Patient Information and Informed Consent for Research in the Elderly: Lessons Learned from a Randomized Controlled Trial.

The informed consent (IC) of subjects participating in experimental studies is the mainstay to comply with the ethical principle of autonomy to ensure that the participation is voluntary. This experience was performed within the context of a single-center randomized clinical trial in elective prosthetic surgery. Obtaining IC in clinical trials is not without difficulties, and especially in the case of vulnerable populations it can be very challenging. This work aimed to identify the difficulties during the IC process for a clinical trial in subjects older than 65 years old and quantify and describe the use of IC in front of a witness. METHODS: This is a mixed methodology study with a qualitative part (focus group with 4 nurses involved in the inclusion of subjects) and a quantitative part describing the characteristics of patients who signed IC forms. RESULTS: The main difficulties identified are related to comprehension, sensory impairments, education level, and time. IC in front of witnesses was used in 20 patients out of 508. CONCLUSIONS: The participation of subjects older than 65 years old in clinical trials requires an adaptation of the process. The use of IC in front of a witness should always be considered in studies including elderly subjects.

Cribado nutricional en pacientes quirúrgicos en un hospital universitario / Nutritional screening in surgical patients at a university hospital

Objetivo: conocer la prevalencia de riesgo de desnutrición de los pacientes quirúrgicos hospitalizados de un hospital de tercer nivel. Método: estudio descriptivo transversal unicéntrico con pacientes quirúrgicos hospitalizados. Se realizó un cálculo de tamaño muestral de 323 pacientes y se reclutaron por conveniencia. Se analizó el riesgo de desnutrición con la escala Nutrition Risk Screening 2002 y su asociación con diferentes variables sociodemográficas y clínicas. Para el análisis de datos se aplicaron las pruebas de Chi cuadrado, prueba exacta de Fisher, t de Student y U de Mann Whitney con una significancia estadística de p< 0,05. Resultados: participaron 318 pacientes, de los cuales el 74,8% era hombre, con una edad media de 62,2 años (DE: 15,54). En el cribado inicial, 80 participantes (25,2%) presentaron riesgo potencial de desnutrición mientras que tras el screening final, solo 12 presentaron riesgo de desnutrición real (3,8%). No se halló relación entre la desnutrición y el sexo aunque sí con la edad, aumentando el riesgo proporcionalmente (p< 0,001). Otros factores asociados fueron la necesidad de un cuidador/a (p= 0,001), el tipo de patología de ingreso (p= 0,034) y tener antecedentes personales oncológicos (p< 0,001) y de deterioro cognitivo (p= 0,001). Conclusiones: la prevalencia de desnutrición en pacientes quirúrgicos hospitalizados es baja y parece que aumenta con la edad, y con antecedentes personales de deterioro cognitivo y enfermedad neoplásica, aunque los resultados deben ser interpretados con cautela. Identificar la presencia de desnutrición al ingreso favorece el fomento de medidas de prevención que permitan implementar un plan nutricional y facilitar el seguimiento tras el alta.(AU)

Objectives: to understand the prevalence of the risk of malnutrition among hospitalized surgical patients in a tertiary hospital. Method: a descriptive cross-sectional single-centre study with hospitalized surgical patients. The sample size was calculated at 323 patients, and there was convenience recruitment. The malnutrition risk was analysed with the Nutrition Risk Screening 2002 scale, and its association with different sociodemographic and clinical variables. The Chi Square, Fisher’s Exact, Student’s t and Mann-Whitney tests were applied for data analysis, with a statistical significance of p< 0.05. Results: the study included 318 patients; 74.8% of them were male, with a mean age of 62.2 years (SD: 15.54). At the initial screening, 80 participants (25.2%) presented potential risk of malnutrition; while after the final screening, only 12 presented a real risk of malnutrition (3.8%). No relationship was found between malnutrition and gender, but it was found with age, with a proportional increase in risk (p< 0.001). Other factors associated were the need for a caregiver (p= 0.001), the type of condition at admission (p= 0.034) and having a personal background of neoplasia (p< 0.001) and cognitive deterioration (p= 0.001). Conclusions: there is a low prevalence of malnutrition among hospitalized surgical patients, and it seems to increase with age and with a personal history of cognitive deterioration and neoplasia, although these results must be interpreted with caution. The detection of malnutrition at admission will promote taking prevention measures, therefore allowing to implement a nutritional plan and facilitating follow-up after discharge.(AU)

Comprehensive geriatric assessment among elderly people in a convalescence unit: a best practice implementation project.

AIM: The aim of this project was to audit the usual assessment practices employed when admitting patients to a convalescence unit on the outskirts of Barcelona, Spain. The project implemented strategies to improve evidence-based practice using the Joanna Briggs Institute methodology. The specific objectives of this project were (1) to improve completion of the comprehensive geriatric assessment (CGA) record, (2) to improve professionals' CGA knowledge, (3) to promote interdisciplinary work, (4) to improve tailored therapeutic plan generation by implementing evidence-based practice criteria within the instrument, and (5) to evaluate the records and action plans derived from the CGA. METHODS: Pre-/post-implementation audit methodology was used the Practical Application of Clinical Evidence System and Getting Research into Practice, and was developed in multiple phases. The implementation phase took 6 months. A sample of 34 consecutive admissions had their CGA patient records evaluated. Descriptive statistics were calculated. RESULTS: A total of 64 records (34 pre/30 post) were reviewed to assess CGA completion. The baseline audit results showed that only two audit criteria were higher than 50%, indicating poor knowledge about the concept of CGA and poor compliance with the current program. Following the implementation of the strategies, which included education and the development of a checklist, there was an improvement in all the criteria audited: the record was correctly completed in 67% of cases, and 80% of team members were knowledgeable and competent in CGA. CONCLUSION: Several barriers were identified at baseline, and various strategies were implemented to improve CGA compliance. The results show that the project increased awareness of the importance of a comprehensive assessment of the care that patients receive, resulting in better CGA completion.

Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study.

AIM OF STUDY: The main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. RESULTS: High baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. CONCLUSIONS: SARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.

Barreras para la utilización de la investigación en la práctica clínica: opinión de las enfermeras de un hospital universitario / Barriers for the use of research in clinical practice: the opinion by nurses in a University Hospital

OBJETIVO: identificar las principales barreras percibidas para la utilización de la investigación en la práctica clínica por parte de las enfermeras. MÉTODO: se realizó un estudio descriptivo transversal mediante la administración del cuestionario de "Barreras para la utilización de la investigación enfermera" en profesionales de Enfermería que estaban trabajando en el Consorci Corporació Parc Taulí de Sabadell (Barcelona) en mayo-septiembre de 2017. El muestreo fue no probabilístico accidental. La distribución de este cuestionario autoadministrado se efectuó vía online. Se llevó a cabo análisis univariante y bivariante. Se consideró que había diferencias estadísticamente significativas si la p< 0,05. RESULTADOS: participaron 276 profesionales de Enfermería. 244 (88,4%) mujeres. La media (DE) de experiencia laboral fue de 18,7 años (10,4) y de 11,32 años (8) de experiencia en el servicio en el que trabajaban en el momento del estudio. Un 46,7% recibió formación pregrado en investigación y un 70,3% postgrado. Las participantes consideran que la investigación es una actividad necesaria (88,8%) que contribuye al desarrollo de la profesión (98,9%), aunque opinan que requiere una gran inversión de tiempo y esfuerzo (94,9%) para poder llevarla a cabo. Las tres barreras identificadas con mayor puntuación fueron "los artículos/informes de investigación se publican con mucha demora" con una media (DE) de 3,03 (0,89), "los médicos no colaboran en la implementación" con una media (DE) de 2,99 (0,90) y "no hay tiempo suficiente en el trabajo para implementar nuevas ideas" con una media (DE) de 2,98 (1,03). CONCLUSIÓN: las principales barreras identificadas en este estudio por parte de los profesionales de Enfermería que han participado han sido falta de tiempo, falta de conocimientos en metodología investigadora y la percepción de falta de apoyo institucional

OBJECTIVE: to identify the main barriers perceived for the use of research in clinical practice by nurses. METHOD: a descriptive cross-sectional study, conducted through the administration of the Questionnaire on Barriers for the Use of Nursing Research by Nursing professionals, which was prepared by the Consorci Corporació Parc Taulí of Sabadell (Barcelona) during May-September, 2017. There was non-probabilistic accidental sampling. This self-administered questionnaire was distributed online. Univariate and bivariate analyses were conducted. It was considered that there were statistically significant differences if p < 0.05. RESULTS: the study included 276 Nursing professionals; 244 (88.4%) were women. Their mean (SD) work experience was 18.7 years (10.4) and 11.32 years (8) of experience at the Hospital Unit where they worked at the time of the study. Of them, 46.7% had received undergraduate training in research, and 70.3% postgraduate. The participants considered that research is a necessary activity (88.8%) which contributes to the development of the profession (98.9%); although they reckon that it requires a major investment in time and effort (94.9%). The three barriers identified with the highest scores were: "research articles / reports are published with delay" with a mean (SD) 3.03 (0.89), "there is no collaboration by physicians in their implementation" with a mean (SD) 2.99 (0.90) and "there is not enough time at work to implement new ideas" with a mean (SD) 2.98 (1.03). CONCLUSION: the main barriers identified in this study by Nursing professionals who have participated are: lack of time, lack of knowledge regarding research methodology, and the perceived lack of support by the institutions

Investigación en enfermería: análisis de actitud y motivación en un centro universitario regional / Nursing research: analysis of attitude and motivation in a regional university center

OBJETIVO: Conocer la producción, motivación y consumo de investigación entre las enfermeras de nuestros centros asistenciales. MATERIAL Y MÉTODO: Se realiza un estudio descriptivo transversal mediante la administración del cuestionario de Actitud y Motivación de Enfermería hacia la Investigación. RESULTADOS: Un total de 276 enfermeras participaron en el estudio, la mayoría mujeres, con 18,7 años de experiencia laboral media, 45 % con carga familiar alta o muy alta y formación profesional variada en cuanto a postgrados, máster y especialidades. Un 46,7 % recibió formación pre-grado en investigación y un 70,3 %, postgrado. Las participantes consideran que la investigación es una actividad necesaria (88,8 %) que contribuye al desarrollo de la profesión (98,9 %), aunque opinan que requiere una gran inversión de tiempo y esfuerzo (94,9 %) para poder llevarla a cabo. Se muestran los resultados en las distintas dimensiones del cuestionario. CONCLUSIÓN: Se pone de manifiesto que las barreras expresadas por las profesionales pueden ser convertidas en un incentivo positivo en la motivación profesional que nos permita la difusión, crecimiento y facilitación de la investigación enfermera, aplicando estrategias de favorecimiento relacionadas con las necesidades expresadas por las enfermeras que han participado en el estudio

OBJECTIVE: We have to know the production, motivation and consumption of research between the nurses of our healthcare centers. MATERIAL AND METHOD: We have realized a cross-sectional descriptive study by administering the Nursing Attitude and Motivation to Research questionnaire. RESULTS: A total of 276 nurses took part in the study, most of them women, with 18.7 years of average work experience, 45 % with high or very high family burden and varied professional training in postgraduate, master's and specialties. 46.7 % received pre-graduate training in research and 70.3 %, postgraduate. The competitors consider that research is a necessary activity (88.8 %) that contributes to the development of the profession (98.9 %), although they believe that it requires a great investment of time and effort (94.9 %) to carry it out. The results are shown in the different dimensions of the questionnaire. CONCLUSION: It is evident that the barriers expressed by the professionals can be converted into a positive incentive in the professional motivation that allows us the diffusion, growth and facilitation of the nursing research, applying strategies of favoring related to the needs expressed by the nurses who have participated in the study

Open-label randomized controlled trial to compare wound dressings for patients undergoing hip and knee arthroplasty: study protocol for a randomized controlled trial.

BACKGROUND: Surgical wounds are covered to prevent bleeding, absorb the exudates, and provide a barrier against external contamination. Currently, in our hospital, after orthopedic surgery, traditional occlusive dressing of sterile gauze and non-woven hypoallergenic adhesive tape is placed. Some of the newest dressings have been shown to reduce the incidence of blisters compared with traditional dressing or colloid adhesive dressings. However, there are no comparative evaluations between the different types of dressings and their contribution to the overall results of the healing process. METHODS/DESIGN: This is a randomized, controlled, open-label trial to compare five types of dressings used in total knee and hip arthroplasty surgical wounds. A total of 550 patients will be randomly allocated to one of the following dressings: (1) traditional occlusive dressing, (2) Aquacel Surgical®, (3) Mepilex® Border Post-Op, (4) OpSite Post-Op Visible, or (5) UrgoTul® Absorb Border. The dressing assigned is placed right after surgery. Patients will be followed up to 14 days after surgery when the dressing is definitively removed and will be tracked up to 3 months to record any late complications. During the immediate postoperative period and patient hospitalization and at the ambulatory visits after discharge, every time that the dressing is changed, nurses perform the study assessments. The main study outcome will be the percentage of patients with skin integrity at all times when the dressing has been changed. Skin integrity is a composite of the absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates. Secondary outcomes include time to first change of dressing; percentage of patients with presence/absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates; number of dressing changes needed; days of hospital stay; and nurse and patient satisfaction. Differences in the main variable between each treatment group and group 1 will be tested by means of a chi-squared test or Fisher's exact test. Subgroup analyses of diabetic and non-diabetic patients, patients with a body mass index of more than 30 or not more than 30, and type of surgery (hip or knee) are planned. DISCUSSION: The results of this study will be useful for clinical decision making by giving information on the contribution of the dressings studied to the outcome of the wound and may also show which dressing offers better results depending on the characteristics of patients. TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov ( NCT03190447 ). Retrospectively registered on 16 June 2017.