Longitudinal assessment of the eating pattern of people with dementia and its association with problems for feeding and malnutrition: a prospective follow-up study protocol.

INTRODUCTION: Dementia conditions the patient's nutrition from the beginning and vice versa. Generating difficulties for feeding (FEDIF) will influence its evolution. There are currently few nutritional longitudinal studies in people with dementia. Most focus on problems already established. The Edinburgh Feeding Evaluation in Dementia (EdFED) Scale identifies FEDIF of patients with dementia by studying their behaviours while eating or being fed. It also indicates areas of potential clinical interventions. METHODS AND ANALYSIS: Prospective multicentre observational study carried out in nursing homes, Alzheimer's day care centres and primary healthcare centres. The study population will be dyads composed by the patient (diagnosed of dementia, over 65 years of age and who have feeding difficulties) and their family caregiver. Sociodemographic variables and nutritional status (body mass index, Mini Nutritional Assessment, blood test and calf and arm circumference) will be assessed. The Spanish version of the EdFED Scale will be completed and the presence of nursing diagnoses related to feeding behaviours will be collected. Follow-up will take place for 18 months. ETHICS AND DISSEMINATION: All data will be carried out respecting European legislation 2016/679 in data protection, and the Spanish 'Organic Law 3/2018 of December 2005'. The clinical data will be kept segregated and encrypted. The informed consent has been obtained. The research has been authorised by the Costa del Sol Health Care District on 27 February 2020 and the Ethics Committee on 2 March 2021. It has obtained funding from the Junta de Andalucía on 15 February 2021. Findings of the study will be presented at provincial, national and international conferences and published in peer-reviewed journals.

Predictors of health service use by family caregivers of persons with multimorbidity.

BACKGROUND: Informal caregivers of patients with multiple chronic conditions are socially good, promoting the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services. This study analyses the use of health services by informal carers, comparing it with the use made by the general population with similar characteristics. METHODOLOGY: Cross-sectional analytical study carried out in the Malaga-Valle Guadalhorce Primary Health Care District (Spain). Healthcare demand and perceived health were measured in the family caregivers, compared to the general population. Strobe Statement for observational studies has been used to strength the report of the results. RESULTS: Final sample consisted of 314 family caregivers together with a subsample of 2.290 non-caregivers taken from data of the National Health Survey. This subsample was paired by gender with our sample. Formal caregivers make fewer annual visits to the health services, with respect to the general population, regardless of the perceived level of health. The difference of the means between those who perceive their health as very poor was 0.11 (95% CI: 0.01 to 0.20) consultations with the family doctor, 0.21 (95% CI: 0.15 to 0.26) consultations with medical specialists and 1.70 (95% CI: 1.52 to 1.87) emergency room attention. Three independent factors were identified that predispose to the increased use of health services: background of greater education achievement (OR 8.13, 95% CI: 1.30 to 50.68), non-cohabitation with the care recipient (OR 3.57, 95% CI: 1.16 to 11.11) and a more positive physical quality of life component (OR 1.06; 95% CI: 1.03 to 1.09). DISCUSSION AND IMPLICATIONS: Intrinsic components of the caregiver reveal their independent relationship with the provision of informal care and the use of health services. A broader vision is needed for the factors that influence the health of these caregivers to develop multipurpose interventions and improve the consistency and effectiveness of the health services offered to the caregiver.

Nursing students' perceptions on the use of clinical simulation in psychiatric and mental health nursing by means of objective structured clinical examination (OSCE).

BACKGROUND: In view of the rising incidence and prevalence of mental disorders, and the stigma often attached to persons with these pathologies, the question of specific, appropriate training for nursing students is one of great importance. Objective structured clinical examination (OSCE) and clinical simulation may provide a useful means of introducing the student to this environment. OBJECTIVES: To examine the perceptions and satisfaction of nursing students after their participation in a targeted mental health course in which the main specialist skills were acquired via clinical simulation. DESIGN: A quantitative, descriptive, transversal study was conducted, in which the participants in a mental health course completed a questionnaire on their satisfaction with the experience. PARTICIPANTS: The study population consisted of 141 nursing students enrolled in a mental health course and currently in the third year of their Nursing Degree studies at the University of Málaga (Spain). RESULTS: The overall satisfaction expressed was more than 8 out of 10 (mean score = 8.43, SD = 1.25) and the students' satisfaction with specific aspects of the procedure exceeded 4 out of 5. The study results show that these nursing students considered the methodology in question to be useful preparation for clinical practice (mean score = 4.78, SD = 0.45), that they appreciated the participation of an expert (mean score = 4.72, SD = 0.60) and that receiving the opinions of their peers about their performance was an enriching part of the experience (mean score = 4.54, SD = 0.64). CONCLUSIONS: The participants reported a high degree of satisfaction with the OSCE procedure and observed that this method should be implemented more frequently. Debriefing is viewed as a vital contribution to the learning process and to the participants' satisfaction. However, further research is needed to study the impact of stress and anxiety on the acquisition of skills via OSCEs.

Tissue temperature, flux and oxygen of sacral and trochanteric area under pressure of healthy subjects: A quasi-experimental study.

AIM: To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h. METHODS: Quasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements. RESULTS: The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant. CONCLUSION: Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.

Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol.

AIM: To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour. DESIGN: Cluster randomized controlled clinical trial. METHODS: This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014. DISCUSSION: The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population. IMPACT: The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.

Adverse events encountered during clinical placements by undergraduate nursing students in Spain.

BACKGROUND: During clinical placements, nursing students are exposed to adverse events generated by the clinical tasks they must perform. OBJECTIVES: To describe the profile of adverse events encountered and the risks facing nursing students in clinical practice, as well as the severity and incidence of these events. DESIGN: Observational retrospective longitudinal study. SETTING: Clinical placements of undergraduate nursing students from the University of Málaga, in hospitals and primary health care. PARTICIPANTS: A total of 4284 undergraduate nursing students, enrolled during seven consecutive years (2011-2018). METHODS: Study data were obtained from students' notifications of adverse events during their clinical placements. The form for making this notification is available online, in the virtual campus for the practicum and notification is mandatory. RESULTS: A total of 1638 reports of adverse events were made during the study period. The adverse events most commonly reported were clinical accidents, followed by sharp and needle-stick injuries, and medication errors. By clinical settings, adverse events occurring in critical care were most frequently reported (35.9%). By the severity of the event, the largest proportion (32.4%) were classified as serious. By the risk of recurrence, 49.8% of the events reported were classified as accidents that "could happen again at some time". In this respect, there were significant differences among the respondents, with fourth-year students reporting up to four times more events of this type than second and third-year students (p < 0.001). CONCLUSIONS: Nursing students are subject to clinical safety-related events during their practices, mostly concerning medication errors and sharps and needlestick injuries. The pattern of these events changes over time, as students evolve in their competences. To improve clinical safety competencies among student nurses, priority attention should be paid to medication management, dose calculations and reactions to situations of aggression and violence in healthcare settings.

Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study).

AIM: To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact® ) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health-related quality of life, level of pain, and time to complete healing. DESIGN: Open randomized controlled trial, with blinded endpoint. METHODS: Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound-related variables (area, exudate, and time to healing), level of pain, adverse effects, and health-related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA-typing technique through polymerase chain reaction to obtain the level of colony-forming units. Measures will be collected at baseline, 4, 8, and 12 weeks. DISCUSSION: Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced. IMPACT: Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.

Quality of Life and Health Services Utilization for Spanish Children With Cerebral Palsy.

PURPOSE: To examine the health-related quality of life of children with cerebral palsy and its relationship with their use of health resources, taking into account sociodemographic factors concerning the family context. DESIGN AND METHODS: Cross-sectional study of children with cerebral palsy in Granada (Spain). Quality of life was evaluated with PedsQL questionnaire. RESULTS: A total of 75 children were analysed (mean age 7.41 years; SD 4.37; 50.7% male). They made an average of 22.80 visits (SD 12.43) per year; greater use was made of resources by children who had been diagnosed with cerebral palsy for <45 months (36.00 vs. 26.93 visits per year, p < 0.0001). Older children suffered more fatigue and pain. Children aged 2-4 years who presented with fatigue had more hospitalizations (r = -0.35; p = 0.20), whereas those >4 years who had a higher quality of life for daily activities had made more visits to hospital A&E (r = 0.35, p = 0.043). Among the children studied, there was no significant association between HRQOL and the parents' education or occupation. CONCLUSION: These findings highlight variables that may influence children's quality of life and their use of health resources, identifying certain profiles of children who might need individualized interventions. PRACTICE IMPLICATIONS: These findings could inform services provided by paediatric nurses to children with cerebral palsy, to individualize interventions and improve patient centred care.

Attitudes Toward Organ Donation: Differences Between Medical and Nursing Andalusian Students.

INTRODUCTION: A favorable attitude toward organ donation and transplantation (ODT) is fundamental among health professionals at the time of transplant promotion. In this sense, the training and awareness of professionals are fundamental. OBJECTIVE: To analyze the differences in the attitude toward ODT and the factors that condition it among Andalusian medical and nursing students. METHODS AND DESIGN: The study is a sociologic, multicenter, observational study. The population includes medical and nursing students in Andalusian universities. Database of the Collaborative International Donor Project is used and data are stratified by geographic area and academic course. The instrument of measurement was a validated questionnaire (PCID-DTO-RIOS) that was handed out to every student in a compulsory session. Completion of the questionnaire was anonymous and self-administered. The sample included Andalusian medical and nursing students (99% confidence and precision of ±1%) stratified by geographic area and year of study. RESULTS: There was a completion rate of 91%; 79% (n = 2879) of Andalusian students were in favor of donation and 21% were not in favor. The attitude toward ODT is more favorable in medical compared with nursing students (80% vs 77%; P = .021). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): knowing a transplant patient, having received information about the subject, attitude toward family donation, and having discussed transplantation with family and friends. CONCLUSION: Andalusian medical students favored organ donation more than Andalusian nursing students, and the favorable attitude is associated with having an awareness of the subject.

Impact of self-care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta-analysis.

AIMS AND OBJECTIVES: To evaluate the effectiveness of self-care programmes in type 2 diabetes mellitus (T2DM) population in primary health care. BACKGROUND: The impact of educational interventions on T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care. DESIGN: Systematic review and meta-analysis. METHODS: A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005-December 2017, including studies with at least one face-to-face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta-analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. PROSPERO registration Number: CRD42016038833. RESULTS: In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA1 c, the overall reduction obtained was -0.29%, decreasing the effect in long-term follow-up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent. CONCLUSIONS: Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high-quality trials. RELEVANCE TO CLINICAL PRACTICE: Most of self-care programmes for T2DM in primary care are focused on metabolic control, while other cardiovascular profile variables with greater impact on mortality or patient-reported outcomes are less intensely addressed.

Perfusion, tissue oxygenation and peripheral temperature in the skin of heels of healthy participants exposed to pressure: a quasi-experimental study.

AIM: To evaluate the relationship between the pressure exerted on the heel of one foot resting directly on a mattress, versus that exerted on the other heel, protected by a pillow beneath the Achilles tendon area and the changes thus produced in perfusion, oxygenation and temperature in the skin of heels of healthy volunteers lying in a supine position. DESIGN: Experimental study in a pre-clinical phase, with healthy volunteer participants and intrapeople control. METHODS: The study was carried out from November 2017 - May 2018. A pressure measurement surface was placed between the participant and the constant low-pressure support surface. Doppler laser devices were used to measure local temperature and perfusion. The degree of oxygenation was determined using an infrared beam close to the pressure zone in each heel. Both feet rested immobile on the bed, in a natural position, for 2 hr. To ensure intrapeople control, in every case the left heel was raised slightly, compared with the right. RESULTS: Eighteen participants took part in this study. Analysis of the results obtained showed that capillary blood flow was significantly reduced in the heel subjected to pressure, compared with the other heel, while no significant effects on oxygen saturation or temperature were observed. The variables associated with greater oxygen saturation were capillary blood flow, local temperature and pressure exerted. Fat-free mass, fat mass and duration of exposure to pressure were all significantly associated with reduced oxygen saturation. CONCLUSIONS: In healthy participants, when the heel is subjected to constant pressure against a constant low-pressure support surface, there is a significant reduction in blood flow, compared with the heel where pressure is relieved. However, there are no significant differences in temperature or tissue oxygenation. IMPACT: Significant reductions in vascular flow were observed; however, the oxygenation and temperature of the heel tissues remained unchanged. These findings, corroborated in real patients, would advance our understanding and facilitate decision-making on measures to prevent pressure ulcers, such as repositioning or tissue protection. TRIAL REGISTRATION: The protocol is registered in ClinicalTrials.gov (NCT02736838).

Development and Psychometric Validation of an Instrument to Identify Barriers to Self-Care Among Spanish Patients With Type 2 Diabetes on the Basis of Theory of Planned Behavior.

BACKGROUND: Several instruments are available to evaluate barriers to self-care in people with type 2 diabetes, but with significant psychometric weaknesses and poor theoretical background. OBJECTIVES: To develop and psychometrically validate a questionnaire to identify barriers to self-care in this population on the basis of the theory of planned behavior. METHODS: The study was carried out in 15 primary healthcare centers belonging to the Public Health Care System in Andalusia (Spain). After content validity was confirmed, an initial pilot study was undertaken (n = 54) and the model was evaluated in 2 samples of 205 subjects each to test its configural and metric invariance by confirmatory factor analysis. Internal consistency, test-retest reliability, criterion validity, and interpretability were carried out following COSMIN standards. RESULTS: A 4-factor instrument (intention, subjective norms, perceived control, and attitudes) with 15 items was obtained with a good fit: goodness-of-fit index = 0.92, comparative fit index = 0.93, and root mean square error of approximation = 0.043 (90% confidence interval 0.034-0.052). Cronbach α was 0.78, and test-retest reliability was adequate (intraclass correlation coefficient 0.73; P < .0001). The instrument revealed an adequate criterion validity depending on the treatment complexity and level of metabolic control. Thus, participants with poor self-care scores were more likely to suffer from diabetes-related complications (odds ratio 1.91; 95% confidence interval 1.15-3.1). CONCLUSIONS: A theory-driven instrument is suitable for its use with Spanish people with type 2 diabetes to assess their self-care needs and make tailored recommendations for lifestyle modifications on the basis of their behavioral determinants.

A scoping review of safety management during clinical placements of undergraduate nursing students.

BACKGROUND: The abundant knowledge on nursing students' competencies in clinical safety, and the multiple approaches adopted make it difficult to obtain an overview of the current status of this question. PURPOSE: To review the literature on undergraduate nursing students' safety competencies during their clinical placements. METHOD: A scoping review was carried out. Searches were executed in PubMed, CINAHL, WOS, MEDES, and websites of relevant organizations. The framework proposed by the Joanna Briggs Institute was adopted. FINDINGS: A total of 43 studies were selected for the final sample. The review identified four major topics: the presence of adverse events in clinical placements, the acquisition of competencies in clinical safety, student experiences regarding clinical safety, and pedagogical approaches for clinical safety. DISCUSSION: Nursing students encounter adverse events and clinical safety incidents throughout their clinical training. Faculties should assign the highest priority to this question, due to its importance in the creation of a culture of safety.

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse-Led Services: A Cross-Sectional Study.

AIM: To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services. DESIGN: Cross-sectional study. METHODS: Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions. RESULTS: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (ß = 0.71), with a relatively recent diagnosis (ß = -0.11), with criteria for palliative care 1 (ß = -0.26), and whose mothers were older (ß = 0.36) and had a higher educational level (ß = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r2 = 78.0%, p < .001). CONCLUSIONS: Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization. CLINICAL RELEVANCE: A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients' families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM / Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

Objetivo: Describir las características de la gestión de casos en cuanto a población atendida, intervenciones, utilización de servicios y los desenlaces mortalidad, reingresos, úlceras por presión, caídas, problemas con medicamentos e institucionalización. Método: Estudio de seguimiento de una cohorte a partir del registro multicéntrico RANGECOM de Andalucía. La población de estudio son pacientes atendidos en la cartera de servicios de gestión de casos de centros de salud y sus cuidadores familiares. Resultados: Se presentan datos de 835 pacientes con edad media de 76,8años (DE:12,1), un 50,24% mujeres. Presentan una comorbilidad importante (Charlson 3,1; DE:2,5) y dependencia elevada (Barthel 37,5; DE:31,4). El 60,2% de las intervenciones desplegadas por las gestoras de casos se aglutina en tres dominios: conductual (26,0%), sistema sanitario (20,2%) y seguridad (14,1%). La mortalidad fue del 34,4% y los ingresos hospitalarios, del 38,1%. Los pacientes con más reingresos hospitalarios tenían más visitas a urgencias (OR:1,41; IC95%: 1,22-1,63), más intervenciones telefónicas de las gestoras de casos (OR:1,12; IC95%: 1,02-1,24) y pruebas de imagen (OR:1,37; IC95%: 1,17-1,60), junto con un mayor cansancio en la cuidadora (OR:1,31; IC95%: 1,08-1,59), la presencia de dispositivos médicos en domicilio (OR:1,69; IC95%: 1,00-2,87) y recibían menos la intervención «Gestión de Casos». Conclusiones: Los pacientes que absorben la demanda de las enfermeras gestoras de casos presentan una alta complejidad, frente a la cual despliegan intervenciones conductuales, de navegación por el sistema sanitario y de seguridad clínica

Objective: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Method: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Results: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. Conclusions: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry. / Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM.

OBJECTIVE: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. METHOD: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. RESULTS: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. CONCLUSIONS: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Validation of the Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale for older people with dementia.

AIMS: To adapt the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) for use in a Spanish-speaking population and to assess its validity and reliability in patients with dementia. METHOD: A cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation (translation, back-translation, review by committee of experts, pilot test and weighting of results); 2. Clinimetric validation comprising interobserver reliability assessment, test-retest reliability and internal consistency. To determine construct validity, confirmatory factorial analysis and principal components analysis were performed by oblique rotations. Criteria validity was analysed using the Pearson correlation (p<0.05) with the BMI, MNA and analytical values of albumin, transferrin, cholesterol, absolute lymphocytes and total proteins. Data collection was carried out for six months in 2016 in nursing homes and Alzheimer's day centers in the province of Málaga (Spain), at nine centers, with 262 patients (aged over 60 years and presenting feeding difficulties), 20 nurses, 20 professional caregivers and 103 family caregivers. RESULTS: A version of EdFED culturally adapted to Spanish was obtained. The sample presented the following characteristics: 76.3% women, mean age 82.3 years (SD: 7.9); MNA 18.73 (SD: 4.44); BMI 23.99 (SD: 4.72); serum albumin 3.79 mg/dl (SD: 0.36). A Cronbach's alpha of 0.88 was obtained, with an inter-item global correlation of 0.43 and a homogeneity index ranging from 0.42 to 0.73. The exploratory factor analysis reproduced the three-factor model identified by the original authors, explaining 62.32% of the total variance. The criterion validity showed a good inverse correlation with MNA and a moderate one with albumin, total proteins, transferrin and BMI. DISCUSSION: The Spanish version of EdFED is reliable and valid for use in elderly people with dementia. The most appropriate for our environment is the three-factor model, which maintains the original factors, with a slight redistribution of the items.

Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain.

BACKGROUND: The clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. AIMS: To obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. DESIGN, PARTICIPANTS AND SETTING: Cultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Málaga (Spain). METHODS: A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium-fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. RESULTS: 152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92-0.95) (p = 0.0001) and Cronbach's alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a χ2/df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000-0.066). CONCLUSIONS: The rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs.

Peripheral perfusion and oxygenation in areas of risk of skin integrity impairment exposed to pressure patterns. A phase I trial (POTER Study).

AIM: The aim of this study was to analyse the change in peripheral oxygenation and microvascular flow in tissues subjected to different pressure regimes in healthy subjects and in hospitalized patients. BACKGROUND: The presence of pressure ulcers in hospitalized patients is a common complication that has a negative impact on health and often prolongs hospital stay and increases healthcare costs. DESIGN: Experimental non-controlled, non-randomized study in two phases: pre-clinical and clinical. METHODS: The pre-clinical phase will be conducted in healthy volunteers and the clinical phase, in patients at risk of impaired skin integrity. Vascular flow, tissue oxygenation and local temperature in areas at risk of pressure ulcers will be evaluated by Doppler laser in subjects lying on a capacitive surface to measure pressure at 10,249 points. Different levels of pressure will be generated by changes in body position and changes in tissue perfusion and oxygenation will be monitored for up to 4 hours, to determine the implications for repositioning interventions in patients at risk. This study was funded in July 2015. The protocol is registered in ClinicalTrials.gov (NCT02736838). DISCUSSION: Pressure ulcer is a significant and complex health problem in long-term bedridden patients and there is currently no effective treatment or efficient prevention method. The information provided by our study will provide an accurate assessment of different thresholds for the onset of damage to the skin, associated with different body positions and pressure levels. TRIAL REGISTRATION: The protocol is registered in ClinicalTrials.gov (NCT02736838).

A cost minimization analysis of olive oil vs. hyperoxygenated fatty acid treatment for the prevention of pressure ulcers in primary healthcare: A randomized controlled trial.

Pressure ulcers represent a major current health problem and cause an important economic impact on the healthcare system. Most studies on the prevention of pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids (HOFA), and to date no studies have specifically examined the use of olive oil-based treatments. AIM: To evaluate the cost of using extra virgin olive oil, rather than HOFA, in the prevention of pressure ulcers among persons with impaired mobility and receiving home care. STUDY DESIGN: Cost minimization analysis of the results obtained from a noninferiority, triple-blind, parallel, multicenter, randomized clinical trial. Population attending primary healthcare centers in Andalusia (Spain). STUDY SAMPLE: 831 immobilized patients at risk of suffering pressure ulcers. These persons were included in the study and randomly assigned as follows: 437 to the olive oil group and 394 to the HOFA group. At the end of the follow-up period, the results obtained by the olive oil group were not inferior to those of the HOFA group, and did not exceed the 10% delta limit. The total treatment cost for 16 weeks was €19,758 with HOFAs and €9,566 with olive oil. Overall, the olive oil treatment was €10,192 less costly. It has been concluded the noninferiority of olive oil makes this product an effective alternative for the prevention of pressure ulcers in patients who are immobilized and in a domestic environment. This treatment enables considerable savings in direct costs. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01595347. Date: 2011-2013.