A Digital Tool for Measuring Healing of Chronic Wounds Treated with an Antioxidant Dressing: A Case Series.

(1) Abstract: Wound monitoring is an essential aspect in the evaluation of wound healing. This can be carried out with the multidimensional tool HELCOS, which develops a quantitative analysis and graphic representation of wound healing evolution via imaging. It compares the area and tissues present in the wound bed. This instrument is used for chronic wounds in which the healing process is altered. This article describes the potential use of this tool to improve the monitoring and follow-up of wounds and presents a case series of various chronic wounds with diverse etiology treated with an antioxidant dressing. (2) Methods: A secondary analysis of data from a case series of wounds treated with an antioxidant dressing and monitored with the HELCOS tool. (3) Results: The HELCOS tool is useful for measuring changes in the wound area and identifying wound bed tissues. In the six cases described in this article, the tool was able to monitor the healing of the wounds treated with the antioxidant dressing. (4) Conclusions: the monitoring of wound healing with this multidimensional HELCOS tool offers new possibilities to facilitate treatment decisions by healthcare professionals.

Drone Applications for Emergency and Urgent Care: A Systematic Review.

INTRODUCTION: In recent years, the use of drones in health emergencies has increased. Among their main benefits are avoiding endangering rescuers, travelling long distances in a short time, or contacting victims in risky situations; but despite their multiple advantages, their use has not been fully demonstrated. STUDY OBJECTIVE: This study aims to identify the available evidence on the use of drones in emergency health care compared to traditional health care. METHODS: Systematic review of the literature was conducted. Search protocols were developed to locate studies that met the established selection criteria. Six experimental or quasi-experimental studies with high methodological quality published from the beginning of indexing until 2020 were included. RESULTS: Drones covered a significantly larger area than other traditional tracking methods and were very useful for performing preliminary triage, determining needs, and knowing the scene prior to the arrival of rescuers. In addition, drones reduced the time required to locate the victim. CONCLUSIONS: Drones are an element to be taken into account when attending health emergencies as they significantly improve the distance travelled to locate accident victims, have the possibility of performing triage prior to the arrival of the health care units, and improve the time and quality of the care provided.

The Role of Antioxidants on Wound Healing: A Review of the Current Evidence.

(1) Background: Reactive oxygen species (ROS) play a crucial role in the preparation of the normal wound healing response. Therefore, a correct balance between low or high levels of ROS is essential. Antioxidant dressings that regulate this balance are a target for new therapies. The purpose of this review is to identify the compounds with antioxidant properties that have been tested for wound healing and to summarize the available evidence on their effects. (2) Methods: A literature search was conducted and included any study that evaluated the effects or mechanisms of antioxidants in the healing process (in vitro, animal models or human studies). (3) Results: Seven compounds with antioxidant activity were identified (Curcumin, N-acetyl cysteine, Chitosan, Gallic Acid, Edaravone, Crocin, Safranal and Quercetin) and 46 studies reporting the effects on the healing process of these antioxidants compounds were included. (4) Conclusions: this review offers a map of the research on some of the antioxidant compounds with potential for use as wound therapies and basic research on redox balance and oxidative stress in the healing process. Curcumin, NAC, quercetin and chitosan are the antioxidant compounds that shown some initial evidence of efficacy, but more research in human is needed.

Actitud hacia la prevención de lesiones por presión en estudiantes de enfermería: cuestionario APuP / Attitude towards pressure injury prevention in nursing students: the APuP questionnaire

OBJETIVOS: Conocer la actitud hacia la prevención de las lesiones por presión que tienen los estudiantes y las estudiantes del Grado en Enfermería. Objetivos secundarios: a) realizar la valoración psicométrica de la versión española del cuestionario Attitudes towards Pressure ulcer Prevention (APuP) (Actitudes hacia la prevención de las UPP) en población de estudiantes y b) identificar los factores formativos asociados con la actitud. MÉTODOS: Estudio observacional transversal, llevado a cabo en la Universidad de Jaén mediante un cuestionario online en estudiantes de los 4 cursos del Grado en Enfermería. Se utilizó el análisis de Rasch para establecer las propiedades psicométricas del cuestionario. Se calculó la puntuación de actitud y su asociación con variables formativas. Para estimar el tamaño del efecto se usó la diferencia estandarizada de medias (d de Cohen). RESULTADOS: Se analizaron un total de 188 cuestionarios válidos. La puntuación media obtenida en el cuestionario APuP fue 22,60 (44,23% del máximo). El cuestionario presenta una buena consistencia global (α = 0,74) y los índices de ajuste de los ítems fueron buenos. Se encontró una actitud menos positiva en estudiantes que habían realizado prácticas clínicas (p < 0,0001) y los de los cursos superiores (p < 0,0001). Existe una correlación inversa entre la puntuación de actitud y la puntuación de conocimientos (r = -0,46). CONCLUSIONES: El cuestionario APuP (versión española) es un instrumento válido y fiable para su uso en estudiantes de enfermería. La actitud hacia la prevención no es positiva en estos estudiantes y se evidencia un posible efecto de la realización de prácticas clínicas y el aumento de conocimientos en una actitud menos favorable

OBJECTIVES: To explore the attitude towards pressure injury prevention of nursing students. Secondary objectives: a) To establish the psychometric properties of the questionnaire of Attitudes towards the prevention of pressure ulcer (APuP) -Spanish version- in student population, and b) To identify the educational factors associated with the attitude. METHODS: A cross-sectional observational and validation study was carried out with students of the four years of the Bachelor in Nursing in the University of Jaén (Spain) using an online survey. Rasch analysis was used to establish the psychometric properties of the questionnaire. Also, the score of attitude and its association with educational variables were analysed. The standardised median difference (Cohen's d) was used to estimate the effect size. RESULTS: A total of 188 valid questionnaires were analysed. The average score obtained in the APuP questionnaire was 22.60 (44.23% of the maximum). The questionnaire has a good overall internal consistency (α=0.74) and the item fit indices were good. It was found a less positive attitude in students who had done clinical placements (p < 0.0001) and those in higher years (p < 0.0001). There is an inverse correlation between the attitude score and the knowledge score (r= -0.46). CONCLUSIONS: The questionnaire of attitudes towards prevention of pressure ulcers (APuP) Spanish version is a valid and reliable instrument to use in nursing students. The attitude towards prevention is not positive in these students and there is some evidence for a possible effect of clinical placements and increased knowledge over a less favourable attitude

Validación del cuestionario de Conocimientos sobre prevención de lesiones por presión en estudiantes de Enfermería: análisis Rasch / Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis

OBJETIVO: Medir el conocimiento de los estudiantes de enfermería de la Universidad de Jaén hacia las pautas basadas en la evidencia para la prevención de las lesiones por presión. MÉTODO: Estudio observacional transversal de validación de un cuestionario utilizando un formulario online con estudiantes de enfermería de la Universidad de Jaén. Se invitó a participar a todos los matriculados en los 4 cursos. Se evaluaron las propiedades psicométricas del cuestionario «Conocimientos sobre prevención de lesiones por presión» (PIPK) mediante un análisis de Rasch. Se calcularon porcentajes de respuestas correctas y errores para cada ítem, puntuación total y su asociación con variables formativas. RESULTADOS: El cuestionario PIPK mostró adecuadas características psicométricas (alfa=0,89) y buen ajuste del modelo de Rasch. La puntuación media de conocimientos fue de 21,0 (67,7% del máximo). Obtuvieron mayores puntuaciones aquellos estudiantes que habían realizado prácticas clínicas, más periodos de prácticas, habían asistido a jornadas específicas sobre lesiones por presión o estaban matriculados en cursos superiores. CONCLUSIONES: El cuestionario PIPK es un instrumento válido y fiable para medir los conocimientos de los estudiantes de enfermería hacia la prevención de lesiones por presión. Los estudiantes de enfermería de la Universidad de Jaén obtuvieron una puntuación de conocimientos hacia la prevención de las lesiones por presión superior al 50%

OBJECTIVE: The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD: A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS: The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS: The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%

Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis. / Validación del cuestionario de Conocimientos sobre prevención de lesiones por presión en estudiantes de Enfermería: análisis Rasch.

OBJECTIVE: The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD: A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS: The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS: The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%.

Development and validation of the Pressure Injury Prevention Barriers questionnaire in hospital nurses in Spain.

OBJECTIVE: To develop and validate a new questionnaire to measure the nurses' perceptions of the barriers towards the prevention of pressure injuries (PIs) at hospitals. DESIGN: Validation study with mixed methods. SETTING: Four university hospitals in southern Spain. PARTICIPANTS: The questionnaire was developed based on a literature review. A panel of 14 wound care experts rated the content validity. A sample of 438 nurses (registered nurses and assistant nurses) participated in the survey. MAIN OUTCOME MEASURES: The psychometric properties of the Pressure Injury Prevention Barriers (PIPB) questionnaire evaluated were: content validity, internal consistency reliability and construct validity. RESULTS: The final version of the questionnaire has 25 items grouped into four factors (management and organisation, motivation and priority, knowledge, and staff and collaboration). The confirmatory factor analysis showed good fit and error indices for the model (Comparative Fit Index=0.92, root mean square error of approximation=0.074). Cronbach's alpha was 0.90 (overall), and 0.89 (factor 1), 0.75 (factor 2), 0.72 (factor 3) and 0.45 (factor 4). Construct validity was good, demonstrated by the expected association with the scores on patient safety culture and on considering PIs as an adverse effect of hospital stay, but not with attitude score. CONCLUSION: The PIPB questionnaire is an instrument useful for measuring nurses' perceptions of the barriers to PIs prevention. The initial evidence shows that the questionnaire has good content validity, internal consistency and adequate construct validity. Relevance and comprehensiveness need to be assessed in further studies. It can be used both in research and in the evaluation of clinical settings to implementation of PIs preventive programmes in hospitals.

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument.

The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach's alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.

Antioxidant dressing therapy versus standard wound care in chronic wounds (the REOX study): study protocol for a randomized controlled trial.

BACKGROUND: A wound that does not heal in the orderly stages of the healing process or does not heal within 3 months is considered a chronic wound. Wound healing is impaired when the wound remains in the inflammatory stage for too long. A range of factors can delay the healing process: imbalance between proteases and protease inhibitors in the wound bed; bacterial colonization and the presence of biofilm; and oxidative stress. Recently, wound management has improved significantly. A new antioxidant dressing has been developed, which combines an absorbent matrix obtained from locust bean gum galactomannan and a hydration solution with curcumin and N-acetylcysteine. This dressing combines the advantages of moist healing in exudate management and free radical neutralization, achieving wound reactivation. The primary aim of this study is to compare the effect of the antioxidant dressing on chronic wound healing against the use of a standard wound dressing in patients with hard-to-heal wounds. METHODS: We will conduct a multicentre, single-blind, randomized controlled trial with parallel groups. Participants will be selected from three primary public health care centres located in Andalucía (southern Spain). Patients will be randomized into an intervention group (antioxidant dressing) or a control group (standard wound dressing). Assessments will be carried out at weeks 2, 4, 6 and 8. Follow-up will be for a period of 8 weeks or until complete healing if this occurs earlier. DISCUSSION: The findings from this study should provide scientific evidence on the efficacy of the antioxidant dressing as an alternative for the treatment of chronic wounds. This study fills some of the gaps in the existing knowledge about patients with hard-to-heal wounds. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03934671. Registered on 2 May 2019.

Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses.

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.

Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

OBJECTIVES: The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates. INTRODUCTION: Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events. METHODS: A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria. RESULTS: The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline. CONCLUSIONS: The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.