Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project.

OBJECTIVES: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward. INTRODUCTION: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief. METHODS: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit. RESULTS: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced. CONCLUSIONS: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

Delirium risk screening and assessment among older patients in general wards and the emergency department: a best practice implementation project.

OBJECTIVES: The aim of this project was to improve compliance with evidence-based criteria regarding risk of delirium and the assessment of delirium among older patients in the general hospitalization wards and the emergency department. INTRODUCTION: More than 50% of older hospitalized patients experience delirium. Some studies have highlighted the need to implement an orientation protocol in the emergency department and to continue this in the general wards, with the aim of decreasing the delirium rate among older patients admitted to hospital. METHODS: The project followed the JBI evidence implementation framework. We conducted a baseline audit, a half-way audit, and final audit of 50 patients at risk of delirium admitted to the emergency department and the general wards, respectively. The audits measured compliance with eight criteria informed by the available evidence. RESULTS: In the final audit, three of the eight criteria achieved more than 50% compliance in the general wards: pressure injury screening (96%); monitoring changes (74%); and performing interventions (76%). In the emergency department, worse results were reported because of the service conditions. The exception was the criterion on the training of nurses on the topic, with 98%. The integration of a tool to screen for delirium in older patients in the hospital's electronic clinical history records increased the percentage of compliance with audit criteria regarding the use of the scale and delirium detection (rising from 0% to 32% in the final audit in the general wards). CONCLUSION: Through the implementation of this project, validated and evidence-based evaluation will ensure that nurses are supported through appropriate measures to reduce patient confusion and aggression resulting from delirium.

Lenalidomide and dexamethasone maintenance with or without ixazomib, tailored by residual disease status in myeloma.

From November 2014 to May 2017, 332 patients homogeneously treated with bortezomib, lenalidomide, and dexamethasone (VRD) induction, autologous stem cell transplant, and VRD consolidation were randomly assigned to receive maintenance therapy with lenalidomide and dexamethasone (RD; 161 patients) vs RD plus ixazomib (IRD; 171 patients). RD consisted of lenalidomide 15 mg/d from days 1 to 21 plus dexamethasone 20 mg/d on days 1 to 4 and 9 to 12 at 4-week intervals, whereas in the IRD arm, oral ixazomib at a dose of 4 mg on days 1, 8, and 15 was added. Therapy for patients with negative measurable residual disease (MRD) after 24 cycles was discontinued, whereas those who tested positive for MRD remained on maintenance with RD for 36 more cycles. After a median follow-up of 69 months from the initiation of maintenance, the progression-free survival (PFS) was similar in both arms, with a 6-year PFS rate of 61.3% and 55.6% for RD and IRD, respectively (hazard ratio, 1.136; 95% confidence interval, 0.809-1.603). After 2 years of maintenance, treatment was discontinued in 163 patients with negative MRD, whereas 63 patients with positive MRD continued with RD therapy. Maintenance discontinuation in patients tested negative for MRD resulted in a low progression rate (17.2% at 4 years), even in patients with high-risk features. In summary, our results show the efficacy of RD maintenance and support the safety of maintenance therapy discontinuation in patients with negative MRD at 2 years. This trial was registered at www.clinicaltrials.gov as #NCT02406144 and at EudraCT as 2014-00055410.

Definition and Clinical Significance of the Monoclonal Gammopathy of Undetermined Significance-Like Phenotype in Patients With Monoclonal Gammopathies.

PURPOSE: The existence of patients with multiple myeloma (MM) and light-chain (AL) amyloidosis who present with a monoclonal gammopathy of undetermined significance (MGUS)-like phenotype has been hypothesized, but methods to identify this subgroup are not standardized and its clinical significance is not properly validated. PATIENTS AND METHODS: An algorithm to identify patients having MGUS-like phenotype was developed on the basis of the percentages of total bone marrow (BM) plasma cells (PC) and of clonal PC within the BM PC compartment, determined at diagnosis using flow cytometry in 548 patients with MGUS and 2,011 patients with active MM. The clinical significance of the algorithm was tested and validated in 488 patients with smoldering MM, 3,870 patients with active MM and 211 patients with AL amyloidosis. RESULTS: Patients with smoldering MM with MGUS-like phenotype showed significantly lower rates of disease progression (4.5% and 0% at 2 years in two independent series). There were no statistically significant differences in time to progression between treatment versus observation in these patients. In active newly diagnosed MM, MGUS-like phenotype retained independent prognostic value in multivariate analyses of progression-free survival (PFS; hazard ratio [HR], 0.49; P = .001) and overall survival (OS; HR, 0.56; P = .039), together with International Staging System, lactate dehydrogenase, cytogenetic risk, transplant eligibility, and complete remission status. Transplant-eligible patients with active MM with MGUS-like phenotype showed PFS and OS rates at 5 years of 79% and 96%, respectively. In this subgroup, there were no differences in PFS and OS according to complete remission and measurable residual disease status. Application of the algorithm in two independent series of patients with AL predicted for different survival. CONCLUSION: We developed an open-access algorithm for the identification of MGUS-like patients with distinct clinical outcomes. This phenotypic classification could become part of the diagnostic workup of MM and AL amyloidosis.

Radon Dynamics and Effective Dose Estimation in a Touristic Volcanic Cave: La Cueva del Viento, Tenerife (Canary Islands, Spain).

La Cueva del Viento is a volcanic lava tube located in Tenerife Island (Canary Islands, Spain). Its touristic section, 180 m long, receives more than 28,200 visitants each year. According to the European and Spanish legislation, a radon monitoring program is required to minimize the radon exposition of workers, tourists, and cavers. In this work, we studied the radon concentration dynamics in the touristic section of the cave for ca. 1 year, using both passive and active radon detectors. Pluviometry and external air temperature played an important role in the seasonal and daily variations of indoor radon concentrations. Daily fluctuations during the dry season were analyzed using time series (Box-Jenkins methodology) and frequency analysis (Fourier and Wavelet transforms) methods. The experimental radon time-series was well-fitted using a seasonal autoregressive integrated moving average model: Seasonal Auto-Regressive Integrated Moving Average (2,0,1) (2,1,0)24, and its value, in a short-time window (ca. 1 week) was conveniently forecasted. Finally, this work revealed that the annual effective doses received, during the observation period (1 year), by the touristic guides and visitors was ca. 2 mSv/yr and 4 µSv/hr, respectively. We concluded that the touristic exploitation of La Cueva del Viento is safe for both tourists and guides. However, based on our results, La Cueva del Viento had to be classified as a "Monitoring zone" and a regular monitoring program should be implemented.

Prognostic Value of Serum Paraprotein Response Kinetics in Patients With Newly Diagnosed Multiple Myeloma.

INTRODUCTION: Response kinetics is a well-established prognostic marker in acute lymphoblastic leukemia. The situation is not clear in multiple myeloma (MM) despite having a biomarker for response monitoring (monoclonal component [MC]). MATERIALS AND METHODS: We developed a mathematical model to assess the prognostic value of serum MC response kinetics during 6 induction cycles, in 373 NDMM transplanted patients treated in the GEM2012Menos65 clinical trial. The model calculated a "resistance" parameter that reflects the stagnation in the response after an initial descent. RESULTS: Two patient subgroups were defined based on low and high resistance, that respectively captured sensitive and refractory kinetics, with progression-free survival (PFS) at 5 years of 72% and 59% (HR 0.64, 95% CI 0.44-0.93; P = .02). Resistance significantly correlated with depth of response measured after consolidation (80.9% CR and 68.4% minimal residual disease negativity in patients with sensitive vs. 31% and 20% in those with refractory kinetics). Furthermore, it modulated the impact of reaching CR after consolidation; thus, within CR patients those with refractory kinetics had significantly shorter PFS than those with sensitive kinetics (median 54 months vs. NR; P = .02). Minimal residual disease negativity abrogated this effect. Our study also questions the benefit of rapid responders compared to late responders (5-year PFS 59.7% vs. 76.5%, respectively [P < .002]). Of note, 85% of patients considered as late responders were classified as having sensitive kinetics. CONCLUSION: This semi-mechanistic modeling of M-component kinetics could be of great value to identify patients at risk of early treatment failure, who may benefit from early rescue intervention strategies.

[Limited Reuse and Extended Use of Filtering Facepiece Respirators]. / Reutilización limitada y uso extendido de mascarillas de media-alta filtración.

AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like COVID-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: Scoping review. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: The reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model.

Tumor cells in light-chain amyloidosis and myeloma show distinct transcriptional rewiring of normal plasma cell development.

Although light-chain amyloidosis (AL) and multiple myeloma (MM) are characterized by tumor plasma cell (PC) expansion in bone marrow (BM), their clinical presentation differs. Previous attempts to identify unique pathogenic mechanisms behind such differences were unsuccessful, and no studies have investigated the differentiation stage of tumor PCs in patients with AL and MM. We sought to define a transcriptional atlas of normal PC development in secondary lymphoid organs (SLOs), peripheral blood (PB), and BM for comparison with the transcriptional programs (TPs) of tumor PCs in AL, MM, and monoclonal gammopathy of undetermined significance (MGUS). Based on bulk and single-cell RNA sequencing, we observed 13 TPs during transition of normal PCs throughout SLOs, PB, and BM. We further noted the following: CD39 outperforms CD19 to discriminate newborn from long-lived BM-PCs; tumor PCs expressed the most advantageous TPs of normal PC differentiation; AL shares greater similarity to SLO-PCs whereas MM is transcriptionally closer to PB-PCs and newborn BM-PCs; patients with AL and MM enriched in immature TPs had inferior survival; and protein N-linked glycosylation-related TPs are upregulated in AL. Collectively, we provide a novel resource to understand normal PC development and the transcriptional reorganization of AL and other monoclonal gammopathies.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

[Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.] / Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico.

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses´Association of Ontario (RNAO). METODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p<0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado.

Cronoterapia antihipertensiva en pacientes diabéticos tipo 2: grado de implantación en una zona de salud del centro de España / Antihypertensive chronotherapy in type 2 diabetes mellitus: application degree in a community health center in central Spain

No disponible

Techo de cristal y desigualdades de género en la carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas / Glass ceiling and gender inequalities in the careers of women academics in biomedical sciences

OBJETIVO: Identificar, en la literatura científica internacional, los obstáculos y factores potencialmente favorecedores para el avance durante su carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas. MÉTODO: Se realizó una búsqueda sistemática en PubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo y Sociological Abstracts de artículos publicados en inglés y español entre enero de 2006 y diciembre de 2016 sobre el fenómeno del techo de cristal en mujeres académicas e investigadoras en ciencias biomédicas. El cribado se llevó a cabo por revisoras independientes. RESULTADOS: Se encontraron 2254 estudios, de los cuales se incluyeron 23 en la revisión. Los obstáculos identificados para la promoción de las mujeres académicas o investigadoras en ciencias biomédicas son los sesgos de género en la evaluación de la investigación, el individualismo y la falta de colaboración, la falta de influencia de las mujeres, las desigualdades de género en la contratación y la promoción, la percepción de sexismo y discriminación en el clima laboral, y las dificultades de conciliación. Los elementos que favorecen son los ejemplos de mujeres en puestos de liderazgo, la mentorización, facilitar la conciliación, la transparencia en la contratación, la participación en la toma de decisiones, realizar auditorías de género en la evaluación de la investigación, la conciencia de las desigualdades de género, promover la colaboración y la equidad salarial. CONCLUSIONES: Potenciar los elementos que favorecen la promoción de las mujeres académicas en ciencias biomédicas contribuiría a reducir el fenómeno del techo de cristal en esta área, al aumentar su participación, representación y liderazgo. Se requiere un cambio de valores organizacional e institucional

OBJECTIVE: To identify in the international scientific literature the obstacles and potential promoters for the advancement of women academics and researchers in biomedical sciences during their professional careers. METHOD: PubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo and Sociological Abstracts were systematically searched for articles published in English and Spanish between January 2006 and December 2016 on the phenomenon of the glass ceiling in women academics and researchers in biomedical sciences. The screening was carried out by independent reviewers. RESULTS: A total of 2254 studies were found, of which 23 were included in the review. The obstacles identified for the promotion of women academics and/or researchers in biomedical sciences are: gender bias in the evaluation of research results, individualism and lack of collaboration, women's lack of influence, the existence of gender inequalities in access to employment. The perception of sexism and discrimination in the work environment, and the difficulties in reconciling work and family life. The promoting elements are: examples of women in leadership positions, mentoring, facilitating conciliation, transparency in recruitment, participation in decision-making, gender assessment of research, awareness of gender inequalities in institutions, promoting collaboration, and pay equity. CONCLUSIONS: By enhancing the elements favouring the promotion of academic women in biomedical sciences would help to reduce the glass ceiling in the career paths of women academics and health science researchers by increasing their participation, leadership and representation. A change of organizational and institutional values is required to achieve this

Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados / The implementation of Best practice guidelines in Spain through the Programme of the Best Practice Spotlight Organizations

La aplicación de Guías de Buenas Prácticas es efectiva en la mejora de la práctica clínica y en la disminución de la variabilidad clínica. En España se implantan desde 2012 las Guías de Buenas Prácticas de la Asociación de Enfermeras de Ontario a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®, siguiendo los principios del programa canadiense Best Practice Spotlight Organizations® (BPSO®). La Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii) coordina dicho programa en España, tras ser nombrada BPSO Host por la Asociación de Enfermeras de Ontario. Se han seguido 4 estrategias: traducción de las Guías de Buenas Prácticas, difusión de las mismas y del programa, implantación de las GuÍas de Buenas Prácticas y evaluación de los resultados en centros seleccionados de forma competitiva, y, finalmente, desarrollo de mecanismos de sostenibilidad. La implantación se apoya en el modelo teórico Knowledge to Action, que establece un ciclo de 6 fases: identificación del problema y formación a Centros Comprometidos con la Excelencia en Cuidados® seleccionados; adaptación al contexto local; evaluación de los facilitadores y barreras; adaptación e implantación de las intervenciones; monitorización y evaluación de resultados, y sostenibilidad. En cada una de estas fases se incorporan aquellos elementos basados en la evidencia que favorecen la efectividad de la implantación, como son la concurrencia competitiva para ser seleccionado candidato a participar en el programa, la selección por la institución de las guías a implantar, el liderazgo por enfermeras con un enfoque multiprofesional, la planificación del proceso a partir de estructuras de trabajo no verticales, pero con apoyo de la institución, el uso de múltiples estrategias de forma simultánea, la evaluación continuada y la retroalimentación de resultados, todo ello tutorizado y apoyado desde el BPSO Host. Actualmente en España hay 27 instituciones de diferentes características que implantan en total 20 guías clínicas. Recientemente se ha ampliado el alcance y estructura del programa con centros coordinadores BPSO Host regionales, lo que ha ampliado el número de instituciones a 36 y el número de guías clínicas implantadas a 22. El programa ha tenido un impacto positivo a nivel de las organizaciones y el sistema, en los procesos de cuidados y en la salud de los pacientes. Se observa en el enriquecimiento de la práctica profesional basada en la evidencia, el fomento del trabajo colaborativo en red, así como en la mejora en los resultados de salud de los pacientes y en la calidad de los cuidados prestados

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided

Implantación de la valoración y el cuidado de los adultos en riesgo de ideación y comportamiento suicida: una Guía de la Registered Nurses' Association of Ontario (RNAO) / Implementation of the assessment and care of adults at risk for suicidal ideation and behaviour: A guideline of the Registered Nurses' Association of Ontario (RNAO)

OBJETIVO: Conocer la evolución de los cuidados tras la implantación de la Guía de buenas prácticas «Valoración y cuidado de adultos en riesgo de ideación y comportamiento suicida». MÉTODO: Se realizó un estudio descriptivo longitudinal en la Unidad de Hospitalización de Salud Mental del Hospital Universitario Virgen de las Nieves de Granada. Se incluyeron 1.471 pacientes, todos los ingresados entre 2016 y 2018. Se evaluaron el cumplimiento en indicadores del proceso de cuidados y la situación de riesgo suicida, y se obtuvo la tasa de suicidio por 100.000 habitantes. Se calcularon frecuencias absolutas y relativas de los indicadores y su evolución en el tiempo con el test chi-cuadrado de Pearson para p < 0,05. RESULTADOS: Se observó un incremento estadísticamente significativo en todos los procesos. El porcentaje de pacientes con valoración de riesgo suicida aumentó del 16% en 2016 al 45,25% en 2018. La aplicación de medidas de seguridad aumentó hasta el 100% en 2018, y la derivación a otros servicios comunitarios pasó del 70,31% al 90,50%. El porcentaje de pacientes en riesgo de ideación suicida se mantuvo estable. La tasa de suicidios por 100.000 habitantes en la provincia de Granada disminuyó un 24,50%. CONCLUSIONES: La mejora en los procesos de cuidados y la disminución de la tasa de suicidio en Granada desde la implantación son consistentes con los hallazgos de otros estudios y ofrecen una visión esperanzadora. Se deben potenciar las estrategias integrales de prevención y continuar con la evaluación de las iniciativas puestas en marcha

OBJECTIVE: To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour». METHOD: A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS: We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS: Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue

Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados / Implementation of best practice guidelines for ostomy care and management: Care outcomes

INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications

Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España / Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain

OBJETIVO: Identificar elementos favorecedores y barreras de implantación en el Programa de Centros Comprometidos con la Excelencia en Cuidados® que instauran guías de práctica clínica de la Registered Nurse' Association of Ontario, con el fin de que experiencias futuras pudieran beneficiarse de las apreciaciones expuestas. MÉTODO: Estudio de investigación evaluativa del proceso de implantación de guías en instituciones que componen las dos primeras cohortes del programa en España, mediante análisis de contenido de memorias de implantación y proceso inductivo, lectura, interpretación, codificación y categorización según estructura DAFO: debilidades, amenazas, fortalezas y oportunidades. RESULTADOS: Se han analizado memorias e informes de 18 centros de 12 Comunidades Autónomas, entre los cuales implantan 22 guías distintas. Como debilidades, destacan por frecuencia e intensidad, problemas relacionados con sistemas de información y su explotación. Se exponen otros elementos relacionados con difusión de resultados, profesionales, cuidados y factores relativos a la institución. Sobresalen como amenazas, la inestabilidad de plantillas y cambios continuados en la alta dirección o políticas corporativas. Entre las fortalezas, se distinguen la dedicación exclusiva de personal al proyecto y su vinculación a objetivos institucionales. Y por último, se identifica como oportunidades, destacan la posibilidad de comparación estandarizada de resultados propios con ajenos, así como la difusión de resultados. CONCLUSIÓN: Se configura un patrón útil para el abordaje de implantación en otras realidades, donde el cambio en la cultura profesional, su formación, comunicación y liderazgo, así como alinear intereses de gestores y políticos, facilitan unas condiciones ideales para la práctica basada en la evidencia

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice

Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain. / Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España.

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.

Implementation of best practice guidelines for ostomy care and management: Care outcomes. / Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados.

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications.