[Fatigue, quality of life, and use of healthcare resources in children with complex chronic diseases].

BACKGROUND: The objective was to assess fatigue in children with complex chronic diseases (CCCDs) and analyze its relationship with clinical and sociodemographic characteristics, use of healthcare services, and quality of life (QoL). METHODS: Cross-sectional study carried out in CCCDs attended in a tertiary hospital during 2016. Fatigue (PedsFacit-F questionnaire) and quality of life (PedsQL) were determined, and the following variables were registered: use of health resources, disease group, time with disease, and educational level and type of employment of the parents. A multiple regression model was developed to predict the use of healthcare resources. RESULTS: Seventy children were included in this study; mean age 10.5 years (range: 8-17), 41.4% girls, and cancer was the most frequent group disease (28.6%). Annual use of healthcare resources (38.86; SD: 30.73) increased with fatigue (r=-0.292; p=0.015). Higher levels of fatigue were determined for children with cancer (24.9; SD: 10.7) in comparison to other pathologies, while lower levels were found for heart diseases (44.5; SD: 7.9). The QoL perceived by CCCDs (20.6; SD: 16.5) directly correlated (p<0.001) with that of their parents (22.8; SD: 16.8); a correlation with fatigue was seen in both cases (r=0.528 and r= 0.441; p<0.0001). The adjusted effect of higher levels of fatigue (lower scores), lower length of disease duration, and higher level of education of the mother, predicted greater use of healthcare resources. CONCLUSION: CCCDs with higher fatigue levels use healthcare resources more often and perceive a worse QoL. This should be considered when providing care to this population.

Fatiga, calidad de vida y utilización de recursos sanitarios en niñoscon enfermedades crónicas complejas / Fatigue, quality of life and health resource utilisation in children with complex chronic diseases

Fundamento: Nuestro objetivo fue determinar la fatiga en niños con enfermedades crónicas complejas (NECC) y analizar su asociación con características clínicas, sociodemográficas, utilización de servicios de salud y calidad de vida. Material y método: Estudio transversal realizado en NECC atendidos en un hospital terciario durante 2016. Se determinaron la fatiga (cuestionario PedsFacit-F) y la calidad de vida (cuestionario PedsQL), y se recogieron las variables uso de recursos sanitarios, grupo de enfermedad, tiempo con la enfermedad, y nivel de estudios y ocupación profesional de los progenitores. Se elaboró un modelo de regresión múltiple para predecir el uso de recursos. Resultados: Se incluyeron 70 niños, edad media 10,5 años (rango: 8-17), 41,4% niñas; la enfermedad oncológica fue la más frecuente (28,6%). El uso anual de recursos sanitarios (38,86; DE: 30,73) aumentó con la fatiga (r=-0,292; p=0,015). Las enfermedades oncológicas causaron más fatiga (24,9; DE: 10,7) que otras patologías y las cardiológicas menos (44,5; DE: 7,9). La calidad de vida percibida por NECC (20,6; DE: 16,5) correlacionó directa y significativamente (p<0,001) con la de sus progenitores (22,8; DE: 16,8); ambas se correlacionaron con la fatiga (r=0,528 y r=0,441; p<0,0001). El modelo de regresión lineal mostró que el efecto ajustado de mayor fatiga (menor puntuación), menor tiempo con la enfermedad y mayor nivel de estudios de la madre predijeron mayor uso de recursos de salud. Conclusión: Los NECC con mayor fatiga hacen mayor uso de los recursos sanitarios, y perciben una peor calidad de vida, aspectos que deberían tenerse en cuenta a la hora de prestar atención a esta población.(AU)

Background: The objective was to assess fatigue in children with complex chronic diseases (CCCDs) and analyze its relationship with clinical and sociodemographic characteristics, use of health care services, and quality of life (QoL). Methods.: Cross-sectional study carried out in CCCDs attended in atertiary hospital during 2016. Fatigue (PedsFacit-F questionnaire) and quality of life (PedsQL) were determined, and the following variables were registered: use of health resources, disease group, time with disease, and educational level and type of employment of the parents. A multiple regression model was developed to predict the use of healthcare resources. Results: Seventy children were included in this study; mean age 10.5 years (range: 8-17), 41.4% girls, and cancer was the most frequent group disease (28.6%). Annual use of healthcare resources (38.86; SD: 30.73) increased with fatigue (r= -0.292; p= 0.015). High-er levels of fatigue were determined for children with cancer (24.9; SD: 10.7) in comparison to other pathologies, while lower levels were found for heart diseases (44.5; SD: 7.9). The QoL perceived by CCCDs (20.6; SD: 16.5) directly correlated (p <0.001) with that of their parents (22.8; SD: 16.8); a correlation with fatigue was seen in both cases (r= 0.528 and r= 0.441; p <0.0001). The adjusted effect of higher levels of fatigue (lower scores), lower length of diseaseduration, and higher level of education of the mother, predicted greater use of healthcare resources. Conclusion: CCCDs with higher fatigue levels use healthcare resources more often and perceive a worse QoL. This should be con-sidered when providing care to this population.(AU)

[Modal analysis of failures and effects in intra-hospital transfers]. / Análisis modal de fallos y efectos en las transferencias intrahospitalarias.

OBJECTIVES: To identify gaps in patient safety during intra-hospital transfers. MATERIAL AND METHODS: A working group was set up and patient transfers carried out in the different healthcare areas of a hospital were identified. Using the Modal Failure and Effects Analysis (FMEA), the risks of each failure mode identified were quantified using the Risk Prioritisation Index (RPI) and establishing improvement measures for all RPIs with scores greater than 100. RESULTS: There were 31 critical points that could lead to failures / deficiencies in 20 types of transfers. A total of 35 safety improvement measures were proposed for the transfers in the different areas analysed. CONCLUSIONS: The use of FMEA has made it possible to objectify the risks for patient safety during internal hospital transfers by providing information to prioritise improvement strategies.

[Consequences of errors in the translation of questionnaires: Spanish version of Downton index]. / Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton.

UNLABELLED: The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. MATERIAL AND METHODS: A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients' risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. RESULTS: Application of the original version of the index reduced the number of patients classified as "high risk" of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as "high risk" of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). CONCLUSIONS: The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients.