Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review.

Objectives: To explore nursing health education interventions for non-communicable disease patients. Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD. Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses' interventions included house calls, home care, and individual and group health education. Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of non-communicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020208809.

The Implementation of Nursing Specialties in Spain, 2005-2018: A Documental Study.

Nursing specialization is considered a significant professional requirement to meet the challenges and needs of the health systems under evolving epidemiological patterns and scientific, technological, and social advances. In Spain, experiences in the training of specialist nurses have followed the same pattern and have been consolidated through legislation. This study aimed to analyze the implementation of the Spanish Nursing Specialty process according to the Royal Decree 450/2005. It used the documentary and systematic analysis method: a systematic review of official regulation documents published in the State Official Bulletin of Spain, Spanish legislative and historical nursing inventories, and other nursing-specific literature. This study shows an extensive account of nursing specialties' development process through a rather long period in Spain. It evidences the complexity involved to ensure legislative legality. The study also points to the need for homogeneity within the programs across the national territory and legal definition for specialty practice. This study could be an illustration to stimulate other nurse leaders in the world working in regulation and nursing specialty development to empower nurses' development and enhance the nurse specialists' contribution to archive the needs of the health system and healthcare of the population. HIGHLIGHTS:.

Fiabilidad de una escala para la evaluación de competencias enfermeras: estudio de concordancia / Reliability of a scale for the evaluation of nurses competence: Concordance study

INTRODUCCIÓN: Evaluar las competencias es una cuestión de importancia que ocupa un lugar primordial en el contexto de la educación superior. Para ello, es necesario disponer de instrumentos que reúnan criterios de validez y fiabilidad, y que puedan ser utilizados en escenarios de desempeño, capacidad y actuación profesional. Por esta razón, nos planteamos el siguiente objetivo: determinar la concordancia intra e interobservador de una escala para la evaluación de competencias enfermeras (ECOEnf) en España. MATERIAL Y MÉTODO: Estudio observacional, descriptivo y transversal para evaluar la fiabilidad mediante el análisis de concordancia intra e interobservadores de la escala «ECOEnf». Se utilizó la prueba no paramétrica Tau-b de Kendall para establecer la correlación, aplicada a la misma población, en el mismo tiempo, por 2observadores diferentes. RESULTADO: La concordancia intraobservador se obtuvo una excelente consistencia interna (r = 0,98). Respecto a la concordancia entre observadores se mostraron escasos ítems con una correlación menor de 0,5; sin embargo, todos los ítems cumplen con una buena fiabilidad, estadísticamente significativa, p valor < 0,05. CONCLUSIÓN: En general, al realizar la correlación entre los resultados de la herramienta medido 2veces por diferentes observadores en el mismo momento se encontró estadísticamente una buena concordancia, por lo cual se considera un instrumento fiable para ser utilizado en la evaluación de las competencias enfermeras en España

INTRODUCTION: Competences assessment is an important issue, playing a key role in higher education. It is necessary to have an evaluation instrument that meet validity and reliability criteria and can be used in different clinical scenarios for professional performance measurement. For this reason, we set ourselves the following objective: Establishing the intra- and inter-observer concordance of a scale for the evaluation of nursing competencies (ECOEnf) in Spain. MATERIAL AND METHOD: An observational, descriptive, cross-sectional study was conducted to evaluate the reliability of the "ECOEnf" scale using intra- and inter-observer analysis. Kendall's Tau-b non-parametric test was used for establishing correlation, applied to the same population, at the same time, by 2different observers. RESULTS: Intra-observer concordance was obtained an excellent degree of internal consistency (r=0.98), Regarding inter-observer concordance, few items had a correlation lower than 0.5. However, all items display a sound statistically significant reliability with a p-value <0.05. CONCLUSION: In general, when establishing the correlation between the results of the instrument measured twice by different observers at the same time, was found a statistically good concordance. For this reason, it is regarded as a reliable instrument to be used in the evaluation of nursing competencies

Diseño y validación de un nuevo registro clínico de enfermería, para la continuidad de los cuidados y seguridad del paciente en hemodiálisis / Design and validation of a new nursing clinical registry for the continuity of care and patient safety in hemodialysis

Introducción: Diseñar y Validar una herramienta para la mejora del proceso de atención en enfermería en una unidad de hemodiálisis de un hospital de segundo nivel. Material y Método: Se desarrolló un estudio de mejora de la calidad de la atención, en el Hospital General Regional nº 1 "Vicente Guerrero" en Guerrero, (México), entre mayo-agosto de 2017. Se modificó la hoja de registros clínicos de enfermería de la unidad de hemodiálisis en dos etapas. Para la etapa de diseño se realizó un grupo focal con expertos y para la validación de contenido se aplicó el método Delphi. Los datos recolectados se procesaron y analizaron en el programa estadístico SPSS V.22. Resultados: El 70% de los expertos consideró el instrumento como bueno en cuanto a la calidad del registro. Hubo una discrepancia en el diseño encontrándose como parcialmente eficiente (70%) ya que cada experto evaluó de acuerdo al área que dominaba. Se incorporaron todas las observaciones realizadas en el diseño final. Conclusión: El instrumento se considera válido, proporcionando información adecuada del paciente previo al tratamiento hemodialítico, lo cual satisface los requerimientos legales respecto a la continuidad de los cuidados

Objective: To design and validate a tool for improving nursing care process in a hemodialysis unit of a secondary level hospital. Material and Method: A quality improvement study was developed at Regional General Hospital N°1 Vicente Guerrero in Guerrero, Mexico, between may-august 2017. Hemodialysis nurse clinical record sheet was modified in two stages. For the design stage, a focus group with experts was carried out and for content validation, Delphi method was applied. The collected data were processed and analyzed with statistics program SPSS V.22. Results: 70% of experts considered the instrument as good in terms of quality of the record. There was a discrepancy in the design, considered partially efficient (70%), since each expert evaluated according the area that dominated. All the observations made were included in the final design. Conclusion: The instrument is valid, giving the right information about the patient prior to hemodialysis, satisfying legal requirements regarding the continuity of care

Factores asociados al desarrollo de eventos adversos en pacientes con hemodiálisis en Guerrero, México / Factors associated with the development of adverse events in hemodialysis patients in Guerrero, Mexico

Objetivo: Determinar los eventos adversos más prevalentes y los factores asociados a su desarrollo en el paciente que se somete a hemodiálisis en el estado de Guerrero, México. Material y Método: Estudio observacional, longitudinal, retrospectivo en 157 pacientes en hemodiálisis afiliados al Instituto Mexicano del Seguro Social en Guerrero, atendidos en 5 unidades privadas y 2 públicas. Se recolectaron variables socio-demográficas, mediciones de laboratorio, evolución de la enfermedad, complicaciones propias de la enfermedad y del tratamiento dialítico. Resultados: Los eventos adversos se presentaron en el 73% de la población estudiada, la principal causa etiológica fue Diabetes mellitus tipo 2 (DM2) e hipertensión arterial. Los eventos adversos más frecuentes fueron: hipotensión (35,5%) infección de angioacceso (24%), cefalea (22,3%), crisis hipertensiva (14,5%), mareos (9,9%), escalofríos (9,9%), y trombosis de fístula arteriovenosa (9,9%). Los factores que se asociaron a su desarrollo fueron: pacientes mayores de 65 años, (OR=6,859IC 95%;1,55-30,35), ser obeso, (OR=1,70, IC95%:1,60-4,81), e hipoalbuminemia (OR=0,251, IC 95%: 0,160-0,593). Conclusión: Los pacientes mayores de 65 años, obesos, con hipertensión diastólica e hipoalbuminemia tienen mayor probabilidad de desarrollar eventos adversos durante el periodo de hemodiálisis

Objective: To determine the most prevalent adverse events and the risk factors associated in the patient undergoing hemodialysis in the state of Guerrero, Mexico. Material and Method: Observational, longitudinal, retrospective study in 157 hemodialysis patients affiliated to the Mexican Institute of Social Security in Guerrero, assisted in 5 private and 2 public units. Socio-demographic variables, laboratory measurements, evolution of the disease, complications of the disease and dialysis treatment were collected. Results: Adverse events occurred in 73% of the studied population, the main etiological cause was Diabetes mellitus type 2 (DM2) and arterial hypertension. The most frequent adverse events were: hypotension (35.5%) angioaccess infection (24.0%), headache (22.3%), hypertensive crisis (14.5%), dizziness (9.9%), chills (9.9%), and thrombosis of arteriovenous fistula (9.9%). The associated risk factors: patients over 65, (OR=6.859, 95% CI:1.55-30.35) being obese, (OR=1.70, 95% CI: 1.60-4.81), and hypoalbuminemia (OR=0.251, 95% CI:0.160-0.593). Conclusion: Patients over 65, obese, with diastolic hypertension and hypoalbuminemia are more likely to develop adverse events during the hemodialysis

Foot biomechanics in patients with diabetes mellitus: doubts regarding the relationship between neuropathy, foot motion, and deformities.

BACKGROUND: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. METHODS: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. RESULTS: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). CONCLUSIONS: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors.

Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot.

OBJECTIVE: To compare the diagnostic characteristics of tests used for a prompt diagnosis of chronic osteomyelitis in the diabetic foot, using bone histology as the criterion standard. The tests assessed were probe-to-bone (PTB), clinical signs of infection, radiography signs of osteomyelitis, and ulcer specimen culture. RESEARCH DESIGN AND METHODS: A prospective study was performed on patients with foot ulcers referred to our diabetic foot clinic. Ulcer infection was diagnosed by recording clinical signs of infection and taking specimens for culture. The presumptive diagnosis of osteomyelitis was based on these results and the findings of a plain X-ray and PTB test. All patients with a clinical suspicion of bone infection were subjected to surgical treatment of the affected bone. During surgery, bone specimens were obtained for a histological diagnosis of osteomyelitis. RESULTS: Over 2.5 years, 210 foot lesions were consecutively examined and 132 of these wounds with clinical suspicion of infection selected as the study sample. Of these, 105 (79.5%) lesions were diagnosed as osteomyelitis. Among the tests compared, the best results were yielded by the PTB test including an efficiency of 94%, sensitivity of 98%, specificity of 78%, positive predictive value of 95%, and negative predictive value of 91% (P < 0.001, κ 0.803); the positive likelihood ratio was 4.41, and the negative likelihood ratio was 0.02 (95% CI). CONCLUSIONS: In our outpatient population with a high prevalence of osteomyelitis, the PTB test was of greatest diagnostic value, especially for neuropathic ulcers, and proved to be efficient for detecting osteomyelitis in the diabetic foot.