estudios de intervención para prevenir UPP en el área quirúrgica, debido a que existe poca bibliografía al respecto. Por otro lado, la alta incidencia hallada nos hace plantearnos la necesidad de aumentar las medidas preventivas por parte de enfermería

Objectives: Identify the incidence of pressure ulcers (PU) in surgery in patients undergoing spinal fusion performed in the range of 2 years. Material and methods: Descriptive, transversal and retrospective design. Review of medical histories. Results: 269 patients were evaluated, 52% were women and the average age of 58.7 years. The most frequent were supine and prone positions (34% both). PU prevalence was 14%, with 51.4% grade II, the most frequent location was chest and forehead. The highest frequency of occurrence was from 4 hours intervention, but we have not significant relationships between pressure ulcers and other variables. Conclusions: It is necessary to carry out intervention studies to prevent PU in the surgical area, because there is little literature. On the other hand the high incidence found begs the need to increase preventive measures by nurses

El cuidado centrado en la persona con demencia en la prevención de la agitación y otros síntomas neuropsiquiátricos en ancianos institucionalizados / Person-centred dementia care for prevention of agitation and other neuropsychiatric symptoms in institutionalized elderly people

OBJETIVO: examinar si el cuidado centrado en la persona con demencia (CCPD) es más eficaz que la educación brindada por el equipo de Enfermería sobre la demencia en la reducción de la agitación y otros síntomas neuropsiquiátricos, así como en la mejora de la calidad de la vida de ancianos con demencia institucionalizados. MÉTODO: ensayo controlado aleatorizado realizado en seis residencias de cuatro ciudades españolas. Muestra: 150 personas en el grupo experimental (GE) y 150 en el grupo control (GC). Intervención en GE: CCPD con modelo de práctica VIPS. Variables de resultado: cambio en la escala de agitación de Cohen, en el cuestionario neuropsiquiátrico (NPI), en la escala de Cornell para la depresión en la demencia (CSDD) y en la escala de calidad de vida QUALID. Se realizaron modelos de regresión lineal múltiple de efectos mixtos. RESULTADOS: se realizó el seguimiento a 109 sujetos en el GE y 122en el GC. En lo que respecta a la diferencia de puntuaciones entre la situación basal y la final, en el GE se produjeron cambios estadísticamente significativos en el NPI agitación (-0,5; p= 0,05) y en la calidad de vida (1,6; p= 0,02). Relativo a los cambios entre la situación basal y final, ajustados por edad, sexo, estado de salud y grado de demencia, se produjo una reducción estadísticamente significativa (p< 0,05) en NPI (-2,4) y escala de depresión de Cornell (-2,6).CONCLUSIONES: la intervención CCPD ha mostrado eficacia en la reducción y prevención de la agitación y otros síntomas neuropsiquiátricos en los pacientes con demencia institucionalizados. Aún así, es preciso seguir investigando sobre el tema, especialmente en el impacto en la calidad de vida de los pacientes y en la depresión

OBJECTIVE: to examine if person-centred dementia care (PCDC) is more effective than the education on dementia provided by the Nursing team in terms of the reduction of agitation and other neuropsychiatric symptoms, as well as in the improvement of quality of life for institutionalized elderly people with dementia. METHOD: a randomized controlled clinical trial conducted in six retirement homes in four Spanish cities. Sample: 150 persons in the Experimental Group (EG), and 150 in the control group (CG).Intervention in the EG: PCDC with the VIPS practice model. Outcome variables: change in Cohen's agitation scale, in the neuropsychiatric questionnaire (NPI), in Cornell's scale for depression in dementia (CSDD) and in the QUALID quality of life scale. Multiple linear mixed effects regression models were conducted. RESULTS: follow-up was conducted on 109 subjects in the EG and122 in the CG. Regarding the difference in scores between basal and final situation, there were statistically significant changes in the agitation NPI (-0.5; p= 0.05) and in quality of life (1.6; p= 0.02).Regarding changes between basal and final situation, adjusted by age, gender, health condition and degree of dementia, there was a statistically significant reduction (p< 0.05) in NPI (-2.4) and Cornell's Depression Scale (-2.6).CONCLUSIONS: the PCDC intervention has shown efficacy in the reduction and prevention of agitation and other neuropsychiatric symptoms in institutionalized patients with dementia. Even so, it is necessary to conduct more research on this matter, particularly in terms of its impact on the quality of life of patients and on depression

The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain.

AIM: Determine the incidence of dysphagia, identify its consequences and objectify related complications and mortality associated with pneumonia, in the institutionalized elderly. METHODS: A prospective observational and multicenter study with a 3-year follow-up period was designed in a cohort of 12 nursing homes within 6 cities in Spain. A total of 2384 patient records were studied. Demographic and clinical data (dementia, cerebrovascular disease), as well as an evaluation of the Barthel Index, dysphagia and aspiration, and mortality at 30 days and 1 year after pneumonia in patients with dysphagia were collected. RESULTS: Of the 2384 patients, 69.6% presented clinical signs of oropharyngeal dysphagia. Patients with dysphagia were older and showed lower functional status and higher prevalence of comorbidities. They had higher mortality as well. CONCLUSIONS: Oropharyngeal dysphagia is a highly prevalent clinical finding in elderly institutionalized patients. Among this population, there is also a higher prevalence of pneumonia, dementia, and cerebrovascular disease and pneumonia is an indicator of mortality.

Emotional processing in patients with mild cognitive impairment: the influence of the valence and intensity of emotional stimuli: the valence and intensity of emotional stimuli influence emotional processing in patients with mild cognitive impairment.

UNLABELLED: We studied the ability of individuals with mild cognitive impairment (MCI) to process emotional facial expressions (EFEs). To date, no systematic study has addressed how variation in intensity affects recognition of the different type of EFEs in such subjects. DESIGN: Two groups of 50 elderly subjects, 50 healthy individuals and 50 with MCI, completed a task that involved identifying 180 EFEs prepared using virtual models. Two features of the EFEs were contemplated, their valence (operationalized in six basic emotions) and five levels of intensity. RESULTS: At all levels of intensity, elderly individuals with MCI were significantly worse at identifying each EFE than healthy subjects. Some emotions were easier to identify than others, with happiness proving to be the easiest to identify and disgust the hardest, and intensity influenced the identification of the EFEs (the stronger the intensity, the greater the number of correct identifications). Overall, elderly individuals with MCI had a poorer capacity to process EFEs, suggesting that cognitive ability modulates the processing of emotions, where features of such stimuli also seem to play a prominent role (e.g., valence and intensity). Thus, the neurological substrates involved in emotional processing appear to be affected by MCI.